Polish Journal of Surgery最新文献_第5页

One-year cyclic therapy with rifaximin-α is effective in the treatment of SUDD (Symptomatic Uncomplicated Diverticular Disease) also in patients with a history of complicated diverticulitis 利福昔明-α一年循环治疗对有并发症憩室炎史的患者也有效

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-08-31 DOI: 10.5604/01.3001.0053.8079

A. Pietrzak, G. Rydzewska, K. Neubauer, T. Banasiewicz, W. Tarnowski

Introduction: The treatment of diverticulosis symptoms in patients with a history of diverticulitis is a challenge in everyday clinical practice. Aim: Efficacy assessment of a cyclic, year-long treatment with rifaximin-α in patients with symptomatic uncomplicated diverticular disease (SUDD) and a history of past diverticulitis. Material and methods: This study is a multicenter, retrospective, observational study involving 48 centers. The study group included patients who reported to the outpatient clinic within a month with SUDD symptoms, who had a history of diverticulitis, and who were given a cyclic rifaximin-α treatment of 2 x 400 mg/day for 7 days and then once a month for 12 months. Epidemiological and demographic data, the course of diverticulosis, the number of inflammation episodes and their diagnoses, complications, symptoms of SUDD, and its treatment were evaluated. The efficacy of rifaximin-α therapy was assessed on a 4-point scale (0 – no symptoms, 3 – severe symptoms) every 3 months, and analyzed: pain, tenderness, bloating, bowel movements, and recurrence of inflammation during the 12-month treatment. Results: 178 patients (67% women, median age 65 years [34–92]) were included in the study. The average duration of diverticulosis was 6.4 years (3–20), and 59% of patients had more than one episode of diverticulitis during this period. In total, 87% of patients had symptoms of SUDD after or between episodes of diverticulitis. Abdominal pain was the most common symptom (92%). An inflammation episode was diagnosed using imaging in 50.5% of cases, and the rest – based on typical clinical symptoms. As many as 46.2% of patients required hospitalization, and complications were diagnosed in 44% of cases. One hundred and seventy (95%) patients completed the 12-month rifaximin-α therapy. Changes in the severity of pain, abdominal tenderness, diarrhea, constipation, and bloating were assessed every 3 months. After 12 months of treatment with rifaximin-α, there was a statistically significant reduction in the severity of symptoms overall (median from 1.5 [0–3 points] to 0.2; P<0.001) and each symptom evaluated individually. Regardless of the previous diagnostic method of diverticulitis (imaging or typical clinical presentation) or its complications (e.g. perforation, abscess), treatment with rifaximin-α was equally effective. Conclusions: Cyclic therapy with rifaximin-α is effective in treating SUDD symptoms and in preventing the recurrence of symptoms, also in patients with a history of diverticulitis – regardless of how the diagnosis was made and disease complications. The extended treatment regimen leads to a gradual resolution of symptoms during 12 months of observation. Cyclic use of rifaximin-α is necessary to maintain symptom remission.

引言：有憩室炎病史的患者的憩室炎症状的治疗是日常临床实践中的一项挑战。目的：利福昔明-α对有症状的无并发症憩室病（SUDD）和既往有憩室炎病史的患者进行为期一年的周期性治疗的疗效评估。材料和方法：本研究是一项多中心、回顾性、观察性研究，涉及48个中心。研究组包括在一个月内因SUDD症状到门诊就诊的患者，有憩室炎病史的患者，以及接受2 x 400 mg/天周期性利福昔明-α治疗7天，然后每月一次，持续12个月的患者。评估流行病学和人口统计学数据、憩室病的病程、炎症发作次数及其诊断、并发症、SUDD症状及其治疗。每3个月对利福昔明-α治疗的疗效进行4分制评估（0–无症状，3–严重症状），并分析12个月治疗期间的疼痛、压痛、腹胀、排便和炎症复发。结果：178名患者（67%为女性，中位年龄65岁[34-92]）被纳入研究。憩室病的平均持续时间为6.4年（3-20年），59%的患者在此期间有一次以上的憩室炎发作。总的来说，87%的患者在憩室炎发作后或发作之间出现SUDD症状。腹痛是最常见的症状（92%）。50.5%的病例使用影像学诊断出炎症发作，其余病例基于典型的临床症状。多达46.2%的患者需要住院治疗，44%的患者被诊断出并发症。一百七十名（95%）患者完成了为期12个月的利福昔明-α治疗。每3个月评估一次疼痛、腹部压痛、腹泻、便秘和腹胀的严重程度变化。利福昔明-α治疗12个月后，症状的严重程度总体上有统计学意义的降低（中位数从1.5[0-3分]降至0.2；P<0.001），并对每种症状进行单独评估。无论以前的憩室炎诊断方法（影像学或典型临床表现）或其并发症（如穿孔、脓肿）如何，利福昔明-α治疗同样有效。结论：利福昔明-α循环治疗对SUDD症状和预防症状复发是有效的，对有憩室炎病史的患者也是有效的，无论诊断和疾病并发症如何。延长的治疗方案可在12个月的观察期内逐渐缓解症状。周期性使用利福昔明-α是维持症状缓解的必要条件。

