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[Laparoscopic approach in acute appendicitis: experience with 501 consecutive cases]. [腹腔镜入路治疗急性阑尾炎:附501例经验]。
Pub Date : 2009-05-01
Nicola Romano, Valerio Prosperi, Cristina Gabellieri, Graziano Biondi, Roberto Andreini, Giancarlo Basili, Paolo Carnesecchi, Orlando Goletti

Appendicitis is an acute disease requiring urgent surgical treatment. Acute appendicitis is the most common surgical emergency in children and young adults, with an incidence of about 100-140 cases per 100,000 people. In our study we analyse 501 consecutive appendectomies performed in our department. From June 2003 to December 2008 we performed 501 appendectomies, 287 in male and 214 in female patients. The average age was 27.99 years (range: from 4 to 94 years). We routinely perform a laparoscopic approach with a standard protocol for patient selection. Following a standard protocol, 429 patients were selected for the laparoscopic approach and 72 for an open appendectomy. In 411 patients (95.8%) the surgical procedure was completed in laparoscopy with a conversion rate of about 4.2% (18/429). The conversion rate in the simple appendectomy subgroup was 0.98%, as against about 12.1% in the complex appendectomy subgroup. The open appendectomy group comprised 72 patients, 27 patients treated with an open approach by choice, 26 for necessity and 19 for protocol violation. There were 9 post-appendectomy complications (2.1%) and 3 re-operations (0.5%); the mortality rate was nil. Although 20 years have passed since the first laparoscopic appendectomy, today it is still debated whether or not the laparoscopic approach is the correct surgical procedure for the treatment of acute appendicitis. Several studies have shown that laparoscopic appendectomy presents a number of advantages in terms of a shorter hospital stay, less postoperative pain and fewer wound infections. Some authors, however, have demonstrated that the laparoscopic approach for acute appendicitis is associated with increased operative times and risk of intra-abdominal abscesses (above all if the appendix is perforated). Our experience confirms that the routinely performed laparoscopic approach to treat acute appendicitis is associated with a low rate of abscess complications: in our series some of the complications could be attributed to the surgical learning curve.

阑尾炎是一种急性病,需要紧急手术治疗。急性阑尾炎是儿童和年轻人最常见的外科急诊,发病率约为每10万人100-140例。在我们的研究中,我们分析了在我科进行的501例连续阑尾切除术。从2003年6月到2008年12月,我们进行了501例阑尾切除术,其中男性287例,女性214例。平均年龄27.99岁(4 ~ 94岁)。我们例行执行腹腔镜方法与患者选择的标准协议。按照标准方案,429例患者选择腹腔镜入路,72例患者选择开放式阑尾切除术。411例(95.8%)患者在腹腔镜下完成手术,转换率约为4.2%(18/429)。单纯阑尾切除术亚组的转换率为0.98%,而复杂阑尾切除术亚组的转换率约为12.1%。开放阑尾切除术组72例,选择开放入路27例,必要性26例,违反方案19例。术后并发症9例(2.1%),再手术3例(0.5%);死亡率为零。尽管自第一例腹腔镜阑尾切除术以来已经过去了20年,但今天腹腔镜入路是否是治疗急性阑尾炎的正确手术方法仍然存在争议。一些研究表明,腹腔镜阑尾切除术在缩短住院时间、减少术后疼痛和减少伤口感染方面具有许多优势。然而,一些作者已经证明,腹腔镜入路治疗急性阑尾炎与手术次数增加和腹内脓肿的风险相关(尤其是如果阑尾穿孔)。我们的经验证实,常规腹腔镜入路治疗急性阑尾炎与脓肿并发症发生率低有关:在我们的研究中,一些并发症可归因于手术学习曲线。
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引用次数: 0
Ultrasound-guided percutaneous treatment of abdominal collections. 超声引导下腹腔积液的经皮治疗。
Pub Date : 2009-05-01
Guido Azzarello, Raffaele Lanteri, Cristian Rapisarda, Marco Santangelo, Agostino Racalbuto, Vincenzo Minutolo, Antonio Di Cataldo, Antonio Licata

