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[Thoracoscopic thymectomy for myasthenia gravis and non-invasive thymoma after COVID-19 pneumonia]. [胸腔镜胸腺切除术治疗重症肌无力和 COVID-19 肺炎后的非侵袭性胸腺瘤]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202408126
E B Topolnitskiy, V V Gusakov

Modern guidelines have identified thoracoscopic thymectomy as a preferable option for myasthenia gravis and non-invasive thymoma. In the era of the new coronavirus infection, it is relevant to develop protocols for anesthetic and perioperative support of patients undergoing thymectomy for myasthenia gravis after COVID-associated pneumonia (CAP). We present the results of thoracoscopic thymectomies in patients after CAP. Multidisciplinary team should determine therapeutic support, the need for plasmapheresis and thymectomy. Plasmapheresis and glucocorticosteroids are effective in addition to anticholinesterase therapy at the stages of perioperative support for correction of neurological status in patients with myasthenia combined with chronic obstructive pulmonary disease and pulmonary hypertension. Outpatient direct anticoagulants are advisable considering the need for prolonged postoperative prevention of thrombotic events.

现代指南已将胸腔镜胸腺切除术确定为治疗重症肌无力和非侵袭性胸腺瘤的首选方案。在新型冠状病毒感染的时代,为 COVID 相关肺炎(CAP)后因重症肌无力而接受胸腺切除术的患者制定麻醉和围手术期支持方案具有重要意义。我们介绍了胸腔镜胸腺切除术在 CAP 患者中的应用效果。多学科团队应确定治疗支持、血浆置换和胸腺切除术的必要性。在肌无力合并慢性阻塞性肺疾病和肺动脉高压患者围手术期支持治疗阶段,除抗胆碱酯酶治疗外,浆细胞吸出术和糖皮质激素对纠正患者的神经状态也很有效。考虑到术后需要长时间预防血栓事件,建议使用门诊直接抗凝剂。
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引用次数: 0
[Vacuum-assisted laparostomy for advanced peritonitisis]. [真空辅助腹腔切开术治疗晚期腹膜炎]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia20240517
A V Shabunin, V V Bedin, D D Dolidze, M Z Eminov, D S Bocharnikov

Objective: To evaluate the efficacy of negative pressure therapy in patients with peritonitis.

Material and methods: The study included 127 patients with advanced secondary peritonitis between 2019 and 2022. All patients were divided into 2 groups. All ones underwent staged sanitation of the abdominal cavity. In the first group (n=76), re-laparotomies were accompanied by skin suture only and passive abdominal drainage. The second group included patients (n=51) with open abdominal cavity strategy and negative pressure therapy (vacuum-assisted laparostomy). We analyzed the number of surgeries, postoperative complications, duration of hospital-stay and mortality.

Results: In the second group, there were significantly lower morbidity, mean number of surgeries and hospital-stay. In addition, incidence of fascial closure of abdominal cavity was higher and mortality rate was lower in the same group.

Conclusion: Vacuum-assisted laparostomy in patients with advanced peritonitis can reduce the number of secondary purulent complications and mortality, as well as increase the incidence of fascial closure of abdominal cavity. This approach reduces the number of surgical interventions and duration of in-hospital treatment.

目的:评估负压疗法对腹膜炎患者的疗效:评估负压疗法对腹膜炎患者的疗效:研究纳入了2019年至2022年期间的127例晚期继发性腹膜炎患者。所有患者分为两组。所有患者都接受了腹腔分阶段消毒。第一组患者(76 人)只进行了皮肤缝合和被动腹腔引流术。第二组患者(人数=51)采用开放腹腔策略和负压疗法(真空辅助腹腔造口术)。我们分析了手术次数、术后并发症、住院时间和死亡率:结果:第二组的发病率、平均手术次数和住院时间均明显低于第一组。结果:第二组的发病率、平均手术次数和住院时间均明显较低,此外,腹腔筋膜闭合的发生率较高,死亡率较低:结论:对晚期腹膜炎患者进行真空辅助腹腔造口术可减少继发性化脓性并发症的数量和死亡率,并增加腹腔筋膜闭合的发生率。这种方法可减少手术干预次数,缩短住院治疗时间。
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引用次数: 0
[Preventive myocardial revascularization prior to abdominal aortic repair in patients without cardiac symptoms: long-term results]. [无心脏症状患者腹主动脉修补术前的预防性心肌血管重建:长期结果]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202405158
A V Chupin, A V Abrosimov, A F Kharazov, N R Masalimov

Objective: To evaluate the long-term influence of preoperative invasive coronary screening and preventive myocardial revascularization on mortality and cardiac complications after open surgery for abdominal aortic aneurysms (AAA).