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引用次数: 0

Comparison of clinicopathologic characteristics of Invasive Papillary Carcinoma with Invasive Ductal Carcinoma and their survival outcome 浸润性乳头状癌与浸润性导管癌的临床病理特征及其生存结果比较

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-07-26 DOI: 10.5604/01.3001.0053.7691

V. Zangouri, Negin Nourinejad, Souzan Soufizadeh Balaneji, Ali Ghaeini Hesarooeih, Seyed Amin Mousavi, Aliey Ranjbar, Morteza Amestejani, M. Ghoddusi Johari, M. Shariat, Maral Mokhtari

Background: Invasive Papillary Carcinoma (IPC) of the breast is a rare breast cancer subtype. This study aimed to evaluate the clinicopathologic characteristics of IPC of the breast, its differences from Invasive Ductal Carcinoma (IDC), and their survival outcomes.Materials and Methods: The medical records of 6599 patients were retrospectively reviewed at the Breast Disease Research Center from December 1993 to December 2021. The patients were divided into two groups: IPC and IDC. The tumor size, lymph node metastasis, pathologic stage, nuclear and histological grade, hormonal receptor status, and survival were reviewed and compared between the IPC and IDC groups.Results: Of the 6599 patients, 27 had IPC, and 6572 had IDC. The mean age of patients with IPC and IDC was 58.5 and 49 years, respectively (P=0.02). Patients with IPC were more likely to have a positive node status and had a significantly higher incidence of lymphovascular invasion (14.9% for IPCs and 53.3% for IDCs, P<0.001). ER status was positive in 66.6% of IPCs and 78.1% of IDCs (P=0.23). Additionally, 62.5% of patients with IPC and 94.9% of those with IDC received adjuvant chemotherapy (P<0.001). Disease-free survival (DFS) and overall survival (OS) were better in IPC patients for stage I (5-year DFS: 69% vs. 81%, P=0.008; 5-year OS: 75% vs. 85%, P=0.001).Conclusion: IPC is a rare tumor type that presents unique clinicopathological characteristics and is associated with a higher rate of breast-conserving surgery and a favorable prognosis than IDC

背景：乳腺浸润性乳头状癌（IPC）是一种罕见的乳腺癌亚型。本研究旨在评估乳腺浸润性乳头状癌（IPC）的临床病理特征、与浸润性导管癌（IDC）的差异以及它们的生存结果：乳腺疾病研究中心回顾性审查了 1993 年 12 月至 2021 年 12 月期间 6599 名患者的病历。患者分为两组：IPC组和IDC组。对肿瘤大小、淋巴结转移情况、病理分期、核分级和组织学分级、激素受体状态以及IPC组和IDC组的生存情况进行回顾性分析和比较：结果：在 6599 名患者中，27 人患有 IPC，6572 人患有 IDC。IPC和IDC患者的平均年龄分别为58.5岁和49岁（P=0.02）。IPC患者的结节状态更有可能呈阳性，淋巴管侵犯的发生率也明显更高（IPC为14.9%，IDC为53.3%，P<0.001）。66.6%的IPC和78.1%的IDC的ER状态为阳性（P=0.23）。此外，62.5%的IPC患者和94.9%的IDC患者接受了辅助化疗（P<0.001）。IPC患者的无病生存期（DFS）和总生存期（OS）均优于I期患者（5年DFS：69% vs. 81%，P=0.008；5年OS：75% vs. 85%，P=0.001）：IPC是一种罕见的肿瘤类型，具有独特的临床病理特征，与IDC相比，IPC患者的保乳手术率更高，预后更好。

