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Laparoscopic biliopancreatic diversion: our preliminary experience with 201 consecutive cases. 腹腔镜胆胰分流术201例的初步经验。
Pub Date : 2009-03-01
Luigi Piazza, Angelo Pulvirenti, Francesco Ferrara, Angelo Bellia, Silvana Leanza, Danilo Coco, Claudia Piazza, Giovanni Lo Giudice

Surgery as a treatment modality for morbid obesity has shown impressive progress over the past decades because of a better understanding of the metabolic characteristics of obesity and the rationale for its surgical treatment. Biliopancreatic diversion was first performed in humans in 1976. Since then it has been an excellent operation for morbid obesity to achieve long-term weight reduction. We present our laparoscopic biliopancreatic diversion protocol, with or without distal gastrectomy (Resa's operation). From 1995 to October 2008 we operated on 201 patients; open biliopancreatic diversion was performed in 48 patients, while the remaining patients underwent laparoscopic biliopancreatic diversion (84 laparoscopic Scopinaro's operations, 69 laparoscopic Resa's operations). The mean operating time was 140 minutes for the open procedures, 180 minutes for Scopinaro's laparoscopic operation and 135 minutes for Resa's laparoscopic operation. The mean postoperative stay was 5.5 days. Our mortality rate consisted of two patients (0.99%) who had pulmonary embolisms. Other major complications were three cases of leakage from the jejuno-ileal anastomosis, 18 cases of incisional hernia, 6 cases of metabolic diseases; 1 case of acute hepatitis and 1 case of bronchopneumonia. Biliopancreatic diversion can be performed satisfactorily by laparoscopy. A factor that may reduce the technical difficulties and make the technique totally reversible is the gastric sparing. Thus an upper digestive endoscopy can determine preoperatively whether the patient will need a gastrectomy, depending on its results.

在过去的几十年里,由于对肥胖的代谢特征和手术治疗的基本原理有了更好的了解,手术作为病态肥胖的一种治疗方式已经取得了令人印象深刻的进展。胆胰分流术于1976年首次在人类身上进行。从那时起,它一直是一种很好的手术病态肥胖实现长期减肥。我们提出我们的腹腔镜胆胰转移方案,有或没有远端胃切除术(Resa手术)。从1995年到2008年10月,我们为201例患者进行了手术;48例患者行开放胆胰分流术,其余患者行腹腔镜胆胰分流术(腹腔镜Scopinaro手术84例,腹腔镜Resa手术69例)。开腹手术平均手术时间140分钟,Scopinaro腹腔镜手术平均手术时间180分钟,Resa腹腔镜手术平均手术时间135分钟。术后平均住院时间为5.5天。我们的死亡率包括2例肺栓塞患者(0.99%)。其他主要并发症为空肠-回肠吻合口瘘3例,切口疝18例,代谢性疾病6例;急性肝炎1例,支气管肺炎1例。胆胰分流术在腹腔镜下可获得满意的效果。一个可能减少技术难度并使该技术完全可逆的因素是胃保留。因此,根据手术结果,上消化道内窥镜检查可以在术前确定患者是否需要进行胃切除术。
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引用次数: 0
[Gastrointestinal stromal tumour: our experience]. [胃肠道间质瘤:我们的经验]。
Pub Date : 2009-03-01
Antonino Versaci, Antonio Macrì, Antonio Ieni, Marialuisa Terranova, Grazia Leonello, Edoardo Saladino, Giuseppe Speciale, Ciro Famulari

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. These tumours originate in Cajal interstitial cells and the majority are located in the stomach and small intestine. They frequently develop in males aged 50-60 years. The symptoms of GIST are non-specific and depend on the size and location of the lesion. Imaging difficulties impede an early diagnosis; sometimes these tumours represent an unexpected intraoperative finding or an emergency abdominal picture. GISTs are classified as tumours with low- and high-risk of malignancy, depending on tumour size and mitotic count. Tumour site and acute onset are also significant parameters for prognostic purposes. Fifteen patients with GIST - gastric in 7 cases, ileal in 6, jejunal in 1 and colonic in 1 - were treated surgically and, in 9 cases, with adjuvant therapy (chemotherapy in 4 patients and imatinib mesylate in 5). The mean follow-up was 38 months. No postoperative mortality was recorded, and the morbidity was 13.3%. Histological examinations documented 6 benign tumours and 9 malignancies. Two patients, one with gastric and one with colonic GIST, were lost to follow-up. One patient, with two synchronous gastric neoplasms (GIST + adenocarcinoma) died after 16 months, while the other 5 patients with gastric GIST are still alive; two patients with ileal GIST, treated with chemotherapy, died after 15 and 18 months, respectively. The mean survival of patients treated with imatinib mesylate was 36 months. Surgical management and the use of imatinib constitute the therapeutic gold standard for GIST. The use of imatinib mesylate is recommended today in the treatment of advanced GIST, especially in cases with liver and peritoneal metastases.