Abdominal abscess is a very important problem nowadays, being responsible for prolonged hospitalisation, because these infections still cause substantial morbidity and mortality. For many years, surgical drainage has been considered the best therapeutic option in abdominal abscesses but several studies have subsequently shown that the percutaneous approach is as effective as surgical drainage. Starting from this background, the aim of this study was to evaluate whether or not percutaneous drainage is a valid treatment of choice. In the Department of Surgical Sciences, Organ Transplantation and Advanced Technologies of the University of Catania, 451 ultrasound guided percutaneous drainages of intra-abdominal abscesses were performed on 430 patients. Abscess drainage was successful in 322/403 (80%) of postoperative abscess, in 16/18 (90%) of primitive abscesses, in 10/12 cases (85%) of acute cholecystitis, in 3/6 cases (50%) of intrahepatic abscess and in 12/12 cases (100%) of pyelonephritis. US-guided drainage is currently the gold standard in the treatment of simple abdominal abscesses.

腹腔脓肿是当今一个非常重要的问题,造成长期住院,因为这些感染仍然导致大量的发病率和死亡率。多年来,手术引流一直被认为是腹部脓肿的最佳治疗选择,但随后的一些研究表明,经皮入路与手术引流一样有效。从这个背景出发,本研究的目的是评估经皮引流是否是一种有效的治疗选择。在卡塔尼亚大学外科科学、器官移植和先进技术系,对430例患者进行了451例超声引导下经皮腹腔脓肿引流。术后脓肿322/403例(80%)、原始脓肿16/18例(90%)、急性胆囊炎10/12例(85%)、肝内脓肿3/6例(50%)、肾盂肾炎12/12例(100%)引流成功。美国引导引流术是目前治疗单纯性腹部脓肿的金标准。
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引用次数: 0
[Multiple intestinal perforations due to tuberculosis: a case report and review of the literature]. 【肺结核致多发肠穿孔1例报告及文献复习】。
Pub Date : 2009-05-01
Fablo Rondelli, Luigi Finocchi, Piero Covarelli, Carlo Boselli, Roberto Cristofani, Giuseppe Noya

The incidence of tuberculosis in Italy steadily decreased until two decades ago, but the infection is now frequently diagnosed in common clinical practice. The Authors describe a rare acute abdominal presentation of the disease featuring a double intestinal perforation in a subject affected by pulmonary, renal and gastrointestinal miliary tuberculosis. A review of the literature is also presented. Intestinal resection is the treatment of choice in such cases, even if it leads to frequent, major complications, but the authors stress that there may be a possibility for a less radical form of management of these patients.

直到20年前,意大利的结核病发病率一直在稳步下降,但现在在普通临床实践中经常诊断出这种感染。作者描述了一种罕见的急性腹部疾病的表现,以双肠穿孔为特征,患者受肺、肾和胃肠道军性结核的影响。文献综述也提出。肠切除术是这种情况下的治疗选择,即使它会导致频繁的严重并发症,但作者强调,可能有一种不太激进的方式来治疗这些患者。
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引用次数: 0
Aggressive sebaceous carcinoma of the head. 头部侵袭性皮脂腺癌。
Pub Date : 2009-05-01
Stefano Scuderi, Michele Giaccone, Emanuele D'Errico, Marcela Alejandra Maorenzic, Marco Fontanellaa, Isabella Castellano, Claudio Zanon, Alessandro Maria Gaetini

Cutaneous sebaceous carcinoma (SC) is a rare malignancy deriving from the adnexal epithelium of the sebaceous glands. Periorbital SC is approximately three times more common than extraorbital cutaneous SC. Extraocular SC is reported to be less aggressive than orbital sebaceous carcinoma and rarely metastasizes. We report a case of sebaceous carcinoma of the scalp, characterised by highly aggressive behaviour and huge invasion of the intracranial space. The patient was a 79-year-old woman who developed an infiltrating sebaceous carcinoma followed by lymph-node metastases shortly after excision of the primary lesion, resulting in death. In this case, aggressive biological behaviour was observed in a carcinoma arising in an extraorbital area, although it has traditionally been considered a less aggressive neoplasm.

