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[Totally trans-umbilical laparoscopic cholecystectomy: our experience]. 完全经脐腹腔镜胆囊切除术:我们的经验。
Pub Date : 2009-09-01
Silvia Marco Scalambra, Andrea Galli, Andrea Gambetti, Domenico Giuliani, Stefano Schipani, Massimo Rasini, Sara Leone, Francesca Ciccarese, Gianluca Grillone

Videoassisted surgery has recently led to a new era, aimed mainly at minimising surgical trauma and improving the cosmetic result. Natural Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) are emerging as effective techniques whose advantages and possible applications have been widely explored in the most recent literature. Twenty-two consecutive patients, mean age 51.5 years (range: 24-86 years), were subjected to a laparoscopic cholecystectomy through a single, trans-umbilical, incision (SILS). We utilised standard laparoscopic instruments, placing one 10 mm trocar for the camera and two 5 mm trocars for the operative instruments. Mean operative time was 69 min (range: 40 - 120 min). There were no major complications during surgery, and the postoperative recovery was uneventful. All patients referred complete satisfaction with the surgical and cosmetic result obtained 1 and 3 weeks postoperatively.

视频辅助手术最近开创了一个新时代,其主要目的是尽量减少手术创伤和改善美容效果。自然腔内内镜手术(NOTES)和单切口腹腔镜手术(SILS)是新兴的有效技术,其优点和可能的应用在最近的文献中得到了广泛的探讨。连续22例患者,平均年龄51.5岁(范围:24-86岁),通过单经脐切口(SILS)行腹腔镜胆囊切除术。我们使用标准的腹腔镜器械,放置一个10毫米的套管针作为相机,放置两个5毫米的套管针作为手术器械。平均手术时间69分钟(范围:40 - 120分钟)。手术中无重大并发症,术后恢复顺利。所有患者术后1周和3周均对手术和美容效果满意。
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引用次数: 0
Surgical treatment of a double splenic artery aneurysm. 双脾动脉瘤的外科治疗。
Pub Date : 2009-09-01
Emanuele D'Errico, Roberto Gulino, Davide Mazza

Splenic artery aneurysms account for the majority of splanchnic artery aneurysms. These constitute a uncommon pathology, but with a mortality rate greater 70%. We report a case of a double symptomatic aneurysm of the splenic artery with a proximal and distal localization. The patient was a 65-year-old woman with chronic abdominal pain of the left hypochondrium, irradiating to the ipsilateral iliac fossa. In this case, the particular anatomical characteristics, which prevented a conservative endovascular treatment, were well suited to surgical treatment, performed successfully. In conclusion, in the case of a low-risk patient, in the presence of aneurysms with favourable anatomical characteristics one should prefer surgical rather than endovascular treatment, despite the widespread use of the latter.

脾动脉瘤占绝大多数。这是一种罕见的病理,但死亡率高达70%。我们报告一例双症状性脾动脉动脉瘤与近端和远端定位。患者为65岁女性,左胁肋慢性腹痛,照射至同侧髂窝。在这种情况下,特殊的解剖特征,阻止了保守的血管内治疗,非常适合手术治疗,成功进行。总之,在低风险患者的情况下,如果存在具有良好解剖特征的动脉瘤,则应选择手术而不是血管内治疗,尽管后者被广泛使用。
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引用次数: 0
[A new needle for colon-proctological surgery: personal experience]. [一种用于结肠直肠外科手术的新型针头:个人经验]。
Pub Date : 2009-09-01
Fabio Gaj, Antonello Trecca, Pietro Crispino

