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[Synchronous adenocarcinoma of the sigmoid colon and multifocal intraductal papillary mucinous neoplasm of the pancreas in an elderly patient]. [老年患者乙状结肠同步腺癌和胰腺多灶导管内乳头状黏液瘤]。
Pub Date : 2009-05-01
Mariateresa Mirarchi, Emilio De Raffele, Stefania Lega, Lucia Calculli, Samuele Vaccari, Bruno Cola

Intraductal papillary mucinous neoplasms are a well-recognized pathologic entity of the pancreas that is being reported with increasing frequency. These tumours carry a relatively favourable prognosis and are frequently associated with extrapancreatic malignancies. The combination of advanced age and co-existence of two neoplasms challenges the planning of the best treatment option. A 78-year-old man presented with rectal bleeding which led to the diagnosis of a stenosing adenocarcinoma of the sigmoid colon. No metastatic lesions were present but a 30 mm intraductal papillary mucinous neoplasm with mural nodules was detected in the uncinate process of the pancreas. Small diffused dilations of the side branches were present in the body and tail of the gland. A two-stage procedure was planned: an R0 sigmoid resection was undertaken first with an uneventful postoperative course. Forty-five days later a pancreaticoduodenectomy was performed and the postoperative course was again uneventful apart from delayed gastric emptying. Histology showed a combined-type intraductal papillary mucinous neoplasm with foci of non-invasive carcinoma. The patient is still alive without evidence of cancer recurrence 33 month after the pancreatico-duodenectomy. The co-existence of a potentially malignant pancreatic tumour with an extra-pancreatic overt malignancy in elderly patients poses difficulties in the attempt to cure the patient with minimal morbidity. In the present case we considered a staged surgical procedure with the aim of reducing the perioperative risk, since the excision of the pancreatic neoplasm required a pancreaticoduodenectomy in an elderly patient.

导管内乳头状黏液性肿瘤是一种公认的胰腺病理实体,报道的频率越来越高。这些肿瘤预后较好,常与胰腺外恶性肿瘤相关。高龄和两种肿瘤共存的结合对最佳治疗方案的规划提出了挑战。一个78岁的男人提出直肠出血,导致乙状结肠狭窄性腺癌的诊断。未见转移性病变,但在胰腺钩突处发现一30毫米导管内乳头状粘液瘤伴壁结节。腺体的体部和尾部有小的弥漫性扩张。计划进行两阶段手术:首先进行R0乙状结肠切除术,术后过程平稳。45天后行胰十二指肠切除术,除胃排空延迟外,术后过程再次顺利。组织学表现为混合型导管内乳头状黏液性肿瘤伴非侵袭性癌灶。患者在胰十二指肠切除术33个月后仍然存活,没有癌症复发的迹象。潜在的恶性胰腺肿瘤与胰腺外显性恶性肿瘤共存的老年患者,在试图以最小的发病率治愈患者方面存在困难。在本病例中,我们考虑分阶段手术,目的是降低围手术期风险,因为在老年患者中切除胰腺肿瘤需要胰十二指肠切除术。
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引用次数: 0
Mucinous cystic neoplasm of the pancreas: a case report. 胰腺粘液囊性肿瘤1例。
Pub Date : 2009-05-01
Giorgio Catalano, Francesco Puglisi, Michele De Fazio, Michele Tedeschi, Antonia Gentile, Riccardo Memeo, Vincenzo Memeo

Cystic neoplasms of the pancreas account for only a small percentage of pancreatic tumours. They include mucinous cystic tumours, which have a higher incidence in females in their forties or fifties. Cystic neoplasms of the pancreas can present in a benign, borderline or malignant form. These tumours have a natural evolution from a benign (mucinous cystadenoma) to a malignant form (cystadenocarcinoma). It is not always easy to diagnose cystic tumours, including mucinous cystic tumours of the pancreas, and the final diagnosis is often reached only after the surgical procedure, which is the gold standard treatment of this disease. We present the case of a 56-year-old woman affected by a mucinous cystic tumour of the body-tail of the pancreas, who underwent distal splenopancreasectomy. She was discharged on postoperative day 12. After an 18-month followup, she is in good general condition and disease-free.