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引用次数: 0

Prevalence of Colonic Polyps Detected by Colonoscopy in Symptomatic Patients and Comparison Between Different Age Groups. What Should Age be Considered for Investigation? 有症状患者通过结肠镜检查发现结肠息肉的患病率及不同年龄组之间的比较。检查时应考虑哪些年龄段？

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-07-11 DOI: 10.5604/01.3001.0053.3997

F. Ejtehadi, Ali Reza Taghavi, Farshid Ejtehadi, I. Shahramian, R. Niknam, Maryam Moini, Masoud Tahani

Introduction: The Burden of Colorectal cancer (CRC) as one of the most common malignancies is considerable worldwide, with 1.8 million diagnoses each year. Although it is well established that most CRCs arise from colonic polyps, guidelines and recommendations indicate different ages as starting points for endoscopic examination of the colon, either as cancer screening programs or in symptomatic patients. Most standard guidelines adapt the cut-off age of 50. However, this has been challenged by the results of recent studies. This multicentric prospective study aimed to investigate the frequency, distribution, and histopathological findings of colonic polyps in patients who underwent colonoscopy with special attention to the age group of 40–49-year-olds compared with 50–59 in the population. Material and methods: This multicentric, prospective study was designed to enroll adult patients referred to three universityaffiliated endoscopy units. As many as 723 patients met all the inclusion criteria. Data analysis was performed on endoscopic and histopathological characteristics of all detected lesions, including colonic polyps and neoplastic lesions. Results: A total of 723 patients with a mean age of 46.03 (16.8) years were included in this study. Rectal bleeding was the most frequent symptom (40.9%). One hundred and thirteen patients (15.6%) were found to have colonic polyps, and 11 cases (1.52%) of CRC were detected. Most polyps were located in the left colon (67.5%). There was no statistical difference in the prevalence of adenomatous polyps between the age group of 40–49 years and 50–59 years (P = 0.77). Detailed examination of data using receiver operating characteristic (ROC) curve analysis not only showed age is a risk factor for the presence of colonic polyps but also revealed the cut-off age of 42.5 for the presence of all types of colonic polyps (44.5 years for adenomatous polyps). Conclusion: This study has showed a similar polyp prevalence in the age group of 40-49 years as compared to 50-59. Our study suggests that appropriate colon examination should be performed at a younger age to achieve early detection of colonic polyps, specifically in patients with red flag symptoms.

导言：结肠直肠癌（CRC）是全球最常见的恶性肿瘤之一，每年有 180 万人确诊，其负担相当沉重。虽然大多数 CRC 都是由结肠息肉引起的，但指南和建议指出，作为癌症筛查项目或对有症状的患者，结肠内窥镜检查的起始年龄各不相同。大多数标准指南将截止年龄定为 50 岁。然而，最近的研究结果对此提出了质疑。这项多中心前瞻性研究旨在调查接受结肠镜检查的患者中结肠息肉的频率、分布和组织病理学结果，特别关注 40-49 岁年龄组与 50-59 岁年龄组人群的比较。材料和方法：这项多中心前瞻性研究旨在招募转诊到三所大学附属内窥镜检查室的成年患者。多达 723 名患者符合所有纳入标准。对所有检出病变（包括结肠息肉和肿瘤病变）的内窥镜和组织病理学特征进行了数据分析。结果本研究共纳入 723 名患者，他们的平均年龄为 46.03（16.8）岁。直肠出血是最常见的症状（40.9%）。113 名患者（15.6%）被发现患有结肠息肉，其中 11 例（1.52%）被检测出患有结肠癌。大多数息肉位于左侧结肠（67.5%）。40-49 岁年龄组和 50-59 岁年龄组的腺瘤性息肉发病率没有统计学差异（P = 0.77）。利用接收器操作特征曲线（ROC）分析法对数据进行的详细检查不仅表明年龄是结肠息肉出现的风险因素，而且还揭示了出现所有类型结肠息肉的分界年龄为 42.5 岁（腺瘤性息肉为 44.5 岁）。结论本研究显示，40-49 岁年龄组与 50-59 岁年龄组的息肉发病率相似。我们的研究表明，应在较年轻时进行适当的结肠检查，以便及早发现结肠息肉，尤其是有明显症状的患者。

