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From the editorial office 来自编辑部
Pub Date : 2023-04-07 DOI: 10.14341/serg12793
N. S. Kuznetsov
.
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引用次数: 0
Draft of clinical guidelines for the diagnosis and treatment of differentiated thyroid cancer in adult patients 成人分化型甲状腺癌诊断与治疗临床指南草案
Pub Date : 2023-04-07 DOI: 10.14341/serg12792
E. Choinzonov, I. Reshetov, S. A. Ivanov, A. Polyakov, M. Kropotov, A. Mudunov, V. Polkin, P. Isaev, A. Ilyin, D. G. Beltsevich, V. Vanushko, P. Rumyantsev, G. Melnichenko, Y. Alymov, I. S. Romanov, A. V. Ignatova, E. Borodavina, V. Krylov, A. Shurinov, N. Severskaya, Z. Radjabova, D. Kulbakin, A. Nevolskikh, A. Gevorkov, E. Khmelevsky, S. Kutukova, A. Guz, I. Sleptsov, R. Chernikov, A. Stepanova, N. Falaleeva, S. Podvyaznikov, N. Rubtsova, A. N. Rudyk, S. Musin, I. Gulidov, L. Vladimirova, T. Semiglazova, T. A. Aghababyan, E. Kostromina
The article presents a draft of clinical recommendations for the diagnosis and treatment of differentiated thyroid cancer in adult patients, which provides a modern examination algorithm, discusses the basic principles of laboratory, instrumental diagnostics and treatment approaches.
本文提出了成人分化型甲状腺癌症诊断和治疗的临床建议草案,该草案提供了现代检查算法,讨论了实验室、仪器诊断和治疗方法的基本原则。
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引用次数: 0
From the editorial office 来自编辑部
Pub Date : 2023-04-07 DOI: 10.14341/serg12795
N. S. Kuznetsov
.
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引用次数: 0
Tension-free thyroidectomy (TFT, medial thyroidectomy) — a prospective study: surgical technique and results of 259 operations 无张力甲状腺切除术(TFT,内侧甲状腺切除术)-一项前瞻性研究:259例手术的手术技术和结果
Pub Date : 2023-03-11 DOI: 10.14341/serg12774
I. Sleptsov, R. Chernikov, A. Pushkaruk, I. Sablin, T. Tilloev, N. Timofeeva, K. Gerasimova, D. Buzanakov, S. Shikhmagomedov, S. Alekseeva, A. Bubnov, Yana Osokina, M. V. Liubimov
BACKGROUND: One of the most important tasks in thyroid surgery is to prevent the development of specific complications — laryngeal nerve dysfunction and hypoparathyroidism. A significant number of technical solutions introduced into clinical practice in recent years are aimed at solving this problem.AIM: Тo evaluate the results of an alternative technique of thyroid surgery — medial thyroidectomy.MATERIALS AND METHODS: 270 patients with thyroid diseases were operated on using tension free thyroidectomy technique in the volume of hemi- or thyroidectomy with or without cervical lymphadenectomy. The selection of patients was continuous. All patients underwent ultrasound or videolaryngoscopy before the operation and on the 1st postoperative day. Patients who underwent thyroidectomy underwent blood analysis for parathormone and blood analysis for ionized calcium.RESULTS: For hemithyroidectomy the duration of surgery did not change. In the group of patients with nodes up to 30 mm the duration of surgery increased. An increase in the operation time was also noted for thyroidectomy. Unilateral laryngeal paresis was registered in 6 (2.3%) patients or 1.7% of the number of recurrent laryngeal nerves in the risk area. The risk of parathyroid gland (PTG) removal was 0.39% of the number of operations and 0.14% of the number of PTG in the risk area. Decrease in the level of parathormone in the first day after surgery was noted in 11.5% of patients. The development of postoperative hematoma was noted in 1 patient (0.39%).CONCLUSION: The technique of thyroid surgery with medial access to the recurrent laryngeal nerve and parathyroid glands is feasible in the vast majority of patients with thyroid diseases requiring surgical treatment and shows high safety and a number of advantages over the traditional method of thyroid surgery.