胰腺囊性肿瘤仅占胰腺肿瘤的一小部分。其中包括粘液囊性肿瘤,在四五十岁的女性中发病率较高。胰腺囊性肿瘤可表现为良性、交界性或恶性。这些肿瘤从良性(粘液囊腺瘤)自然演变为恶性(囊腺癌)。诊断囊性肿瘤并不总是那么容易,包括胰腺的粘液囊性肿瘤,最终的诊断往往只有在手术后才能得出,这是治疗这种疾病的金标准。我们提出的情况下,56岁的妇女受粘液囊性肿瘤的身体尾胰腺,谁接受远端脾胰腺切除术。术后第12天出院。经过18个月的随访,患者总体状况良好,无疾病。
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引用次数: 0
Laparoscopic repair of Morgagni hernia in an adult: use of a porcine small intestine submucosa biocompatible prosthesis. 腹腔镜下修复成人莫格尼疝:使用猪小肠粘膜下生物相容性假体。
Pub Date : 2009-05-01
Francesco Puglisi, Palma Capuano, Onofrio Caputi Iambrenghi, Nicola Armenise, Francesco Carlucci, Maurizio Memeo, Riccardo Memeo, Gennaro Martines

Morgagni hernia is a rare cause of diaphragmatic hernia. There are few reports of laparoscopic repair in the literature. Tension-free hernia closure with synthetic mesh reduces recurrence but occasionally results in complications, such as visceral stricture, erosion or perforation. We report a case of successful laparoscopic repair of a very large symptomatic Morgagni hernia in a 78-year-old patient, treated by positioning a gradually resorbable mesh made from porcine SIS (Surgisis Soft Tissue Graft device--Cook Inc, Bloomington, Ind). After surgery, the patient reported an immediate, marked improvement in clinical symptoms. During the postoperative course, pleural and pericardial leakage occurred. The pleural leakage was immediately drained with thoracentesis, and the pericardial leakage was treated conservatively. No other complications occurred after patient discharge. One year later, the patient was in very good general condition. No recurrence was documented with abdominal CT scan, which also demonstrated connective tissue proliferation that was progressively replacing the prosthesis. Laparoscopic repair is a safe, efficacious procedure for the treatment of diaphragmatic hernia, and presents all the advantages of minimally invasive surgery. The use of new types of material featuring marked biocompatibility and gradual reabsorbability characteristics offers considerable benefits.

Morgagni疝是膈疝的一种罕见病因。文献中很少有关于腹腔镜修复的报道。用合成补片闭合无张力疝可减少复发,但偶尔会导致并发症,如内脏狭窄、糜烂或穿孔。我们报告一例78岁的患者成功的腹腔镜修复了一个非常大的有症状的Morgagni疝,通过放置由猪SIS制成的逐渐可吸收的网状物(Surgisis Soft Tissue Graft device——Cook Inc, Bloomington, Ind)进行治疗。手术后,患者报告临床症状立即明显改善。术后出现胸膜及心包渗漏。胸膜渗漏立即行胸腔穿刺引流,心包渗漏保守处理。出院后无其他并发症发生。一年后,病人的总体情况很好。腹部CT扫描无复发记录,也显示结缔组织增生逐渐取代假体。腹腔镜下膈疝修补术是一种安全、有效的治疗膈疝的方法,具有微创手术的优点。新型材料具有显著的生物相容性和可逐渐重新吸收的特性,其使用带来了相当大的好处。
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引用次数: 0
[Primary intrahepatic lithiasis: indications and results of liver resection]. 原发性肝内结石:肝切除术的适应症和结果。
Pub Date : 2009-05-01
Gennaro Clemente, Agostino Maria De Rose, Marco Giordano, Caterina Mele, Maria Vellone, Francesco Ardito, Marino Murazio, Felice Giuliante, Ivo Giovannini, Gennaro Nuzzo

