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[Five-year oncological results of laparoscopic versus open left hemicolectomy]. [腹腔镜与开放式左结肠切除术的5年肿瘤学结果]。
Pub Date : 2009-09-01
Luca Maria Siani, Fabrizio Ferranti, Marco Marzano, Antonio De Carlo, Alberto Quintiliani

Laparoscopic left hemicolectomy is still uncommon in surgical practice, because of both an unjustified fear of oncological inadequacy and technical difficulties with a steep learning curve. The aim of the present study was to analyse our 5-year experience with laparoscopic left hemicolectomy and its short- and long-term results. Thirty patients with non-metastatic non-infiltrating left colon cancer were treated laparoscopically and retrospectively compared to a group treated laparotomically and well matched for age, comorbidity and stage of disease in respect to the laparoscopic group. The duration of the laparoscopic procedures was longer, but intraoperative blood loss, passage of flatus and hospital stay were significantly less. Morbidity was similar and there was no 30 days mortality in either group. Specimen length and number of harvested lymph nodes were similar and 5-year cumulative survival curves showed no significant statistical difference (73.1% laparoscopic vs 70.8% open). Today, laparoscopic colon procedures are rarely performed, due both to fear of oncological inadequacy and to technical difficulties, yet several recent trials have presented evidence of safety, and oncological results comparable to those of the open counterpart. Our 5-year experience confirms these studies: our short- and long-term results show no statistical differences between the laparoscopic and "open" procedure. Laparoscopic left hemicolectomy is a safe, effective and oncologically adequate surgical procedure for non-metastatic non-infiltrating left colon cancer and is therefore a valid option for the surgical treatment of these neoplasms.

腹腔镜左半结肠切除术在外科实践中仍然不常见,因为对肿瘤不充分的不合理的恐惧和技术上的困难和陡峭的学习曲线。本研究的目的是分析我们5年腹腔镜左结肠切除术的经验及其短期和长期的结果。30例非转移性非浸润性左结肠癌患者进行腹腔镜治疗,并与腹腔镜治疗组进行回顾性比较,并在年龄,合并症和疾病分期方面与腹腔镜组相匹配。腹腔镜手术持续时间较长,但术中出血量、胃肠胀气通过和住院时间明显减少。两组发病率相似,均无30天死亡率。标本长度和淋巴结数量相似,5年累积生存曲线无统计学差异(73.1%腹腔镜vs 70.8%开放)。今天,由于担心肿瘤方面的不足和技术上的困难,腹腔镜结肠手术很少进行,但最近的几项试验已经提供了安全性的证据,并且肿瘤结果与开放式手术相当。我们5年的经验证实了这些研究:我们的短期和长期结果显示腹腔镜和“开放”手术之间没有统计学差异。腹腔镜左结肠切除术对于非转移性、非浸润性左结肠癌来说是一种安全、有效且符合肿瘤学要求的手术方法,因此是此类肿瘤手术治疗的有效选择。
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引用次数: 0
Carcinoma of the appendix and its natural history in relation to surgical management. A case report. 阑尾癌及其自然史与手术治疗的关系。一份病例报告。
Pub Date : 2009-09-01
Silvana Leanza, Mohamed Bekheit, Danilo Coco, Angelo Bellia, Francesco Ferrara, Salvatore Sarvà, Andrea Pappalardo, Luigi Piazza

There are several classifications of appendicular epithelial cancer with a wide variety of nomenclature. Epithelial tumours of the appendix have been classified into four distinct types: carcinoids, mucinous adenocarcinoma (often called mucinous cystadenocarcinoma or malignant mucocele), colonic-type adenocarcinoma, and adenocarcinoids with a dual cell origin. We report a case of a woman who presented to our emergency unit with a history of acute appendicitis and who had undergone an appendectomy. The histopathological analysis showed the presence of a well differentiated mucinous adenocarcinoma, infiltrating the full thickness of the appendix wall.

