One hundred laparoscopic cholecystectomies were performed since April 1991. Eleven patients were treated with a new technique without CO2 insufflation, using a traction device to elevate the right upper quadrant wall. Two Kirschner wires were introduced subcutaneously to permit the abdominal wall to be lifted for satisfactory laparoscopic view, as the gas insufflation technique yields. Preoperative evacuation of the intestines and intraoperative muscle relaxation are necessary for easy and successful cholecystectomy. Three cases were converted to laparotomy because of remarkably distended intestine due to incorrect endotracheal intubations. No complications related to subcutaneous wire traction technique were noted in this series. Subcutaneous wire traction technique provides a simpler, and possibly safer alternative to the gas insufflation technique.
Recent development of the radioimmunoassay technique has been enabled to measure the low level of serum alphafetoprotein (AFP). A various kinds of malignant tumors, which show elevated serum AFP except hepatic cell carcinomas and embrionic cancers, have been reported.Those are mainly consisted of gastric cancers and cholangiomas, pancreatic and colorectal cancers have been really reported.Prognosis of AFP-producing gastric cancers is poor, because of rapid growing, and easily metastasis of the liver and lymphnodes.Intensive chemotherapy should be recommended for treatment perioperatively. The measurement of serum AFP level may contribute to make diagnosis and to evaluate therapeutic effects.In this report, we emphasize the importance of strict postoperative follow-up, using regular check of serum AFP, CT scan and ultrasonogram.
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