The aim of this study was to review a series of patients submitted to hepatectomy for primary intrahepatic lithiasis to evaluate early and late results with an assessment of indications, methods and long-term outcomes. From January 1992 to December 2007, 40 patients (25 males and 15 females with a mean age of 51 years) underwent surgery for primary intrahepatic lithiasis in our Hepato-biliary Surgery Unit. Left hepatectomy (20 patients) and left lateral segmentectomy (12 patients) were the most common procedures performed. A cholangiocarcinoma was found in 4 patients (10%) and only two of these underwent liver resection, while an exploratory laparotomy was performed in the remaining two patients for an unresectable tumour, unexpected before surgery. There was no postoperative mortality. The morbidity rate was 22.5% with a prevalence of infectious complications related to bile leakage. Long-term results, assessed in 30 patients with a follow-up longer than 12 months, were good or fair in 28 patients (93.3%). Primary intrahepatic lithiasis is diagnosed increasingly in Western countries as a result of the improvement in imaging techniques. The stones originate inside the liver at the level of dilatations of the bile ducts above congenital strictures of the main hilar ducts. Biliary pain and cholangitis are the most common presenting symptoms, whereas cholangiocarcinoma represents the unfavourable complication of the disease. In the majority of cases, a single liver lobe or segment is involved and liver resection allows definitive treatment of the disease and prevention of cancer.

本研究的目的是回顾一系列因原发性肝内结石而接受肝切除术的患者,以评估早期和晚期的结果,并评估适应症、方法和长期结果。从1992年1月到2007年12月,40例患者(男性25例,女性15例,平均年龄51岁)在我们肝胆外科接受了原发性肝内结石手术。左肝切除术(20例)和左外侧节段切除术(12例)是最常见的手术。4例患者(10%)发现胆管癌,其中只有2例接受了肝切除术,而其余2例患者因不可切除的肿瘤进行了探查性剖腹手术,手术前没有预料到。无术后死亡率。发病率为22.5%,伴有胆漏相关的感染性并发症。在随访时间超过12个月的30例患者中,28例患者(93.3%)的长期结果为良好或一般。由于影像学技术的进步,原发性肝内结石在西方国家的诊断越来越多。结石起源于肝内主要肝门管先天性狭窄上方的胆管扩张处。胆道疼痛和胆管炎是最常见的症状,而胆管癌则是该疾病的不利并发症。在大多数病例中,单个肝叶或肝段受累,肝切除可以明确治疗疾病并预防癌症。
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引用次数: 0
Biofeedback therapy for outlet dysfunction: our experience. 出口功能障碍的生物反馈疗法:我们的经验。
Pub Date : 2009-05-01
Antonino Carlo Privitera, Conchita Emanuela Oliveri, Giuseppe Randazzo, Nnawuihe Luca Ohazuruike, Serafina Prumeri, Antonino Politi, Lino Succi

Biofeedback is an important therapeutic option in patients with outlet dysfunction. A total of 75 patients referred to our proctological division from March 2004 to June 2008 and complaining of chronic constipation were studied by history, physical examination, anorectal functional tests and a structured questionnaire. Patients were treated with biofeedback plus electrical stimulation or both biofeedback plus electrical stimulation and surgery. Sixty of the 75 patients were treated with biofeedback only; and 15 with both treatments. All patients underwent, on average, twice weekly 15-minute EMG-biofeedback training sessions followed by 5 minutes of electrical stimulation. At 6 months' follow-up all physiological parameters with the exception of anal squeeze pressure showed a significant improvement (p < 0.05); there were reductions in sensation of incomplete evacuation (from 72 to 29.3 percent), in difficult stool passage (from 76 to 18.7 percent), and in the use of laxatives, enemas or digital manoeuvres (from 88 to 40 percent). At a telephone follow-up at 1 year, an improvement in satisfaction was reported by 77.3% of patients (58/75). The results of this study confirm that biofeedback plus electrical stimulation produces an improvement in bowel symptoms in patients with outlet dysfunction, as well as underlining the importance of anorectal functional tests as a guide to the most appropriate treatment.