Material and methods: We present long-term outcomes after open surgery for AAA between 2011 and 2022. Patients without clinical or objective signs of coronary artery disease were included. In the 1st group, routine coronary angiography was performed before surgery. Prophylactic myocardial revascularization was performed in 12 cases. Long-term data on 45 patients were obtained. In the 2nd group, 53 patients underwent repair without invasive coronary screening, and data on 48 patients were obtained in this group.

Results: The median follow-up was 32 and 79 months, respectively. Kaplan-Meyer overall 48-month survival was 87.3% and 82.1%, respectively (p=0.278). In the first group, 2 patients developed angina pectoris in the same period. In the second group, we observed 2 cases of myocardial infarction and 3 cases of angina pectoris without infarction. Analysis of survival curves found no significant differences (p=0.165).

Conclusion: In our study, invasive coronary screening and preventive myocardial revascularization in patients without clinical and objective signs of coronary artery did not improve 4-year long-term period after abdominal aortic repair. Perhaps, differences will appear after 4 years, and this requires further follow-up after coronary angiography. However, there is a tendency towards more common onsets of coronary artery disease that dictates the need for cardiac monitoring of such patients.

目的评估术前有创冠状动脉筛查和预防性心肌血运重建对腹主动脉瘤(AAA)开放手术后死亡率和心脏并发症的长期影响:我们展示了2011年至2022年间腹主动脉瘤开放手术后的长期结果。纳入的患者均无冠状动脉疾病的临床或客观体征。第一组患者在手术前进行常规冠状动脉造影。12例患者接受了预防性心肌血管重建术。获得了 45 名患者的长期数据。在第二组中,53 名患者在未进行侵入性冠状动脉筛查的情况下进行了修复手术,该组获得了 48 名患者的数据:中位随访时间分别为 32 个月和 79 个月。结果:中位随访时间分别为 32 个月和 79 个月,Kaplan-Meyer 48 个月总生存率分别为 87.3% 和 82.1%(P=0.278)。在第一组中,有两名患者在同一时期出现心绞痛。在第二组中,我们观察到 2 例心肌梗死,3 例心绞痛但无梗死。对生存曲线的分析没有发现明显差异(P=0.165):在我们的研究中,对没有冠状动脉临床和客观体征的患者进行有创冠状动脉筛查和预防性心肌血管再通手术,并不能改善腹主动脉修补术后 4 年的长期生存状况。也许 4 年后会出现差异,这需要在冠状动脉造影后进一步随访。不过,冠状动脉疾病的发病率呈上升趋势,因此有必要对这类患者进行心脏监测。
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引用次数: 0
[Improving surgical technique for tracheal resection with anastomosis]. [改进气管切除吻合手术技术]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia20240116
V D Parshin, V A Porkhanov, I S Polyakov, A L Kovalenko, V A Zhikharev, A V Parshin, M A Rusakov, V V Parshin

Objective: To present modern aspects of improving surgical techniques in tracheal resection developed in recent years.

Material and methods: The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described.

Conclusion: Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.

