Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Clin Case Rep ; 9(12): e05153, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34917370

RESUMO

Lymphangiomas are benign, often subclinical, neoplasms, which can develop in the digestive tracts. Hemorrhagic jejunal tumors are relatively rare and diagnostic challenge. We report herein a case of hemorrhagic jejunal hemolymphangioma successfully diagnosed and treated by double-balloon enteroscopy.

2.
Gan To Kagaku Ryoho ; 48(13): 1661-1663, 2021 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-35046289

RESUMO

Case 1 was a 78-year-old woman with a tumor in the stomach on preoperative CT of an inguinal hernia. The patient was diagnosed with advanced gastric cancer at posterior wall of fornix and underwent total gastrectomy and splenectomy. Postoperative pathological diagnosis was gastric mixed adenoneuroendocrine carcinoma(MANEC), T1b2, N1, M0, StageⅠB. She has been alive without recurrence for 3 years without postoperative adjuvant chemotherapy. Case 2 was a 78-year-old man who was admitted to the hospital with acute pancreatitis and had a thickened wall of the lesser curvature of the gastric antrum on CT. He was diagnosed with advanced gastric cancer and underwent distal gastrectomy and D2 dissection. Postoperative pathological diagnosis was gastric MANEC, T1b2, N1, M0, Stage ⅠB. Oral administration of S-1 was started as postoperative adjuvant chemotherapy, but he was very tired and ended in 1 course at his request. Computed tomography 6 months after the operation revealed multiple liver metastases, and he was transferred to best supportive care at his request. He died 1 year after surgery. We experienced 2 valuable cases of gastric MANEC.


Assuntos
Pancreatite , Neoplasias Gástricas , Doença Aguda , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Gastrectomia , Humanos , Masculino , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
3.
World J Gastroenterol ; 26(14): 1628-1637, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32327911

RESUMO

BACKGROUND: Hepatic portal venous gas (HPVG) generally indicates poor prognoses in patients with serious intestinal damage. Although surgical removal of the damaged portion is effective, some patients can recover with conservative treatments. AIM: To establish an optimal treatment strategy for HPVG, we attempted to generate computed tomography (CT)-based criteria for determining surgical indication, and explored reliable prognostic factors in non-surgical cases. METHODS: Thirty-four cases of HPVG (patients aged 34-99 years) were included. Necessity for surgery had been determined mainly by CT findings (i.e. free-air, embolism, lack of contrast enhancement of the intestinal wall, and intestinal pneumatosis). The clinical data, including treatment outcomes, were analyzed separately for the surgical cases and non-surgical cases. RESULTS: Laparotomy was performed in eight cases (surgical cases). Seven patients (87.5%) survived but one (12.5%) died. In each case, severe intestinal damage was confirmed during surgery, and the necrotic portion, if present, was removed. Non-occlusive mesenteric ischemia was the most common cause (n = 4). Twenty-six cases were treated conservatively (non-surgical cases). Surgical treatments had been required for twelve but were abandoned because of the patients' poor general conditions. Surprisingly, however, three (25%) of the twelve inoperable patients survived. The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments, and only one patient (7%) died. Comparative analyses of the fatal (n = 10) and recovery (n = 16) cases revealed that ascites, peritoneal irritation signs, and shock were significantly more frequent in the fatal cases. The mortality was 90% if two or all of these three clinical findings were detected. CONCLUSION: HPVG related to intestinal necrosis requires surgery, and our CT-based criteria are probably useful to determine the surgical indication. In non-surgical cases, ascites, peritoneal irritation signs and shock were closely associated with poor prognoses, and are applicable as predictors of patients' prognoses.