胃肠道间质瘤(gist)是最常见的胃肠道间质肿瘤。这些肿瘤起源于Cajal间质细胞,大多数位于胃和小肠。它们通常发生在50-60岁的男性身上。GIST的症状是非特异性的,取决于病变的大小和位置。成像困难阻碍了早期诊断;有时这些肿瘤是术中意外发现或急诊腹部图片。根据肿瘤大小和有丝分裂计数,gist分为低恶性肿瘤和高危恶性肿瘤。肿瘤部位和急性发作也是预后的重要参数。15例胃肠道间质瘤(7例为胃,6例为回肠,1例为空肠,1例为结肠)经手术治疗,9例为辅助治疗(化疗4例,甲磺酸伊马替尼5例),平均随访38个月。术后无死亡记录,发病率为13.3%。组织学检查显示6例良性肿瘤,9例恶性肿瘤。2例患者,1例为胃间质瘤,1例为结肠间质瘤,均未随访。1例伴有两种同步胃肿瘤(GIST +腺癌)的患者在16个月后死亡,而另外5例伴有胃GIST的患者仍然存活;2例接受化疗的回肠间质瘤患者分别在15个月和18个月后死亡。接受甲磺酸伊马替尼治疗的患者平均生存期为36个月。手术治疗和伊马替尼的使用构成了GIST治疗的金标准。甲磺酸伊马替尼目前被推荐用于晚期GIST的治疗,特别是肝和腹膜转移的病例。
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引用次数: 0
[Mesenteric Castleman's disease and inflammatory fibroid polyp of the stomach: a case report and review of the literature]. [肠系膜Castleman病合并胃炎性肌瘤息肉1例报告及文献复习]。
Pub Date : 2009-03-01
Mauro Andreano, Vito D'Ambrosio, Massimo Antropoli, Raffaele Fioretto, Luciano Vicenzo, Marco Clemente

Castleman's disease is a very rare disease that causes many problems both in diagnosis and therapy. It is often associated with other diseases and can develop in any part of the body. Castleman's disease can be classified as uni-centric or multicentric based on clinical and radiological findings, as hyaline-vascular or plasma-cell based on the histological aspect, and as HIV-related or non-HIV-related, based on the HIV status of the patient. An inflammatory fibroid polyp is a very rare benign lesion that can develop anywhere in the gastrointestinal tract. Such polyps are most commonly found in the gastric antrum and usually occur in 50- to 60-year-old people. The authors report the unusual finding of mesenteric Castleman's disease and an inflammatory fibroid polyp of the stomach in a 41-year-old woman.

Castleman氏病是一种非常罕见的疾病,在诊断和治疗上都存在许多问题。它通常与其他疾病有关,可以在身体的任何部位发展。Castleman病可根据临床和放射学表现分为单中心型和多中心型,根据组织学特征分为透明血管型和浆细胞型,根据患者的HIV感染状况分为HIV相关型和非HIV相关型。炎性肌瘤息肉是一种非常罕见的良性病变,可以在胃肠道的任何地方发展。这种息肉最常见于胃窦,通常发生在50至60岁的人群中。作者报告了一名41岁女性的肠系膜Castleman病和胃炎性肌瘤息肉的不寻常发现。
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引用次数: 0
Voluminous bleeding stomach GIST: reflections on etiopathogenesis, diagnosis and therapy. 胃大出血GIST:对病因、诊断和治疗的思考。
Pub Date : 2009-03-01
Valerio Caracino, Gustavo Maggi, Simone Altobelli, Carlo Lambiase, Costantina Danza, Giampiero D'Amico

Gastrointestinal stromal tumours (GIST) constitute a heterogeneous group of neoplasms which, although rare (around 1% of the total number of malignant tumours), are the most common mesenchymal tumours of the gastrointestinal tract. In the past they were not very well known, whereas today, thanks to the remarkable progress made in the immunohistochemical and molecular fields, considerable knowledge has been acquired, offering new opportunities for classification and, above all, for a more adequate multidisciplinary treatment of this pathology. In this study, the authors report a case of a bleeding GIST of the stomach which they recently observed and discuss it in the light of recent reflections on the aetiopathogenesis, diagnosis and therapy of these tumours in the literature.