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引用次数: 0

Principles for the use of non-steroidal anti-inflammatory drugs with proton pump inhibitors 非甾体抗炎药与质子泵抑制剂的使用原则

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-07-03 DOI: 10.5604/01.3001.0053.7274

A. Pietrzak

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in numerous areas of medicine. By inhibiting the prostaglandin synthesis pathway, they contribute to the development of injuries to the mucous membranes within the gastrointestinal tract, possibly leading to gastrointestinal bleeding. Proton pump inhibitors (PPIs) are used to prevent such events in high-risk groups. The bleeding risk is highest in patients above the age of 65, patients with a history of gastrointestinal bleeding, and patients with a history of peptic ulcer disease. The efficacy of bleeding prevention could not be proven in other groups. Notably, PPIs are associated with serious side effects, including acute kidney injury, malabsorption syndrome, and osteoporosis. Therefore, recommending the use of PPIs within the framework of prevention should be approached with caution. The widespread belief that IPP should be automatically prescribed together with NSAIDs is false and harmful to patients.

非甾体抗炎药(NSAIDs)广泛应用于许多医学领域。通过抑制前列腺素合成途径，它们有助于胃肠道粘膜损伤的发展，可能导致胃肠道出血。质子泵抑制剂(PPIs)用于预防高危人群发生此类事件。65岁以上患者、有胃肠出血史的患者和有消化性溃疡病史的患者出血风险最高。预防出血的效果在其他组中未得到证实。值得注意的是，PPIs与严重的副作用有关，包括急性肾损伤、吸收不良综合征和骨质疏松症。因此，建议在预防框架内使用PPIs应谨慎对待。人们普遍认为IPP应该与非甾体抗炎药一起自动开处方，这是错误的，而且对患者有害。

引用次数: 0

Neurological complications in patients undergoing general surgery - a literature review 普外科手术患者的神经系统并发症——文献综述

Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-06-30 DOI: 10.5604/01.3001.0053.6869

Bartosz Wilczyński, Jan Śnieżyński, Małgorzata Nowakowska, Grzegorz Wallner

Surgical procedures are extremely burdensome for patients, as in addition to complications directly related to the intervention, they expose the patient to complications resulting from the disturbance of key functions for maintaining homeostasis of the body's systems, particularly the circulatory, respiratory, and nervous systems. Furthermore, they may contribute to the exacerbation of symptoms of chronic diseases present in the patient before surgical treatment. This paper focuses on the most common possible neurological complications that may occur after surgical procedures and includes topics such as stroke, chronic pain, neuropathy, and delirium. The risk factors for neurological deficits, their known or possible etiology, the most characteristic symptoms, and potential preventive actions are discussed. The paper analyzed articles from PubMed, ResearchGate, and Scopus databases. A surgeon's knowledge of possible complications that may occur in the perioperative period enables early recognition and effective reduction of their negative impact on the patient's functioning and quality of life after surgery, contributing to better overall treatment outcomes.

