Ulusal cerrahi dergisi最新文献

英文中文

Role of serum levels of tumour necrosis factor-like weak inducer of apoptosis (TWEAK) in predicting severity of acute appendicitis. 血清肿瘤坏死因子样细胞凋亡弱诱导剂(TWEAK)水平在预测急性阑尾炎严重程度中的作用

Ulusal cerrahi dergisi

Pub Date : 2023-06-19 eCollection Date: 2023-06-01 DOI: 10.47717/turkjsurg.2023.5747

Barış Zülfikaroğlu, Gökhan Akkurt, Merve Akın, Ferruh Kemal İşman, Ahmet Çınar Yastı, Mehmet Mahir Özmen

Objectives: One of the most prevalent abdominal crises is acute appendicitis (AA). Clinical diagnosis, even for skilled surgeons, is frequently challenging, as indicated by the high proportion of negative investigations. The purpose of this study was to see if serum TWEAK levels might be used to diagnose acute appendicitis.

Material and methods: Between June 2017 and May 2019, all patients who had surgery with the original diagnosis of AA were included in the study. TWEAK, WBC, CRP, and bilirubin levels were compared.

Results: The levels of WBC, CRP, and bilirubin were compared to pathology. All three blood indicators increased significantly in AA patients. However, no statistically significant difference in the levels of all three blood indicators was seen between individuals with simple AA and those with severe AA. TWEAK plasma concentrations were considerably greater in patients with severe AA than in the healthy control and NAA groups. TWEAK levels were significantly greater in individuals with severe AA compared to patients with simple AA.

Conclusion: Serum TWEAK levels that are elevated may be used to diagnose acute appendicitis as well as prognostic indicators for the severity of appendicitis.

目的：最常见的腹部危象之一是急性阑尾炎（AA）。临床诊断，即使是熟练的外科医生，也经常具有挑战性，正如高比例的阴性调查所表明的那样。本研究的目的是观察血清TWEAK水平是否可以用于诊断急性阑尾炎。材料和方法：在2017年6月至2019年5月期间，所有最初诊断为AA的手术患者都被纳入研究。比较TWEAK、WBC、CRP和胆红素水平。结果：WBC、CRP和胆红素水平与病理对照。AA患者的三项血液指标均显著升高。然而，在单纯性AA患者和重度AA患者之间，所有三项血液指标的水平都没有统计学上的显著差异。重度AA患者的TWEAK血浆浓度明显高于健康对照组和NAA组。与单纯AA患者相比，严重AA患者的TWEAK水平显著升高。结论：血清TWEAK升高可用于诊断急性阑尾炎以及阑尾炎严重程度的预后指标。

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引用次数: 0

Impact of curative parathyroidectomy on left ventricular functions assessed with 2D ECHO and MUGA study. 用二维超声和MUGA评价根治性甲状旁腺切除术对左心室功能的影响。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.5167

K. Abuji, D. Dahiya, A. Sood, Madan Parmar, S. Bhadada, R. Vijayvergiya, A. Behera

ObjectivesPrimary hyperparathyroidism (PHPT) is associated with increased cardiovascular morbidity and mortality with inconsistent results on the reversibility of cardiovascular changes after parathyroidectomy (PTx). The present study was undertaken to evaluate both structural and functional cardiac changes and their reversal after PTx in patients with PHPT.Material and MethodsThirty patients of symptomatic PHPT without cardiovascular risk factors were evaluated prospectively by means of 2D echocar- diography (ECHO) and Multigated Acquisition (MUGA) study before surgery and six months after curative parahyroidectomy.ResultsNine of 30 patients had hypertension which improved in two after PTx (p 0.20). Two patients had left ventricle hypertrophy on 2D ECHO pre- operatively which improved after PTx (p <0.001). Left ventricular ejection fraction (LVEF) did not show significant change before and after PTx on 2D ECHO. Nine out of 30 patients had hypertension which improved in two after PTx (p 0.20). Two patients with left ventricle hypertrophy on 2D ECHO preoperatively improved after PTx (p <0.001). Left ventricular ejection fraction (EF) did not depict significant change before and after PTx on 2D ECHO. Whereas, four out of six patients with preoperative EF <50% representing systolic dysfunction on MUGA study showed improvement after PTx. On 2D ECHO, eight patients depicted diastolic dysfunction which improved in six patients after curative surgery (p= 0.07). However, on MUGA study, 13 pa- tients presented with tTPF >180 ms indicating diastolic dysfunction, of which ten showed improvement after PTx (p= 0.007).ConclusionThe present study analyzed preoperative and postoperative cardiac function using both 2D ECHO and MUGA study. MUGA study provided a more objective assessment of the cardiac function by determining left ventricular ejection fraction and diastolic dysfunction.

