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Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol 预览 被引量:1
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作者 Varut Lohsiriwat 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2016年第7期543-549,共7页
AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2(COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery.METHODS: Patients undergoing open colorectal resection within an... AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2(COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery.METHODS: Patients undergoing open colorectal resection within an enhanced recovery after surgery protocol from 2011 to 2015 were reviewed. Patients with combined general anesthesia and epidural anesthesia, and those with acute colonic obstruction or perforation were excluded. Patients receiving selective COX-2 inhibitor were compared with well-matched individuals without such a drug. Outcome measures included numeric pain score and morphine milligram equivalent(MME) consumption on postoperative day(POD) 1-3, gastrointestinal recovery(time to tolerate solid diet and time to defecate), complications and length of postoperative stay.RESULTS: There were 75 patients in each group. Pain score on POD 1-3 was not significantly different between two groups. However, MME consumption and MME consumption per kilogram body weight on POD 1-3 was significantly less in patients receiving a selective COX-2 inhibitor(P < 0.001). Median MME consumption per kilogram body weight on POD 1-3 was 0.09, 0.06 and nil, respectively in patients receiving a selective COX-2 inhibitor and 0.22, 0.25 and 0.07, respectively in the comparative group(P < 0.001), representing at least 59% opioidreduction. Patients prescribing a selective COX-2 inhibitor had a shorter median time to resumption of solid diet [1(IQR 1-2) d vs 2(IQR 2-3) d; P < 0.001] and time to first defecation [2(IQR 2-3) d vs 3(IQR 3-4) d; P < 0.001]. There was no significant difference in overall postoperative complications between two groups. However, median postoperative stay was significantly 1-d shorter in patients prescribing a selective COX-2 inhibitor [4(IQR 3-5) d vs 5(IQR 4-6) d; P < 0.001]. CONCLUSION: Perioperative administration of oral selective COX-2 inhibitors significantly decreased intravenous opioid consumption, shortened time to gastrointestinal recovery and reduced hospital stay after open colorectal surgery. 展开更多
关键词 Selective CYCLOOXYGENASE-2 inhibitor Outcome Colon SURGERY Rectal SURGERY Enhanced recovery AFTER SURGERY OPIOID ILEUS NON-STEROIDAL anti-inflammatory drug Pain
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Anorectal emergencies 预览
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作者 Varut Lohsiriwat 《世界胃肠病学杂志:英文版》 SCIE CAS 2016年第26期5867-5878,共12页
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and man... Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis(Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. 展开更多
关键词 ANORECTAL EMERGENCIES HEMORRHOID FISSURE ABSCESS Rectal PROLAPSE Sepsis Complication Sexually transm
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Treatment of hemorrhoids: A coloproctologist’s view 预览 被引量:4
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作者 VarutLohsiriwat 《世界胃肠病学杂志:英文版》 SCIE CAS 2015年第31期9245-9252,共8页
Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Genera... Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Generally,hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Meanwhile,low-graded internal hemorrhoids can be effectively treated with medication and nonoperative measures(such as rubber band ligation and injection sclerotherapy). Surgery is indicated for highgraded internal hemorrhoids,or when non-operative approaches have failed,or complications have occurred. Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids,several minimally invasive operations(including Ligasure hemorrhoidectomy,doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist- which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy,hemorrhoids in immunocompromised patients,hemorrhoids in patients with cirrhosis or portal hypertension,hemorrhoids in patients having antithrombotic agents,and acutely thrombosed or strangulated hemorrhoids. Future perspectives in the treatment of hemorrhoids are also discussed. 展开更多
关键词 HEMORRHOIDS PATHOPHYSIOLOGY TREATMENT OUTCOME COMP
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Enhanced recovery after surgery vs conventional care in emergency colorectal surgery 预览 被引量:3