胃肠道间质瘤(GIST)是一类异质性肿瘤,虽然罕见(约占恶性肿瘤总数的1%),但却是胃肠道最常见的间质肿瘤。在过去,它们不太为人所知,而今天,由于免疫组织化学和分子领域取得的显著进展,已经获得了相当多的知识,为分类提供了新的机会,最重要的是,为这种病理学提供了更充分的多学科治疗。在这项研究中,作者报告了一个胃胃肠道间质瘤出血的病例,他们最近观察到,并讨论了最近的反思在这些肿瘤的发病机制,诊断和治疗的文献。
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引用次数: 0
[Intestinal intussusception due to metastatic melanoma: a case report]. 【转移性黑色素瘤致肠套叠1例】。
Pub Date : 2009-03-01
Carmine Ammaturo, Salvatore Pastore, Costantino Cerrato, Massimiliano Santoro, Romualdo Rossi, Flavio Fabozzi, Rossella Brunaccino, Miaria De Nigris, Pietro Paolo Podio, Raffaele De Luca

Although the gastrointestinal tract is a fairly frequent site of melanoma metastases, reports of small bowel intussusception caused by this condition are rare. The presence of intestinal metastases is an expression of what is already a disease at an advanced stage and, therefore, the prognosis of these patients is generally poor with only sporadic cases of long-term survival after resective surgery. We describe the case of a patient referred to our department with a clinical picture of frank occlusion. Ileo-ileal intussusception was diagnosed preoperatively thanks to ultrasound and abdominal CAT scans. The patient was unaware that he had a cutaneous melanoma and, moreover, the diagnosis of a metastasised melanoma was possible only after histological examination of the surgical specimen and the subsequent search for and identification of the primary lesion at the level of the dorsal skin. We performed an extensive ileal resection with an end-to-end entero-enteroanastomosis. Ten months after the operation the patient is still alive but in poor general condition due to the presence of diffuse liver metastases and ascites. We believe that radical resective surgery affords valid palliation for these patients, with disappearance of symptoms and minimal postoperative morbidity and mortality.

虽然胃肠道是黑色素瘤转移的一个相当常见的部位,但由这种情况引起的小肠肠套叠的报道很少。肠道转移的存在是一种已经处于晚期的疾病的表现,因此,这些患者的预后通常很差,只有零星的病例在切除手术后长期存活。我们描述的情况下,病人转介到我们的部门与坦率闭塞的临床图片。术前通过超声和腹部CAT扫描诊断回肠-回肠肠套叠。患者不知道自己患有皮肤黑色素瘤,而且,只有在对手术标本进行组织学检查并随后在背侧皮肤水平上寻找和确定原发病变后,才有可能诊断为转移性黑色素瘤。我们进行了广泛的回肠切除术和端到端肠肠吻合术。手术后10个月患者仍然存活,但由于存在弥漫性肝转移和腹水,总体情况不佳。我们认为根治性切除手术可以有效缓解这些患者的症状,使其症状消失,术后发病率和死亡率最低。
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引用次数: 0
[Neuroendocrine carcinoma of the breast: a rare entity]. [乳腺神经内分泌癌:罕见病例]。
Pub Date : 2009-03-01
Alberto Sartori, Serena Scomersi, Arrigo Spivach, Silvia Vigna

Nowadays neuroendocrine breast cancer is a rare entity, though the presence of neuroendocrine cells is often detected within breast cancers. Most of these tumours are associated with conventional ductal or globular breast cancers. We describe the case of neuroendocrine cancer of the breast and discuss its clinical, radiological and cytological aspects.

虽然神经内分泌细胞在乳腺癌中经常被发现,但目前神经内分泌乳腺癌是一种罕见的肿瘤。这些肿瘤大多与传统的导管性或球状乳腺癌有关。我们描述的情况下,神经内分泌癌的乳房和讨论其临床,放射学和细胞学方面。
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引用次数: 0
Adult idiopathic intussusception: a case report and review of the literature. 成人特发性肠套叠1例报告及文献复习。
Pub Date : 2009-03-01
Giuseppe Pisano, Alessandro Manca, Stefania Farris, Alberto Tatti, Jenny Atzeni, Pietro Giorgio Calò

