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Experiencia inicial con esofagectomia mínimamente invasiva transtorácica en posición semiprono por cáncer esofágico 食管癌半前位经胸微创食管切除术的初步经验
Q4 Medicine Pub Date : 2018-01-15 DOI: 10.4067/S0718-40262018000100027
Enrique Norero, Marco Ceroni, A. Ramírez, R. Mejía, Cristian Martínez, R. Muñoz, F. Araos, Paulina González, Alfonso Díaz
Introduction: Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim: To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods: Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results: We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion: The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.
食管癌的手术治疗具有高发病率和高死亡率。引入微创入路的目的是减少术后发病率。目的:介绍半俯卧位经胸微创食管切除术(MIE)的手术方法及手术效果。材料和方法:描述性队列研究。2013年4月至2017年5月期间,接受选择性MIE治疗的癌症患者被纳入研究。记录人口统计学、围手术期、病理和生存变量。结果:我们纳入了33例患者(24例男性,年龄69岁,91%有合并症)。肿瘤主要发生在食管中下三分之一(90%)。15例(45%)患者接受了新辅助治疗。没有转开胸的病例。胃重建率为93%。颈吻合术66%,胸吻合术30%。手术时间420 (330 ~ 570)min,出血200 (20 ~ 700)cc, 90天死亡率为0%。总发病率为78%,肺炎发生率为15%,9%需要再次手术。住院时间23 (11-81)d。组织学为鳞状癌占51%,腺癌占45%。利润率为87%。淋巴结数达到30(9-45)个。总的2年生存率为68%。结论:该技术初步效果良好,无术后死亡病例。肿瘤学结果显示高比例的RO手术和足够的淋巴结计数。
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引用次数: 2
Evolución y pronóstico oncológico de fístulas anastomóticas esofágicas en el tratamiento del cáncer de esófago. Estudio comparativo según vía de ascenso de tubo gástrico 这篇文章是我们2011年拉丁美洲和加勒比研究的一部分。根据胃管上升路径进行比较研究
Q4 Medicine Pub Date : 2018-01-15 DOI: 10.4067/S0718-40262018000100019
M. Í. Braghetto, G. Figueroa, P. Sanhueza, Héctor Valladares, H. G. Cardemil, L. SolangeCortés, B. Contreras
Introduction: Post operative leaks of esophageal anastomosis after esophagectomy is a risky event associated with poor postoperative evolution. Its frequency and severity will depend mainly on surgical technical aspects. Objectives: To analyze the frequency, management and prognosis of leakage of esophageal anastomosis after esophagectomy for esophageal cancer. Material and Method: Analysis of our prospective oncologic database of patients with esophageal cancers submmitted to esofagectomy. Statistical analysis with Fisher’s exact test. Results: 34 out of 37 esophageal cancer patients were included submitted to completely invasive mini esophagectomy. Cervical anastomosis was performed in 79.4% of patients, in the remaining 20.6%, a distal esophagectomy with intrathoracic anastomosis was performed. The leak rate was 38.2% (13/34), of these, 69.2% (9/13) correspond to grade Clavien - Dindo I - II complications. The leak rate was 54.5% (6/11) for retro-sternal gastric ascensus and 43.7% (7/16) for mediastinal route, without significative difference (p = 1.0). The reoperation rate was 11.7%, being a 100% secondary to mediastinal ascensus, 3 of them were submitted to thoracoscopic toilets and an innominate vein