RESUMO
Since the introduction of laparoscopic cholecystectomy, the management of common bile duct (CBD) stones has undergone significant change. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is now routinely done in cases where the diagnosis of choledocholithiasis is suspected preoperatively, with clearance of the bile ducts before laparoscopic cholecystectomy. Intraoperative discovery of CBD stones by cholangiography represents a challenge to the surgeon, who must make a decision about when to perform laparoscopic CBD exploration, convert to open surgery, or send the patient for ERCP during the postoperative period. Because ERCP has a definite failure rate, laparoscopic CBD exploration can be a treatment option. Among 2500 laparoscopic cholecystectomies done by our group from January 1991 to June 1997, 50 patients (2%) underwent laparoscopic CBD exploration, 13 by the transcystic technique and 37 by choledocotomy, with a conversion rate of 8% and a hospital stay of 4.3 days. One patient died from complicated pancreatitis following ERCP and unsuccessful extraction of a CBD stone. We obtained our goal of a CBD free of stones in 92% of the cases. We conclude that laparoscopic CBD exploration is an effective method for treating choledocolithiasis that allows management of this pathology in one stage, although it requires advanced laparoscopic skills and adequate equipment.
Assuntos
Colecistectomia Laparoscópica , Ducto Colédoco/cirurgia , Cálculos Biliares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Ducto Colédoco/diagnóstico por imagem , Feminino , Cálculos Biliares/diagnóstico por imagem , Hospitalização , Humanos , Cuidados Intraoperatórios , Laparoscópios , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Planejamento de Assistência ao Paciente , Cuidados Pós-Operatórios , Radiografia Intervencionista , Estudos Retrospectivos , Esfinterotomia EndoscópicaRESUMO
La mayoría de los modelos experimentales en cirugía laparoscópica se practican en animales porcino y caninos; algunos inconvenientes que presentan estas especies son alto costo y que requieren de personal especializado para su manejo. La rata, animal ampliamente utilizado en microcirugía (investigación y docencia), es una especie que puede ser empleada en la laparoscopia para adiestramiento especialmente del cirujano pediatra y en la investigación. En el presente trabajo se comparan los resultados obtenidos con la operación de Nissen abierta y con técnica laparoscópica. Se emplearon 24 ratas cepa Wistar de 250 a 300 g de peso anestesiadas con pentotal, las cuales fueron divididas en tres grupos. En el grupo 1 (n =.8) se midió la presión intragástrica necesaria para producir reflujo esofágico (11 mmHg en promedio); en el grupo 2 (n = 8) se efectuó la funduplicatura con técnica abierta y medición de presiones intragástricas hasta obtener reflujo. Al grupo 3 (n = 8) se le determinaron los mismos parámetros después de practicada la funduplicatura por vía laparoscópica. La presión necesaria para producir reflujo fue similar en los grupos 2 y 3 (60 a 80 mmHg). el modelo esperimental diseñado es económico, de fácil montaje si se cuenta con experiencia en las técnicas laparoscópicas donde se emplean dos manos y se ralizan suturas
Assuntos
Animais , Laparoscopia , Laparoscopia/estatística & dados numéricos , Ratos Wistar , Procedimentos Cirúrgicos Operatórios , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricosRESUMO
Several techniques of patent ductus arteriosus occlusion primarily by thoracotomy have been practiced. They have shown to be more reliable than nonsurgical procedures. Videothoracoscopy has been useful in several intrathoracic surgical procedures with faster recovery and minimal mortality and morbidity. We report 2 patients with clipping and ligation of a patent ductus arteriosus by a thoracoscopic approach. This technique may be useful in children with a noncomplicated patent ductus arteriosus. It allows an easier recovery and causes less pain.
Assuntos
Permeabilidade do Canal Arterial/cirurgia , Toracoscopia , Criança , Pré-Escolar , Constrição , Feminino , Humanos , Ligadura/métodos , MasculinoAssuntos
Transplante de Coração , Miocárdio/ultraestrutura , Preservação de Tecido/métodos , Adenosina/farmacologia , Animais , Parada Cardíaca Induzida , Isquemia/patologia , Microscopia Eletrônica , Nifedipino/farmacologia , Potássio/farmacologia , Ratos , Ratos Endogâmicos , Soluções/farmacologia , Fatores de TempoRESUMO
Severe hypoglycemia may be present in seriously ill patients; if it is not corrected opportunely a series of neuroendocrinal mechanisms take place aimed at correcting metabolic alterations. These mechanisms can produce hemodynamic alterations as well. Nine mongrel dogs were studied with continuous registration of: blood pressure, central venous pressure, cardiac frequency, respiratory frequency, electrocardiogram and first derivative (Dp/Dt). Six dogs received crystalline (fast acting) insuline intravenously (group 1). After hemodynamic changes were registered hypoglycemia was corrected with 50 per cent glucose solution. Complementary insuline doses were administered to three dogs (group 2); in this group hypoglycemia was not corrected. In group 1 during hypoglycemia there was an increase in blood pressure, central venous pressure, cardiac frequency, respiratory frequency and Dp/Dt, and changes in QT and T wave on the EKG; these changes were partially reversible after hypoglycemia was corrected. The above mentioned alterations persisted in group 2, breathing became irregular irregular and respiratory arrest supervened. It can be inferred that the hemodynamic response to hypoglycemia is predominantly adrenergic. The role of catecolamines, glucocorticoides, glucagon, insuline, cyclic AMP in metabolic and hemodynamic alterations consecutive to hypoglycemia are discussed.