摘要介绍近年来改进气管切除手术技术的现代方法:作者在气管手术方面拥有最丰富的经验(在过去的 50 年中收治了超过 2000 名患者)。在这么长的时间里,诊断能力、围手术期管理和手术技术都发生了变化。这涉及卡他性气管狭窄的分类建议、内窥镜和 X 射线诊断的特点、各种手术的适应症、手术方法的选择、气管切开后气管导管的移动和吻合技术。此外,还介绍了术后严重并发症的预防措施:作者凭借丰富的经验制定了一套气管狭窄患者的治疗方案,大大降低了术后并发症的发生率。这大大降低了术后并发症的发生率和死亡率。这种设备的推广与医院的技术支持以及由内窥镜医生、麻醉师、重症监护专家和胸外科医生组成的专家队伍的专业水平有关。
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引用次数: 0
[Domestic system for fluorescent diagnostics in breast cancer: pros and cons]. [用于乳腺癌荧光诊断的国内系统:利弊]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202402255
K A Anichkina, A V Pasternak, Kh S Arslanov, G E Kvetenadze, E V Shivilov, A V Klimashevich

Objective: To analyze the effectiveness of identifying the sentinel lymph node in breast cancer using the «MARS» system for fluorescent diagnostics in near infrared light.

Material and methods: There were 51 patients with breast cancer cT0-2N0M0 between July 2023 and October 2023. Mean age of patients was 52.3 years. Invasive ductal carcinoma was diagnosed in 39 (76.5%) patients, invasive lobular carcinoma - in 8 (15.7%) patients, other forms of breast cancer - in 4 (7.8%) patients.

Results: Sentinel lymph node was successfully identified in all cases (n=51). A total of 122 sentinel lymph nodes were detected and mapped (2.4 nodes per a patient).

Conclusion: The MARS system for intraoperative fluorescence diagnostics in near-infrared light is effective for identifying the sentinel lymph node in breast cancer.

目的分析使用近红外荧光诊断系统 "MARS "识别乳腺癌前哨淋巴结的有效性:2023 年 7 月至 2023 年 10 月期间,51 例乳腺癌 cT0-2N0M0 患者。患者平均年龄为 52.3 岁。39例(76.5%)患者被诊断为浸润性导管癌,8例(15.7%)患者被诊断为浸润性小叶癌,4例(7.8%)患者被诊断为其他形式的乳腺癌:结果:所有病例(n=51)都成功确定了前哨淋巴结。结果:所有病例(n=51)都成功确定了前哨淋巴结,共检测并绘制了 122 个前哨淋巴结图(每名患者 2.4 个淋巴结):结论:用于术中近红外荧光诊断的 MARS 系统能有效识别乳腺癌前哨淋巴结。
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引用次数: 0
[Fenestrated stent-graft as an option for the treatment of type I endoleak in a patient with giant abdominal aortic aneurysm]. [开窗支架移植作为治疗巨大腹主动脉瘤I型内漏的一种选择]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024122159
R S Polyakov, K A Kur-Ipa, M V Puretskiy, G V Mardanyan, V M Safonova, S A Abugov

Endovascular aortic repair has advanced significantly over the last decades, but type IA endoleaks are still formidable complications requiring immediate intervention due to high risk of rupture. We present successful endovascular treatment of type IA endoleak in a patient with giant abdominal aortic aneurysm. A modified fenestrated stent graft was implanted. This technique was effective in complex vascular anatomy. Modified fenestrated stent grafts can be an effective alternative for the treatment of delayed type IA endoleaks. However, such interventions should be performed in specialized hospitals with subsequent careful follow-up to ensure efficacy and safety.

在过去的几十年里,血管内主动脉修复已经取得了显著的进展,但由于血管破裂的高风险,IA型血管内渗漏仍然是一种可怕的并发症,需要立即进行干预。我们报告了一例巨大腹主动脉瘤患者的IA型内漏的成功血管内治疗。植入改良的开窗支架。该技术在复杂的血管解剖中是有效的。改良开窗支架移植是治疗迟发性IA型内漏的有效选择。然而,此类干预措施应在专科医院进行,并随后进行仔细随访,以确保疗效和安全性。
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引用次数: 0
[Treatment of postoperative complications in cardiothoracic surgery: single-center 10-year experience]. 【心胸外科术后并发症的治疗:单中心10年经验】。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202412266
D V Bazarov, A Yu Grigorchuk, O B Povolotskaya, G A Kazaryan, E R Charchyan, M A Vyzhigina, V V Nikoda, E V Boranov, A A Kavochkin, D G Kabakov, A S Zelyanin

Objective: To evaluate the results of treatment of postoperative complications in one surgical center over 10 years.