背景:甲状腺手术中最重要的任务之一是预防特定并发症的发展——喉神经功能障碍和甲状旁腺功能减退。近年来引入临床实践的大量技术解决方案都是为了解决这个问题。目的:评价甲状腺手术的替代技术——甲状腺内侧切除术的效果。材料和方法:对270例甲状腺疾病患者采用无张力甲状腺切除术,在半甲状腺或甲状腺切除术的体积内进行颈淋巴结清扫或不进行颈淋巴结清扫。患者的选择是连续的。所有患者在术前和术后第一天均接受了超声或视频喉镜检查。接受甲状腺切除术的患者接受了甲状旁腺激素的血液分析和电离钙的血液分析。结果:半甲状腺切除术的手术时间没有改变。在淋巴结达30mm的患者组中,手术持续时间增加。甲状腺切除术的手术时间也有所增加。6例(2.3%)患者出现单侧喉轻瘫,占危险区域喉返神经数量的1.7%。甲状旁腺(PTG)切除的风险为手术次数的0.39%,为风险区域甲状旁腺切除次数的0.14%。11.5%的患者术后第一天甲状旁腺激素水平下降。1例(0.39%)患者术后出现血肿。结论:喉返神经和甲状旁腺内侧入路甲状腺手术技术在绝大多数需要手术治疗的甲状腺疾病患者中是可行的,与传统的甲状腺手术方法相比,该技术具有较高的安全性和许多优点。
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引用次数: 0
Unilateral adrenalectomy for primary bilateral macronodular adrenal hyperplasia 单侧肾上腺切除术治疗原发性双侧肾上腺大结节性增生
Pub Date : 2023-03-11 DOI: 10.14341/serg12779
A. Chevais, A. Elfimova, D. Derkatch, A. Romanova, A.  K. Ebzeeva
BACKGROUND: To date, surgical treatment is an effective treatment of hypercortisolism in primary bilateral macronodular hyperplasia (PBMAH). Due to the bilateral lesion, the most common treatment in Russia is the bilateral adrenalectomy, which requires the appointment of hormone replacement therapy. The results of various studies on the effectiveness of unilateral adrenalectomy (UA) in PBMAH are rather discordant.AIM: The objective of the study was to assess the outcomes of UA in patients with PBMAH, accompanied by mild autonomous cortisol excess (MACE) or overt Cushing’s syndrome (CS).MATERIALS AND METHODS: 44 patients with PBMAH and a manifest form of CS (n=21) MACE with comorbid conditions (n=23) underwent UA in the surgical department of the Endocrinology Research Centre. The dynamics of laboratory parameters (cortisol after overnight dexamethasone suppression test (cortisol ONDST) urinary free cortisol (СКМ), ACTH), as well as the course of comorbid diseases (diabetes mellitus, arterial hypertension (AH), metabolic disorders) were assessed before and after 6 months of surgical intervention. The cut-off level of blood cortisol (8:00–9:00) during the first day after OA was determined as a predictor of the development of adrenal insufficiency (AI) in the early postoperative period.RESULTS: 6 months after OA, laboratory parameters improved in 40/44 (91%, 95% CI: 78%-97%) cases: cortisol ONDST decreased from 466 [173; 652] to 86 [61; 149] nmol/l, p=<0.01, СКМ dropped from 840 [468; 1892] to 267 [204; 432] nmol/day, p=<0.01), while ACTH increased gradually from 1 [1; 2.1] to 8.3 [2.6; 15.0] pg/ml, p=<0.01), which indicates the effectiveness of UA. Statistically significant changes in BMI were also obtained (before UA — 30.8 [27.5; 34.4], after — 28.5 [23.9; 32.2] kg/m2 (p <0.01)). When analyzing the long-term outcomes of UA on carbohydrate metabolism, a decrease in the level of HbA1c from 7.0 [6.3; 7.7] to 6.0 [5.6; 6.7] %, (p<0.01) was observed. Further, there was an improvement in the course of AH. After UA, antihypertensive therapy was completely discontinued in 27.7% of cases, and a reduction in the number of antihypertensive drugs was carried out in 44.4%. The level of cortisol in the early postoperative period less than 325 nmol/l was the strongest factor predicting the potential adrenal failure (AUC=0.96).CONCLUSION: UA can be recommended as the first line treatment of PBMAH with CS due to the high probability of longterm remission of hypercortisolism and improvement in the course of comorbid diseases.