皮脂腺癌是一种罕见的恶性肿瘤,起源于皮脂腺的附件上皮。眼眶周围SC的发生率大约是眼眶外皮肤SC的三倍。据报道,眼外SC的侵袭性不如眼眶皮脂腺癌,而且很少转移。我们报告一个头皮皮脂腺癌的病例,其特征是高度侵袭性的行为和巨大的侵犯颅内空间。患者是一名79岁的女性,在原发病灶切除后不久发生浸润性皮脂腺癌并伴有淋巴结转移,导致死亡。在这个病例中,尽管传统上认为它是一种侵袭性较低的肿瘤,但在眼眶外区域的肿瘤中观察到侵袭性的生物学行为。
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引用次数: 0
[Cardiac tamponade: a modified video-assisted thoracoscopic approach]. 心包填塞:一种改进的电视胸腔镜方法。
Pub Date : 2009-05-01
Francesco Monaco, Mario Barone, Antonio David, Domenica Claudia Risitano, Salvatore Lentini

Pericardial effusion may lead to cardiac tamponade sometimes requiring surgical treatment. The aim of the study was to retrospectively analyse a group of patients with cardiac tamponade treated with a modified video-assisted thoracoscopy technique. We treated 15 patients (8 males and 7 females; mean age 63 years; range 24-80 years) with cardiac tamponade. All patients were treated by a modified video-assisted thorascopic approach on the right hemithorax, with the use of two trocars: a 15-mm trocar on the 4th right intercostal space on the anterior axillary, and a 10-mm trocar on the 7th right intercostal space on the median axillary line. We used a 5-mm optic, the size of which permitted the simultaneous use of two instruments through a single trocar (both for the optic and the endoscopic forceps), leaving the second trocar for the dissecting scissors. In all patients we obtained a pericardial resection equivalent to the one obtainable in an anterolateral thoracotomy. There was no intraoperative mortality or perioperative morbidity. Drainage of the pericardial effusion was effective in all cases. The modified video-assisted thoracoscopic technique on the right chest using two trocars seems a feasible surgical technique for patients suffering from cardiac tamponade.

心包积液可导致心包填塞,有时需要手术治疗。本研究的目的是回顾性分析一组采用改良电视胸腔镜技术治疗的心包填塞患者。我们治疗了15例患者(男8例,女7例;平均年龄63岁;范围24-80岁)伴有心脏填塞。所有患者均采用改进的电视胸腔镜入路治疗右半胸,使用两个套管针:一个15毫米套管针位于腋窝前的第4右肋间隙,一个10毫米套管针位于腋窝中线的第7右肋间隙。我们使用了一个5mm的光学套管针,其尺寸允许通过一个套管针同时使用两个器械(包括光学套管针和内窥镜钳),留下第二个套管针用于解剖剪刀。在所有患者中,我们都获得了与前外侧开胸术相同的心包切除术。术中无死亡,围手术期无发病。所有病例心包积液引流均有效。改良电视胸腔镜技术在右胸使用两个套管针似乎是可行的手术技术,为患者的心脏填塞。
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引用次数: 0
Complicated small-bowel diverticulosis: a case report and review of the literature. 复杂性小肠憩室病1例报告及文献复习。
Pub Date : 2009-05-01
Edoardo Rimini, Valentina Claudiani, Davide Pertile, Giampiero Damiani, Emanuele Romairone, Renato Scordamaglia, Valter Ferrando, Stefano Scabini

Here we report a case of a 60 years old woman who came to the Emergency Department of San Martino Hospital suffering from abdominal pain for about a week with high fever in the last 24 hours. The final histological examination led to the diagnosis of ileal diverticulosis associated with perforation and peritonitis with a fibrotic reaction involving the last ileal loop, the caecum and the appendix.

我们在此报告一位60岁的妇女,她来到圣马蒂诺医院急诊科,在过去的24小时内腹痛约一周,并伴有高烧。最后的组织学检查诊断为回肠憩室病伴穿孔和腹膜炎,纤维化反应累及最后的回肠袢、盲肠和阑尾。
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引用次数: 0
[Whole laparoacopic trans-hiatal extended total gastrectomy with the Or-Vil device: preliminary results in the treatment of Siewert type II and III tumors]. [Or-Vil装置全腹腔镜经裂孔扩大全胃切除术:治疗Siewert II型和III型肿瘤的初步结果]。
Pub Date : 2009-05-01
Luca Maria Siani, Fabrizio Ferranti, Marco Marzano, Marco Benedetti, Alberto Quintiliani