Assuntos
Ascite/terapia , Embolia Aérea/terapia , Isquemia Mesentérica/terapia , Pneumatose Cistoide Intestinal/terapia , Veia Porta/cirurgia , Choque/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/diagnóstico , Ascite/etiologia , Ascite/mortalidade , Tratamento Conservador/estatística & dados numéricos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Embolia Aérea/mortalidade , Feminino , Gases , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia , Masculino , Isquemia Mesentérica/complicações , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/mortalidade , Necrose/complicações , Necrose/diagnóstico , Necrose/mortalidade , Necrose/cirurgia , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/mortalidade , Veia Porta/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Choque/diagnóstico , Choque/etiologia , Choque/mortalidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Gan To Kagaku Ryoho ; 47(13): 2248-2250, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33468923

RESUMO

A 72-year-old woman was admitted to the gastroenterology division of our hospital due to abdominal pain and vomiting. Dynamic contrast-enhanced CT showed a tumor at the body of the pancreas and main pancreatic duct dilation. She was diagnosed with carcinoma of the body of the pancreas via EUS-FNA. There was no vascular invasion or distant metastasis on preoperative imaging. She was introduced to the Gastrointestinal Surgery division where a mesenteric nodule was found at the time of the surgery. Intraoperative frozen section confirmed the diagnosis of occult peritoneal metastases. After consulting with her family, we completed the pancreatosplenectomy. On histopathological examination, this case was TS2, tub2, pT3, mpd0, S1, RP1, PV0, A0, PL0, OO0, N0, M1(PER), CY1, PCM0, DPM0, R1, stage Ⅳ. After the operation, we treated the patient with gemcitabine(GEM)plus nab-paclitaxel for 3 months(4 courses). She then developed side effects such as anorexia and tiredness. After discussing with the patient, chemotherapy was discontinued. The patient remains alive without recurrence 19 months after the operation. Patients with metastatic pancreatic adenocarcinoma have poor prognoses because they are no longer candidates for surgical therapy. We encountered a case of pancreatic body cancer with peritoneal dissemination, followed up for 15 months without recurrence.


Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Humanos , Recidiva Local de Neoplasia , Pâncreas , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia
5.
Gan To Kagaku Ryoho ; 47(13): 2346-2348, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33468956

RESUMO

A 73-year-old man presented with the chief complaint of hematemesis(bloody vomiting). Upon examination, he was diagnosed as having gastric cancer with liver metastasis. He consulted our hospital for a second opinion. Gastrointestinal endoscopy showed a 50 mm early stomach cancer. Contrast-enhanced CT showed a progressive contrast-enhanced tumor in the S7 segment of the liver. FDG-PET/CT showed increased FDG uptake in the prostate. High PSA levels were also observed. He was diagnosed as having gastric cancer and prostate carcinoma. Intrahepatic cholangiocarcinoma and metastatic liver cancer were mentioned as differential diagnoses of the liver tumor. Hormonal therapy for prostate carcinoma failed to reduce the size of the liver tumor. PSA staining of the liver biopsy revealed negative results. As gastric cancer rarely metastasizes, metastatic liver cancer was unlikely. The patient was diagnosed as having intrahepatic cholangiocarcinoma. He underwent distal gastrectomy with hepatic posterior sectionectomy. The treatment strategy for multiple cancers depends on the primary lesion and the stage of cancer progression. Therefore, adequate evaluation is necessary before initiating treatment.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Neoplasias Hepáticas , Neoplasias Gástricas , Idoso , Ductos Biliares Intra-Hepáticos , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Próstata , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
6.
Gan To Kagaku Ryoho ; 46(13): 2149-2151, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-32156861