手术对患者来说是极其繁重的，因为除了与干预直接相关的并发症外，它们还使患者暴露于因维持身体系统(特别是循环系统、呼吸系统和神经系统)稳态的关键功能受到干扰而导致的并发症。此外，它们可能有助于患者在手术前存在的慢性疾病症状的恶化。本文的重点是外科手术后可能发生的最常见的神经系统并发症，包括中风、慢性疼痛、神经病变和谵妄。神经功能障碍的危险因素，其已知或可能的病因，最典型的症状，和潜在的预防措施进行了讨论。该论文分析了来自PubMed、ResearchGate和Scopus数据库的文章。外科医生了解围手术期可能发生的并发症，可以早期识别并有效减少其对患者术后功能和生活质量的负面影响，有助于提高整体治疗效果。

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引用次数: 0

Results Following Stent-Graft Coverage of the Hypogastric Artery in the Management of Aortoiliac Aneurysms in Endovascular Aneurysm Repair. 结果胃下动脉支架覆盖治疗血管内动脉瘤修复中的主髂动脉瘤

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-06-13 DOI: 10.5604/01.3001.0053.6870

Paul Armatowicz, Małgorzata Szostek, Wawrzyniec Jakuczun, Maciej Skórski

Aim: The aim of our study was to assess the outcomes of stent-graft coverage of the hypogastric artery in the management of aortoiliac aneurysms with endovascular aneurysm repair (EVAR). Material and methods: From January 2013 to March 2017, a total of 93 patients with aortoiliac aneurysms were treated with EVAR, which required occlusion of one or both of the hypogastric arteries. The patients of the Department of General, Vascular, Endocrine and Transplant Surgery were included in the study continuously and all procedures were elective. Results: A total of 93 patients with aortoiliac aneurysms required a unilateral or bilateral procedure. Six patients were excluded from our study because they did not appear at their follow-up appointments. The study included 87 patients (80 men; mean age 71.9 (7.9) years, range 54-88), of which 30 had a unilateral procedure and 57 had a bilateral procedure. In 8 procedures (5.55%, n = 7) there was a type II endoleak that resolved during follow-up and required no surgical intervention. In 10 procedures (6.94%, n = 10) there was a type IB endoleak, with 8 procedures requiring surgical re-intervention in the form of an extension. In 12 procedures (8.33%, n = 9), the hypogastric artery thrombosed. Conclusion: Coverage of the hypogastric artery by stent-graft has been proven to be a safe procedure, but there is still a risk of type II endoleak. Although 5.55% (n = 7) of the procedures in our study had a type II endoleak, none required surgical intervention..

目的:我们研究的目的是评估在血管内动脉瘤修复中覆盖腹下动脉支架治疗髂主动脉动脉瘤的效果。材料和方法:2013年1月至2017年3月，在普通、内分泌和血管外科，共93例髂主动脉动脉瘤患者接受了EVAR治疗，该治疗需要闭塞一条或两条腹下动脉。患者被连续纳入研究，所有的手术都是选择性的。结果:共有93例主动脉髂动脉瘤患者需要单侧或双侧手术。6名患者因未按时随访而被排除在我们的研究之外。目前的研究包括87例患者(80名男性;平均年龄71.9(7.9)岁，范围54-88)，30例单侧手术，57例双侧手术。8例患者(5.55%，N=7)出现II型内漏，随访期间解决，无需手术干预。在10例手术中(6.94%，N=10)出现IB型内漏，其中8例手术需要以延长的形式再次进行手术干预。在12例手术中(8.33%，N=9)胃下动脉血栓形成。结论:覆盖胃下动脉的支架移植物已被证明是一种安全的手术，但仍有II型内漏的风险。在我们的研究中，虽然5.55% (N=7)的手术有II型渗漏，但没有一例需要手术干预。

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引用次数: 0

Treatment of early-stage chronic venous disease – management standards for 2023 2023年早期慢性静脉疾病治疗管理标准

Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-03-09 DOI: 10.5604/01.3001.0016.2971

Zbigniew Krasiński, Beata Krasińska

Chronic venous disease (CVD) is one of the most prevalent diseases in the world. Most patients with early-stage CVD willeventually deteriorate, which will result in an increase in treatment costs, but most importantly, a decrease in quality of life.The advances made with regard to the knowledge of the natural history and pathophysiology of CVD as well as the results ofresearch on effects of different drugs depending on the severity of the disease suggest the likely cost-effectiveness of CVDpatients being treated at an early stage of the disease. Recommendations in this group of patients may include lifestylechanges, compression therapy and venoactive drugs (VADs). Combination of ruscus, hesperidin methyl chalcone, andvitamin C is a well-established VAD presenting with anti-inflammatory effects, reducing endothelial activation and leukocyteadhesion, increasing capillary resistance and integrity and improving venous tone and performance of the lymphatic vesselsthus leading to a reduction in CVD symptoms in patients and an improvement in quality of their lifes. This article is based onthe latest guidelines regarding the management of chronic venous disease.