Rectocele and haemorrhoidal prolapse are two pathologies that in all cases entail partial excision of anorectal tissue possibly with less invasive surgical procedures. For these pathologies, the authors have recently improved their treatment procedures, introducing the sequential transfixed stitch technique (STST) for rectocele and the transfixed stitch technique (TST) for haemorrhoidal prolapse, and thereby obtaining a significant technical and clinical improvement in terms of both outcomes (complete correction of rectal prolapse and haemorrhoidal prolapse) and discomfort and quality of life in the postoperative period. Moreover, in the present study the authors propose a subsequent innovation of the technique developed recently for the treatment of rectocele and haemorrhoidal disease using a new curved siliconate needle, thinner than the traditional lanceolate needles, with a longer, more rigid needle-thread junction in order to achieve less invasiveness and mucosal trauma, enabling the surgeon to perform sutures in a simple, easy manner. Ten consecutive patients with a clinical and instrumental diagnosis of rectocele--6 type II and 4 type III--were treated with TSTS and 20 patients with third (12 patients) and fourth degree (8 patients) haemorrhoidal disease were treated with TST. The surgical procedures were the same for all patients, although patients were divided into two groups. To the first group (A) were allocated patients treated with traditional stitches with a cylindrical, half circle needle, (Hr 25.9 mm). To the second group (B) were allocated, for the same objective, patients treated with the new siliconate needle, with an ultrafine tip, manufactured by Assut Europe S.p.A. The mean duration of the TST surgical procedures was 16 minutes using the new siliconate needle, whereas the mean duration using the traditional lanceolate needle was 17 minutes (p = ns). The surgical team judged the TST performed with the siliconate needle to be easier in 90% of cases in comparison to 70% of cases treated with the traditional lanceolate needle (p < 0,05). In patients treated with TSTS using the traditional lanceolate needle the mean duration of the surgical procedures was 20 minutes as against 18 minutes in the cases treated with the siliconate needle (p = ns). The surgical team judged the TSTS performed with the siliconate needle to be easier in all cases, while in two cases treated with the traditional lanceolate needle there were technical difficulties related to the use of the needle. The use of the ultrafine siliconate siliconate needle is more effective for the treatment of rectocele with TSTS and for haemorrhoidectomy with TST, particularly with a view to improving the surgical procedures and limiting the extent of mucosal damage related to suture oedema.

直肠膨出和痔疮脱垂是两种病理,在所有情况下都需要部分切除肛肠组织,可能需要较少的侵入性手术。对于这些病理,作者最近改进了他们的治疗方法,引入了直肠突出的连续穿刺技术(STST)和痔疮脱垂的穿刺技术(TST),从而在结果(直肠脱垂和痔疮脱垂的完全矫正)和术后不适和生活质量方面获得了显著的技术和临床改善。此外,在本研究中,作者提出了对最近发展起来的治疗直肠前突和痔疮疾病的技术的后续创新,使用一种新的弯曲硅酸针,比传统的披针形针更细,具有更长,更刚性的针线连接,以实现更小的侵入性和粘膜损伤,使外科医生能够以简单,容易的方式进行缝合。连续10例临床和仪器诊断为直肠前突的患者(6例II型和4例III型)接受TSTS治疗,20例第三度(12例)和第四度(8例)痔疮患者接受TST治疗。所有患者的手术过程都是一样的,尽管患者被分为两组。第一组(A)采用传统的圆柱形半圆针缝合(Hr 25.9 mm)。第二组(B)被分配,为了同样的目的,患者使用Assut Europe S.p.A生产的具有超细尖端的新型硅酸针进行治疗。使用新型硅酸针进行TST手术的平均持续时间为16分钟,而使用传统针形针的平均持续时间为17分钟(p = ns)。手术小组认为,与传统针管治疗的70%的病例相比,90%的病例使用硅酸针进行TST更容易(p < 0.05)。在使用传统针管治疗TSTS的患者中,平均手术时间为20分钟,而使用硅酸针管治疗的患者为18分钟(p = ns)。外科小组认为,在所有病例中,使用硅酸针进行TSTS更容易,而在两例使用传统披针形针治疗的病例中,存在与针的使用有关的技术困难。使用超细硅酸硅酸针治疗TSTS治疗直肠膨出和TST痔疮切除术更有效,特别是在改进手术程序和限制与缝合水肿相关的粘膜损伤程度方面。
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引用次数: 0
[The RET gene and medullary thyroid cancer: from mutations to the planning of therapy]. RET基因与甲状腺髓样癌:从突变到治疗计划。
Pub Date : 2009-09-01
Giovanni Conzo, Roberto Ruggiero, Antonietta Palazzo, Cristina Della Pietra, Francesco Stanzione, Antonio Livrea, Giovanni Docimo

The RET gene codes for a tyrosine kinase receptor, expressed in neural crest derived cells playing a central role during embryogenesis. The RET proto-oncogene is responsible for medullary thyroid cancer and multiple endocrine neoplasia type 2. To date, more than 50 germline point mutations have been described. A specific correlation between genotype and phenotype is well recognized. Genetic testing is predictive of cancer onset, age at onset and biological aggressiveness. In recent years, the concept of codon-oriented prophylactic surgery has been introduced and three levels of risk have been identified on the basis of specific mutations. A review of the literature shows the excellent results of laboratory, genetic and clinical research that have made it possible to reduce medullary thyroid cancer-related mortality.