生物反馈是出口功能障碍患者的重要治疗选择。本研究选取2004年3月至2008年6月至我院直肠科就诊的75例慢性便秘患者,对其进行病史、体格检查、肛肠功能检查和结构化问卷调查。患者采用生物反馈+电刺激或生物反馈+电刺激+手术治疗。75例患者中有60例仅接受生物反馈治疗;同时接受两种治疗的15人。所有患者平均每周接受两次15分钟的肌电生物反馈训练,随后进行5分钟的电刺激。随访6个月时,除肛门挤压压力外,其他生理指标均有显著改善(p < 0.05);感觉不完全排便(从72%减少到29.3%),排便困难(从76%减少到18.7%),使用泻药、灌肠或数字操作(从88%减少到40%)。在1年的电话随访中,77.3%的患者(58/75)报告满意度改善。本研究的结果证实,生物反馈加电刺激可改善出口功能障碍患者的肠道症状,同时也强调了肛肠功能检查作为最合适治疗指导的重要性。
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引用次数: 0
Laparoscopic surgical treatment of perforated duodenal ulcer. 十二指肠溃疡穿孔的腹腔镜手术治疗。
Pub Date : 2009-05-01
Vincenzo Minutolo, Giuseppe Gagliano, Calogero Rinzivillo, Orazio Minutolo, Maurizio Carnazza, Agostino Racalbuto, Salvatore Dipietro, Giovanni Li Destri

Perforation of peptic ulcer is a surgical emergency which still carries a risk of mortality. The main risk factors are delayed diagnosis > 24 hours, ASA-III or ASA-IV, age over 70 years, and associated cardiorespiratory pathologies. There is no unanimous consensus regarding the gold standard treatment of such complications. In this study we report our experience and analyse the literature with the aim of assessing the possible advantages of laparoscopic treatment of perforated duodenal ulcers versus open surgery. From April 2003 to December 2008, 39 patients underwent laparoscopic repair and 7 patients open repair of perforated duodenal ulcer. The following parameters were evaluated in all patients: operative time, duration of hospital stay, time to intestinal canalisation, morbidity and mortality. The conversion rate, in laparoscopic treated patients, was 0%. The mean operative time was longer in the laparoscopic group than in the open group (76.15 +/- 9.49 vs. 63.57 +/- 15.19 minutes; Mann Whitney test p < 0.05). The laparoscopic cases had a shorter mean hospital stay than the open cases (5.8 +/- 1.02 vs. 7.8 +/-1.34 days; Mann Whitney test p < 0.001). The time to canalisation in the two groups of patients was similar. One patient (2.56%) in the laparoscopic group and two (28.57%) in the open repair group presented morbidity in the postoperative period. One patient (ASA IV) in the open group died. Laparoscopic treatment in the emergency setting is a safe, reliable procedure, affording all the advantages of the minimally invasive approach.

消化性溃疡穿孔是一种外科急症,仍然有死亡的危险。主要危险因素为延迟诊断> 24小时、ASA-III或ASA-IV、年龄超过70岁及相关心肺病变。对于这类并发症的金标准治疗并没有一致的共识。在这项研究中,我们报告了我们的经验并分析了文献,目的是评估腹腔镜治疗十二指肠溃疡穿孔与开放手术的可能优势。2003年4月至2008年12月,39例患者行腹腔镜修补术,7例患者行十二指肠溃疡穿孔开腹修补术。对所有患者的以下参数进行评估:手术时间、住院时间、肠通管时间、发病率和死亡率。在腹腔镜治疗的患者中,转换率为0%。腹腔镜组平均手术时间较开放组长(76.15 +/- 9.49 vs. 63.57 +/- 15.19 min;Mann Whitney检验p < 0.05)。腹腔镜组的平均住院时间短于开腹组(5.8 +/- 1.02 vs. 7.8 +/-1.34);曼-惠特尼检验p < 0.001)。两组患者的通管时间相似。腹腔镜组术后发病1例(2.56%),开放式修复组术后发病2例(28.57%)。开放组死亡1例(ASA IV)。在紧急情况下,腹腔镜治疗是一种安全、可靠的方法,具有微创方法的所有优点。
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引用次数: 0
[Aneurysms of the splenic artery: our experience]. 脾动脉动脉瘤:我们的经验。
Pub Date : 2009-05-01
Tommaso Mandolfino, Aldo Canciglia, Mario D'Alfonso

Splenic artery aneurysms, although rare, are the most common visceral artery aneurysms with a high risk of rupture. The purpose of this retrospective study was to analyse our experience with such aneurysms. Eight patients (6 women, 2 men; mean age: 60.2 years; range: 33-76 years) with a diagnoses of splenic artery aneurysm were reviewed. Six patients were asymptomatic and two had chronic pancreatitis with left flank pain. The condition was diagnosed by ultrasonography and computed tomography. Five patients underwent surgery, two requiring splenectomy, and three patients were treated by embolisation. There were no postoperative deaths. Follow-up data were available for 7 patients, the mean follow-up period being 60 months (range: 2-72 months). Although open surgical repair remains the gold standard, endovascular techniques may, in selected cases, offer a viable alternative in high-risk patients with significant co-morbid conditions.