有几种分类的阑尾上皮癌与各种各样的命名。阑尾上皮肿瘤被分为四种不同的类型:类癌、黏液性腺癌(通常称为黏液性囊腺癌或恶性黏液囊肿)、结肠型腺癌和双细胞起源的类腺癌。我们报告一个病例的妇女谁提出了我们的急诊科与急性阑尾炎的历史,谁接受了阑尾切除术。组织病理学分析显示存在分化良好的粘液腺癌,浸润阑尾壁的全层。
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引用次数: 0
[Self-expanding oesophageal stents: comparison of Ultraflex and Choostent]. 自扩式食管支架:Ultraflex与Choostent的比较。
Pub Date : 2009-09-01
Davide Bona, Letizia Laface, Stefano Siboni, Moshe Schaffer, Daniela Baldoli, Andrea Sironi, Francesca Sorba, Luigi Bonavina

Two types of covered self-expanding metal stents were compared in a consecutive series of 57 patients. Stent placement was successful in all patients. No procedure-related deaths were observed. The overall hospital morbidity was 7%. No significant differences in the efficacy of palliation of dysphagia, rate of complications, and survival rates were seen using the two types of stent. An endoscopic reintervention was required in 14% of the patients. Both stents proved to be safely removable in the short term follow-up, and the benefit of temporary insertion was documented in patients with primary oesophageal neoplasms prior to chemotherapy or chemoradiation therapy and in those with anastomotic strictures/leaks. A multidisciplinary strategy, guided by the concept that a stent should not represent the only, definitive treatment modality, may improve the quality of life of patients with advanced oesophageal carcinoma.

在连续57例患者中比较两种类型的有盖自膨胀金属支架。所有患者支架置入均成功。未观察到与手术相关的死亡。医院总发病率为7%。两种支架在缓解吞咽困难的疗效、并发症发生率和生存率方面均无显著差异。14%的患者需要内窥镜再干预。在短期随访中,两种支架都被证明是安全可移除的,并且在化疗或放化疗前的原发性食管肿瘤患者和吻合口狭窄/泄漏患者中,临时插入的益处被记录下来。一个多学科的策略,在支架不应该代表唯一的、确定的治疗方式的概念指导下,可以改善晚期食管癌患者的生活质量。
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引用次数: 0
[Rectus sheath haematoma as an early complication of laparoscopic hemicolectomy: a case report and review of the literature]. [腹直肌鞘血肿作为腹腔镜结肠切除术的早期并发症:一例报告和文献回顾]。
Pub Date : 2009-07-01
Fabio Procacciante, Giulia Diamantini, Daniele Paolelli, Pietro Picozzi

We report a case of rectus sheath haematoma (RSH) in a patient undergoing laparoscopic right hemicolectomy and anticoagulant prophylaxis of a pulmonary thromboembolism (PTE) with low molecular weight heparin. This pathological condition is rare and could be a cause of misdiagnosis in patients with acute abdominal pain. It can be a serious complication in the course of anticoagulant therapy. A rapid, correct diagnosis may lead to better treatment which must be timely, aggressive and ultimately curative. Our patient, with acute onset and swift worsening of his general condition, benefited from an immediate surgical procedure, with ligature of the epigastric artery stumps and drainage of the haematoma.

我们报告一例直肌鞘血肿(RSH)在病人接受腹腔镜右半结肠切除术和抗凝预防肺血栓栓塞(PTE)与低分子肝素。这种病理状况是罕见的,可能是一个误诊的原因,病人的急性腹痛。在抗凝治疗过程中,这可能是一个严重的并发症。快速、正确的诊断可能导致更好的治疗,这种治疗必须及时、积极并最终治愈。我们的病人,急性发作,一般情况迅速恶化,得益于立即手术,结扎腹壁动脉残端和引流血肿。
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引用次数: 0
[Giant angiomyolipoma of the kidney not associated with tuberous sclerosis: a case report and review of the literature]. 【与结节性硬化症无关的肾脏巨大血管平滑肌脂肪瘤:1例报告及文献回顾】。
Pub Date : 2009-07-01
Valerio Panizzo, Gloria Goi, Eliana Moroni, Giancarlo Micheletto, Barbara Bruni, Piergiorgio Danelli

The authors describe a paradigmatic case of a large renal angiomyolipoma not associated with tuberous sclerosis. The lesion was discovered as an incidental finding during abdominal ultrasound for other pathology. Owing to the extent of the lesion and the appreciable risk of spontaneous rupture and bleeding, we opted for surgical treatment. The impossibility of dissecting the angiomyolipoma from the right kidney obliged us to perform a nephrectomy. The clinical interest of angiomyolipoma is in its rapid growth, the difficulty of distinguishing it from malignant lesions, the association with tuberous sclerosis, the presence of numerous aspecific symptoms and the difficulty of establishing the correct diagnosis and treatment strategy.