背景:迄今为止,手术治疗是治疗原发性双侧大结节增生症(PBMAH)皮质醇增多症的有效方法。由于双侧病变,在俄罗斯最常见的治疗方法是双侧肾上腺切除术,需要预约激素替代疗法。关于单侧肾上腺切除术(UA)治疗PBMAH的有效性的各种研究结果相当不一致。目的:本研究的目的是评估伴有轻度自主皮质醇过量(MACE)或显性库欣综合征(CS)的PBMAH患者UA的疗效。材料和方法:44名PBMAH和明显的CS(n=21)MACE合并症患者(n=23)在内分泌研究中心的外科接受UA。在手术干预前后6个月,评估了实验室参数(地塞米松抑制试验后的皮质醇(皮质醇ONDST)、尿游离皮质醇(СКМ)、ACTH)以及合并症(糖尿病、动脉高压(AH)、代谢紊乱)的动态。OA后第一天的血皮质醇临界水平(8:00–9:00)被确定为术后早期肾上腺功能不全(AI)发展的预测指标。结果:OA后6个月,40/44例(91%,95%CI:78%-97%)的实验室参数有所改善:皮质醇ONDST从466[173;652]降至86[61;149]nmol/l,p=0.01,СКМ从840[468;1892]降至267[204;432]nmol/天,p=0.01),而ACTH从1[1;2.1]逐渐增加至8.3[2.6;15.0]pg/ml,p=0.01),这表明UA的有效性。BMI也发生了统计学意义上的显著变化(UA前30.8[27.5;34.4],UA后28.5[23.9;32.2]kg/m2(p<0.01))。在分析UA对碳水化合物代谢的长期结果时,观察到HbA1c水平从7.0[6.3;7.7]下降到6.0[5.6;6.7]%(p<0.01)。此外,AH的过程也有所改善。UA后27.7%的患者完全停止降压治疗,术后早期皮质醇水平低于325nmol/l是预测潜在肾上腺功能衰竭的最强因素(AUC=0.96)合并症病程的改善。
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引用次数: 0
The history of the development of endocrine surgery in Saratov: professor Myshkin K.I. is the founder of the school of endocrine surgery 萨拉托夫内分泌外科发展史:Myshkin K.I.教授是内分泌外科学院的创始人
Pub Date : 2023-03-11 DOI: 10.14341/serg12722
T. B. Duboshina, V. Meshcheryakov, S. Kapralov, V. Yakubenko, E. V. Amirov, I. Turlykova, Y. Vanzha
The article tells about the work and scientific achievements of Professor K.I. Myshkin — surgeon, founder of the school of endocrine surgery, teacher, whose example has become a guide for many on their professional path. Materials about the  biography of the great professional, information about the continuation of his scientific achievements by his students and followers are given.
这篇文章告诉了K.I.Myshkin教授的工作和科学成就,他是外科医生,内分泌外科学院的创始人,教师,他的榜样已经成为许多人职业道路上的指南。提供了关于这位伟大专业人士传记的材料,以及关于他的学生和追随者继续他的科学成就的信息。
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引用次数: 0
Pancreatic resections or observation in management of sporadic non-functioning stage T1 neuroendocrine tumors of the pancreas (PNET) (literature review) 胰腺切除或观察对散发性T1期胰腺神经内分泌肿瘤(PNET)的治疗(文献综述)
Pub Date : 2023-03-11 DOI: 10.14341/serg12775
D. Salimgereeva, I. Feidorov, I. Khatkov
The availability of modern high-precision diagnostic methods increased the detection rate of pancreatic neuroendocrine neoplasia (pNEN). There is no doubt concerning the necessity of surgical treatment for localized functioning tumors, whilecurrently there is no objective way to choose the tactic for non-functioning asymptomatic neuroendocrine tumors of the pancreas (pNET) with the exception of the tumor size.Treatment tactics for non-functioning asymptomatic T1 neuroendocrine tumors (less 2 cm in size) are debatable. According to literature surgical treatment for lesions less than 2 cm does not always increase survival. In the same time even in high-volume centers pancreatic surgery shows high morbidity and mortality rate. Prospective randomized trials comparing surveillance and operative treatment are not published yet, as far as authors concerned. International guidelines answer the question of treatment such neoplasms ambiguously, while national Russian recommendations do not cover the topic. Guidelines are based on heterogeneous retrospective studies; therefore, the aim of scientific research is to determine reliable criteria for patient selection for dynamic observation or surgical treatment.This article provides an overview of 60 scientific publications covering the problem.