脾动脉瘤虽然罕见,但却是最常见的内脏动脉瘤,有很高的破裂风险。本回顾性研究的目的是分析我们治疗此类动脉瘤的经验。8例患者(女6例,男2例;平均年龄:60.2岁;范围:33-76岁)诊断为脾动脉瘤。6例无症状,2例慢性胰腺炎伴左侧疼痛。通过超声和计算机断层扫描诊断。5例患者接受手术治疗,2例需要脾切除术,3例接受栓塞治疗。无术后死亡病例。7例患者获得随访资料,平均随访时间60个月(2-72个月)。虽然开放手术修复仍然是金标准,但在某些情况下,血管内技术可能为具有显著合并症的高风险患者提供可行的替代方案。
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引用次数: 0
Use of biological material as an adjuvant in Bassini hernia repair: technical notes. 在巴西尼疝修补术中使用生物材料作为辅助剂:技术说明。
Pub Date : 2009-03-01
Massimiliano Tuveri, Valentina Borsezio, Raffaela Argiolas, Augusto Tuveri

The aim of this study was to describe the feasibility and efficacy of a new operative technique using biological material as an adjuvant for the repair of inguinal hernia according to the original Bassini technique in an attempt to achieve complete restoration not only of the anatomical integrity but also of the physiological elasticity and flexibility of the inguinal canal. Between February and July 2008 a total of 12 patients underwent the original Bassini repair of primary and recurrent inguinal hernia. The biological material was used as an adjuvant to create a quadruple layer in the restoration of the posterior wall of the inguinal canal in order to further strengthen it. Fourteen procedures were performed on 12 adult male, unselected patients. Inguinal hernias were unilateral in 10 patients, bilateral in 2 patients, and recurrent in 3 patients. Mean operation time was 45 minutes (range: 30-70). No general or local intraoperative complications were registered. Mean postoperative pain was rated with the VAS pain score was 2.8 (range: 2-4) in the first 48 hours. No postoperative complications occurred. After a mean follow-up of 5 months (range: 3-6), there were no early recurrences nor persisting inguinal pain. The use of biological material as an adjunct to the Bassini procedure achieves four main objectives: two mechanical and two biological. The two mechanical aims include: further decrease of the tension of the suture line when anchored to the isolated posterior border of Poupart's ligament. The second mechanical objective is that the biological material acts as a binder that protects the suture line when the intra-abdominal pressure increases. The two biological objectives are regrowth of the fascia over the transversalis fascia, and increased production and deposition of collagen on the suture line ten times greater than that of the native fascia, thus improving the healing process.

本研究的目的是描述一种新的手术技术的可行性和有效性,该技术使用生物材料作为辅助材料,根据原始的Bassini技术修复腹股沟疝,试图实现完全恢复腹股沟管的解剖完整性和生理弹性和柔韧性。2008年2月至7月间,共有12名患者接受了原发性和复发性腹股沟疝的原始Bassini修复术。在腹股沟管后壁修复中,使用生物材料作为辅助材料创建四层,以进一步加强它。对12名未选定的成年男性患者进行了14次手术。腹股沟疝单侧10例,双侧2例,复发3例。平均手术时间45分钟(范围:30 ~ 70分钟)。术中无全身或局部并发症。术后48小时VAS疼痛评分平均为2.8(范围:2-4)。无术后并发症发生。平均随访5个月(范围:3-6个月),无早期复发,无持续腹股沟疼痛。使用生物材料作为Bassini程序的辅助实现了四个主要目标:两个机械和两个生物。两个机械目的包括:当锚定在孤立的Poupart韧带后缘时,进一步降低缝合线的张力。第二个机械目标是,当腹内压力增加时,生物材料作为粘合剂保护缝合线。两个生物学目标是筋膜横肌上的筋膜再生,缝合线上胶原蛋白的产生和沉积比天然筋膜多十倍,从而改善愈合过程。
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引用次数: 0
[Laparoscopic sleeve gastrectomy: technique and preliminary results]. 腹腔镜袖式胃切除术:技术及初步结果。
Pub Date : 2009-03-01
Daniele Capizzi, Sergio Boschi, Patrizio Patrizi, Luciano Fogli, Rossana Berta, Francesco Domenico Capizzi