repair. Postoperative mortality rate was 5.8%, all concentrated in the group of patients with posterior mediastinal ascensus, but without statistical difference (p = 0.26). Conclusion: Leaks are frequent in patients operated on for esophageal cancer, especially after cervical esophago-gastro-anastomosis with anterior route for ascensus. However, retro-sternal ascensus did not require re-operations, nor postoperative mortality compared to gastric ascensus through posterior mediastinum
前言:食管切除术后食管吻合口漏是一种与术后发展不良相关的危险事件。其发生频率和严重程度主要取决于手术技术方面。目的:分析食管癌切除术后食管吻合口漏的发生率、处理及预后。材料和方法:对食管癌行食管癌切除术患者的前瞻性肿瘤学数据库进行分析。用费雪精确检验进行统计分析。结果:37例食管癌患者中有34例行全侵入性小食管切除术。79.4%的患者行颈部吻合,20.6%的患者行远端食管切除术加胸内吻合。渗漏率为38.2%(13/34),其中69.2%(9/13)为Clavien - Dindo I - II级并发症。胸骨后胃登突漏率为54.5%(6/11),纵隔漏率为43.7%(7/16),差异无统计学意义(p = 1.0)。再手术率为11.7%,100%继发于纵隔上升,其中3例行胸腔镜下厕所及无名静脉修复。术后死亡率为5.8%,均集中在后纵隔上隆组,但无统计学差异(p = 0.26)。结论:食管癌手术中漏诊较多,尤其是颈食管胃吻合术前路上凸术后。然而,与经后纵隔的胃升肌相比,胸骨后升肌不需要再手术,术后死亡率也不高
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引用次数: 1
Tumores neuroendocrinos primarios de colon y recto
Q4 Medicine Pub Date : 2018-01-15 DOI: 10.4067/S0718-40262018000100053
Guillermo Bannura, Alejandro Barrera, Carlos Melo, Felipe Illanes, V. CristiánGallardo
Introduccion: La clasificacion y el manejo de los tumores neuroendocrinos (TNEs) han cambiado drasticamente en la ultima decada. Se realiza un analisis critico del manejo de los TENs colorrectales primarios intervenidos en nuestro centro a la luz de la nueva clasificacion. Material y Metodo: Analisis retrospectivo de los resultados del tratamiento quirurgico radical de este tipo de lesiones en un periodo de 15 anos. Resultados: Se trata de 10 pacientes, con un promedio de 56 anos (extremos 48-76), 6 ubicados cercanos a la valvula ileocecal (VIC) que se presentaron con un cuadro de obstruccion intestinal incompleto y tres en el recto (2 polipos) y un polipo en colon sigmoides. La cirugia efectuada incluye cuatro resecciones anteriores y seis colectomias derechas (con reseccion de una metastasis hepatica en 1 caso). La mediana de seguimiento fue de 78,3 meses (extremos 8-180), durante el cual dos pacientes fallecen por metastasis a distancia. Conclusion: Los TNEs ubicados en el colon habitualmente se presentaron como grandes masas tumorales cercanos a la VIC, lo que proporcionalmente no ocurre con las lesiones del rectosigmoides que son diagnosticados mas precozmente como polipos o lesiones submucosas. Algunos tumores de bajo grado muestran un compromiso avanzado en la pared y/o los linfonodos regionales lo que justifica la reseccion radical y/o la quimioterapia adyuvante. A la luz de esta experiencia, es necesario complementar el grado del tumor OMS 2010 (Ki-67 y numero de mitosis) con el estadio TNM para caracterizar adecuadamente los TNEs, lo que influye en el manejo multidisciplinario.
