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Hysterosalpingo contrast sonography as a screening test for tubal patency in infertile women

JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 1999年第12期92卷 628-631页

作者： Killick, SR Princess Royal Hosp Dept Obstet & Gynaecol Hull HU8 9HE N Humberside England

The most informative method for assessing tubal patency in subfertile women is laparoscopy-and-dye. This investigation, however, puts a large burden on services and a screening test is needed that identifies a high likelihood of occlusion. In our infertility programme we introduced hysterosalpingo contrast sonography for this purpose, operated entirely by ultrasonographers. A series of audits indicated that this innovation speeded the process of investigation by several weeks and reduced the number of laparoscopy-and-dye procedures by 75%. The negative predictive value was 89% and the positive predictive value was 44%. The main limitation of the method was the long period required for training, in those without extensive experience of vaginal ultrasonography.

关键词：造影剂输卵管开放试验/方法输卵管/诊断显像不育女(雌)性/诊断显像不育女(雌)性/外科学腹腔镜检查/统计学和数值数据病人接受卫生保健的程度多糖类敏感性与特异性超声检查非必要的操作/统计学和数值数据女(雌)性人类

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The laparoscopic management of appendicitis and cholelithiasis during pregnancy

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 523-528页

作者： Affleck, DG Handrahan, DL Egger, MJ Price, RR Latter Day St Hosp Dept Surg Salt Lake City UT 84143 USA

BACKGROUND: Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy remains controversial. We report the single largest series of laparoscopic cholecystectomies and appendectomies during pregnancy, METHODS: Medical records of all pregnant patients who underwent open or laparoscopic management of appendicitis/cholelithiasis at LDS Hospital from 1990 to 1998 were reviewed. RESULTS: Eighteen open appendectomies (OA) and 13 open cholecystectomies (OC) were performed. Forty-five laparoscopic cholecystectomies (LC) and 22 laparoscopic appendectomies (LA) were performed without birth defects, fetal loss or uterine injury. Preterm delivery rates (PTD) in the LA and OA groups were similar (15.8% versus 11.8%, P > 0.9), The PTD rate in the LC group was not significantly different than in the OC group (11.9% versus 10.0%, P > 0.9). Neither birth weights nor Apgar scores were significantly different across groups. CONCLUSIONS: Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy can be performed with minimal fetal and maternal morbidity when accepted management guidelines are followed. Am J Surg. 1999;178:523-529. (C) 1999 by Excerpta Medica, Inc.

关键词：畸形/流行病学阑尾切除术/方法阑尾切除术/统计学和数值数据阑尾炎/流行病学阑尾炎/外科学胆囊切除术腹腔镜/统计学和数值数据胆结石/流行病学胆结石/外科学胎儿疾病/流行病学腹腔镜检查/统计学和数值数据分娩过早/流行病学妊娠并发症/流行病学妊娠并发症/外科学成年人女(雌)性人类妊娠

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Laparoscopic finger-assisted technique (fingeroscopy) for treatment of complicated appendicitis

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第1期189卷 131-133页

作者： Katkhouda, N Mason, RJ Mavor, E Campos, GMR Rivera, RT Hurwitz, MB Waldrep, D Univ So Calif Div Emergency Nontrauma & Minimally Invas Surg Dept Surg Los Angeles CA 90033 USA

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A state wide evaluation of appendectomy in children

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 537-540页

作者： Kokoska, ER Murayama, KM Silen, ML Miller, TA Dillon, PA Weber, TR Cardinal Glennon Childrens Hosp St Louis MO 63104 USA St Louis Univ Hlth Sci Ctr Dept Surg Div Pediat Surg St Louis MO 63103 USA

BACKGROUND: Traditional management of appendicitis in children involves open appendectomy (OA), an operation that is relatively inexpensive and carries few risks and complications. However, little information is available regarding the use, cost, and complication of laparoscopic appendectomy (LA) in children. METHODS: Our initial aim was to determine if LA is frequently performed in children (<15 years). We then compared the surgical results of OA versus LA. In conjunction with the Missouri Department of Health, we evaluated 793 children treated for appendicitis throughout the state between January 1997 and June 1997, The authors were blinded to the patient, surgeon, and hospital;no children were excluded. RESULTS: LA was infrequently performed in children with advanced disease. Overall, children undergoing LA were older and had a shorter hospitalization but no difference in hospital charge. When separated by child age, LA was associated with a shorter length of stay in all groups (0 to 5, 6 to 10, and 11 to 15 years) but only children in the 6 to 10 year range had a lower hospital charge when compared with patients undergoing OA. CONCLUSIONS: LA is becoming a common surgical approach for older children with simple appendicitis. Furthermore, these data suggest that LA, independent of individual surgeon or medical center, is associated with a decreased length of hospitalization without a significant difference in hospital charge. Am J Surg. 1999;178:537-540. (C) 1999 by Excerpta Medica, Inc.