目的原发性甲状旁腺功能亢进(PHPT)与心血管发病率和死亡率增加有关，甲状旁腺切除术(PTx)后心血管变化的可逆性结果不一致。本研究旨在评估PHPT患者PTx治疗后心脏结构和功能的改变及其逆转。材料与方法采用二维超声心动图(ECHO)和多门采集(MUGA)对30例无心血管危险因素的有症状的PHPT患者术前和治愈性甲状旁腺切除术后6个月进行前瞻性评价。结果30例患者中有9例高血压，经PTx治疗后2例好转(p = 0.20)。2例患者术前2D ECHO显示左心室肥厚，经PTx治疗后改善(p 180 ms提示舒张功能不全)，其中10例经PTx治疗后改善(p= 0.007)。结论采用二维超声心动图(2D ECHO)和超声心动图(MUGA)分析术前和术后心功能。MUGA研究通过测定左室射血分数和舒张功能不全提供了更客观的心功能评估。

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引用次数: 0

Esophageal perforation: diagnosis, management and decision-making - a retrospective tertiary centre study. 食管穿孔：诊断、管理和决策——一项三级中心的回顾性研究。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.5289

N. El-Sourani

ObjectivesPerforation of the esophagus is an extremely rare but life-threatening emergency associated with a high morbidity and mortality. Therefore, time-management is of utmost importance and it is crucial to have an algorithm for diagnostic methods and the subsequent decision-making process.Material and MethodsAll patients who were diagnosed with an esophageal perforation between 2010 and 2020 at our university hospital were ret- rospectively analysed. In addition to patient demographics, the diagnostic method, treatment strategy, defect size and location, etiology and mortality were recorded.ResultsA total of 27 patients were identified with an esophageal perforation. All patients were diagnosed through a computed tomography initiat- ing the treatment algorithm 18 patients underwent conservative/endoscopic treatment, while 9 patients received primary surgery for event-related complications. The overall mortality rate was 25.9%, 11.1% within the endoscopic group and 55% within the surgical group.ConclusionA timely diagnosis in cases of an esophageal perforation is of utmost importance. Therefore, every patient should undergo an emergency computed tomography (CT) with oral and intravenous contrast followed by an upper endoscopy if event-related complications are ruled out in the CT.

食管穿孔是一种极其罕见但危及生命的紧急情况，发病率和死亡率都很高。因此，时间管理至关重要，制定诊断方法和后续决策过程的算法至关重要。材料和方法对我校医院2010年至2020年间诊断为食管穿孔的所有患者进行回顾性分析。除患者人口统计外，还记录了诊断方法、治疗策略、缺陷大小和位置、病因和死亡率。结果共有27例患者被确认为食管穿孔。所有患者均通过启动治疗算法的计算机断层扫描进行诊断，18名患者接受了保守/内窥镜治疗，9名患者因事件相关并发症接受了初次手术。总死亡率为25.9%，内镜组为11.1%，手术组为55%。结论及时诊断食管穿孔是至关重要的。因此，如果CT中排除了与事件相关的并发症，每个患者都应该接受紧急计算机断层扫描（CT），并进行口腔和静脉造影，然后进行上内窥镜检查。

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引用次数: 0

Is appendectomy always the adequate treatment? Clinical manifestations of isolated actinomycosis in appendix. 阑尾切除术总是合适的治疗方法吗?孤立性阑尾放线菌病的临床表现。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.4015

Veysi Hakan Yardimci, Aytul Hande Yardimci

Isolated appendiceal actinomycosis is a rare chronic progressive suppurative infection. Causative agent in humans is gram-positive saprophytic an- aerobic bacteria, Actinomyces Israelii. Herein, it was aimed to present a case of acute appendicitis that developed in a 54-year-old female due to isolated appendiceal actinomycosis. Diagnosis of appendiceal actinomycosis causing acute appendicitis is generally performed postoperatively histopathologi- cally, and appendectomy alone is not sufficient in treatment. It is an important point that should be considered by clinicians that definitive treatment of the infection is possible by appropriate antibiotic use.