RET基因编码酪氨酸激酶受体,在胚胎发生过程中发挥核心作用的神经嵴衍生细胞中表达。RET原癌基因与甲状腺髓样癌和2型多发性内分泌肿瘤有关。迄今为止,已经描述了50多种种系点突变。基因型和表型之间的特定相关性是公认的。基因检测可以预测癌症的发病、发病年龄和生物侵袭性。近年来,以密码子为导向的预防性手术的概念被引入,并根据特定的突变确定了三个级别的风险。对文献的回顾表明,实验室、遗传和临床研究的优异结果使降低甲状腺髓样癌相关死亡率成为可能。
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引用次数: 0
[Lymphectomy in differentiated thyroid carcinoma]. 分化型甲状腺癌的淋巴切除术。
Pub Date : 2009-09-01
Giovanni Conzo, Francesco Stanzione, Antonietta Palazzo, Umberto Brancaccio, Cristina Della Pietra, Maria Grazia Esposito, Salvatore Celsi, Antonio Livrea

Papillary and follicular thyroid carcinoma are still characterised by unclear biological and clinical behaviour with an autoptic incidence higher than the clinical incidence. Lymph-node involvement represents a prognostic factor that may increase the rate of local relapse, reducing long-term survival only in high risk patients--age > 45 years, M+, T > 3 cm, extra thyroidal extension, follicular histotype. The authors analyse the role of lymph-node cervical dissection. Routine or selective, extended or conservative lymphectomy are described in the literature. Prognostic factors are useful to determine the most appropriate surgical procedure. An elective cervical central dissection may be indicated in patients at high risk, while in cases of monolateral lymph-node metastases, in patients at low risk, a selective lymph node dissection of levels VI-III-IV is associated with lower morbidity. Modified radical neck dissection is reserved for patients at high risk or in cases of multiple lymph-node metastases (> 5) to reduce the incidence of local relapse. In the treatment of differentiated thyroid carcinoma an elective total thyroidectomy must be performed in combination with adjuvant radioiodine ablation.

甲状腺乳头状癌和滤泡癌的生物学和临床行为尚不清楚,自噬发生率高于临床发生率。淋巴结累及是可能增加局部复发率的预后因素,仅在高风险患者(年龄> 45岁,M+, T > 3cm,甲状腺外展,滤泡组织型)中才会降低长期生存率。作者分析了颈淋巴结清扫术的作用。文献中描述了常规或选择性,扩大或保守淋巴切除术。预后因素有助于确定最合适的手术方式。高危患者可择期行颈椎中央淋巴结清扫术,而单侧淋巴结转移病例中,低危患者可择期行VI-III-IV级淋巴结清扫术,其发病率较低。改良根治性颈部清扫术用于高危患者或多发淋巴结转移(> 5)的患者,以减少局部复发的发生率。在分化型甲状腺癌的治疗中,选择性甲状腺全切除术必须与辅助放射性碘消融联合进行。
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引用次数: 0
Rare cases of bowel obstruction: internal hernias. 肠梗阻的罕见病例:内疝。
Pub Date : 2009-09-01
Valerio Caracino, Giampiero D'Amico, Roberto Di Mizio, Fenesia D'Amario

Internal hernias are a rare form of dislocation of the abdominal viscera, usually in the small intestine, in the peritoneal sacs or cavities, resulting from the defective coalescence of the peritoneal flaps due to abnormal rotation of the medium intestine in the second stage of embryogenesis. In this paper the authors describe three cases observed during the last twelve months: two cases were ascribable to left paraduodenal hernia and one to a transepiploic hernia. Special attention needs to be paid to knowledge of the rotation process of the primitive medium intestine and to understanding whether an internal hernia underlies the clinical picture, when occlusive patients have not previously undergone surgery and show no signs of external hernias. In the surgical treatment of paraduodenal hernias, special attention must be paid to incarcerated loops, in order to prevent severe vascular complications caused by potential lesions to the mesenteric vessels.