关键词：年龄分布阑尾切除术/方法阑尾切除术/统计学和数值数据阑尾炎/外科学评价研究医院收费/统计学和数值数据腹腔镜检查/统计学和数值数据住院时间/统计学和数值数据密苏里/流行病学青少年儿童儿童学龄前女(雌)性人类男(雄)性

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Relaparoscopy for the detection and treatment complications of laparoscopic cholecystectomy

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AMERICAN JOURNAL OF SURGERY 2000年第4期179卷 316-319页

作者： Dexter, SPL Miller, GV Davides, D Martin, IG Ling, HMS Sagar, PM Larvin, M McMahon, MJ Univ Leeds Gen Infirm Acad Dept Surg Leeds LS1 3EX W Yorkshire England Univ Leeds Ctr Digest Dis Leeds Inst Minimally Invas Therapy Leeds LS1 3EX W Yorkshire England

BACKGROUND: Laparotomy remains the commonest intervention in patients with abdominal complications of laparoscopic surgery. Our own policy is to employ relaparoscopy to avoid diagnostic delay and unnecessary laparotomy. The results of using this policy in patients with suspected intra-abdominal complications following laparoscopic cholecystectomy are reviewed. METHODS: Data were collected from laparoscopic cholecystectomies carried out by five consultant surgeons in one center. Details of relaparoscopy for complications were analyzed. RESULTS: Thirteen patients underwent relaparoscopy within 7 days of laparoscopic cholecystectomy far intra-abdominal bleeding (2 patients) or abdominal pain (11 patients). The causes of pain were subhepatic haematoma (1), acute pancreatitis (1), small bowel injury (1), and minor bile leakage (6). In 2 patients no cause was identified. Twelve patients were managed laparoscopically and 1 patient required laparotomy. Median stay after relaparoscopy was 7 days (range 2 to 19). CONCLUSIONS: Exploratory laparotomy can be avoided by prompt relaparoscopy in the majority of patients with abdominal complications of laparoscopic cholecystectomy. Am J Surg. 2000;179:316-319. (C) 2000 by Excerpta Medica, Inc.

关键词：胆囊切除术腹腔镜/统计学和数值数据腹腔镜检查/方法腹腔镜检查/统计学和数值数据手术后并发症/诊断手术后并发症/病因学手术后并发症/外科学前瞻性研究再手术/方法再手术/统计学和数值数据时间因素成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Laparoscopic splenectomy in patients with hematologic malignancies - Discussion

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 536-536页

作者： Berman, RS Department of Surgical Oncology University of Texas M.D. Anderson Cancer Center Houston 77030 USA

Background: Although laparoscopic splenectomy (LS) for benign hematologic disease is well accepted, its role in hematologic malignancies is not clearly defined. This study examined the efficacy and feasibility of LS for hematologic ***: Records were reviewed from patients who underwent LS at two university hospitals. Charts from 77 open splenectomies for malignancy (OM) during the same period were also ***: Fifty-three patients underwent LS, 22 for hematologic malignancies (LM) and 31 for benign hematologic disorders (LB). Median splenic weight was greater in the LM group (930 g) than in the LB group (164 g, P = 0.001). LM was associated with longer operations and greater blood loss than was LB. LM had a 41% conversion rate. Morbidity, mortality, and transfusion rates were similar. Median hospital stay was shorter for LM (4 days) than for OM (6 days, P = 0.001).Conclusions: LS is feasible in hematologic malignancies but is associated with increased operative time and blood loss and a high conversion rate. Morbidity and mortality, however, was similar. Shorter hospital stays for LM compared with OM may translate into earlier recovery and initiation of antineoplastic therapy.