孤立性阑尾放线菌病是一种罕见的慢性进行性化脓性感染。人类的病原体是革兰氏阳性腐生需氧菌以色列放线菌。本文旨在介绍一例54岁女性因孤立性阑尾放线菌病而发生的急性阑尾炎。引起急性阑尾炎的阑尾放线菌病的诊断通常在术后进行组织病理学检查，单纯的阑尾切除术治疗是不够的。临床医生应该考虑的一个重要问题是，通过适当的抗生素使用可以最终治疗感染。

引用次数: 1

Letter to: Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: A prospective cohort study. 致:择期肠手术后早期检测血清c反应蛋白和降钙素原的序列评估:一项前瞻性队列研究。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.5340

F. Hayati, Syed Sharizman Syed Abdul Rahim, Andee Dzulkarnaen Zakaria

1 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia 2 Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia 3 Department of Surgery, Faculty of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia Letter to: Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: A prospective cohort study LETTER TO THE EDITOR Turk J Surg 2021; 37 (4): 417

1马来西亚沙巴亚庇大学医学与健康科学院外科2马来西亚沙巴亚庇亚庇亚庇大学公共卫生医学院医学与健康学系3马来西亚吉兰丹Sains大学医学科学院外科，马来西亚致：选择性肠道手术后早期检测吻合口瘘的血清C反应蛋白和降钙素原的系列评估：致编辑Turk J Surg 2021的前瞻性队列研究信；37（4）:417

引用次数: 0

Letter to: Endometriosis of the rectosigmoid colon mimicking gastrointestinal stromal tumor. 致:类似胃肠道间质瘤的直肠乙状结肠子宫内膜异位症。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.5297

Dg Marshitah pg Baharuddin, F. Hayati, N. Azizan, Andee Dzulkarmaen Zakaria

1 Department of Reproductive Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia 2 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia 3 Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia 4 Depatment of Surgery, Sains Malaysia University Faculty of Medical Sciences, Kota Bharu, Malaysia Letter to: Endometriosis of the rectosigmoid colon mimicking gastrointestinal stromal tumor LETTER TO THE EDITOR Turk J Surg 2021; 37 (4): 420-421

1马来西亚沙巴大学医学与健康科学学院生殖健康系，马来西亚沙巴州亚庇市2马来西亚沙巴市亚庇市亚庇大学医学与卫生科学学院外科，马来西亚沙巴，Sains Malaysia大学医学院外科4系，马来西亚Kota Bharu致：模仿胃肠道间质瘤的直肠乙状结肠子宫内膜异位症致编辑Turk J Surg 2021的信；37（4）：420-421

引用次数: 0

Limited upper midline incision for major hepatectomy in adults: safety and feasibility. 成人大肝切除术的有限上中线切口：安全性和可行性。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.1016/j.hpb.2021.08.439

A. Mahamid, Y. Fenig, S. Amodeo, Lucas Facciuto, Dagny Vonahrens, Omri Sulimani, T. Schiano, M. Facciuto

引用次数: 1

Rhabdomyolysis as a rare complication of bariatric surgery. 横纹肌溶解是减肥手术中一种罕见的并发症。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.3990

S. Usta, K. Karabulut

Rhabdomyolysis after bariatric surgery is a quite rare occurrence with low recognition. Due to the breakdown of striated muscle fibers, creatine kinase and myoglobin are released into systemic circulation with variable effects on renal filtering functions. Herein, it was aimed to present a patient who de- veloped rhabdomyolysis following revision bariatric surgery. This 34-year-old male patient was admitted for bariatric surgery. He had had a gastric band surgery approximately six years ago, with regain of weight starting one year after surgery gradually reaching the previous weight level. Consequently, the gastric band had been removed with open surgery three years ago. The patient had a body mass index of 69 kg/m2 as well as an incisional hernia due to previous surgery. Although initially laparoscopic sleeve gastrectomy was planned, a switch to open surgery was made due to the presence of diffuse intra-abdominal adhesions and giant incisional hernia precluding laparoscopic intervention. The total duration of surgery was 420 minutes. Postoperative laboratory work-up showed elevated blood creatine kinase (25837 U/L). Upon the failure of fluid replacement and diuretics, hemodialy- sis was initiated at postoperative day 1. Despite daily sessions of hemodialysis, acidosis did not improve, his general status worsened and the patient died on postoperative day 14. Rhabdomyolysis is a severe and potentially life-threatening complication of bariatric surgery. Its severity may vary from asymptomatic elevations of creatine kinase to death. Postoperative creatine kinase levels should be routinely checked in high-risk patients as a practical and inexpensive laboratory modality for early diagnosis.