Adult intussusception is a rare condition. Most of the cases are due to an organic lesion and unlike the incidence in children idiopathic forms are really exceptional, occurring at a rate of 5% of all cases. Whereas in children a main cause is seldom found, adult intussusception is usually characterised by the presence of a leading intraluminal benign or malignant lesion. The authors report their experience with a clinical case of ileocolic intussusception occurring in an 28-year-old white male. In spite of the patient's age, the clinical presentation was very typical with the classic triad of abdominal pain, blood per rectum and a palpable mass. Diagnostic tools, namely US and TC scan, together with colonoscopy confirmed the physical examination, so that surgery was initiated with a definite diagnosis of intussusception. A large polyp or a lymphoma were considered the possible leading causes. After right hemicolectomy, pathology revealed that there was no organic lesion and the bulging mass was caused only by oedema and haemorrhagic infiltration of the invaginated loop. The patient had been on antipsychotic drugs for several months and the possible explanation of the pathology was linked to altered peristalsis induced by the pharmacological agents he was taking. The authors compare their experience with the data reported in the literature, evaluating in particular the incidence, pathology, clinical presentation, diagnosis and treatment of adult intussusception.

成人肠套叠是一种罕见的疾病。大多数病例是由器质性病变引起的,与儿童的发病率不同,特发性形式确实很少见,占所有病例的5%。虽然在儿童中很少发现主要原因,但成人肠套叠通常以存在主要的腔内良性或恶性病变为特征。作者报告他们的经验与临床病例的回肠结肠肠套叠发生在一个28岁的白人男性。尽管患者年龄大,但临床表现非常典型,腹痛,直肠出血和可触及的肿块。诊断工具,即US和TC扫描,以及结肠镜检查证实了体格检查,因此在明确诊断为肠套叠的情况下开始手术。大息肉或淋巴瘤被认为是可能的主要原因。右半结肠切除术后病理显示无器质性病变,隆起肿块仅为内陷袢水肿及出血浸润所致。该患者已服用抗精神病药物数月,病理的可能解释与他所服用的药物引起的蠕动改变有关。作者将他们的经验与文献报道的数据进行比较,特别评估成人肠套叠的发病率、病理、临床表现、诊断和治疗。
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引用次数: 0
[Magnetic oesophageal sphincter for the treatment of gastro-oesophageal reflux disease: results of a prospective clinical trial]. 磁性食管括约肌治疗胃食管反流病:一项前瞻性临床试验的结果。
Pub Date : 2009-03-01
Marco Nencioni, Emanuele Asti, Greta Saino, Davide Bona, Stefano Pallotta, Letizia Laface, Luigi Bonavina

The authors report the preliminary results of a prospective study in 30 patients with gastro-oesophageal reflux disease. The aim was to assess the efficacy of an-original device designed to augment the lower oesophageal sphincter barrier using magnetic force. The device was placed laparoscopically around the oesophagogastric junction, at the level of the z line identified by intraoperative endoscopy. Transient dysphagia not requiring any treatment was recorded in 45% of patients. At 3 months postoperatively, the GORD-HRQL score was fond to be significantly decreased from 24.4 to 2.2 (p < 0.001) and the DeMeester score was normalised in 80% of patients. At one year follow-up, 100% of patients were off proton pump inhibitors, and 70% of them had a normal DeMeester score. All patients preserved the ability to belch.

作者报告了对30例胃食管反流病患者进行前瞻性研究的初步结果。目的是评估一种设计用于利用磁力增强食管下括约肌屏障的原始装置的有效性。该装置在腹腔镜下放置在食管胃交界处,术中内窥镜识别的z线水平。45%的患者出现不需要任何治疗的短暂性吞咽困难。术后3个月,gor - hrql评分从24.4降至2.2 (p < 0.001), 80%的患者DeMeester评分恢复正常。在一年的随访中,100%的患者停用质子泵抑制剂,70%的患者DeMeester评分正常。所有病人都保留了打嗝的能力。
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引用次数: 0
[Spontaneous rupture of the femoral artery after radiotherapy: a case report]. 放射治疗后自发性股动脉破裂1例。
Pub Date : 2009-03-01
Gian Franco Veraldi, Bruno Genco, Maurizio Governa, Eliana Gilioli, Marco Paolo Zecchinelli, Anna Maria Minicozzi, Christian Segattini

Radiation-induced arteriopathy is a well-known disease whose incidence is not known and which usually arises chronically many years after radiation therapy. When it arises acutely, spontaneous rupture or, more rarely, thrombosis of the involved vessel may occur. Spontaneous rupture can occur within 4 to 32 weeks of radiotherapy, and usually affects the carotid artery involved in radiotherapy of the neck and head. Spontaneous rupture of the femoral artery is a very rare event and only a few cases have been reported in the literature. In this paper we report a case of spontaneous rupture of the left femoral superficial artery after adjuvant radiotherapy following surgery for a liposarcoma of the spermatic cord with multiple local recurrences, successfully treated with an extra-anatomic bypass through the obturator canal and rectal muscle flap.

