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Diagnostic difficulties and therapeutic choices in intrapancreatic accessory spleen: case reports 胰腺内副脾的诊断困难及治疗选择:1例报告
IF 1 Q4 SURGERY Pub Date : 2016-03-18 DOI: 10.2147/OAS.S86394
M. Massani, P. Maccatrozzo, G. Morana, L. Fabris, C. Ruffolo, L. Bonariol, B. Pauletti, N. Bassi
because of a mass of the pancreatic tail misdiagnosed as a pancreatic neuroendocrine tumor due to its radiologic features on computed tomography and magnetic resonance imaging (MRI) (small, ovoidal, and well defined). Misdiagnosis also occurred in the second case, in which an 82-year-old woman was referred to our hospital because of a pancreatic mass of uncertain diagnosis. She also underwent an operation, and pathologic examination showed splenic parenchyma. A correct diagnosis was achieved in the remaining three cases that are still under radiologic monitoring. Discussion: IPAS is a benign entity and therefore does not require surgical treatment. We discuss the best diagnostic options that have recently been experienced, focusing on diffusion-weighted and superparamagnetic iron oxide MRI, which in our experience seem to be the safest and most easily accessible diagnostic tools. Conclusion: We suggest that a multidisciplinary approach should guide the diagnosis. When a pancreatic mass with specific features (round, ovoid, and well defined) is detected by computed tomography or MRI, an IPAS should be suspected.
由于胰腺尾部肿块在计算机断层扫描和磁共振成像(MRI)上的放射学特征(小,卵形,界限清楚)被误诊为胰腺神经内分泌肿瘤。第二个病例也发生了误诊,其中一名82岁的妇女因诊断不明确的胰腺肿块而被转介到我院。同时行手术,病理检查示脾实质。在其余三例仍在放射学监测下的病例中获得了正确的诊断。讨论:IPAS是一种良性实体,因此不需要手术治疗。我们讨论了最近经历的最佳诊断选择,重点是扩散加权和超顺磁氧化铁MRI,这在我们的经验中似乎是最安全,最容易获得的诊断工具。结论:我们建议多学科方法指导诊断。当计算机断层扫描或MRI检测到具有特定特征的胰腺肿块(圆形、卵形、轮廓清晰)时,应怀疑IPAS。
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引用次数: 2
Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions 降低胃肠道吻合口漏率:挑战与对策综述
IF 1 Q4 SURGERY Pub Date : 2016-01-22 DOI: 10.2147/OAS.S54936
Benjamin Phillips
Various techniques and interventions have been developed in an effort to obviate gas- trointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and sur - gical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following
各种技术和干预措施已经发展,以努力避免气肠吻合口泄漏。这篇综述的目的是描述潜在的修改,可以减少胃肠道手术后吻合口泄漏的风险。它也可用于帮助识别有吻合口漏风险增加的患者。讨论的可改变的泄漏危险因素包括营养不良、吸烟、类固醇使用、肠道准备、化疗、手术持续时间、使用升压药、静脉输液、输血和外科吻合技术。根据文献回顾,手术技术应包括缩短手术时间、减少缺血和使用吻合器。用大网膜支撑吻合口已被证明是食道手术的实用方法。进一步的建议包括对营养不良患者给予5-7天的免疫调节营养补充,围手术期停止吸烟,限制类固醇的使用,结肠直肠手术使用口服抗生素制剂,避免术后早期手术(4周)
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引用次数: 27
Bullet to the femoral head 子弹打中了股骨头
IF 1 Q4 SURGERY Pub Date : 2016-01-18 DOI: 10.2147/OAS.S96097
Krishna Akella, Nupur Murthy, Phoenix D Bell, A. Chendrasekhar
A bullet being lodged in the femoral head is a unique trauma situation, which can be managed either operatively or non-operatively. We present two different scenarios of a bullet being lodged in the femoral head with a discussion of both operative and non-operative manage- ment as well as diagnostic considerations.
子弹卡在股骨头中是一种独特的创伤情况,可以通过手术或非手术治疗。我们提出了两种不同的情况下,一颗子弹被卡在股骨头,并讨论了手术和非手术处理以及诊断的考虑。
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引用次数: 0
Abdominal wound closure: current perspectives 腹部伤口闭合:目前的观点
IF 1 Q4 SURGERY Pub Date : 2015-12-04 DOI: 10.2147/OAS.S60958
Z. Williams, W. Hope
: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh.