Material and methods: There were 100 patients with intrapleural complications and indications for surgical correction after various cardiothoracic interventions between 2013 and 2023.

Results: Mortality after thoracoscopic surgeries for cardiothoracic complications was 5%. There were 3 patients after on-pump cardiac and aortic surgeries, 1 patient after right-sided pneumonectomy with resection of the tracheobronchial angle. In all cases, the indication for video-assisted thoracoscopy was pulmonary-pleural complications with sepsis. One patient died after repeated VATS. This was a 66-year-old patient with severe mitral and tricuspid regurgitation. Postoperative period was accompanied by severe respiratory failure and hemopneumothorax that required emergency VATS surgery for hemostasis and one-stage tracheostomy. Despite the intensive care, the patient died under progressive multiple organ failure. Other patients were discharged.

Conclusion: Thoracoscopic technologies allow for complete debridement of the pleural cavities and mediastinum, as well as elimination of causes of complications. Interdisciplinary interaction and trust are necessary for successful treatment of postoperative complications in cardiothoracic surgery.

目的:评价某外科中心10年来对术后并发症的治疗效果。材料与方法:2013 - 2023年共100例胸膜内并发症及各种心胸外科干预后手术矫正指征。结果:胸腔镜手术后心胸并发症的死亡率为5%。有3例患者行无泵心脏及主动脉手术,1例患者行右侧肺切除术并切除气管支气管角。在所有病例中,视频胸腔镜的适应症是肺胸膜并发症合并脓毒症。1例患者在多次VATS后死亡。这是一位66岁的患者,患有严重的二尖瓣和三尖瓣反流。术后伴有严重呼吸衰竭和血气胸,需要紧急VATS手术止血和一期气管切开术。尽管经过精心护理,病人还是死于进行性多器官衰竭。其他患者出院。结论:胸腔镜技术可以完全清除胸膜腔和纵隔,并消除并发症的原因。跨学科的互动和信任是成功治疗心胸外科术后并发症的必要条件。
{"title":"[Treatment of postoperative complications in cardiothoracic surgery: single-center 10-year experience].","authors":"D V Bazarov, A Yu Grigorchuk, O B Povolotskaya, G A Kazaryan, E R Charchyan, M A Vyzhigina, V V Nikoda, E V Boranov, A A Kavochkin, D G Kabakov, A S Zelyanin","doi":"10.17116/hirurgia202412266","DOIUrl":"https://doi.org/10.17116/hirurgia202412266","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the results of treatment of postoperative complications in one surgical center over 10 years.</p><p><strong>Material and methods: </strong>There were 100 patients with intrapleural complications and indications for surgical correction after various cardiothoracic interventions between 2013 and 2023.</p><p><strong>Results: </strong>Mortality after thoracoscopic surgeries for cardiothoracic complications was 5%. There were 3 patients after on-pump cardiac and aortic surgeries, 1 patient after right-sided pneumonectomy with resection of the tracheobronchial angle. In all cases, the indication for video-assisted thoracoscopy was pulmonary-pleural complications with sepsis. One patient died after repeated VATS. This was a 66-year-old patient with severe mitral and tricuspid regurgitation. Postoperative period was accompanied by severe respiratory failure and hemopneumothorax that required emergency VATS surgery for hemostasis and one-stage tracheostomy. Despite the intensive care, the patient died under progressive multiple organ failure. Other patients were discharged.</p><p><strong>Conclusion: </strong>Thoracoscopic technologies allow for complete debridement of the pleural cavities and mediastinum, as well as elimination of causes of complications. Interdisciplinary interaction and trust are necessary for successful treatment of postoperative complications in cardiothoracic surgery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 12. Vyp. 2","pages":"66-71"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814466","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
[Influence of Clinical, Laboratory and Intraoperative Parameters on Postoperative Complications in Geriatric Patients with Acute Appendicitis: A Cross-Sectional Analysis]. [临床、实验室和术中参数对老年急性阑尾炎患者术后并发症的影响:横断面分析]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024111106
A Franco-Alva, J Caballero-Alvarado, C Zavaleta-Corvera

Objective: To determine the impact of clinical, laboratory, and intraoperative variables on postoperative complications in patients over 50 years of age with acute appendicitis.