放射性动脉病变是一种众所周知的疾病,其发病率尚不清楚,通常在放射治疗多年后慢性发生。当急性发作时,可发生自发性破裂或更罕见的受累血管血栓形成。自发性破裂可在放疗后4 ~ 32周内发生,通常累及颈部和头部放疗的颈动脉。自发性股动脉破裂是一种非常罕见的事件,文献中只有少数病例报道。在本文中,我们报告了一例精索脂肪肉瘤伴多发局部复发手术后辅助放射治疗后自发性左股浅动脉破裂的病例,并通过闭孔管和直肠肌瓣解剖外旁路成功治疗。
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引用次数: 0
Laparoscopic reoperative approach after open bariatric surgery. 开放式减肥手术后腹腔镜再手术入路。
Pub Date : 2009-03-01
Paolo Gentileschi, Francesca Lirosi, Domenico Benavoli, Giuseppe Sica, Nicola Di Lorenzo, Marco Venza, Ida Camperchioli, Iviarco D'Eletto, Pierpaolo Sileri, Achille L Gaspari

The aim of the study was to evaluate the laparoscopic approach to reoperative bariatric surgery. From January 2003 to July 2007, 26 obesity surgery patients were referred to our Institution for revision. Nineteen patients previously had an open gastric banding, 3 an open vertical banded gastroplasty, 2 an open jejunoileal by-pass (J-l BP) and 2 an open gastric by-pass. Indications for re-operation were insufficient weight loss in 14 patients, band slippage in 7, band erosion in 3 and severe malabsorptive syndrome in 2. Mean preoperative BMI was 45 kg/m2. Twenty-six laparoscopic re-operative procedures were performed. Three patients required a third operation. Eleven gastric banding patients underwent band removal, 7 gastric banding patients were converted to an open gastric by-pass, 1 band was removed and simultaneously re-placed, the 2 jejuno-ileal by-pass patients underwent an intestinal restoration, 3 vertical banded gastroplasty patients were converted to laparoscopic gastric by-pass, 1 open gastric by-pass patient was converted to a laparoscopic long-limb gastric by-pass and in 1 patient with a gastro-gastric fistula after open gastric by-pass the fistula was resected. Further procedures included 1 laparoscopic gastric banding, 1 laparoscopic gastric bypass and 1 laparoscopic bilio-pancreatic diversion. Conversion to laparotomy was needed in 5 cases (5/29, 17.2%). Early complications included 1 case of pneumothorax and 6 cases of wound infection (24.1%). Mortality was zero. The mean follow-up was 36.2 months. Mean postoperative BMI was 34.3 kg/m2. Laparoscopic reoperative bariatric surgery is feasible, safe and effective after open bariatric surgery.

本研究的目的是评估腹腔镜下再手术减肥手术的方法。从2003年1月至2007年7月,26例肥胖手术患者转介至我院进行翻修。19例患者先前接受了开放式胃束带,3例接受了开放式垂直胃束带成形术,2例接受了开放式空肠回肠旁路(j - 1bp), 2例接受了开放式胃旁路。再手术指征为减重不足14例,带滑脱7例,带糜烂3例,重度吸收不良2例。术前平均BMI为45 kg/m2。26例腹腔镜再手术。三名患者需要进行第三次手术。11例胃束带患者行胃束带切除,7例胃束带转为开放式胃旁路,1例胃束带切除并同时重新放置,2例空肠-回肠旁路患者行肠道修复,3例垂直胃束带成形术患者转为腹腔镜胃旁路。1例开胃旁路患者转为腹腔镜下长肢胃旁路,1例开胃旁路术后胃瘘切除。进一步的手术包括1例腹腔镜胃束带,1例腹腔镜胃分流术和1例腹腔镜胆胰分流术。5例(5/ 29,17.2%)需转开腹手术。早期并发症包括气胸1例,伤口感染6例(24.1%)。死亡率为零。平均随访36.2个月。术后平均BMI为34.3 kg/m2。腹腔镜再手术是开放式减肥手术后可行、安全、有效的方法。
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引用次数: 0
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Chirurgia italiana
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