RESUMO

A92 -year-old woman underwent laparoscopic sigmoid colectomy with D3 lymphadenectomy. Histological examination confirmed a pT3(SS), pN0, pM0, pStageⅡ tumor. Abdominal CT 6 months after surgery revealed liver metastasis close to the right branch of the portal vein in the S6 region of the liver. There were no indications for transcatheter arterial embolization, radiofrequency ablation, or hepatectomy. Although she had Grade 3 neutropenia, the patient received 15 courses of oral UFT/LV. Three courses of UFT/LV plus bevacizumab were also administered. She was judged to have achieved stable disease (SD); however, Grade 4 proteinuria was observed. After she was administered 2 courses of TAS-102, we shifted to best supportive care. She died of a sigmoid cancer 32 months after UFT/LV initiation. Careful adaptation of chemotherapy can be used to control a patient's condition during certain periods, even in patients with super-advanced age.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Hepáticas , Neoplasias do Colo Sigmoide , Idoso de 80 Anos ou mais , Colectomia , Feminino , Humanos , Leucovorina , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias do Colo Sigmoide/tratamento farmacológico , Tegafur , Uracila
7.
Gan To Kagaku Ryoho ; 45(1): 142-144, 2018 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-29362335

RESUMO

A 40's woman had a complaint of abdominal and back pain. Enhanced CT visualized a large retroperitoneal tumor and huge multiple myomas of the uterus. The tumor was 10cm in diameter and located in the anterior of the inferior vena cava, and progressed from the posterior of the duodenum to the abdominal aortic bifurcation. Diffusion-weighted MR image showed the tumor with high signal intensity. Upper gastrointestinal endoscopy revealed a type 2 tumor at the anal side of the Vater. The patient was performed curativly abdominal total hysterectomy and pancreaticoduodenectomy with inferior vena cava resection. Immunohistochemical examination showed that the tumor cells were negative for CD34 and c-kit, and positive for desmin and a-SMA. The tumor was histopathologically diagnosed as leiomyosarcoma originating from the duodenum.


Assuntos
Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Leiomiossarcoma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Neoplasias Duodenais/irrigação sanguínea , Neoplasias Duodenais/diagnóstico por imagem , Feminino , Humanos , Leiomiossarcoma/irrigação sanguínea , Leiomiossarcoma/diagnóstico por imagem , Invasividade Neoplásica , Pancreaticoduodenectomia , Neoplasias Retroperitoneais/diagnóstico por imagem , Veia Cava Inferior/cirurgia
8.
Gan To Kagaku Ryoho ; 45(1): 157-159, 2018 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-29362340

RESUMO

A man in his 60s was admitted to our hospital with anemia. An endoscopic examination revealed advanced gastric cancer. CT revealed peri-gastric and para-aortic lymphadenopathy, and a nodular shadow(20mm)in the lower lobe of the right lung. PET-CT revealed abnormal uptake in the para-aortic lymph node and stomach wall and the nodular shadow in the right lung. A bronchoscopy revealed pulmonary adenocarcinoma. From the above, he was diagnosed with gastric cancer(cT4a, cN2, cM1, cStage IV )and lung cancer(cT2a, cN0, cM0, cStage I B). Because of gastric bleeding, we decided to operate on the gastric cancer before the lung cancer. First, total gastrectomy, splenectomy, and cholecystectomy were performed and then dissection of lymph node No. 16was performed. Histopathological examination indicated that lymph node No. 16was common to lung cancer, so the final diagnosis was gastric cancer(pT4a, pN0, cM0, fStage II A)and lung cancer(cT2a, cN0, pM1, fStage IV ). In this case, lymphadenectomy of No. 16in the first and pathological diagnosis during surgery could help us avoid splenectomy and cholecystectomy, and could reduce invasion.


Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Gástricas/diagnóstico , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
9.
Gan To Kagaku Ryoho ; 45(13): 1866-1868, 2018 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-30692380

RESUMO

A man in his sixties with a medical history of diabetes and dyslipidemia was detected with a tumor with massive submucosal invasion on colonoscopy. He was diagnosed with sigmoid cancer and underwent laparoscopic sigmoid colectomy with D3 lymph node dissection. An electric surgical knife and an ultrasonically activated device was used to perform D3 lymph node dissection with preservation of the left colic artery(LCA)and division of the S1A and S2A. On postoperative day 4(POD4), 1 day after oral intake was started, chylous ascites began to develop. Owing to the small volume of ascites, oral feeding was continued, and chylous ascites was treated successfully with a low-fat diet. Chylous ascites immediately reduced on POD6, after which the drain was removed on POD7. He was discharged on POD9. Fasting and complete parenteral nutrition are not necessarily required in the treatment of chyle leakage after laparoscopic colorectal cancer surgery.