本文回顾了剖腹手术后早期和晚期的伤口并发症,特别强调了减少疝形成的技术方面。腹筋膜闭合在普通外科领域是一个变化很大的领域。腹壁切口后疝的形成仍然是一个具有挑战性的问题。腹疝修补是普通外科医生最常见的手术之一,尽管该领域的技术进步很多,切口疝的发病率仍然很高。疝气的外科治疗受到了广泛的关注和研究。尽管预防疝的形成具有明显的重要性,但人们对它的关注却很少。本文综述了切口类型、缝线类型和大小、闭合方法、患者危险因素和预防性补片的使用等因素的影响。
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引用次数: 6
Perioperative management of facial bipartition surgery 面部双隔手术的围手术期处理
IF 1 Q4 SURGERY Pub Date : 2015-11-06 DOI: 10.2147/OAS.S80036
M. Caruselli, M. Tsapis, F. Ughetto, G. Pech-gourg, D. Galante, O. Paut
: Severe craniofacial malformations, such as Crouzon, Apert, Saethre-Chotzen, and Pfeiffer syndromes, are very rare conditions (one in 50,000/100,000 live births) that often require corrective surgery. Facial bipartition is the more radical corrective surgery. It is a high-risk intervention and needs complex perioperative management and a multidisciplinary covered. including and major
严重的颅面畸形,如Crouzon、Apert、saethree - chotzen和Pfeiffer综合征,是非常罕见的情况(每5万/10万活产婴儿中有1例),通常需要手术矫正。面部双隔是更为根治的矫正手术。这是一个高风险的干预,需要复杂的围手术期管理和多学科的覆盖。包括和主修
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引用次数: 0
Decompressive craniectomy in the management of traumatic brain injury: a review of current practice 颅脑减压术治疗外伤性脑损伤:当前实践回顾
IF 1 Q4 SURGERY Pub Date : 2015-10-20 DOI: 10.2147/OAS.S52742
W. Mezue, C. Ndubuisi
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 73–83 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 73-83 Open Access Surgery Dovepress上找到
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引用次数: 5
Pilonidal sinus - challenges and solutions 毛窦-挑战和解决办法
IF 1 Q4 SURGERY Pub Date : 2015-09-25 DOI: 10.2147/OAS.S54939
A. Guner, A. Çekiç
Although it is clinically asymptomatic in some cases, pilonidal sinus disease may also present as a complicated disease, characterized by multiple sinus tracts, leading to severe impairment of patient quality of life. Although clinical studies of pilonidal sinus have been conducted for approximately a century, the gold standard for treatment is undefined. The ideal treatment requires a shorter hospital stay, requires less wound care, results in rapid recovery, maintains quality of life, and has low recurrence rates. In this review, we aim to discuss the challenges and possible solutions for the management of pilonidal sinus disease.
虽然在某些情况下临床无症状,但毛窦疾病也可能表现为一种复杂的疾病,以多窦束为特征,严重损害患者的生活质量。虽然临床研究已经进行了大约一个世纪,治疗的黄金标准是不明确的。理想的治疗方法需要较短的住院时间,较少的伤口护理,快速恢复,保持生活质量,复发率低。在这篇综述中,我们的目的是讨论的挑战和可能的解决方案,管理的毛毛窦疾病。
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引用次数: 8
Infrared parietal colorectal flowmetry: a new application of the pulse oximeter. is this method useful for general surgeons in preventing anastomotic leakage after colorectal resections? 红外线顶结肠血流仪:脉搏血氧仪的新应用。这种方法对普通外科医生预防结直肠切除术后吻合口漏有用吗?
IF 1 Q4 SURGERY Pub Date : 2015-06-18 DOI: 10.2147/OAS.S81138
R. Delfrate, Massimo Bricchi, P. Forti, C. Franceschi
Background: Anastomotic leak is a major complication of colorectal surgery. Among the causes of dehiscence, anastomotic ischemia seems to be fundamental and consequently so is the evaluation of the parietal flow. We proposed a new application of infrared flowmeter for the evaluation of the parietal flow at the stumps after colon resection. Objective: The aim of this study is to assess the feasibility of using an intraoperative intestinal wall flowmeter to assess arterial capillary flow in order to avoid the execution of anastomoses in poorly vascularized segments of bowel, and consequently to reduce the risk of anastomotic leakage. Methods: Retrospective analysis of two groups of patients with different methods of evaluation of colon resection stump vascularization. Ninety-two consecutive patients (Group A) underwent surgical colorectal resection for cancer. In this group, we used a pulse-oximetry sensor to assess the parietal flow: once the magnitude of the colon resection was established according to surgi cal and oncological criteria, the exact location of the resection was adjusted according to the parietal flowmetry curve. This method was compared with 139 consecutive colorectal resections (Group B) in which vascularization was