作者描述了一个典型的情况下,一个大的肾血管平滑肌脂肪瘤不相关的结节性硬化症。该病变是在腹部超声检查其他病理时偶然发现的。由于病变的程度和明显的自发性破裂和出血的风险,我们选择手术治疗。由于无法从右肾解剖血管平滑肌脂肪瘤,我们不得不行肾切除术。血管平滑肌脂肪瘤的临床意义在于其生长迅速,难以与恶性病变区分,与结节性硬化症有关,存在许多特定症状,难以建立正确的诊断和治疗策略。
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引用次数: 0
[Role of endoanal ultrasonography in reducing anal fistula recurrence]. 【肛管超声检查在减少肛瘘复发中的作用】。
Pub Date : 2009-07-01
Marco Milone, Giuseppe Pesce, Maddalena Leongito, Francesco Milone

The aim of surgical treatment of fistula-in-ano is to eradicate the suppurative process permanently without compromising faecal continence. The appearance of a recurrence of fistula-in-ano is often due to non-identification of the internal opening by the surgeon, and to the presence of complex fistulae. We evaluated the clinical course of 214 patients in a randomised. controlled trial with respect to the recurrence rate of anal fistula with or without preoperative endoanal ultrasonography. In this study we demonstrate that endoanal ultrasonography was the most accurate diagnostic modality for detecting internal opening and complex fistulae. Therefore, endoanal ultrasonography is reliable and useful in the preoperative assessment of anal fistula, and particularly for decreasing the recurrence rate of this disease.

手术治疗肛瘘的目的是在不影响大便失禁的情况下永久根除化脓性过程。瘘管复发的出现通常是由于外科医生没有识别出内部开口,以及存在复杂的瘘管。我们对214例患者的临床过程进行了评估。术前行或不行肛管超声检查肛瘘复发率的对照研究。在这项研究中,我们证明了肛管超声检查是检测内部开口和复杂瘘管最准确的诊断方式。因此,肛管超声检查在肛瘘的术前评估中是可靠和有用的,特别是对于降低肛瘘的复发率。
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引用次数: 0
[Usefulness of plug test for the intraoperative staging of rectal mucosal prolapse]. [塞试验在直肠粘膜脱垂术中分期中的应用]。
Pub Date : 2009-07-01
Fabio Gaj, Antonello Trecca, Pietro Crispino

Rectal mucosal prolapse is characterised by protrusion of the rectal mucosa alone in the anal lumen. To correctly establish the intraoperative stage of rectal mucosal prolapse the authors performed a test based on the intrarectal introduction of a large-sized hydrophilic plug, to be extracted later from the anal canal. A total of 40 patients with proctological symptoms and with a diagnosis of rectal mucosal prolapse were submitted, in the outpatient setting, to a minimally invasive test with a small plug and later, in the preoperative stage, in patients under anaesthesia, using a plug entirely inserted into the rectal lumen and extracted via the anus. The same procedure was performed after surgery to verify the results of the excision. In all cases the plug test used in the preoperative stage permitted the perfect surgical evaluation of the extent of the prolapse. The plug test revealed a mucosal prolapse occupying 25% of the anal circumference in 10 patients, up to 50% in 20 patients and more than 50% in 10 patients. The first 30 patients were treated with the transfixed stitch technique, while for the others the Longo surgical technique was preferred. The plug test for the preoperative and postoperative evaluation of rectal mucosal prolapse is an effective tool for obtaining a more precise indication as to the optimal surgical intervention and for verifying the radicality of the surgical excision. The plug test, moreover, proved to be a minimally invasive and easily performed test for evaluating rectal mucosal prolapse.