Adenocarcinoma of the gastro-oesophageal junction is progressively rising in western countries and, because of its poor prognosis, presents a real clinical challenge for the oncological surgeon. We evaluate our initial experience with wholly laparoscopic trans-hiatal extended total gastrectomy with the Or-Vil device for treating Siewert type II and III tumours of the gastro-oesophageal junction. Ten patients were enrolled in the present study; ASA score, stage of disease, length of surgery, estimated blood loss, number of lymph nodes harvested, length of proximal margin clearance, morbidity and mortality were analysed. Mortality was nil and morbidity 20%; the average proximal clearance margin was 5.7 cm and all margins were tumour-free (RO). The number of lymph nodes harvested was 38 +/- 19. Neither anastomotic fistulas nor major dehiscence were observed. In our initial experience, wholly laparoscopic trans-hiatal extended total gastrectomy for treating Siewert type II and III tumours of the gastro-oesophageal junction is safe, effective and, according to our preliminary results, oncologically correct, but it remains a complex, advanced laparoscopic procedure, requiring major skills and adequate experience. Prospective, randomised trials--possibly multicentric--are required to establish its efficacy in terms of long-term oncological outcomes.

胃-食管交界处腺癌在西方国家逐渐上升,由于其预后不良,对肿瘤外科医生提出了真正的临床挑战。我们评估了我们的初步经验,全腹腔镜经裂孔扩大全胃切除术与Or-Vil装置治疗siwert型II和III型肿瘤的胃-食管交界处。本研究共纳入10例患者;分析ASA评分、疾病分期、手术时间、估计失血量、淋巴结数量、近端切缘清扫长度、发病率和死亡率。死亡率为零,发病率为20%;近端间隙平均为5.7 cm,所有边缘均无肿瘤(RO)。淋巴结数量为38 +/- 19。未见吻合口瘘或大裂。根据我们的初步经验,全腹腔镜经裂孔扩展全胃切除术治疗胃-食管交界处的siwert II型和III型肿瘤是安全有效的,并且根据我们的初步结果,肿瘤学上是正确的,但它仍然是一个复杂的高级腹腔镜手术,需要专业技能和足够的经验。需要前瞻性随机试验(可能是多中心试验)来确定其在长期肿瘤预后方面的有效性。
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引用次数: 0
Triple synchronous tumours of the urinary system with different histologies: a case report. 不同组织学的泌尿系统三联发肿瘤1例。
Pub Date : 2009-05-01
Antonino Gatto, Laura Falvo, Simone Sebastiani, Giuliano Roncolini, Guerino Pinna

We present the case report of a male patient with a diagnosis of synchronous kidney, bladder and prostate tumours with different histologies: renal oncocytoma, urothelial carcinoma of the bladder, and adenocarcinoma of the prostate. This is the first case report described in the literature in which a complete surgical resection of triple tumours has been performed with surgery in a single session. Recent advances in the field of genetics enable the surgeon to hypothesise new strategies in the early treatment of synchronous tumours, particularly when a number of common tumour markers are positive. One such marker recently identified is the prostate-specific membrane antigen (PSMA), present with high expression in carcinoma of the prostate and in the vascular endothelium of solid tumours; only overexpression of PSMA is to be regarded as diagnostic, inasmuch as this antigen is normally expressed in the renal tubular epithelium. Recent knowledge in the field of genetics has led to new strategies for the early treatment of synchronous tumours, but clinical data and instrumental diagnostics are still of fundamental importance, in that they may enable the surgeon to diagnose the presence of synchronous tumours at an early stage. The execution of prompt surgical treatment remains of basic importance for the purposes of guaranteeing oncological radicality also of synchronous tumours, in association with more sensitive and accurate instrumental diagnostics.