assessed by checking the pulsatility of the mesenteric arteries, macroscopic wall resection stump appearance, and bleeding of the wall stump. The main outcome measure was the reduction in anastomotic dehiscence. Results: In Group A no anastomotic leakage occurred (0/92). Conversely, in Group B six anastomotic leaks occurred (6/139). The statistical analysis of the two groups thanks to the Fisher’s exact test shows that P,0.05, which is statistically significant. Conclusion: We tested a new application of the pulse oximeter: the evaluation of the colon parietal flow (infrared parietal flowmeter). The infrared parietal flowmetry appears to be a fea sible, simple, and low-cost method, able to detect the vascularization of the large bowel stump; for this reason this procedure appears to be useful in order to avoid a colon anastomosis of two poorly vascularized bowel stumps, thus reducing the risk of anastomotic leakage. Despite the positive results of our experience in the assessment of the intestine vascularization with the intraoperative infrared stump flowmeter, the possibility of reducing the number of anastomotic
背景:吻合口瘘是结直肠手术的主要并发症。在裂的原因中,吻合口缺血似乎是最基本的,因此对壁血流的评估也是最基本的。我们提出了一种新的应用红外流量计评估结肠切除后残端血流的方法。目的:探讨术中使用肠壁流量计评估动脉毛细血管流量的可行性,以避免在血管不通畅的肠段进行吻合,从而降低吻合口漏的风险。方法:回顾性分析两组患者用不同方法评价结肠切除残端血管成形术的效果。连续92例患者(A组)行结直肠癌手术切除。在本组中,我们使用脉搏血氧仪传感器评估结肠壁血流:一旦根据外科和肿瘤学标准确定结肠切除的大小,根据壁血流曲线调整切除的确切位置。将该方法与139例连续结直肠切除术(B组)进行比较,B组通过检查肠系膜动脉搏动性、宏观切除残端外观和残端出血来评估血管化情况。主要观察指标为吻合口裂开的减少。结果:A组无吻合口漏(0/92)。相反,B组发生6例吻合口瘘(6/139)。通过Fisher精确检验对两组进行统计分析,P,0.05,具有统计学意义。结论:我们测试了脉搏血氧仪的一种新应用:评估结肠壁流量(红外壁流量仪)。红外顶血流仪是一种可行、简单、低成本的方法,能够检测大肠残端血管化;由于这个原因,这个手术似乎是有用的,以避免结肠吻合两个血管化不良的肠残端,从而减少吻合口漏的风险。尽管我们的经验在评估肠血管化与术中红外线残端流量计积极的结果,可能性减少吻合器的数量
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引用次数: 0
Removal of excess skin after massive weight loss: challenges and solutions 大量减肥后去除多余的皮肤:挑战和解决方案
IF 1 Q4 SURGERY Pub Date : 2015-06-08 DOI: 10.2147/OAS.S62235
S. Giordano
: The advent of bariatric surgery has led to a subspecialty in plastic surgery for skin and fat contouring which remain after massive weight loss. The author discusses the preoperative assessment, surgical treatment plan, postoperative management, possible complications, and benefits of postbariatric surgery. Preoperative planning includes medical history and patient assessment. Surgical procedures for brachioplasty, upper back lift, breast reshaping, abdominoplasty, panniculectomy, lower back lift, and thigh lift are discussed. Indications, postoperative complications, and benefits are also discussed. The best candidates for postbariatric plastic surgery are those who have achieved weight loss stability with a BMI of 32 or less and who have adequate nutrition in order to heal the surgical excisions. Abdominal and truncal deformity are the most common presenting complaints in massive weight loss patients, and the procedure of choice to address this region is a body lift. Postoperative care focuses on patient safety, pri-oritizing in deep venous thrombosis (DVT) prophylaxis and seroma prevention. Postbariatric body contouring aims to correct the deformity due to the excess of skin after massive weight loss and to restore a sense of normalcy.
当前位置减肥手术的出现导致了大量减肥后皮肤和脂肪轮廓整形手术的亚专业。作者讨论了术前评估,手术治疗计划,术后处理,可能的并发症,以及减肥后手术的好处。术前计划包括病史和病人评估。讨论了肱成形术、上背部提升术、乳房重塑术、腹部成形术、胰腺切除术、下背部提升术和大腿提升术的手术方法。适应症,术后并发症和益处也进行了讨论。减肥后整形手术的最佳人选是那些体重稳定下降,体重指数在32或以下,并且有足够的营养来治愈手术切除的人。腹部和躯干畸形是大量减肥患者最常见的主诉,解决这一区域的手术选择是身体提升。术后护理的重点是患者安全,优先考虑深静脉血栓形成(DVT)预防和血清肿预防。减肥后身体轮廓的目的是纠正由于大量减肥后皮肤过多而造成的畸形,并恢复正常的感觉。
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引用次数: 3
Assessment of surgeon fatigue by surgical simulators 用手术模拟器评估外科医生疲劳
IF 1 Q4 SURGERY Pub Date : 2015-04-13 DOI: 10.2147/OAS.S77711
Khaled Tuwairqi, J. Selter, S. Sikder
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 43–50 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 43-50 Open Access Surgery Dovepress上找到
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引用次数: 6
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Open Access Surgery
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