关键词：失血手术可行性研究血液病/外科学血液肿瘤/外科学腹腔镜检查/方法腹腔镜检查/统计学和数值数据住院时间/统计学和数值数据回顾性研究安全脾切除术/方法脾切除术/统计学和数值数据时间因素成年人女(雌)性人类男(雄)性中年人

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Use of new technology in endourology and laparoscopy by American urologists: Internet and postal survey

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UROLOGY 2000年第5期56卷 760-765页

作者： Kim, HL Hollowell, CMP Patel, RV Bales, GT Clayman, RV Gerber, GS Univ Chicago Pritzker Sch Med Dept Surg Urol Sect Chicago IL 60637 USA Washington Univ Sch Med Dept Surg Urol Sect St Louis MO 63110 USA

Objectives. To assess the use of new technology by American urologists. Methods. Using the American Urological Association directory, surveys were sent via the U.S. postal service to 1000 randomly selected American urologists and 3065 urologists who had an Internet address listed in the directory. Results, Responses were received from 601 urologists (415 postal, 186 Internet), Overall, 81% of survey respondents reported performing fewer or the same number of percutaneous procedures as compared with 3 to 4 years ago and 84% reported carrying out more or the same number of ureteroscopic procedures in the treatment of patients with stone disease. Open dismembered pyeloplasty (43%) and Acucise endopyelotomy (42%) were most frequently reported as the preferred treatment for adult patients with symptomatic ureteropelvic junction obstruction. Although 60% of respondents reported that they have taken a laparoscopy course, 67% currently do not perform any laparoscopy in their practice. In addition, only 7% of urologists stated that laparoscopy comprises more than 5% of their practice. When stratified by the number of years in practice, those in practice less than 10 years were more likely than those in practice 10 to 20 years and those in practice longer than 20 years to have performed an endopyelotomy (77%, 60%, and 48%, respectively, P <0.001) and to be currently performing laparoscopy (49%, 36%, and 18%, respectively, P <0.001). Conclusions. Compared with 3 to 4 years ago, American urologists are performing more ureteroscopy and fewer percutaneous stone procedures. Although most urologists have taken laparoscopy courses, this modality has not been widely incorporated into their practices at present. UROLOGY 56: 760-765, 2000. (C) 2000, Elsevier Science Inc.

关键词：禁忌证数据收集因特网腹腔镜检查/统计学和数值数据碎石术机器人美国输尿管镜检查/统计学和数值数据尿路结石/治疗泌尿系疾病/治疗泌尿外科手术/分类泌尿科学/统计学和数值数据儿童儿童学龄前人类婴儿

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Laparoscopic repair of large type III hiatal hernia: Objective followup reveals high recurrence rate

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2000年第5期190卷 553-560页

作者： Hashemi, M Peters, JH DeMeester, TR Huprich, JE Quek, M Hagen, JA Crookes, PF Theisen, J DeMeester, S Sillin, LF Bremner, CG Univ So Calif Dept Surg Los Angeles CA 90033 USA Univ So Calif Dept Radiol Los Angeles CA 90033 USA

Background: Recent studies based on symptomatic outcomes analyses have shown that laparoscopic repair of large type III hiatal hernias is safe, successful, and equivalent to open repair. These outcomes analyses were based on a relatively short followup period and lack objective confirmation that the hernia has not recurred. The aim of this study was to compare the outcomes of laparoscopic and open repair of large type III hiatal hernia using both symptomatic evaluation and barium study to assess the integrity of the repair. Study Design: Fifty-four patients underwent repair of a large type III hiatal hernia between 1985 and 1998. The surgical approach was laparotomy in 13, thoracotomy in 14, and laparoscopy in 27. An antireflux procedure was included in all patients. Symptomatic outcomes were assessed using a structured questionnaire at a median of 24 months and was complete in 51 of 54 patients (94%). A single radiologist, without knowledge of the operative procedure, assessed the integrity of the repair using video esophagram. Videos were performed at a median of 27 months (35 months open and 17 laparoscopic) and were completed in 41 of 54 patients (75%). Results: Symptomatic outcomes were similar in both groups with excellent or good outcomes in 76% of the patients after laparoscopic repair and 88% after an open repair. Reherniation was present in 12 patients and was asymptomatic in 7. A recurrent hernia was present in 12 of the 41 patients (29%) who returned for a followup video esophagram. Forty-two percent (9 of 21) of the laparoscopic group had a recurrent hernia compared with 15% (3 of 20) of the open group (p < 0.001 log-rank value on recurrence-free followup). Conclusions: Laparoscopic repair of type III hiatal hernias is associated with a disturbingly high (42%) prevalence of recurrent hernia. More than half such recurrences have few, if any, symptoms. (J Am Coil Surg 2000;190:553-561. (C) 2000 by the American College of Surgeons).