减肥手术后的横纹肌溶解症是一种罕见的低识别率的疾病。由于横纹肌纤维的分解，肌酸激酶和肌红蛋白被释放到系统循环中，对肾脏过滤功能有不同的影响。在此，我们的目的是介绍一位在减肥手术后出现横纹肌溶解症的患者。这名34岁的男性患者接受了减肥手术。大约六年前，他做了胃束带手术，手术后一年体重开始恢复，逐渐达到以前的体重水平。因此，胃束带在三年前通过开放手术切除。患者的体重指数为69 kg/m2，并且由于之前的手术而出现切口疝。尽管最初计划进行腹腔镜袖状胃切除术，但由于存在弥漫性腹腔内粘连和巨大切口疝，无法进行腹腔镜干预，因此改为开放式手术。手术总时间为420分钟。术后实验室检查显示血肌酸激酶升高（25837U/L）。液体置换和利尿剂失败后，在术后第1天开始进行血液透析。尽管每天进行血液透析，但酸中毒没有改善，他的总体状况恶化，患者在术后第14天死亡。横纹肌溶解症是减肥手术中一种严重且可能危及生命的并发症。其严重程度可能从无症状的肌酸激酶升高到死亡不等。高危患者术后应定期检查肌酸激酶水平，这是一种实用且廉价的早期诊断实验室模式。

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引用次数: 2

Medical Research and Publishing During The Pandemic: Uncertainty and Responsibility. 大流行期间的医学研究和出版:不确定性和责任。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.99242301

K. Sarıbeyoğlu

引用次数: 0

How we do it: Laparoscopic cholecystectomy in patients with severe obesity. 治疗方法:重度肥胖患者的腹腔镜胆囊切除术。

Ulusal cerrahi dergisi

Pub Date : 2021-12-01 DOI: 10.47717/turkjsurg.2021.5452

T. Russell, S. Aroori

The number of patients with obesity is set to rise, as is the proportion with severe obesity. These patients are a high-risk subgroup who present addi- tional challenges to the surgeon when performing laparoscopic cholecystectomy. It is important that all surgeons who perform this procedure have a safe strategy they can revert to. This article outlines our approach. After obtaining pneumoperitoneum via a supra-umbilical incision, we advise placing a fascial suture before proceeding with the operation. This allows for high-quality closure, reduces the incidence of incisional hernia, and reduces the risk of inadvertent bowel injury. We also advise the repositioning of the patient on the operating table prior to port placement such that an ergonomic set-up can be achieved. In addition to standard ports, we use an additional twelve-millimetre port in the left upper quadrant. A fan retractor can be inserted via this port and used to gently retract the duodenum inferiorly. This provides adequate exposure for Calot's dissection and arguably reduces the risk of injury to a fatty liver. This technique can also be used in non-obese patients in whom Calot's dissection is particularly challenging, for instance in those who undergo delayed cholecystectomy.

肥胖患者的数量将上升，严重肥胖患者的比例也将上升。这些患者是高危亚组，在进行腹腔镜胆囊切除术时对外科医生提出了额外的挑战。重要的是，所有进行这种手术的外科医生都有一个可以恢复的安全策略。本文概述了我们的方法。通过脐上切口获得气腹后，我们建议在进行手术前进行筋膜缝合。这可以实现高质量的闭合，降低切口疝的发生率，并降低意外肠道损伤的风险。我们还建议在放置端口之前将患者重新定位在手术台上，以便实现符合人体工程学的设置。除了标准端口外，我们在左上象限还使用了一个额外的12毫米端口。扇形牵开器可以通过这个端口插入，并用于轻轻地从下方缩回十二指肠。这为Calot的解剖提供了足够的暴露，可以说降低了脂肪肝损伤的风险。这项技术也可以用于非肥胖患者，例如那些接受延迟胆囊切除术的患者。

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