现代高精度诊断方法的应用提高了胰腺神经内分泌肿瘤(pNEN)的检出率。对于局限性功能肿瘤,手术治疗的必要性是毋庸置疑的,而对于无功能无症状胰腺神经内分泌肿瘤(pNET),除肿瘤大小外,目前还没有客观的方法来选择治疗策略。无功能无症状T1神经内分泌肿瘤(小于2cm)的治疗策略是有争议的。根据文献,对小于2厘米的病变进行手术治疗并不总能提高生存率。与此同时,即使在大容量中心,胰腺手术也显示出高发病率和死亡率。就作者而言,比较监测和手术治疗的前瞻性随机试验尚未发表。国际指南对治疗此类肿瘤的问题回答含糊不清,而俄罗斯的国家建议不包括该主题。指南基于异质性回顾性研究;因此,科学研究的目的是为动态观察或手术治疗的患者选择确定可靠的标准。本文概述了涉及该问题的60篇科学出版物。
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引用次数: 0
Pheochromocytoma with paraneoplastic phenomena manifested as myelodysplastic syndrome 嗜铬细胞瘤伴副肿瘤现象,表现为骨髓增生异常综合征
Pub Date : 2023-01-19 DOI: 10.14341/serg12771
S. Sergiiko, D. V. Korotovsky, V. L. Tul`ganova, I. V. Lomova, A. S. Butorin
We present a clinical case of 22yo patient with diagnosis of pheochoromocytoma complicated with myelodysplastic syndrome as manifestation of paraneoplastic phenomenon. The onset of the disease displays typical clinical picture of pheochromacytoma. After medical examination and survey it was discovered a tumor in left adrenal gland and elevation of metanephrines and normetanephrines. In addition, patient has severe anemia and thrombocytopenia. Sternal punction with morphological examination and immunophenotyping were performed. Patient had consulted by hematologist. After all additional analysis cause of anemia and thrombocytopenia remained unknown and related to presence of tumor.Patient was performed a long-time and vast pre-operative preparation with administration of doxazosin and transfusions of blood and platelet concentrate. In continuation, mass in left adrenal gland was excised with spleen by thoracophrenolaparotomy. Morphology confirmed pheochromacytoma, which has typical histological structure and circulatory disorders. Spleen has no specifical features except of focuses of extramedullar hematopoiesis. Patient has short period of hormone therapy to avoid adrenal crisis on post-operative stage. Also massive transfutions of blood and platelet concentrate was performed due to persisting anemia and thrombocytopenia. There were no manifestations of hemorrhage syndrome after the surgery. Myelodysplastic syndrome was detected 3 month later and manifested itself in form of refractory anemia and severe thrombocytopenia, which persisted for long period and required corrections with therapy and transfusions. Only through 5-year observation after adrenalectomy patient has positive dynamic and leveling of laboratory tests without symptoms of myelodysplastic syndrome.
我们报告了一例22岁的临床病例,诊断为嗜铬细胞瘤合并骨髓增生异常综合征,作为副肿瘤现象的表现。该病的发病表现为典型的嗜铬细胞瘤临床表现。经医学检查和调查,发现左肾上腺有肿瘤,后肾和去甲肾上腺素升高。此外,患者还患有严重贫血和血小板减少症。对胸骨点状点进行形态学检查和免疫表型分析。患者已咨询血液科医生。在所有额外的分析之后,贫血和血小板减少症的原因仍然未知,并且与肿瘤的存在有关。患者进行了长时间的大量术前准备,给予多沙唑嗪并输注血液和浓缩血小板。在继续,左肾上腺肿块切除与脾脏通过胸廓切开术。形态学证实嗜铬细胞瘤具有典型的组织学结构和循环系统紊乱。脾脏除髓外造血灶外无特异性。患者需要短时间的激素治疗,以避免术后出现肾上腺危象。由于持续性贫血和血小板减少症,还进行了大量血液和血小板浓缩物的转染。术后无出血综合征表现。骨髓增生异常综合征在3个月后被发现,表现为顽固性贫血和严重血小板减少症,持续时间长,需要通过治疗和输血进行纠正。仅通过肾上腺切除术后5年的观察,患者的实验室检测动态和水平呈阳性,无骨髓增生异常综合征症状。
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引用次数: 0
Microbiota as a factor influencing the change in taste preferences after bariatric surgery 微生物群是影响减肥手术后味觉偏好变化的因素
Pub Date : 2023-01-19 DOI: 10.14341/serg12755
F. Dzgoeva, N. V. Silina
Currently, surgical methods of treatment are increasingly used to achieve remission of diabetes mellitus associated with obesity: laparoscopic gastric bypass, longitudinal resection of the stomach and others. In clinical practice, after this type of surgical intervention, patients often experience changes in taste habits and violations of tolerance to foods, nausea, vomiting, intolerance to the smell, type and texture of food. This review summarizes research data on the factors influencing changes in the gut and salivary microbiota, on the impact of microbiota composition on the development of obesity, on changes in taste habits in patients after bariatric surgery, and on possible causes of changes. To search for sources, Internet resources PubMed, Google Scholar, eLIBRARY.ru were used for the last 10 years, to access the full text of articles, the websites of publishers Springer, Elsevier and others were used. According to the search results, 101 sources were analyzed, 60 of them are included in this review.