关键词：食管/诊断显像随访研究疝食管裂孔/分类疝食管裂孔/诊断显像疝食管裂孔/外科学腹腔镜检查/统计学和数值数据手术后并发症/流行病学放射摄影术复发时间因素治疗结果录像成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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A nation's experience of bleeding complications during laparoscopy

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AMERICAN JOURNAL OF SURGERY 2000年第1期180卷 73-77页

作者： Schäfer, M Lauper, M Krähenbühl, L Univ Zurich Dept Visceral & Transplantat Surg CH-8091 Zurich Switzerland Univ Zurich Swiss Assoc Laparoscop & Thoracoscop Surg CH-8091 Zurich Switzerland

BACKGROUND: Bleeding complications during laparoscopic surgery are rare but probably underreported. The aim of the current study was to elucidate the clinical relevance of bleeding complications and major vascular injuries during standard laparoscopic procedures. PATIENTS AND METHODS: The Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing different standard laparoscopic procedures (1995 to 1997), These data were analyzed with special interest in intraoperative and postoperative bleeding complications and major vascular injuries. RESULTS: In all, 331 patients (2.3%) had intraoperative bleeding complications. Whereas 44 patients suffered from an external bleed of the abdominal wall, the bleeding was internal in the remaining 287, Thirty-three patients with internal bleeding required blood transfusion with a mean blood loss of 1,630 mt. Surgical hemostasis was necessary in 68% of external and 91% of internal bleeds. There were 250 patients (1.8%) with postoperative bleeding complications. External bleeding occurred in 143 patients, and 107 patients developed internal bleeding. External bleeding was mainly treated conservatively (92%), whereas 50% of internal bleeds required further surgical intervention. Major vascular injuries occurred in 12 patients (incidence 0.08%) with open treatment being necessary in all cases. CONCLUSIONS: Bleeding complications are, in fact, common during laparoscopic surgery. Meticulous dissection technique, immediate recognition, and adequate surgical treatment are mandatory for their management. (C) 2000 by Excerpta Medica, Inc.

关键词：腹肌/外科学失血手术/统计学和数值数据输血/统计学和数值数据血管/损伤发病率手术中并发症/流行病学腹腔镜检查/统计学和数值数据手术后出血/流行病学前瞻性研究再手术/统计学和数值数据瑞士/流行病学胸腔镜检查/统计学和数值数据青少年成年人老年人老年人 80以上儿童女(雌)性人类男(雄)性中年人

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Open laparoscopy: 29-year experience

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OBSTETRICS AND GYNECOLOGY 2000年第5期96卷 763-766页

作者： Hasson, HM Rotman, C Rana, N Kumari, NA Louis A Weiss Mem Hosp Dept Obstet & Gynecol Div Obstet & Gynecol Chicago IL 60640 USA Grant Hosp Chicago Dept Obstet & Gynecol Chicago IL USA Oak Brook Inst Endoscopy Oak Brook IL USA

Objective: To describe the safety and efficacy of open laparoscopy as a method of access to the abdominal cavity for laparoscopic surgery. Methods: We reviewed retrospectively all cases of open laparoscopy we did between August 1970 and June 1999. Results: Twenty-seven (0.5%) of 5284 patients who had open laparoscopies during the study years developed complications related to primary access. Twenty-one had minor wound infections, four had minor hematomas, one developed an umbilical hernia that required reoperation, and one had an inadvertent injury to the small bowel that was repaired intraoperatively without adverse outcome. Access to the abdominal cavity was generally secured in 3-10 minutes. Conclusion: Open laparoscopy was associated with no method failure or life-threatening complications. Minor and medium risk complications occurred at a rate of 0.5%. Open laparoscopy is a safe, effective method of accessing the abdominal cavity. (Obstet Gynecol 2000;96:763-6. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：腹部/外科学妇科外科手术/统计学和数值数据伊利诺伊/流行病学腹腔镜检查/副作用腹腔镜检查/方法腹腔镜检查/统计学和数值数据病案手术后并发症回顾性研究危险因素青少年成年人老年人老年人 80以上儿童女(雌)性人类男(雄)性中年人

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