RESUMEN
Diathermy is known to produce a mixture of waste products including carbon monoxide. During transcervical hysteroscopic surgery, carbon monoxide might enter the circulation leading to the formation of carboxyhaemoglobin. In 20 patients scheduled for transcervical hysteroscopic resection of myoma or endometrium, carboxyhaemoglobin was measured before and at the end of the surgical procedure, and compared with levels measured in 20 patients during transurethral prostatectomy, and in 20 patients during tonsillectomy. Haemodynamic data, including ST-segment changes, were recorded. Levels of carboxyhaemoglobin increased significantly during hysteroscopic surgery from median (IQR [range]) 1.0% (0.7-1.4 [0.5-4.9])% to 3.5% (2.0-6.1 [1.3-10.3]%, p < 0.001), compared with levels during prostatectomy or tonsillectomy. Significant ST-segment changes were observed in 50% of the patients during hysteroscopic surgery. Significant correlations were observed between the increase in carboxyhaemoglobin and the maximum ST-segment change (ρ = -0.707, p < 0.01), between the increase in carboxyhaemoglobin and intravasation (ρ = 0.625; p < 0.01), and between intravasation and the maximum ST-segment change (ρ = -0.761; p < 0.01). The increased carboxyhaemoglobin levels during hysteroscopic surgery appear to be related to the amount of intravasation and this could potentially be a contributing factor to the observed ST-segment changes.
Asunto(s)
Carboxihemoglobina/metabolismo , Diatermia/métodos , Electrocardiografía/métodos , Histeroscopía/métodos , Tonsilectomía/métodos , Resección Transuretral de la Próstata/métodos , Adulto , Anciano , Análisis de Varianza , Biomarcadores/sangre , Estudios de Cohortes , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To evaluate the short-term and long-term clinical outcome of transhiatal oesophagectomy without thoracotomy for cancer. DESIGN: Retrospective. METHODS: In the period January 1993-August 1996, 115 patients underwent a transhiatal oesophagectomy with curative intent for adenocarcinoma or squamous cell carcinoma of the middle or distal oesophagus or oesophagogastric junction. There were 87 men and 28 women with a median age of 65 years (range: 37-83). Median duration of postoperative follow-up was 27 months (range: 1-74) for all patients, and 45 months (range: 30-74) for those alive at final follow-up. RESULTS: No emergency thoracotomies were necessary. In-hospital mortality was 3.5% (4 patients). Vocal cord dysfunction (24%) and pulmonary complications (23%) were the most frequent early postoperative complications. Clinical leakage of the cervical anastomosis occurred in 8 patients (7%). Forty per cent developed a benign anastomotic stricture which was treated by (repeated) endoscopic dilatation. A microscopically radical resection was achieved in 73% of the patients. Overall survival was 45% at 3 years. CONCLUSION: Transhiatal oesophagectomy without thoracotomy can be considered a safe procedure for resectable cancer of the midoesophagus, the distal oesophagus or the oesophagogastric junction. Long-term oncological treatment results were in line with the data reported for oesophageal resections via a transthoracic approach.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Contraindicaciones , Neoplasias Esofágicas/mortalidad , Esofagectomía/efectos adversos , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Toracotomía , Resultado del TratamientoRESUMEN
We report pneumomediastinum, pneumopericardium, and subcutaneous emphysema occurring in patients who underwent laparoscopic fundoplication in our clinic. These complications might adversely affect hemodynamics during this procedure.