Laparoscopic surgery for colorectal disease has become widespread as a minimally invasive treatment.This is important because the increasing availability of new devices allows us to perform procedures with a reduced ... Laparoscopic surgery for colorectal disease has become widespread as a minimally invasive treatment.This is important because the increasing availability of new devices allows us to perform procedures with a reduced length of surgery and decreased blood loss.We herein report the results of a literature review of energy sources for laparoscopic colorectal surgery,focused especially on 6 studies comparing ultrasonic coagulating shears(UCS) and other instruments.We also describe our laparoscopic dissection techniques using UCS for colorectal cancer.The short-term outcomes of surgeries using UCS and Ligasure for laparoscopiccolorectal surgery were superior to conventional electrosurgery.Some authors have reported that the length of surgery or blood loss when Ligasure was used for laparoscopic colorectal surgery is less than when UCS was used.On the other hand,a recent study demonstrated that there were no significant differences between the short-term outcomes of UCS and Ligasure for laparoscopic colorectal surgery.It is therefore suggested that the choice of technique used should be made according to the surgeon’s preference.We also describe our laparoscopic dissection techniques using UCS(Harmonic ACE) for colorectal cancer with regard to the retroperitoneum dissection,dissection technique,dissection technique around the feeding artery,and various other dissection techniques.We therefore review the outcomes of using various energy sources for laparoscopic colorectal surgery and describe our laparoscopic dissection techniques with UCS(Harmonic ACE) for colorectal cancer.展开更多
A high risk population consisting of 3034 people with history of rectal polyps or ulcers were screened for colorectal neoplasia with Reverse Passive Hemagglutination Fecal Occult Blood Test (RPHA FOB) and 60 cm fibero...A high risk population consisting of 3034 people with history of rectal polyps or ulcers were screened for colorectal neoplasia with Reverse Passive Hemagglutination Fecal Occult Blood Test (RPHA FOB) and 60 cm fiberoptic colonoscopy. Among 2553 subjects (84.1%)who completed both tests, 11 cases of colorectal malignancies and 465 cases of polyps were detected.Using colonoscopic finding and histopathological examination as the 'gold standard' of diagnosis, results showed that FOB positivity of polyps was related to their size, macroscopic appearance and surface features but no correlation between bleeding of polyps and their location, numbers, pathological types were found. In this study the sensitivity of RPHA in screening of colorectal malignancy was 63.6% (7/11), while that for polyps was only 21.1% (98/465) . For screening of colorectal neoplasia (cancer+polyps) the overall sensitivity and specificity of RPHA FOB were 22.1% and 82.4%, the positive and negative predictive values were 22.3% and 82.2% respectively. Amoug 465 polyps there were 195 adenomas, further analysis showed that villous and tubulovillous adenomas had higher intestinal bleeding rate (FOB positive)than tubular type (45.5%,30.0% and 17.8% respectively, X2=5.8, p=0.05). The results indicate that although the sensitivity of RPHA FOB in screening for colorectal polyps was generally low, but about 40% (8/21) of villous and tubulovillous adenoma which present higher tendency of malignant transformation can be detected by RPHA FOB as a screening Procedure. So the authors suggest that screening of colorectal neoplasia be not only a procedure of secondary prevention but also a measure of primary prevention for colorectal cancer.Accepted March 22, 1994展开更多
To prevent complications, methods of inserting the colonoscope and intraor extra-intestinal factors that influence insertion were studied. Methods: After entering the sigmoid to 10 cm, the shaft of the scope should be...To prevent complications, methods of inserting the colonoscope and intraor extra-intestinal factors that influence insertion were studied. Methods: After entering the sigmoid to 10 cm, the shaft of the scope should be gradually straightened. The scope shouldn’t be advanced continuously though the lumen is obvious, otherwise, a loop may be formed and to straighten the shaft will be difficult. The patients who underwent colonoscopy before laparotomy were followed up to investigate the reasons of difficulties in insertion. For the patients who have several lumens after side-to-end anastomosis, the normal pathway is identified according to the direction of stool fluid and characteristics of large and small intestinal mucosas, and the colonoscope is prevented from entering the blind bottom. Results: In 10 000 colonoscopies, success rate o f reaching the cecum was 98. 8% and there were no complications. Conclusion: The speed of insertion, the success rate in colonoscopy and complications prevention will be improved if the manifestation of anatomic variations and difficulties in inserting scope are concerned.展开更多