Material and methods: An observational, analytical, cross-sectional study included patients over 50 years old who underwent surgery for acute appendicitis. The sample included 206 patients, and clinical, laboratory, and surgical data were collected from medical records. The Clavien-Dindo classification was used to estimate postoperative complications. Data were analyzed using SPSS software v.28.

Results: Postoperative morbidity rate was 30.09%. Clinical variables such as age, male gender, duration of illness, presence of type 2 diabetes (DM2), and arterial hypertension (HTA), along with laboratory variables such as leukocyte count, Neutrophil-to-Lymphocyte Ratio (NLR), blood glucose, creatinine, and C-reactive protein (CRP), were significantly associated with postoperative complications (p<0.05). In addition, intraoperative variables such as surgery time, ASA III score, perforated appendicitis, peritonitis, laparoscopic appendectomy and hospital stay were significantly associated with postoperative complications (p<0.05).

Conclusion: This study highlights the importance of various clinical, laboratory, and intraoperative variables in predicting postoperative complications in patients over 50 years old with acute appendicitis. ASA III score, CRP, perforated appendicitis, and surgery time are associated with postoperative complications.

摘要确定临床、实验室和术中变量对 50 岁以上急性阑尾炎患者术后并发症的影响:这是一项观察性、分析性、横断面研究,研究对象包括因急性阑尾炎而接受手术的 50 岁以上患者。样本包括 206 名患者,并从病历中收集了临床、实验室和手术数据。采用克拉维恩-丁多分类法估算术后并发症。数据使用 SPSS 软件 v.28 进行分析:术后发病率为 30.09%。年龄、男性性别、病程、是否患有 2 型糖尿病(DM2)和动脉高血压(HTA)等临床变量以及白细胞计数、中性粒细胞与淋巴细胞比值(NLR)、血糖、肌酐和 C 反应蛋白(CRP)等实验室变量与术后并发症显著相关(ppConclusion:本研究强调了各种临床、实验室和术中变量在预测 50 岁以上急性阑尾炎患者术后并发症方面的重要性。ASA III评分、CRP、穿孔性阑尾炎和手术时间与术后并发症有关。
{"title":"[Influence of Clinical, Laboratory and Intraoperative Parameters on Postoperative Complications in Geriatric Patients with Acute Appendicitis: A Cross-Sectional Analysis].","authors":"A Franco-Alva, J Caballero-Alvarado, C Zavaleta-Corvera","doi":"10.17116/hirurgia2024111106","DOIUrl":"10.17116/hirurgia2024111106","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of clinical, laboratory, and intraoperative variables on postoperative complications in patients over 50 years of age with acute appendicitis.</p><p><strong>Material and methods: </strong>An observational, analytical, cross-sectional study included patients over 50 years old who underwent surgery for acute appendicitis. The sample included 206 patients, and clinical, laboratory, and surgical data were collected from medical records. The Clavien-Dindo classification was used to estimate postoperative complications. Data were analyzed using SPSS software v.28.</p><p><strong>Results: </strong>Postoperative morbidity rate was 30.09%. Clinical variables such as age, male gender, duration of illness, presence of type 2 diabetes (DM2), and arterial hypertension (HTA), along with laboratory variables such as leukocyte count, Neutrophil-to-Lymphocyte Ratio (NLR), blood glucose, creatinine, and C-reactive protein (CRP), were significantly associated with postoperative complications (<i>p</i><0.05). In addition, intraoperative variables such as surgery time, ASA III score, perforated appendicitis, peritonitis, laparoscopic appendectomy and hospital stay were significantly associated with postoperative complications (<i>p</i><0.05).</p><p><strong>Conclusion: </strong>This study highlights the importance of various clinical, laboratory, and intraoperative variables in predicting postoperative complications in patients over 50 years old with acute appendicitis. ASA III score, CRP, perforated appendicitis, and surgery time are associated with postoperative complications.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 11","pages":"106-112"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711466","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
[Diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. Summary experience of several specialized centers]. [荧光淋巴造影在乳腺癌前哨淋巴结活检中的诊断价值。几个专业中心的经验总结]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202410149
A A Bozhok, A D Zikiryakhodzhaev, G E Kvetenadze, M V Moshurova, V O Timoshkin, M V Shomova, A E Manelov

Objective: To study the diagnostic value of fluorescent lymphography for sentinel lymph node biopsy in breast cancer.