慢性静脉疾病(CVD)是世界上最常见的疾病之一。大多数早期心血管疾病患者最终会恶化，这将导致治疗费用的增加，但最重要的是，生活质量下降。在心血管疾病的自然史和病理生理学知识方面取得的进展以及根据疾病严重程度对不同药物效果的研究结果表明，在疾病早期治疗心血管疾病患者可能具有成本效益。这组患者的建议包括改变生活方式、压迫治疗和静脉活性药物(VADs)。ruscus、橙皮苷甲基查尔酮和维生素C联合使用是一种成熟的VAD，具有抗炎作用，降低内皮细胞活化和白细胞粘附，增加毛细血管阻力和完整性，改善静脉张力和淋巴管的性能，从而减少CVD症状，改善患者的生活质量。这篇文章是基于最新的指导方针关于慢性静脉疾病的管理。

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引用次数: 0

What are the surgical options for recurrent rectal prolapse - a retrospective single-center experience. 复发性直肠脱垂的手术选择-回顾性单中心经验。

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-02-17 DOI: 10.5604/01.3001.0016.2727

Tomasz Kościński, Krzysztof Szmyt

Objectives: Most authors highlight the absence of international guidelines in the treatment of recurrent rectal prolapse (RRP), even among coloproctologists. However, it is clearly indicated that Delormes or Thierschs surgeries are reserved for older and fragile patients, so on the other hand, transabdominal surgeries are dedicated to generally fitter patients. The aim of the study is evaluation of surgical treatment effects for recurrent rectal prolapse (RRP)Methods: The study group comprised of 20 female and 2 male patients aged from 37 to 92 years (subjected to treatment last 20 years). Initial treatment consisted of abdominal mesh rectopexy (n=4), perineal sigmorectal resection (n=9), Delormes technique (n=3), Thierschs anal banding (n=3), colpoperineoplasty (n=2), anterior sigmorectal resection (n=1). The relapses occured between 2 to 30 months.

Results: Reoperations consisted of abdominal without (n=8) or with resection rectopexy (n=3), perineal sigmorectal resection (n=5), Delormes technique (n=1), total pelvic floor repair (n=4), perineoplasty (n=1). 11 patients (50%) were completely cured. 6 patients developed subsequent RRP. They were successfully reoperated (2 rectopexies, 2 perineocolporectopexies, 2 perineal sigmorectal resections).

Conclusions: Abdominal mesh rectopexy is the most effective method for RP and RRP treatment. Total pelvic floor repair may prevent RRP. Perineal rectosigmoid resection results of less permament effects of RRP repair.

目的:大多数作者强调缺乏治疗复发性直肠脱垂(RRP)的国际指南，即使在直肠科医生中也是如此。然而，明确指出Delormes或Thierschs手术是为年长者和身体虚弱的患者保留的，而另一方面，经腹手术是为一般较健康的患者提供的。本研究旨在评价复发性直肠脱垂(RRP)手术治疗的效果。方法:研究组为女性20例，男性2例，年龄37 ~ 92岁(治疗时间近20年)。初始治疗包括腹部网状直肠固定术(n=4)，会阴sigmo直肠切除术(n=9)， Delormes技术(n=3)， Thierschs肛门捆扎术(n=3)，阴道肿瘤成形术(n=2)，前sigmo直肠切除术(n=1)。复发发生在2至30个月之间。结果:再手术包括腹部不切除(n=8)或合并切除直肠固定术(n=3)、会阴sigmo直肠切除术(n=5)、Delormes技术(n=1)、全盆底修复(n=4)、会阴成形术(n=1)。11例(50%)完全治愈。6例患者出现后续RRP。再次手术成功(2例直肠切除术，2例会阴直肠切除术，2例会阴直肠直肠切除术)。结论:腹壁补片固定术是治疗RP和RRP最有效的方法。全盆底修复可预防RRP。会阴乙状结肠直肠切除术的效果较RRP修复效果小。