目前,越来越多的手术治疗方法用于缓解与肥胖相关的糖尿病:腹腔镜胃旁路术、胃纵向切除术等。在临床实践中,在这种类型的手术干预后,患者经常会经历味觉习惯的改变和对食物耐受性的侵犯、恶心、呕吐、对气味、食物类型和质地的不耐受。这篇综述总结了影响肠道和唾液微生物群变化的因素、微生物群组成对肥胖发展的影响、减肥手术后患者味觉习惯的变化以及变化的可能原因的研究数据。为了寻找来源,互联网资源PubMed、Google Scholar、eLIBRARY.ru在过去10年中被使用,为了访问文章的全文,出版商Springer、Elsevier和其他人的网站被使用。根据搜索结果,对101个来源进行了分析,其中60个来源包含在本综述中。
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引用次数: 0
Features of managing patients with amiodarone-induced thyrotoxicosis in real clinical practice 临床实践中胺碘酮致甲状腺毒症患者的管理特点
Pub Date : 2023-01-19 DOI: 10.14341/serg12732
T. Markova, D. G. Beltsevich, E. A. Kalinicheva, A. Koshkodan, N. M. Salavatova, K. A. Gaunova
Amiodarone is an antiarrhythmic drug that is widely used in clinical practice to control various types of arrhythmias. One of the most significant side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 15–20% of patients. This article presents a clinical case of a 55-year-old patient with a paroxysmal form of atrial fibrillation, for which amiodarone therapy was performed with the development of manifest amiodarone-induced thyrotoxicosis, refractory to drug therapy with glucocorticosteroids and thyrostatics. Due to the ineffectiveness of drug therapy, a total thyroidectomy was performed, which led to a rapid resolution of thyrotoxicosis and normalization of the heart rhythm.
胺碘酮是一种抗心律失常药物,广泛应用于临床控制各种类型的心律失常。胺碘酮治疗最显著的副作用之一是甲状腺功能障碍,约有15-20%的患者出现甲状腺功能障碍。本文报道一例55岁阵发性心房颤动患者的临床病例,由于出现明显的胺碘酮诱导的甲状腺毒症,糖皮质激素和甲状腺抑制剂药物治疗无效,因此进行了胺碘酮治疗。由于药物治疗无效,进行了全甲状腺切除术,这导致甲状腺毒症的快速解决和心律的正常化。
{"title":"Features of managing patients with amiodarone-induced thyrotoxicosis in real clinical practice","authors":"T. Markova, D. G. Beltsevich, E. A. Kalinicheva, A. Koshkodan, N. M. Salavatova, K. A. Gaunova","doi":"10.14341/serg12732","DOIUrl":"https://doi.org/10.14341/serg12732","url":null,"abstract":"Amiodarone is an antiarrhythmic drug that is widely used in clinical practice to control various types of arrhythmias. One of the most significant side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 15–20% of patients. This article presents a clinical case of a 55-year-old patient with a paroxysmal form of atrial fibrillation, for which amiodarone therapy was performed with the development of manifest amiodarone-induced thyrotoxicosis, refractory to drug therapy with glucocorticosteroids and thyrostatics. Due to the ineffectiveness of drug therapy, a total thyroidectomy was performed, which led to a rapid resolution of thyrotoxicosis and normalization of the heart rhythm.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41683596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Endokrinnaia khirurgiia
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