腹内疝是一种罕见的腹部脏器脱位,通常发生在小肠、腹膜囊或腹膜腔中,是由于胚胎发生第二阶段中肠异常旋转导致腹膜瓣合并缺陷所致。在本文中,作者描述了在过去12个月观察到的三个病例:两个病例归因于左侧十二指肠旁疝,一个归因于经腹股沟疝。当闭塞的患者以前没有接受过手术,也没有表现出外疝的迹象时,需要特别注意对原始中肠旋转过程的了解,并了解临床表现是否为内部疝。在十二指肠旁疝的手术治疗中,必须特别注意嵌顿袢,以防止肠系膜血管的潜在病变引起严重的血管并发症。
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引用次数: 0
Visual disorders or "eye stroke"after heart surgery: can we prevent it? 心脏手术后视力障碍或“眼中风”:我们能预防吗?
Pub Date : 2009-09-01
Georgios I Tagarakis, Fani Tsolaki, Marios E Daskalopoulos, Ioannis Karantzis, Andony S Baddour, Dimos Karangelis, Nikolaos B Tsilimingas

The aim of the study was to elucidate the problem of visual disorders after heart surgery, focusing on aetiology, modes of prevention and treatment. Information from a literature search and the authors' personal experience are provide clues as to the modes of development and the means of avoidance and therapy of this category of postoperative, neurosensory complications. Multiple morbid situations, such as preoperative augmented ocular pressure, perioperative bleeding and hypotension, are shown to be predisposing and precipitating factors. Medical treatment seems to be less important than minimisation of risk factors. Prevention rather than treatment is more helpful for heart-operated patients, as far as postoperative visual disorders are concerned.

本研究的目的是阐明心脏手术后视力障碍的问题,重点是病因,预防和治疗模式。从文献检索的信息和作者的个人经验提供线索的发展模式和手段的避免和治疗这类术后,神经感觉并发症。术前眼压增高、围手术期出血和低血压等多种疾病均为诱发和诱发因素。医学治疗似乎不如将危险因素最小化来得重要。就术后视力障碍而言,预防比治疗对心脏手术患者更有帮助。
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引用次数: 0
Small bowel obstruction by a congenital band. Report of two cases. 先天性肠梗阻。报告两例病例。
Pub Date : 2009-09-01
Valerio Ranieri, Nicola Sforza, Beniamino Palmieri, Marco Giacometti, Stefania Capone, Aldo Rossi

The authors report two cases of acute small bowel obstruction, the first in an adult patient, and the second in a three-month-old baby due to a congenital fibrous band. The second case was retrospectively detected from a pool of at least 50 cases of secondary fibrous band obstructions over the period from 1970 to 2008. Surgery was performed early, and simple resection of this very rare malformative bundle (usually affecting very young people) was required.

作者报告了两例急性小肠梗阻,第一例为成人患者,第二例为3个月大的婴儿,原因是先天性纤维带。第二个病例是从1970年至2008年期间至少50例继发性纤维带阻塞中回顾性发现的。手术早期进行,简单切除这种非常罕见的畸形束(通常影响非常年轻的人)是必要的。
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引用次数: 0
Mesenteric revascularisation in a young patient with antiphospholipid syndrome and fibromuscular dysplasia: report of a case and review of the literature. 抗磷脂综合征和纤维肌肉发育不良的年轻患者的肠系膜血运重建术:一例报告和文献复习。
Pub Date : 2009-09-01
Gian Franco Veraldi, Marco Paolo Zecchinelli, Francesco Furlan, Bruno Genco, Anna Maria Minicozzi, Christian Segattini, Rosario Pacca

Fibromuscular dysplasia or fibromuscular hyperplasia is a rare non-atherosclerotic and non-inflammatory vascular disease that primarily involves medium-size and small arteries, most commonly the renal and carotid arteries, and less frequently the vertebral, iliac, subclavian or visceral arteries (mesenteric, hepatic, splenic). Antiphospholipid syndrome is one of the most commonly acquired hypercoagulable states, defined by the association of laboratory evidence of anti-phospholipid antibodies with arterial or venous thrombosis or recurrent pregnancy losses. The presence of these antibodies is associated with an increased risk of thromboembolic phenomena, including peripheral thrombophlebitis, pulmonary thromboembolism, stroke, retinal artery occlusion, myocardial infarction, placental thrombosis and Budd-Chiari syndrome. In this report we discuss the uncommon case of a young male patient with both antiphospholipid syndrome and fibromuscular dysplasia that came to our attention for pulmonary embolism and "angina abdominis" due to occlusion of three mesenteric vessels. The possible relationship between antiphospholipid syndrome and fibromuscular dysplasia encountered in our patient still remains unclear. We treated the patient as if he had the two different diseases. After partial failure of endovascular surgery, the patient underwent surgery with reimplantation of three visceral arteries to the aorta. Subsequently he was treated with stent placement after development of a re-stenosis of one of the three reimplanted visceral arteries. The patient was treated conservatively for antiphospholipid syndrome with anticoagulant oral therapy for life.