Assuntos
Ascite Quilosa , Colectomia , Laparoscopia , Ascite Quilosa/etiologia , Ascite Quilosa/terapia , Colectomia/efeitos adversos , Tratamento Conservador , Humanos , Laparoscopia/efeitos adversos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade
10.
Gan To Kagaku Ryoho ; 45(13): 2420-2422, 2018 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-30692484

RESUMO

A 50s man visited our hospital because of abdominal pain that initiated 1 day prior. An approximately 4.0×5.0×4.5c m tumor, which was in contact with the greater curvature of the gastric body, was detected on contrast-enhanced computed tomography. He was diagnosed with a ruptured gastrointestinal stromal tumor and underwent emergency surgery. During the operation, about 250mL of bloody ascites and a ruptured tumor measuring 6-7 cm in size was observed in the middle of the gastric body. Partial gastrectomy was performed. The histopathological diagnosis was GIST of the stomach. In the gene search, PDGFR-a mutation D842V was detected in exon 18. Therefore, he is undergoing a follow-up examination without postoperative adjuvant therapy even though he is classified as high-risk. Currently, the patient has survived for 8 months after surgery without recurrence. We should perform careful follow-up of the patient.


Assuntos
Tumores do Estroma Gastrointestinal , Neoplasias Gástricas , Gastrectomia , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Ruptura Espontânea , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
11.
Asian J Endosc Surg ; 9(2): 116-21, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26804340

RESUMO

INTRODUCTION: Laparoscopic distal gastrectomy (LDG) with D1+ lymph node dissection (LND) for early gastric cancer has been widely accepted. However, LDG with D2 LND for advanced gastric cancer remains in limited use. The aim of this retrospective study was to clarify the safety of LDG with D2 LND for gastric cancer. METHODS: From January 2010 to September 2014, 296 patients underwent LDG; those who received D1+ LND (n = 230) or D2 LND (n = 66) were included in this study. The clinicopathological characteristics and short-term outcomes of both groups were investigated and compared. RESULTS: There were no significant differences in the incidence of postoperative complications between the two groups. However, the frequency of infectious intra-abdominal complications was higher in the D2 LND group than in the D1+ LND group. Additionally, a lower risk of infectious intra-abdominal complications was seen with certified than with uncertified operators. CONCLUSION: The evaluation of short-term outcomes demonstrated that LDG with D2 LND is generally feasible. However, the risk of infectious intra-abdominal complications is higher with D2 LND than with D1+ LND. Also, D2 LND should be performed by trained operators.


Assuntos
Gastrectomia , Laparoscopia , Excisão de Linfonodo , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Surg Today ; 46(7): 815-20, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26354031

RESUMO

PURPOSE: Anastomotic failures that cannot be detected during surgery often lead to postoperative leakage. There have been no detailed reports on the intraoperative leak test for esophagojejunal anastomosis. Our purpose was to investigate the utility of routine intraoperative leak testing to prevent postoperative anastomotic leakage after performing esophagojejunostomy. METHODS: We prospectively performed routine air leak tests and reviewed the records of 185 consecutive patients with gastric cancer who underwent open total gastrectomy followed by esophagojejunostomy. RESULTS: A positive leak test was found for six patients (3.2 %). These patients with positive leak tests were subsequently treated with additional suturing, and they developed no postoperative anastomotic leakage. However, anastomotic leakage occurred in nine patients (4.9 %) with negative leak tests. A multivariate analysis demonstrated that a patient age >75 years and the surgeon's experience <30 cases were risk factors for anastomotic leakage. CONCLUSION: Intraoperative leak testing can detect some physical dehiscence, and additional suturing may prevent anastomotic leakage. However, it cannot prevent all anastomotic leakage caused by other factors, such as the surgeons' experience and patients' age.