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作者 Varut Lohsiriwat 《世界胃肠病学杂志:英文版(电子版)》 SCIE CAS 2014年第38期13950-13955,共6页
AIM:To investigate the feasibility and beneficial effects of enhanced recovery after surgery(ERAS) programme in the setting of emergency colorectal surgery.METHODS:Between January 2011 and October 2013,patients underg... AIM:To investigate the feasibility and beneficial effects of enhanced recovery after surgery(ERAS) programme in the setting of emergency colorectal surgery.METHODS:Between January 2011 and October 2013,patients undergoing emergency resection for obstructing colorectal cancer at the Faculty of Medicine Siriraj Hospital,Bangkok,Thailand using ERAS programme were compared with those using conventional care(1:2 ratio). They were matched for their age,gender,ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity score,and type of surgery. Primary outcomes were length of hospital stay and postoperative morbidity. Secondary outcomes included gastrointestinal recovery,30-d readmission,and time interval from surgery to chemotherapy.RESULTS:Twenty patients treated with ERAS programme were compared with 40 patients receiving conventional postoperative care.Median of hospital stay was shorter in the ERAS group:5.5 d(range:3-16)vs 7.5 d(range:5-25),P=0.009.The ERAS group had a non-significant reduction in the incidence of postoperative complication(25%vs 48%,P=0.094).No 30-d mortality and readmission occurred.Patients with ERAS programme had a shorter time to first flatus(1.6 d vs 2.8 d,P<0.001)and time to resumption of normal diet(3.5 d vs 5.5 d,P=0.002).Time interval between operation and initiation of adjuvant chemotherapy was significantly shorter in the ERAS group(37 d vs 49 d,P=0.009).CONCLUSION:The ERAS programme in the setting of emergency colorectal surgery was safe and feasible.It achieved significantly shorter hospitalisation and faster recovery of bowel function. 展开更多
关键词 COLORECTAL cancer OBSTRUCTION EMERGENCY SURGERY En
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Pattern and distribution of colonic diverticulosis:Analysis of 2877 barium enemas in Thailand 预览
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作者 Varut Lohsiriwat Wanwarang Suthikeeree 《世界胃肠病学杂志:英文版(电子版)》 SCIE CAS 2013年第46期8709-8713,共5页
AIM:To determine the pattern and distribution of colonic diverticulosis in Thai adults.METHODS:A review of the computerized radiology database for double contrast barium enema(DCBE)in Thai adults was performed at the... AIM:To determine the pattern and distribution of colonic diverticulosis in Thai adults.METHODS:A review of the computerized radiology database for double contrast barium enema(DCBE)in Thai adults was performed at the Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded.The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined.The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were reported.Factors influencing the presence of colonic diverticulosis were evaluated.RESULTS:A total of 2877 suitable DCBE examinations were retrospectively reviewed.The mean age of patients was 59.8±14.7 years.Of these patients,1778(61.8%)were female and 700(24.3%)were asymptomatic.Colonic diverticulosis was identified in 820patients(28.5%).Right-sided diverticulosis(641 cases;22.3%)was more frequently reported than left-sided diverticulosis(383 cases;13.3%).Pancolonic diverticulosis was found in 98 cases(3.4%).The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were 1.5%(42 cases),0.4%(12 cases),and 0.03%(1 case),respectively.There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients(28.3%vs 28.6%,P=0.85).DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals(29.5%vs 25.3%,P=0.03).Change in bowel habit was strongly associated with the presence of diverticulosis(a relative risk of 1.39;P=0.005).The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals(P】0.05).CONCLUSION:Colonic diverticulosis was identified in28.5%of DCBE examinations in Thai adults.There was no association between the presence of diverticulosis and gender or age. 展开更多
关键词 COLONIC DIVERTICULOSIS Diverticular disease BARIUM ENEMA PATTERN Thailand Cecal DIVERTICULUM Rectal DIVERTICULUM Giant DIVERTICULUM
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经皮的内视镜的 gastrostomy 试管代替: 一个简单过程? 预览 被引量:1
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作者 Varut Lohsiriwat 《世界胃肠内镜杂志:英文版(电子版)》 2013年第1期14-18,共5页