纤维肌肉发育不良或纤维肌肉增生是一种罕见的非动脉粥样硬化和非炎症性血管疾病,主要累及中小动脉,最常见于肾动脉和颈动脉,较少见于椎动脉、髂动脉、锁骨下动脉或内脏动脉(肠系膜、肝、脾)。抗磷脂综合征是最常见的获得性高凝状态之一,由抗磷脂抗体与动脉或静脉血栓形成或复发性妊娠丢失的实验室证据定义。这些抗体的存在与血栓栓塞现象的风险增加有关,包括外周血栓性静脉炎、肺血栓栓塞、中风、视网膜动脉闭塞、心肌梗死、胎盘血栓形成和Budd-Chiari综合征。在这个报告中,我们讨论了一个不常见的病例,年轻的男性患者同时患有抗磷脂综合征和纤维肌肉发育不良,引起了我们的注意肺栓塞和“心绞痛”,由于三条肠系膜血管闭塞。本例患者所遇到的抗磷脂综合征与纤维肌肉发育不良之间的可能关系尚不清楚。我们对待病人就好像他得了两种不同的病。在血管内手术部分失败后,患者接受了将三条内脏动脉重新植入主动脉的手术。随后,他接受了支架置入术治疗,因为移植的三条内脏动脉中的一条再次狭窄。患者接受抗磷脂综合征保守治疗,口服抗凝治疗终身。
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引用次数: 0
[Emergency colonic surgery: analysis of risk factors predicting morbidity and mortality]. [紧急结肠手术:预测发病率和死亡率的危险因素分析]
Pub Date : 2009-09-01
Gianluca Costa, Federico Tomassini, Simone Maria Tierno, Luigi Venturini, Barbara Frezza, Giulio Cancrini, Alessandro Mero, Luca Lepre

The aim of the present study was to identify risk factors for morbidity and mortality in patients submitted to emergency colonic surgery. Between 1997 and 2008 157 patients, 106 of whom affected by colon cancer (67.5%) and 51 by benign disease (32.5%), were treated. The risk factors for morbidity and mortality were evaluated by univariate and multivariate analysis considering clinical and demographic data. The overall 30-day morbidity and mortality rates were 19.1% (30 patients) and 12.7% (20 patients), respectively. Among patients affected by cancer the mortality rate was 15% (16 patients) and the morbidity rate 23.6% (25 patients), while among the patients with benign disease the mortality rate was 7.8% (4 patients) and the morbidity rate 9.8% (5 patients). No postoperative surgical complications were noted. The strongest risk factors for early death were postoperative medical complications such as cardiopulmonary, renal, thrombo-embolic and infectious complications. The results of the univariate analysis showed that advanced age, neoplastic disease, advanced stage of cancer and associated medical disease prior to surgery play a role as risk factors for morbidity and mortality. In the multivariate analysis only the presence of associated medical disease proved to be a significant independent predictor of outcome. Emergency surgery for both neoplastic and benign colonic disease is still associated with an increased risk of death. Although restorative colectomy should be regarded as the first choice procedure in the emergency setting, Hartmann's procedure is still widely used in high-risk patients.

本研究的目的是确定急诊结肠手术患者发病率和死亡率的危险因素。1997年至2008年期间,157名患者接受了治疗,其中106人患有结肠癌(67.5%),51人患有良性疾病(32.5%)。发病率和死亡率的危险因素通过单因素和多因素分析结合临床和人口统计数据进行评估。30天总发病率和死亡率分别为19.1%(30例)和12.7%(20例)。肿瘤患者死亡率为15%(16例),发病率为23.6%(25例);良性疾病患者死亡率为7.8%(4例),发病率为9.8%(5例)。术后无手术并发症。早期死亡的最大危险因素是术后并发症,如心肺、肾脏、血栓栓塞和感染并发症。单因素分析结果显示,高龄、肿瘤疾病、癌症晚期和术前相关内科疾病是发病率和死亡率的危险因素。在多变量分析中,只有相关医学疾病的存在被证明是结果的重要独立预测因子。肿瘤和良性结肠疾病的急诊手术仍然与死亡风险增加有关。虽然恢复性结肠切除术在紧急情况下应被视为首选手术,但Hartmann手术仍被广泛应用于高危患者。
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引用次数: 0
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Chirurgia italiana
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