Assuntos
Fístula Anastomótica/diagnóstico , Fístula Anastomótica/prevenção & controle , Esôfago/cirurgia , Gastrectomia , Jejunostomia , Jejuno/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Idoso , Feminino , Humanos , Período Intraoperatório , Masculino , Estudos Prospectivos
13.
Surgery ; 159(2): 459-66, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26361833

RESUMO

BACKGROUND: Esophagectomy with extended lymphadenectomy improves prognosis but it is associated with high morbidity and mortality. The thoracoscopic approach is associated with fewer pulmonary complications. Abdominal wall injury greatly affects pulmonary function and complication rates during the acute postoperative phase. In this study we aimed to compare the incidence of pulmonary complications and respiratory recovery after thoracoscopic esophagectomy in the prone position with hand-assisted laparoscopic surgery (HALS) versus open laparotomy (OL). METHODS: This was a case-matched control study of patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position. Thirty-two patients in the HALS group and 32 patients in the OL group were selected by the use of propensity score matching. Operative outcomes and perioperative changes in respiratory function were compared. RESULTS: There was no operative mortality in either group. Estimated blood loss was less in the HALS group (P < .001). The incidence of postoperative pneumonia was 6.2% (4/64) overall; it was less in the HALS group (0%) than in the OL group (12.5%) (P = .016). There were no differences in preoperative vital capacity (VC) and percent predicted vital capacity (%VC). Each parameter, including the ratio of the postoperative to preoperative %VC (%VC ratio), reached its nadir on postoperative day 7 in both groups but was greater in the HALS group (VC, 2.91 ± 0.68 L vs 2.53 ± 0.53 L, P = .018; %VC, 90.62 ± 16.92% vs 78.91 ± 16.65%, P = .007; %VC ratio, 80.90 ± 9.87% vs 72.09 ± 11.95%, P = .002). At 1 and 3 months, respiratory recovery was seen in both groups but more so in the HALS group. At 6 months, further respiratory recovery was seen in both groups, without any significant intergroup differences. CONCLUSION: During the acute phase after thoracoscopic esophagectomy in the prone position, HALS is associated with less-restrictive ventilatory impairment, fewer subsequent pulmonary complications, and less blood loss than OL. The combination of HALS and thoracoscopic esophagectomy in the prone position is less invasive on respiratory function.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Laparoscopia Assistida com a Mão , Laparotomia , Complicações Pós-Operatórias/prevenção & controle , Insuficiência Respiratória/prevenção & controle , Toracoscopia , Adenocarcinoma/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Decúbito Ventral , Pontuação de Propensão , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
Hepatogastroenterology ; 62(137): 69-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25911870

RESUMO

BACKGROUND/AIMS: Thoracoscopic esophagectomy in the prone position (ThE-PP) is usually performed with four ports, which makes the operation almost solo surgery. We now perform ThE-PP with five ports, with the advantage of having the assistant able to provide additional help. The aim of this study was to elucidate the benefits of ThE with five ports over ThE with four ports. METHODOLOGY: We retrospectively reviewed the clinical charts of 47 patients with esophageal cancer who underwent ThE-PP. A total of 14 patients underwent ThE-PP with four ports and 33 with five ports. We compared the number of dissected lymph nodes (LNs)--total; upper left, middle, and lower mediastinum--between the four-port and five-port groups. RESULTS: The number of LNs dissected, including the total, the upper left and middle mediastinum, were not significantly different between the two operations. The number of LNs dissected from the lower mediastinum, however, was significantly higher in the five-port group (median number and interquartile range: 5 and 2-7, respectively) than in the four-port group (0.5 and 0-3, respectively) (P < 0.01). CONCLUSIONS: ThE-PP performed with five ports has an advantage over the same operation done with four ports in terms of lymphadenectomy in the lower mediastinum.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Excisão de Linfonodo , Posicionamento do Paciente , Decúbito Ventral , Toracoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Esofagectomia/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toracoscópios , Toracoscopia/efeitos adversos , Toracoscopia/instrumentação , Resultado do Tratamento
15.
Surg Endosc ; 28(4): 1250-5, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24232135