摘要:神经内分泌肿瘤的分类和治疗在过去十年中发生了巨大的变化。根据新的分类,对我院原发性结直肠TENs的处理进行了批判性分析。本研究的目的是评估根治性手术治疗的有效性,并评估根治性手术治疗的有效性。结果:10例患者,平均年龄56岁(48-76岁),6例位于回肠瓣(VIC)附近,表现为不完全肠梗阻,3例在直肠(2例息肉),1例在乙状结肠。手术包括4例既往切除和6例右侧结肠切除术(1例切除肝转移)。随访中位数为78.3个月(结束8-180个月),其中2例患者因远处转移而死亡。结论:在结肠中发现的TNEs通常表现为VIC附近的大肿块,而在早期诊断为息肉或粘膜下病变的直肠乙状结肠中则没有。一些低级别肿瘤表现为晚期壁累及和/或区域淋巴结,需要根治性切除和/或辅助化疗。根据这一经验,有必要补充OMS 2010肿瘤分级(Ki-67和有丝分裂数)与TNM分期,以充分描述tnn,这影响了多学科治疗。
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引用次数: 3
Análisis de susceptibilidad antimicrobiana y hallazgos microbiológicos: perfil en cirugía abdominal de urgencia 抗菌敏感性分析和微生物学发现:紧急腹部手术概况
Q4 Medicine Pub Date : 2018-01-15 DOI: 10.4067/S0718-40262018000100013
Katya Carrillo, Sebastian Pedraza Lopez, Gunther Bocic, Mario Luppi, Fernanda Ávila, Roberto Olivares, Felipe Bocic, M. Abedrapo, Rodrigo Azolas, Antonella Sanguineti, M. Díaz, J. L. Llanos
Background: Antimicrobial resistance is a worldwide problem. In patients requiring emergency surgery, antibiotics are an important assistance additional to surgical intervention. Objective: Analize peritoneal fluid cultures obtaines from patients who underwent emergency surgery. Methods: A prospective cohort of emergency abdominal surgical patients were enrolled. Peritoneal fluid cultures were taken and processed according to standarized technique. Results: A 39.4% of positive cultures was found. E. coli was the most common bacteria identified. Five positive cultures for P. aeruginosa stand out. E. coli had 25% resistance to ampicillin/sulbactam and 19% for quinolones. Conclusion: Resistance found was lower than international reports, but still noteworthy. Knowledge of local bacteria profile and antimicrobial resistance is important for local antibiotic hospital policy.
背景:抗菌素耐药性是一个世界性的问题。在需要紧急手术的患者中,抗生素是手术干预之外的重要辅助手段。目的:分析急诊手术患者腹膜液培养结果。方法:对急诊腹部手术患者进行前瞻性队列研究。取腹膜液培养液,按标准化工艺处理。结果:培养阳性率为39.4%。大肠杆菌是最常见的细菌。五个铜绿假单胞菌阳性培养突出。大肠杆菌对氨苄西林/舒巴坦的耐药率为25%,对喹诺酮类药物的耐药率为19%。结论:发现的耐药性低于国际报道,但仍值得注意。了解当地细菌概况和抗菌素耐药性对当地抗生素医院政策很重要。
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引用次数: 1
Hernia umbilical en pacientes cirróticos con ascitis. ¿Tratamiento conservador o quirúrgico? 肝硬化腹水患者脐疝。保守治疗还是手术治疗?
Q4 Medicine Pub Date : 2018-01-15 DOI: 10.4067/s0718-40262018000100079
Doyler Cubas-García, J. Galvez-Olortegui, José Caballero-Alvarado, P. Delgado-Guillena, Edward Chávez-Cruzado
Ascites is the most common complication in patients with liver cirrhosis. Umbilical hernias (HU) occur in 20% of these patients and 40% in those with severe ascites. HU occurs due to increased intra-abdominal pressure, weakening of the abdominal fascia and loss of muscle mass. In addition, they have a tendency to enlarge rapidly and present high risk of complications that threaten the patient’s life. The treatment of the uncomplicated HU is controversial, both the surgical management (herniorrhaphy) and the conservative management (control of ascites) present high rate of complications, consequently high morbidity and mortality. Currently, umbilical herniorrhaphy is recommended with prior control of ascites in uncomplicated HU management, it reduces the risk of surgical wound infection, evisceration, ascites drainage, peritonitis, and it reduces up to 41% of HU recurrence. The success of this approach also depends on the degree of liver dysfunction. The treatment of complicated HU is surgical (herniorrhaphy without mesh), with lower mortality rate compared to conservative management. Studies reveal advantages of umbilical herniorrhaphy laparoscopy (minimally invasive and stress-free) compared to open surgery; however there is still no evidence about it.