直肠粘膜脱垂的特征是直肠粘膜在肛门腔内单独突出。为了正确确定术中直肠粘膜脱垂的分期,作者进行了一项基于直肠内引入大尺寸亲水塞的测试,稍后从肛管中取出。共有40名有直肠症状并诊断为直肠粘膜脱垂的患者在门诊进行了微创检查,使用一个小塞,然后在术前阶段,在麻醉下的患者中,使用一个完全插入直肠腔并通过肛门取出的塞。手术后进行相同的程序以验证切除的结果。在所有病例中,术前阶段使用的堵头试验允许对脱垂程度进行完美的手术评估。塞试验显示10例患者粘膜脱垂占肛周的25%,20例高达50%,10例超过50%。前30例患者采用固定针技术,其余患者优先采用Longo手术技术。直肠粘膜脱垂的术前和术后评价的塞试验是获得更精确的指征,以最佳手术干预和验证手术切除的根治性的有效工具。此外,塞试验被证明是一种微创且易于实施的评估直肠粘膜脱垂的试验。
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引用次数: 0
[Anastomotic leak following colorectal surgery: incidence, risk factors and treatment]. 结直肠手术后吻合口瘘:发生率、危险因素及治疗。
Pub Date : 2009-07-01
Enrico Erdas, Alessandro Zedda, Antonella Pitzalis, Daniela Scano, Michela Barbarossa, Simona Aresu, Sergio Licheri, Mariano Pomata, Giampaolo Farina

The aim of this study was to assess the incidence and identify the risk factors associated with colorectal anastomotic leakage. A further objective was to investigate the therapeutic choices. We reviewed the clinical files of 124 patients who underwent mechanical end-to-end anastomosis after colorectal resection during the period 2000-2007. The mean age was 66.9 years and the male:female ratio was 1.2:1. Indications for surgery were malignant neoplasms in 109 cases (87.9%) and benign disease in 15 cases (12.1%). The anastomosis was always performed in an elective setting in the framework of a procedure of one or more stages (87.9% and 7.3% respectively). A pelvic drain was positioned in a routine manner and no protective ileostomies were constructed. Among the various risk factors, co-morbidities, ASA risk and low anastomotic level were the most important we examined. Student's t-test, the Chi-square test and Fisher's test were used for comparative univariate analysis, with significant results for p < or = 0.05. The incidence of anastomotic leak was 10.5% (13/124), but only 4.8% (6/124) required a second operation or failed to heal with simple conservative therapy. The pelvic drain was always effective in allowing the early diagnosis of leakages and limiting the spread of peritoneal inflammation. Mortality was 1.6% (2/124) overall, but, if leakages alone were considered, it increased to 15.4%. Among the risk factors examined, only low anastomotic level was confirmed by statistical analysis. In conclusion, the study confirms low anastomotic level as a negative prognostic factor for the healing of colorectal anastomosis. The pelvic drain proved to be effective in allowing early diagnosis and conservative management of leakages.

本研究的目的是评估结直肠吻合口瘘的发生率并确定与之相关的危险因素。进一步的目标是研究治疗的选择。我们回顾了2000-2007年间124例结直肠癌术后行机械端到端吻合术的临床资料。平均年龄66.9岁,男女比例为1.2:1。手术指征为恶性肿瘤109例(87.9%),良性肿瘤15例(12.1%)。吻合总是在一个或多个阶段的手术框架中选择进行(分别为87.9%和7.3%)。以常规方式放置盆腔引流管,未建立保护性回肠造口。在各种危险因素中,合并症、ASA风险和吻合口低水平是我们研究的最重要的因素。比较单因素分析采用学生t检验、卡方检验和Fisher检验,p <或= 0.05为显著性结果。吻合口漏发生率为10.5%(13/124),仅4.8%(6/124)需要二次手术或单纯保守治疗不能愈合。盆腔引流在早期诊断渗漏和限制腹膜炎症扩散方面总是有效的。总体死亡率为1.6%(2/124),但如果单独考虑泄漏,死亡率增加到15.4%。在检查的危险因素中,只有低吻合口水平被统计分析证实。综上所述,本研究证实吻合口水平低是影响结直肠吻合口愈合的不良预后因素。盆腔引流被证明是有效的,允许早期诊断和保守处理泄漏。
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引用次数: 0
[Laparoscopic splenectomy in haematological diseases: short- and medium-term results in thirty initial cases]. [腹腔镜脾切除术治疗血液病:30例初诊病例的中短期疗效]。
Pub Date : 2009-07-01
Massimo Carlini, Cristiano Giovannini, Fabio Castaldi, Paolo Cianciulli, Francesco Sorrentino, Edoardo Mercadante