According to the WHO about 300 million people in the world are affected by obesity with an increasing trend. The aim of the present study was to assess our preliminary results with sleeve gastrectomy. Over the period from June 2006 to March 2008, 25 laparoscopic sleeve gastrectomy were performed at our Department of Surgery for morbid obesity by the same surgeon. The operation consists in resection of approximately three quarters of the stomach with the creation of a long slender gastric tube, dividing the stomach vertically in two parts and removing all the left side with the greater curvature and gastric fundus. The mean age of the patients was 38 +/- 9 years, and the mean BMI 48 +/- 3. The mean operative time was 110 minutes, and the mean hospital stay 6 days. Mean intraoperative bleeding was negligible (20 cc). In our study we observed just one case of gastric leakage from the staple line, treated by surgical drainage and by placement of an endoscopic stent. There were no cases of bleeding of the resection margin and no long-term stenosis; there was no mortality. The mean follow-up was 18 months. BMI showed a mean reduction of about 17 points. During postoperative visits all the patients reported marked reduction of hunger sensation, together with a sense of early satiety. On the basis of these preliminary results we can consider laparoscopic sleeve gastrectomy as a safe, functional and definitive procedure that constitutes a valid alternative in bariatric surgery, though it is as yet not completely standardised and requires a longer follow-up.

根据世界卫生组织的数据,世界上约有3亿人受到肥胖的影响,并呈上升趋势。本研究的目的是评估袖式胃切除术的初步结果。在2006年6月至2008年3月期间,同一位外科医生在我科为病态肥胖患者实施了25例腹腔镜袖胃切除术。该手术包括切除约四分之三的胃,并建立一个细长的胃管,将胃垂直分为两部分,并切除左侧弯曲较大的胃和胃底。患者平均年龄38 +/- 9岁,平均BMI 48 +/- 3。平均手术时间110分钟,平均住院时间6天。平均术中出血可忽略不计(20cc)。在我们的研究中,我们只观察到一例胃从钉线漏出,通过手术引流和放置内镜支架治疗。无切除缘出血,无长期狭窄;没有死亡。平均随访时间为18个月。身体质量指数平均下降了17分。术后随访期间,所有患者均报告饥饿感明显减少,并伴有早期饱腹感。基于这些初步结果,我们可以认为腹腔镜袖胃切除术是一种安全、有效和确定的手术,是减肥手术的有效选择,尽管它还没有完全标准化,需要更长的随访时间。
{"title":"[Laparoscopic sleeve gastrectomy: technique and preliminary results].","authors":"Daniele Capizzi,&nbsp;Sergio Boschi,&nbsp;Patrizio Patrizi,&nbsp;Luciano Fogli,&nbsp;Rossana Berta,&nbsp;Francesco Domenico Capizzi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>According to the WHO about 300 million people in the world are affected by obesity with an increasing trend. The aim of the present study was to assess our preliminary results with sleeve gastrectomy. Over the period from June 2006 to March 2008, 25 laparoscopic sleeve gastrectomy were performed at our Department of Surgery for morbid obesity by the same surgeon. The operation consists in resection of approximately three quarters of the stomach with the creation of a long slender gastric tube, dividing the stomach vertically in two parts and removing all the left side with the greater curvature and gastric fundus. The mean age of the patients was 38 +/- 9 years, and the mean BMI 48 +/- 3. The mean operative time was 110 minutes, and the mean hospital stay 6 days. Mean intraoperative bleeding was negligible (20 cc). In our study we observed just one case of gastric leakage from the staple line, treated by surgical drainage and by placement of an endoscopic stent. There were no cases of bleeding of the resection margin and no long-term stenosis; there was no mortality. The mean follow-up was 18 months. BMI showed a mean reduction of about 17 points. During postoperative visits all the patients reported marked reduction of hunger sensation, together with a sense of early satiety. On the basis of these preliminary results we can consider laparoscopic sleeve gastrectomy as a safe, functional and definitive procedure that constitutes a valid alternative in bariatric surgery, though it is as yet not completely standardised and requires a longer follow-up.</p>","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 2","pages":"155-60"},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28252437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Laparoscopic total gastrectomy for multifocal gastric GIST: a case report and review of the literature]. [腹腔镜全胃切除术治疗多灶性胃间质瘤:1例报告及文献复习]。
Pub Date : 2009-03-01
Luca Maria Siani, Fabrizio Ferranti, Alberto Stefanuto, Marco Benedetti, Alberto Quintiliani