文摘 Laparoscopic surgery for colorectal disease has become widespread as a minimally invasive treatment.This is important because the increasing availability of new devices allows us to perform procedures with a reduced length of surgery and decreased blood loss.We herein report the results of a literature review of energy sources for laparoscopic colorectal surgery,focused especially on 6 studies comparing ultrasonic coagulating shears(UCS) and other instruments.We also describe our laparoscopic dissection techniques using UCS for colorectal cancer.The short-term outcomes of surgeries using UCS and Ligasure for laparoscopiccolorectal surgery were superior to conventional electrosurgery.Some authors have reported that the length of surgery or blood loss when Ligasure was used for laparoscopic colorectal surgery is less than when UCS was used.On the other hand,a recent study demonstrated that there were no significant differences between the short-term outcomes of UCS and Ligasure for laparoscopic colorectal surgery.It is therefore suggested that the choice of technique used should be made according to the surgeon’s preference.We also describe our laparoscopic dissection techniques using UCS(Harmonic ACE) for colorectal cancer with regard to the retroperitoneum dissection,dissection technique,dissection technique around the feeding artery,and various other dissection techniques.We therefore review the outcomes of using various energy sources for laparoscopic colorectal surgery and describe our laparoscopic dissection techniques with UCS(Harmonic ACE) for colorectal cancer.
文摘A high risk population consisting of 3034 people with history of rectal polyps or ulcers were screened for colorectal neoplasia with Reverse Passive Hemagglutination Fecal Occult Blood Test (RPHA FOB) and 60 cm fiberoptic colonoscopy. Among 2553 subjects (84.1%)who completed both tests, 11 cases of colorectal malignancies and 465 cases of polyps were detected.Using colonoscopic finding and histopathological examination as the 'gold standard' of diagnosis, results showed that FOB positivity of polyps was related to their size, macroscopic appearance and surface features but no correlation between bleeding of polyps and their location, numbers, pathological types were found. In this study the sensitivity of RPHA in screening of colorectal malignancy was 63.6% (7/11), while that for polyps was only 21.1% (98/465) . For screening of colorectal neoplasia (cancer+polyps) the overall sensitivity and specificity of RPHA FOB were 22.1% and 82.4%, the positive and negative predictive values were 22.3% and 82.2% respectively. Amoug 465 polyps there were 195 adenomas, further analysis showed that villous and tubulovillous adenomas had higher intestinal bleeding rate (FOB positive)than tubular type (45.5%,30.0% and 17.8% respectively, X2=5.8, p=0.05). The results indicate that although the sensitivity of RPHA FOB in screening for colorectal polyps was generally low, but about 40% (8/21) of villous and tubulovillous adenoma which present higher tendency of malignant transformation can be detected by RPHA FOB as a screening Procedure. So the authors suggest that screening of colorectal neoplasia be not only a procedure of secondary prevention but also a measure of primary prevention for colorectal cancer.Accepted March 22, 1994
文摘To prevent complications, methods of inserting the colonoscope and intraor extra-intestinal factors that influence insertion were studied. Methods: After entering the sigmoid to 10 cm, the shaft of the scope should be gradually straightened. The scope shouldn’t be advanced continuously though the lumen is obvious, otherwise, a loop may be formed and to straighten the shaft will be difficult. The patients who underwent colonoscopy before laparotomy were followed up to investigate the reasons of difficulties in insertion. For the patients who have several lumens after side-to-end anastomosis, the normal pathway is identified according to the direction of stool fluid and characteristics of large and small intestinal mucosas, and the colonoscope is prevented from entering the blind bottom. Results: In 10 000 colonoscopies, success rate o f reaching the cecum was 98. 8% and there were no complications. Conclusion: The speed of insertion, the success rate in colonoscopy and complications prevention will be improved if the manifestation of anatomic variations and difficulties in inserting scope are concerned.