In 1991 Delaitre and Maignien described the first laparoscopic splenectomy, since when a rapid spread of this technique has been observed and the procedure has become the gold standard in the surgical management of benign and malignant haematological diseases. In the present study, the results of the first 30 laparoscopic splenectomies performed at the Division of General Surgery of the S. Eugenio Hospital of Rome are reported. The operations were performed in patients with benign (27 cases) and malignant (3 cases) haematological diseases, treated in the Regional Haematological Centre of the same hospital. The procedures were carried out according to criteria corresponding to those recently described in the guidelines of the European Association for Endoscopic Surgery. As regards the results, two procedures (6.7%) were converted to open surgery. One postoperative haemorrhage was observed, requiring a laparoscopic reoperation for haemostasis. No other major local or general complications were observed. Mortality was nil. The mean postoperative hospital stay was 4.2 days (range: 4-8 days). Medium-term surgical and haematological results were excellent. Laparoscopic splenectomy is the surgical gold standard, but should be performed in advanced centres in close cooperation with a haematology centre. The procedure is indicated in all patients who are candidates for splenectomy, with the sole exception of those affected by portal hypertension or with general contraindications to laparoscopy. In advanced centres, better early and late results can be achieved, in addition to the well-known benefits of the minimally invasive technique, particularly in aesthetic terms, which in younger patients affected by benign haematological pathologies are very important.

1991年,Delaitre和Maignien描述了第一例腹腔镜脾切除术,从那时起,这项技术迅速传播开来,并成为良性和恶性血液病手术治疗的金标准。在本研究中,报告了在罗马S. Eugenio医院普通外科进行的前30例腹腔镜脾切除术的结果。在同一家医院的区域血液病中心治疗的良性(27例)和恶性(3例)血液病患者进行了手术。手术是根据欧洲内窥镜手术协会指南中最近描述的标准进行的。至于结果,2例(6.7%)转为开放手术。术后观察到1例出血,需要腹腔镜再次手术止血。未观察到其他主要的局部或全身并发症。死亡率为零。术后平均住院时间4.2天(范围:4-8天)。中期手术和血液学结果非常好。腹腔镜脾切除术是手术的金标准,但应在先进的中心与血液学中心密切合作进行。除门静脉高压症患者或有腹腔镜手术禁忌症的患者外,该手术适用于所有需要脾切除术的患者。在先进的中心,除了众所周知的微创技术的好处,特别是在美学方面,可以获得更好的早期和晚期结果,这对受良性血液病影响的年轻患者非常重要。
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引用次数: 0
Biliary stent migration into the abdominal wall: a case report. 胆道支架向腹壁内移位1例。
Pub Date : 2009-07-01
Vincenzo Minutolo, Giuseppe Gagliano, Alessandro Buttafuoco, Orazio Minutolo, Francesco Mosca, Stefano Puleo

Biliary stent migration occurs in about 5% of patients. The most common complications secondary to stent migration are pancreatitis, small bowel perforation and peritonitis. We report the case of a patient presenting with an abdominal wall abscess secondary to migration of a biliary stent. Direct abdominal radiography, abdominal ultrasound and CT scan have proved very useful in the diagnosis, providing the correct localisation of the stent in the left rectus muscle of the abdominal wall that led to a surgical approach under local anaesthesia for the removal, and abscess formation surrounding the stent. The patient was discharged on the day after surgery. After reviewing the literature concerning this rare complication, the Authors conclude that closer monitoring of patients with biliary prostheses is needed to prevent the migration and the consequent serious complications.

约5%的患者发生胆道支架移位。支架移位最常见的并发症是胰腺炎、小肠穿孔和腹膜炎。我们报告的情况下,病人提出腹壁脓肿继发胆道支架的迁移。直接腹部x线摄影,腹部超声和CT扫描在诊断中非常有用,提供了支架在腹壁左直肌的正确定位,导致局部麻醉下手术切除,支架周围形成脓肿。病人在手术后第二天出院。在回顾了有关这一罕见并发症的文献后,作者得出结论,需要对胆道假体患者进行更密切的监测,以防止移位和随之而来的严重并发症。
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引用次数: 0
期刊
Chirurgia italiana
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