Material and methods: The cohort study, conducted at 4 specilized centers between June 2019 and March 2024, included 333 patients with cT1-4 N0-1M0 breast cancer. 50 patients received neoadjuvant systemic therapy, 14 of them had single metastases, confirmed by cytological or histological methods, which clinically completely regressed after systemic treatment. Immediately before the operation, 1 ml (5mg) of indocyanine green was injected subareolarly or subcutaneously into the tumor projection. Fluorescence imaging was performed using various devices for ICG navigation in the open surgical field - MARS, IC-Flow, Stryker SPY-PHI, IC-GOR. In 78 patients after sentinel lymph node biopsy standard axillary lymphadenectomy was performed.

Results: Detection level was 99.1%. The average number of sentinel lymph nodes was 3.4. Metastatic lesions of sentinel lymph nodes were detected in 54 of 330 patients (16.4%). The average number of metastatic lymph nodes was 1.6; in 90.7% of cases metastases to 1-2 lymph nodes were registered. Intraoperative morphological examination revealed metastases only in 59% of cases. No systemic adverse events were recorded. The false-negative error rate in the group of patients who underwent axillary lymphadenectomy was 6.6%. The overall accuracy of fluorescent lymphography for sentinel lymph node biopsy in breast cancer was 94%.

Conclusion: The SLNB technique using fluorescence lymphography is safe and highly accurate as a stand-alone method.

目的:研究荧光淋巴造影在乳腺癌前哨淋巴结活检中的诊断价值:研究荧光淋巴造影在乳腺癌前哨淋巴结活检中的诊断价值:该队列研究于 2019 年 6 月至 2024 年 3 月期间在 4 个专科中心进行,共纳入 333 例 cT1-4 N0-1M0 乳腺癌患者。50名患者接受了新辅助系统治疗,其中14名患者有经细胞学或组织学方法证实的单发转移灶,经系统治疗后临床症状完全消退。手术前,立即在肿瘤投影部位乳晕下或皮下注射 1 毫升(5 毫克)吲哚菁绿。在开放手术区域使用各种 ICG 导航设备--MARS、IC-Flow、Stryker SPY-PHI、IC-GOR--进行荧光成像。78名患者在前哨淋巴结活检后进行了标准的腋窝淋巴结切除术:检测率为 99.1%。前哨淋巴结的平均数目为 3.4。330 例患者中有 54 例(16.4%)发现了前哨淋巴结转移病灶。转移淋巴结的平均数目为 1.6;90.7%的病例有 1-2 个淋巴结转移。只有 59% 的病例通过术中形态学检查发现了转移灶。没有系统性不良事件的记录。接受腋窝淋巴结切除术的患者中,假阴性错误率为6.6%。荧光淋巴造影用于乳腺癌前哨淋巴结活检的总体准确率为 94%:结论:作为一种独立的方法,使用荧光淋巴造影进行前哨淋巴结活检技术既安全又准确。
{"title":"[Diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. Summary experience of several specialized centers].","authors":"A A Bozhok, A D Zikiryakhodzhaev, G E Kvetenadze, M V Moshurova, V O Timoshkin, M V Shomova, A E Manelov","doi":"10.17116/hirurgia202410149","DOIUrl":"https://doi.org/10.17116/hirurgia202410149","url":null,"abstract":"<p><strong>Objective: </strong>To study the diagnostic value of fluorescent lymphography for sentinel lymph node biopsy in breast cancer.</p><p><strong>Material and methods: </strong>The cohort study, conducted at 4 specilized centers between June 2019 and March 2024, included 333 patients with cT1-4 N0-1M0 breast cancer. 50 patients received neoadjuvant systemic therapy, 14 of them had single metastases, confirmed by cytological or histological methods, which clinically completely regressed after systemic treatment. Immediately before the operation, 1 ml (5mg) of indocyanine green was injected subareolarly or subcutaneously into the tumor projection. Fluorescence imaging was performed using various devices for ICG navigation in the open surgical field - MARS, IC-Flow, Stryker SPY-PHI, IC-GOR. In 78 patients after sentinel lymph node biopsy standard axillary lymphadenectomy was performed.</p><p><strong>Results: </strong>Detection level was 99.1%. The average number of sentinel lymph nodes was 3.4. Metastatic lesions of sentinel lymph nodes were detected in 54 of 330 patients (16.4%). The average number of metastatic lymph nodes was 1.6; in 90.7% of cases metastases to 1-2 lymph nodes were registered. Intraoperative morphological examination revealed metastases only in 59% of cases. No systemic adverse events were recorded. The false-negative error rate in the group of patients who underwent axillary lymphadenectomy was 6.6%. The overall accuracy of fluorescent lymphography for sentinel lymph node biopsy in breast cancer was 94%.</p><p><strong>Conclusion: </strong>The SLNB technique using fluorescence lymphography is safe and highly accurate as a stand-alone method.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 10","pages":"49-61"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476633","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
[Factors associated with normal leukocyte count and C-reactive protein in adults with acute appendicitis: a retrospective cohort study]. [急性阑尾炎成人患者白细胞计数和 C 反应蛋白正常的相关因素:一项回顾性队列研究]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202408115
C S Yamir, J Caballero-Alvarado, K Lozano-Peralta, C Zavaleta-Corvera