RESUMO

BACKGROUND: Totally laparoscopic distal gastrectomy (TLDG) with intracorporeal anastomosis has been introduced to achieve safer anastomosis with good vision, and a small wound. However, little is known about the surgical outcomes of newly introduced TLDG compared with established procedures of laparoscopy-assisted gastrectomy (LADG) with extracorporeal anastomosis. METHODS: This retrospective study included 114 patients who underwent laparoscopic distal gastrectomy (LDG) between January 2010 and September 2012. The patients were classified into two groups according to the approach of reconstruction (LADG group: n = 74; TLDG group: n = 40). The parameters analyzed included patients, operation details, and operative outcomes. RESULTS: No complication was observed in the TLDG group. Surgical outcomes of the TLDG group, such as mean operation time, estimated blood loss, and rate of conversion to laparotomy were not inferior to the LADG group. Furthermore, postoperative hospital stay of the TLDG group was significantly shorter than the LADG group (p < 0.05). CONCLUSION: Surgical outcomes in the newly introduced phase of TLDG were safe as well as feasible compared with established LADG. TLDG has several advantages over LADG, such as shorter post-hospital stay, no incidence of operative complication, adequate working space, and small wound size. Although prospective, randomized control studies are warranted, we submit that TLDG can be used as a standard procedure for LDG.


Assuntos
Gastrectomia/métodos , Gastroenterostomia/métodos , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Gástricas/cirurgia , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Reoperação , Estudos Retrospectivos
16.
Hepatogastroenterology ; 59(116): 1138-40, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22580666

RESUMO

BACKGROUND/AIMS: It is very important to achieve a sufficient field and space in laparoscopic assisted distal gastrectomy (LADG) for a less-experienced surgeon. In this study, the usefulness of a novel surgical technique to lift the liver was evaluated in LADG. METHODOLOGY: Fifty-four patients who underwent standardized LADG for gastric cancer using the novel technique of lifting the liver were retrospectively evaluated based on video records. Patient characteristics, the time required to lift the liver and for gastrectomy, total operation time, blood loss and complications were analyzed. RESULTS: The mean time necessary to lift the liver using this novel technique was 240.1±86.1 seconds and that for gastrectomy was 167.6±50.4 minutes. Blood loss was 72.5±59.6mL. The morbidity rate was 4/54 (7.4%). CONCLUSIONS: Standardized LADG using this novel technique is feasible and possible in a period of time.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Fígado , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
17.
Gastric Cancer ; 13(1): 25-9, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20373072

RESUMO

BACKGROUND: The area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed tomography (MDCT) for the identification of the LGV. METHODS: Eighty-one patients with gastric cancer underwent MDCT, which was performed with contrast media in 76 patients and without contrast media in 5 patients. A 5-mm thin slice of the frontal image was reconstructed. These images were examined preoperatively to detect the location of the LGV. Upon gastrectomy, the LGV was identified and its location compared to that determined by MDCT. RESULTS: The LGV was identified by MDCT in 76 of the 81 patients (93.8%). The LGV was subsequently located during the operation in all 81 patients. The LGV was located dorsal to the common hepatic artery in 40 patients (49.4%), ventral to the common hepatic artery in 18 patients (22.2%), ventral to the splenic artery in 17 patients (21.0%), dorsal to the splenic artery in 2 patients (2.5%) and in other positions in 4 patients (4.9%). In all patients, the location of the LGV detected using MDCT was consistent with that identified during gastrectomy. In the 4 patients with relatively unusual locations of the LGV, these 4 LGV variants were identified preoperatively by MDCT. CONCLUSION: MDCT was useful for identifying the location of the LGV prior to gastrectomy.