Replacement of gastrostomy tube in patients under-going percutaneous endoscopic gastrostomy (PEG) is generally considered as a safe and simple procedure. However, it could be associated with serious complications, su... Replacement of gastrostomy tube in patients under-going percutaneous endoscopic gastrostomy (PEG) is generally considered as a safe and simple procedure. However, it could be associated with serious complications, such as gastrocutaneous tract disruption and intraperitoneal tube placement, which may lead to chemical peritonitis and even death. When PEG tube needs a replacement (e.g., occlusion or breakage of the tube), clinicians must realize that the gastrocutaneous tract of PEG is more friable than that of surgical gastrostomy because there is no suture fixation between gastric wall and abdominal wall in PEG. In general, the tract of PEG begins to mature in 1-2 wk after placement and it is well formed in 4-6 wk. However, this process could take a longer period of time in some patients. Accordingly, this article describes three major principles of a safe PEG tube replacement: (1) good control of the replacement tube along the well-formed gastrocutaneous tract; (2) minimal insertion force during the replacement, and, most importantly; and (3) reliable methods for the confirmation of intragastric tube insertion. In addition, the management of patients with suspected intraperitoneal tube placement (e.g., patients having abdominal pain or signs of peritonitis immediately after PEG tube replacement or shortly after tube feeding was resumed) is discussed. If prompt investigation confirms the intraperitoneal tube placement, surgical intervention is usually required. This article also highlights the fact that each institute should have an optimal protocol for PEG tube replacement to prevent, or to minimize, such serious complications. Meanwhile, clinicians should be aware of these potential complications, particularly if there are any difficulties during the gastrostomy tube replacement. 展开更多
关键词 PERCUTANEOUS endoscopic GASTROSTOMY GASTROSTOMY TUBE replacement GASTROSTOMY TUBE exchange GASTROSTOMY TUBE reinsertion COMPLICATION PERITONITIS Prevention Management
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Hemorrhoids:From basic pathophysiology to clinical management 预览 被引量:8
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作者 Varut Lohsiriwat 《世界胃肠病学杂志:英文版》 SCIE CAS CSCD 2012年第17期 2009-2017,共9页
这评论讨论 pathophysiology,传染病学,风险因素,分类,临床的评估,和痔的当前的非起作用、起作用的处理。痔被定义为征兆的增大和正常肛门垫子的远侧的排水量。痔的最普通的症状直肠的流血与肠运动被联系。和在在肛门垫子以内的支... 这评论讨论 pathophysiology,传染病学,风险因素,分类,临床的评估,和痔的当前的非起作用、起作用的处理。痔被定义为征兆的增大和正常肛门垫子的远侧的排水量。痔的最普通的症状直肠的流血与肠运动被联系。和在在肛门垫子以内的支持的结缔组织的破坏变化,脉管的隧道的反常膨胀和失真是痔的首要的发现。看来,脉管的音调和脉管的增生的 dysregulation 可能在痔的开发起一个重要作用,并且能是为医疗的一个潜在的目标。在大多数例子,痔保存地被对待,用象 venotonic 药的生活方式修正,纤维补充,交付栓剂的反煽动性的药,和管理那样的许多方法。非起作用的途径包括 sclerotherapy 和,最好橡胶乐队结扎。当非起作用的途径失败了或复杂并发症发生了时,操作被显示。为对待痔的几条外科的途径包括 hemorrhoidectomy 和 stapled hemorrhoidopexy 被介绍了,但是手术后的疼痛是不变的。一些外科的处理潜在地引起象肛门苛评和不能自制那样的可估计的病态。每个处理的应用和结果彻底地被讨论。 展开更多
关键词 病理生理学 临床管理 痔疮 手术治疗 血管增生 手术方法 流行病学 危险因素
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Surgery for gastrointestinal malignant melanoma:Experience from surgical training center 预览 被引量:1
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作者 Thawatchai Akaraviputh Satida Arunakul +2 位作者 Varut Lohsiriwat Cherdsak Iramaneerat Atthaphorn Trakarnsanga 《世界胃肠病学杂志:英文版(电子版)》 SCIE CAS CSCD 2010年第6期共4页
AIM:To characterize clinical features,surgery,outcome,and survival of malignant melanoma(MM) of the gastrointestinal(GI) tract in a surgical training center in Bangkok,Thailand. METHODS:A retrospective review was perf... AIM:To characterize clinical features,surgery,outcome,and survival of malignant melanoma(MM) of the gastrointestinal(GI) tract in a surgical training center in Bangkok,Thailand. METHODS:A retrospective review was performed for all patients with MM of the GI tract treated at our institution between 1997 and 2007. RESULTS:Fourteen patients had GI involvement either in a metastatic form or as a primary melanoma. Thirteen patients with sufficient data were reviewed. The median age of the patients was 66 years(r... 展开更多
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Colonoscopic perforation:Incidence,risk factors,management and outcome 预览 被引量:3
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作者 Varut Lohsiriwat 《世界胃肠病学杂志:英文版(电子版)》 SCIE CAS CSCD 2010年第4期共6页
This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following... This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current t... 展开更多
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