Objective: To identify the factors associated with normal leukocyte count and C-reactive protein (CRP) in adults with acute appendicitis.

Material and methods: A retrospective cohort study included patients aged 18-60 years after surgeries for acute appendicitis. Convenience sampling was used to select medical records, and variables such as age, sex, weight, height, origin, self-medication, diabetes (DM2), high blood pressure (HBP), type of appendicitis, duration of illness, preoperative time, type of appendectomy, operative time, and hospital stay were analyzed. Patients were categorized into those with normal and abnormal inflammatory parameters. The SPSS version 28 software was used for analysis.

Results: We included 333 patients; 11.11% ones had normal inflammatory parameters. Both groups had mean age of approximately 33 years. Men comprised 56.76% and 57.43%in both groups, respectively. The abnormal group had shorter mean preoperative time, and catarrhal appendicitis was more common in the normal group. Multivariate analysis revealed that rural origin and self-medication were significantly associated with normal inflammatory parameters.

Conclusion: The prevalence of normal inflammatory parameters in acute appendicitis patients was 11.11%. Rural origin, self-medication, shorter preoperative time, and catarrhal appendicitis were significantly associated with normal inflammatory parameters in this context.

目的:确定急性阑尾炎成人患者白细胞计数和C反应蛋白(CRP)正常的相关因素:确定急性阑尾炎成人患者白细胞计数和 C 反应蛋白(CRP)正常的相关因素:一项回顾性队列研究纳入了 18-60 岁的急性阑尾炎术后患者。研究采用方便抽样法选取病历,分析了年龄、性别、体重、身高、籍贯、自我用药、糖尿病(DM2)、高血压(HBP)、阑尾炎类型、病程、术前时间、阑尾切除类型、手术时间和住院时间等变量。患者被分为炎症指标正常和异常两类。采用 SPSS 28 版软件进行分析:我们共纳入了 333 名患者,其中 11.11% 的患者炎症指标正常。两组患者的平均年龄约为 33 岁。男性在两组中分别占 56.76% 和 57.43%。异常组的平均术前时间较短,正常组中腹膜炎更常见。多变量分析显示,农村出身和自行用药与炎症指标正常显著相关:结论:急性阑尾炎患者炎症指标正常的比例为 11.11%。结论:急性阑尾炎患者炎症指标正常的比例为 11.11%,其中农村出身、自行用药、术前时间较短以及卡他性阑尾炎与炎症指标正常有显著相关性。
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引用次数: 0
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