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引用次数: 0

Challenges in restoring bowel continuity: An analysis of 91 patients undergoing a reversal procedure 恢复胃肠道紧张的挑战。91例接受重建手术患者的单中心分析。

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-02-17 DOI: 10.5604/01.3001.0016.2733

Maciej Borejsza-Wysocki, Adam Bobkiewicz, Witold Ledwosiński, Krzysztof Szmyt, Tomasz Banasiewicz, Łukasz Krokowicz

Introduction: The restoration of bowel continuity is associated with significant postoperative morbidity. Aim: The aim of the study was to report the outcomes of restoring intestinal continuity in a large patient cohort.Material and methods: A retrospective analysis was conducted on 91 patients with terminal stoma who were qualified for restoration of GI tract continuity between January 2015 and March 2020. The following demographic and clinical characteristics were analyzed: age, gender, BMI, comorbidities, indication for stoma creation, operative time, the need for blood replacement, the site and type of the anastomosis, and complication and mortality rates.Results: The study group was comprised of 40 women (44%) and 51 men (56%). The mean BMI was 26.8 ±4.9 kg/m2. Only 29.7% of the patients (n = 27) were at normal weight (BMI: 18.5–24.9) and only 11% (n = 10) did not suffer from any comorbidities. The most common indications for index surgery were complicated diverticulitis (37.4%) and colorectal cancer (21.9%). The stapled technique was used in the majority of patients (n = 79, 87%). The mean operative time was 191.7 ±71.4 min.Nine patients (9.9%) required blood replacement peri- or postoperatively, whereas 3 patients (3.3%) required intensive care unit admission. The overall surgical complication rate was 36.2% (n = 33) and the mortality rate was 1.1% (n = 1).Discussion: Restoration of bowel continuity is quite a demanding and complex procedure and thus should be performed by an experienced surgical team. In the majority of patients, the complication rate represents only minor complications. The morbidity and mortality rates are acceptable and comparable to other publications.

肠道连续性的恢复与术后显著的发病率相关。目的:该研究的目的是报告在一个大型患者队列中恢复肠道连续性的结果。材料与方法:回顾性分析2015年1月至2020年3月期间符合胃肠道连续性修复条件的91例末端造口患者。分析以下人口学和临床特征:年龄、性别、BMI、合并症、造口指征、手术时间、补血需求、吻合部位和类型、并发症和死亡率。结果:研究组由40名女性(44%)和51名男性(56%)组成。平均BMI为26.8±4.9 kg/m2。只有29.7% (n = 27)的患者体重正常(BMI: 18.5-24.9)，只有11% (n = 10)的患者没有任何合并症。指数手术最常见的适应症是并发憩室炎(37.4%)和结直肠癌(21.9%)。大多数患者(n = 79,87%)采用了吻合器技术。平均手术时间为191.7±71.4 min, 9例(9.9%)患者需要围手术期或术后换血，3例(3.3%)患者需要入住重症监护病房。总体手术并发症发生率为36.2% (n = 33)，死亡率为1.1% (n = 1)。讨论:恢复肠道连续性是一项要求相当高且复杂的手术，因此应由经验丰富的外科团队进行。在大多数患者中，并发症率仅代表轻微并发症。发病率和死亡率是可以接受的，与其他出版物相当。

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引用次数: 0

Prolonged thromboprophylaxis with rivaroxaban after bariatric interventions: single centre experience. 减肥干预后利伐沙班延长血栓预防:单中心经验。