腹水是肝硬化患者最常见的并发症。脐疝(HU)发生率为20%,严重腹水发生率为40%。HU的发生是由于腹内压力增加,腹筋膜减弱和肌肉量减少。此外,它们有迅速扩大的趋势,并呈现威胁患者生命的并发症的高风险。无并发症HU的治疗存在争议,无论是手术治疗(疝修补)还是保守治疗(控制腹水)都存在高并发症发生率,从而导致高发病率和死亡率。目前,在无并发症的HU治疗中,建议在事先控制腹水的情况下进行脐疝修补术,这样可以降低手术伤口感染、内脏取出、腹水引流和腹膜炎的风险,并可降低高达41%的HU复发率。这种方法的成功还取决于肝功能障碍的程度。复杂性HU的治疗是手术(无补片疝修补术),与保守治疗相比死亡率较低。研究表明,与开放手术相比,腹腔镜脐疝修补术(微创和无压力)具有优势;然而,仍然没有证据证明这一点。
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引用次数: 0
Comité Científico de la Sociedad de Cirujanos de Chile. Enmendando el rumbo 智利外科医生协会科学委员会。改变航向
Q4 Medicine Pub Date : 2018-01-01 DOI: 10.4067/S0718-40262018000100007
Mario Uribe
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引用次数: 0
El recuperador celular y necesidad transfusional en pacientes intervenidos de cirugía cardíaca 心脏手术患者的细胞恢复和输血需求
Q4 Medicine Pub Date : 2018-01-01 DOI: 10.4067/s0718-40262018000100040
M. Luque-Oliveros
{"title":"El recuperador celular y necesidad transfusional en pacientes intervenidos de cirugía cardíaca","authors":"M. Luque-Oliveros","doi":"10.4067/s0718-40262018000100040","DOIUrl":"https://doi.org/10.4067/s0718-40262018000100040","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"26 1","pages":"40-45"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87780484","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
Incidencia de tromboembolismo venoso en cirugía ortognática 正颌手术中静脉血栓栓塞的发生率
Q4 Medicine Pub Date : 2018-01-01 DOI: 10.4067/S0718-40262018000500418
G. A. Campolo, I. T. Rioseco, E. Goñi, D. Vargas, S. Ramírez
{"title":"Incidencia de tromboembolismo venoso en cirugía ortognática","authors":"G. A. Campolo, I. T. Rioseco, E. Goñi, D. Vargas, S. Ramírez","doi":"10.4067/S0718-40262018000500418","DOIUrl":"https://doi.org/10.4067/S0718-40262018000500418","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"30 1","pages":"418-424"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91233463","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: 1
Apendicectomía laparoscópica por sistema «glove port»: nuestros primeros 100 casos 腹腔镜阑尾切除术“手套端口”系统:我们的前100例病例
Q4 Medicine Pub Date : 2017-12-01 DOI: 10.1016/J.RCHIC.2017.05.004
José Felipe Reoyo Pascual, Raquel León Miranda, Carlos Cartón Hernández, E. A. Alonso, R. Castro, J. Manuel
{"title":"Apendicectomía laparoscópica por sistema «glove port»: nuestros primeros 100 casos","authors":"José Felipe Reoyo Pascual, Raquel León Miranda, Carlos Cartón Hernández, E. A. Alonso, R. Castro, J. Manuel","doi":"10.1016/J.RCHIC.2017.05.004","DOIUrl":"https://doi.org/10.1016/J.RCHIC.2017.05.004","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"15 1","pages":"467-471"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82453769","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
Biopsia videotoracoscópica de nódulo pulmonar guiada por imágenes con arpón
Q4 Medicine Pub Date : 2017-12-01 DOI: 10.1016/J.RCHIC.2017.03.002
N. Parra, S. Ortega, M. Cáceres, C. Pérez
{"title":"Biopsia videotoracoscópica de nódulo pulmonar guiada por imágenes con arpón","authors":"N. Parra, S. Ortega, M. Cáceres, C. Pérez","doi":"10.1016/J.RCHIC.2017.03.002","DOIUrl":"https://doi.org/10.1016/J.RCHIC.2017.03.002","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"47 1","pages":"438-440"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78224346","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
期刊
Revista Chilena De Cirugia
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