我们报告一例男性患者,诊断为同步肾、膀胱和前列腺肿瘤,具有不同的组织学:肾嗜瘤细胞瘤、膀胱尿路上皮癌和前列腺腺癌。这是文献中描述的第一个病例报告,在一次手术中完成了三重肿瘤的完全手术切除。遗传学领域的最新进展使外科医生能够在同步肿瘤的早期治疗中提出新的策略,特别是当一些常见的肿瘤标志物呈阳性时。最近发现的一个这样的标志物是前列腺特异性膜抗原(PSMA),在前列腺癌和实体瘤的血管内皮中高表达;只有PSMA过表达才被认为是诊断性的,因为这种抗原通常在肾小管上皮中表达。遗传学领域的最新知识为同步肿瘤的早期治疗带来了新的策略,但临床数据和仪器诊断仍然是至关重要的,因为它们可以使外科医生在早期阶段诊断同步肿瘤的存在。及时的手术治疗对于保证肿瘤的根治性和同步性肿瘤的实施仍然具有基本的重要性,并与更敏感和准确的仪器诊断相关联。
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引用次数: 0
Gastric vascular lesion: a case report. 胃血管病变1例。
Pub Date : 2009-05-01
Mario Solej, Ugo Bertoldo, Stefano Enrico, Valerio Marci, Eleonora Raggio, Mario Nano, Guido Gasparri

Arteriovenous malformations of the gastrointestinal tract are a known but rare cause of bleeding. Those of the stomach are the rarest if compared with other causes of gastric bleeding. The aetiology is still unknown, but senile age is considered an important cause, as are the degenerative processes connected with old age. These lesions are diagnosed by endoscopy which, with a haematostatic intent, often is not sufficient to stop the bleeding. Angiography is necessary for patients with massive bleeding whose endoscopy results are negative. The surgical treatment of gastric arteriovenous malformations requires excision of the lesion and part or all of the stomach. We report the case of a 57-year-old patient admitted to the Casualty Department with haematemesis and anaemia caused by acute gastric bleeding.

胃肠道动静脉畸形是一种已知但罕见的出血原因。与其他原因引起的胃出血相比,胃出血是最罕见的。病因尚不清楚,但老年被认为是一个重要的原因,因为与老年有关的退行性过程。这些病变是由内窥镜诊断,有止血的意图,往往不足以止血。对于内窥镜检查结果为阴性的大出血患者,血管造影是必要的。胃动静脉畸形的手术治疗需要切除病变和部分或全部胃。我们报告的情况下,一个57岁的病人入院急诊科呕血和贫血引起的急性胃出血。
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引用次数: 0
[Radiation proctitis: description of two cases refractory to pharmacological treatment]. 【放射性直肠炎:2例药物治疗难治的描述】。
Pub Date : 2009-05-01
Alessandro Piccolomini, Niccolò Francioli, Luigi Verre, Alfredo Guarnieri, Giuseppe Vuolo, Leonardo Di Cosmo, Andrea Tirone, Raffaele Chieca, Enrico Tucci, Anton Ferdinando Carli

Radiation proctitis, is a relatively frequent complication resulting from the direct or collateral irradiation of the rectum in radiotherapy treatment for genito-urinary or anorectal malignancies. The main symptoms are diarrhoea, tenesmus, proctorrhagia, anal pain, mucorrhoea and faecal incontinence. The evolution of chronic radiation proctitis requires treatment for related anaemia, anal incontinence and micturition disorders. The approach and type of treatment depend on the severity of the symptoms and on the endoscopic aspect, in relation to the response to previous medical therapy performed. In our experience, endoscopic treatment is the best choice in the presence of ongoing bleeding and the possible development of severe anaemia. The surgical option is mandatory in patients at high risk of sepsis, requiring a faecal diversion constructed using the Hartmann technique. We report two cases, observed during the last two years, one treated with endoscopic bipolar coagulation and the other with a double urinary and faecal diversion.

放射性直肠炎是在泌尿生殖系统或肛肠恶性肿瘤的放射治疗中,由于直肠直接或间接照射而引起的一种较为常见的并发症。主要症状为腹泻、下急、大出血、肛门疼痛、黏膜及大便失禁。慢性放射性直肠炎的发展需要治疗相关贫血,肛门失禁和排尿障碍。治疗的方法和类型取决于症状的严重程度和内窥镜方面,以及对先前进行的药物治疗的反应。根据我们的经验,在持续出血和可能发展为严重贫血的情况下,内镜治疗是最好的选择。对于脓毒症风险高的患者,手术是强制性的,需要使用Hartmann技术进行粪便转移。我们报告两个病例,在过去两年中观察到的,一个治疗与内镜双极性凝血和另一个双重尿和粪便转移。
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引用次数: 0
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Chirurgia italiana
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