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the GI tract, deriving from interstitial Cajal cell degeneration. Over 95% of GISTs express CD-117 and CD-34, thus differing from other mesenchymal-derived tumours. The aim of this study was to evaluate our experience with a multifocal GIST, treated by laparoscopic total gastrectomy, and review the literature. A 74-year-old man with a preoperative diagnosis of sub-cardial GIST, obtained by endoscopy, CT scan and endoscopic ultrasound, was submitted to laparoscopic total gastrectomy with an end-to-side oesophago-jejunal anastomosis, using the Or-Vil system. GISTs account for only 1% of all GI tumours, with a variable behaviour, from indolent forms to aggressive tumours with potential for hepatic and peritoneal metastasis. Surgery is the cornerstone of therapy, the aim being to obtain an R0 resection, so as to minimise the risk of recurrence. Laparoscopic total gastrectomy is an excellent solution for their treatment, with possible adjuvant therapy based on imatinib-mesylate, for high-risk GIST.

胃肠道间质瘤(gist)是胃肠道最常见的间质肿瘤,起源于间质Cajal细胞变性。超过95%的gist表达CD-117和CD-34,因此不同于其他间质源性肿瘤。本研究的目的是评估腹腔镜全胃切除术治疗多灶性GIST的经验,并回顾相关文献。一名74岁男性,术前经内镜、CT扫描和内镜超声诊断为心下胃肠道间质瘤,采用Or-Vil系统行腹腔镜全胃切除术,吻合端侧食道空肠。胃肠道间质瘤仅占所有胃肠道肿瘤的1%,其表现各异,从惰性形式到侵袭性肿瘤,有可能发生肝脏和腹膜转移。手术是治疗的基石,目的是获得R0切除,以尽量减少复发的风险。对于高危GIST,腹腔镜全胃切除术是一种很好的治疗方案,可能的辅助治疗是甲磺酸伊马替尼。
{"title":"[Laparoscopic total gastrectomy for multifocal gastric GIST: a case report and review of the literature].","authors":"Luca Maria Siani,&nbsp;Fabrizio Ferranti,&nbsp;Alberto Stefanuto,&nbsp;Marco Benedetti,&nbsp;Alberto Quintiliani","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the GI tract, deriving from interstitial Cajal cell degeneration. Over 95% of GISTs express CD-117 and CD-34, thus differing from other mesenchymal-derived tumours. The aim of this study was to evaluate our experience with a multifocal GIST, treated by laparoscopic total gastrectomy, and review the literature. A 74-year-old man with a preoperative diagnosis of sub-cardial GIST, obtained by endoscopy, CT scan and endoscopic ultrasound, was submitted to laparoscopic total gastrectomy with an end-to-side oesophago-jejunal anastomosis, using the Or-Vil system. GISTs account for only 1% of all GI tumours, with a variable behaviour, from indolent forms to aggressive tumours with potential for hepatic and peritoneal metastasis. Surgery is the cornerstone of therapy, the aim being to obtain an R0 resection, so as to minimise the risk of recurrence. Laparoscopic total gastrectomy is an excellent solution for their treatment, with possible adjuvant therapy based on imatinib-mesylate, for high-risk GIST.</p>","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 2","pages":"199-203"},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28251818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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