Assuntos
Gastrectomia/métodos , Cuidados Pré-Operatórios , Neoplasias Gástricas/cirurgia , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Imageamento Tridimensional , Linfonodos/cirurgia , Flebografia/métodos , Veias/cirurgia
18.
Gan To Kagaku Ryoho ; 36(8): 1337-9, 2009 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-19692774

RESUMO

The patient is a 55-year-old woman who has biliary tract cancer with peritoneal dissemination (T3N1P2M0, Stage IV b). Since a curative operation was deemed impossible, we conducted chemotherapy using S-1. S-1 (120 mg/day) was administered for 2 weeks and then chemotherapy was discontinued for 1 week, which was regarded as one course. After 2 courses of the chemotherapy, CT scan showed that the metastatic lymph node and tumor of peritoneal dissemination were reduced in size, and that there was no ascites. Left lobectomy of the liver, cholecystectomy, and partial resection of omentum were carried out. The pathological diagnosis was also curative (pT1, pN0, pP0, Stage I). We think this case shows the possibility of S-1 for patients with unresectable biliary tract cancer.


Assuntos
Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Tegafur/uso terapêutico , Neoplasias dos Ductos Biliares/patologia , Colecistectomia , Feminino , Hepatectomia , Humanos , Pessoa de Meia-Idade , Inoculação de Neoplasia , Omento/patologia , Omento/cirurgia
19.
Surg Technol Int ; 18: 98-102, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19579195

RESUMO

Various techniques of stapled intestinal anastomoses are performed in gastroenterological surgery. Little is known about which technique is optimal. The intestines of a domestic pig were used in this study. Stapled intestinal anastomoses of three types-functional end-to-end anastomosis (FETEA), stapled side-to-end anastomosis (STEA), and stapled end-to-end anastomosis (EEA)-were constructed using pig intestines. The times for constructing anastomoses, length of the completed anastomosed intestine, strength of anastomoses, and bursting locations were measured and recorded on each group. The times required to construct FETEAs (60 S.D. 1.4 sec) were significantly less than those required for STEAs (191.5 S.D. 46.4 sec) and EEAs (274.5 S.D. 54.5 sec). The mean lengths of the completed anastomosed intestine were significantly different for FETEAs (89 S.D. 8.2 mm), STEAs (135 S.D. 6.1 mm), and EEAs (156 S.D. 6.5 mm). The bursting pressures were not significantly different among the three groups. FETEAs are superior in terms of requiring less surgical time. EEAs are superior in terms of the length of anastomosed intestines. In conclusion, anastomotic techniques should be selected properly in consideration of these features.


Assuntos
Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Intestinos/fisiologia , Intestinos/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Animais , Desenho de Equipamento , Análise de Falha de Equipamento , Estresse Mecânico , Suínos , Resistência à Tração , Resultado do Tratamento
20.
Gan To Kagaku Ryoho ; 36(4): 663-6, 2009 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-19381044

RESUMO

A sixties-man had complained of melena. Colonoscopy revealed type 2 tumor at rectum. Computed tomography (CT)demonstrated lymph node metastasis in front of sacrum and two low density areas which were suspected metastases in the liver. The patient was diagnosed stageIV rectal cancer and resected primary focus and lymph node metastasis.[ Ra-RS, ant, type 2, moderately differentiated adenocarcinoma, ly1, v3, pSE, pN2, sH1(Grade C), sP0, pM1(No. 270)]without liver resection. It was due to high level of CEA and remote lymph node metastasis. The patient was treated with mFOLFOX6 and bevacizumab after the operation. The level of CEA decreased to normal level and CT revealed a partial response after 4 cycles of systemic chemotherapy. Liver resection was performed safely. Histological response was Grade 2 at liver metastases.


Assuntos
Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Anticorpos Monoclonais Humanizados , Bevacizumab , Antígeno Carcinoembrionário/sangue , Fluoruracila/uso terapêutico , Humanos , Imunoterapia , Leucovorina/uso terapêutico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Compostos Organoplatínicos/uso terapêutico , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...