IF 0.6 Q3 Medicine

Polish Journal of Surgery

Pub Date : 2023-02-17 DOI: 10.5604/01.3001.0016.2729

Volodymyr Tyselskyi, Yegor Tryliskyy, Vitaliy Poylin, Andrey Kebkalo

BackgroundVenous thromboembolism (VTE) is common after bariatric surgery and extended prophylaxis is generally recommended. Low molecular weight heparin is the most commonly used agent but requires patients to be trained to self-inject and is expensive. Rivaroxaban is an oral daily formulation approved for VTE prophylaxis after orthopedic surgery. Efficacy and safety of rivaroxaban has been confirmed in major gastrointestinal resections by several observational studies. We report a single centre experience of using rivaroxaban as an agent for VTE prophylaxis in bariatric surgery. MethodsWe performed prospective cohort study assessing safety and efficacy of rivaroxaban as a medication for VTE prophylaxis in patients undergoing bariatric surgery in a single centre in Kyiv, Ukraine. Patients undergoing major bariatric procedure received perioperative prophylaxis of VTE with subcutaneous low molecular weight heparin and then were switched to rivaroxaban for total of 30 days starting on the 4th postoperative day. Thromboprophylaxis was performed in accordance with the VTE risks derived from the Caprini score. On the 3rd, 30th, 60th day after the operation, the patients underwent ultrasound examination of the portal vein, as well as the veins of the lower extremities. Telephone interviews were conducted 30 and 60 days after the surgery to evaluate the presence of complaints which may be characteristic for VTE as well as to assess compliance with the regimen and to assess patient satisfaction. Outcomes studies were incidence of VTE and adverse events related to rivaroxaban administration.Results110 patients were included in the study from July 2019 to May 2021. The average age of the patients was 43.6 years, the average preoperative BMI was 55 (35 to 75). One hundred and seven patients (97.3%) underwent laparoscopic intervention while three patients (2.7%) underwent laparotomy. Eighty-four patients underwent sleeve gastrectomy and twenty-six patients underwent other procedures, including bypass surgery. Average calculated risk of thromboembolic event was 5-6% based on Caprine index. All patients were treated with extended prophylaxis with rivaroxaban. The average follow-up period for patients was 6 months. There were no clinical or radiological evidence of thromboembolic complications in the study cohort. Overall complication rate was 7.2%, however, only one patient (0.9%) developed subcutaneous hematoma associated with rivaroxaban not requiring intervention. ConclusionExtended postoperative prophylaxis with rivaroxaban is safe and effective in preventing thromboembolic complications in patients undergoing bariatric surgery. It is preferred by patients and further studies should be considered to further evaluate its use in bariatric surgery.

背景:静脉血栓栓塞(VTE)在减肥手术后很常见，一般推荐延长预防措施。低分子量肝素是最常用的药物，但需要训练患者自我注射，而且价格昂贵。利伐沙班是一种被批准用于骨科手术后静脉血栓栓塞预防的每日口服制剂。利伐沙班的有效性和安全性已被几项观察性研究证实。我们报告了在减肥手术中使用利伐沙班作为静脉血栓栓塞预防剂的单中心经验。方法:我们在乌克兰基辅的一个单一中心进行了前瞻性队列研究，评估利伐沙班作为预防减肥手术患者静脉血栓栓塞的药物的安全性和有效性。接受重大减肥手术的患者围手术期采用皮下低分子肝素预防静脉血栓栓塞，然后从术后第4天开始改用利伐沙班治疗，共30天。血栓预防是根据capriti评分得出的静脉血栓栓塞风险进行的。术后第3天、第30天、第60天行门静脉及下肢静脉超声检查。手术后30天和60天进行电话访谈，以评估静脉血栓栓塞的特征，以及评估治疗方案的依从性和评估患者满意度。结果研究是与利伐沙班相关的静脉血栓栓塞发生率和不良事件。结果2019年7月至2021年5月，110例患者被纳入研究。患者平均年龄43.6岁，术前平均BMI为55(35 ~ 75)。107例(97.3%)患者行腹腔镜干预，3例(2.7%)患者行剖腹手术。84名患者接受了袖胃切除术，26名患者接受了其他手术，包括搭桥手术。基于Caprine指数计算的血栓栓塞事件平均风险为5-6%。所有患者均接受利伐沙班延长预防治疗。患者平均随访6个月。在研究队列中没有临床或放射学证据表明血栓栓塞并发症。然而，总并发症发生率为7.2%，只有1例患者(0.9%)发生与利伐沙班相关的皮下血肿，无需干预。结论延长利伐沙班预防减肥手术患者术后血栓栓塞并发症安全有效。它是患者的首选，应该考虑进一步的研究来进一步评估其在减肥手术中的应用。

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引用次数: 1