The introduction of minimally invasive technologies, new thermal surgical instruments changed management of NPE patients, reduced the number of traumatic open procedures. So, improved outcomes were achieved.
Voice alterations after thyroidectomy with mobile vocal folds are common. Ultrasonography has been used to assess the mobility of the vocal folds after thyroidectomy. Fifty-four patients underwent thyroidectomy. Indirect laryngoscopy, ultrasonography, and GRBAS (grade, roughness, breathiness, asthenia, strain) scoring were performed preoperatively, 3 days, 2 and 6 months, postoperatively. On the third postoperative day, the mobility of the vocal folds was preserved in 52 patients and pareses were recorded in 2 patients. All patients after thyroidectomy noted the presence of voice alteration in the absence of the postoperative paresis of the vocal folds. On the third postoperative day, the voice was impaired by all criteria of the GRBAS scale, but mainly due to roughness (85%). Sixth month postoperatively, 62% of the subjects considered the voice to be altered. Asthenia was observed in 39%. On the third postoperative day indirect laryngoscopy revealed the unchanged vocal folds, the edema and the shortening of one of the vocal folds in 56%, 42%, and 1.9%. Six months postoperatively, the vocal folds returned to their original form. Indirect laryngoscopy and ultrasonography had 100% concordance in assessing the mobility of the vocal folds. Patients with edema of the vocal folds had a significantly higher mean GRBAS grade than patients without edema. The mean GRBAS score decreased from 3.36 to 0.90, 3 days and 6 months, postoperatively. Voice alteration after thyroidectomy is always present. Postoperative edema represents a likely main cause of voice alteration and resolves within 6 months. Ultrasonography is recommended as alternative to indirect laryngoscopy in assessing of the vocal folds after thyroidectomy.
ВведениеЗа последние 18 лет нами приобретен некото-рый опыт в лечении рубцовых стенозов трахеи. Не-обходимость в освоении этого раздела хирургии бы-ла продиктована неуклонно возрастающим количе-ством пациентов (по данным разных авторов, от 0,2 до 25% всех больных, которым проводилась интуба-ция или трахеостомия) с постинтубационными и посттрахеостомическими стенозами [1,2]. Основ-doi: 10.17116/hirurgia20161231-36 Лечение трахеальных и ларинготрахеальных рубцовых стенозов и рестенозов д.м.н., проф. О.О. яСнОГОрОдСКий*, д.м.н., проф. а.м. ШуЛутКО, д.м.н. т.п. пинЧуК, м.в. таЛдыКин, к.м.н. а.С. КаЧиКин, к.м.н. Ю.а. КатанЭ, к.м.н. а.Ю. мОиСеев, Ю.в. ГурьянОва, к.м.н. Ф.н. наСирОв университетская клиническая больница №4 кафедры факультетской хирургии №2 (зав. -проф. а.м. Шулутко) лечебного факультета первого московского государственного медицинского университета им. и.м. Сеченова, москва, россия Цель исследования -поиск путей улучшения результатов лечения больных с рубцовыми стенозами трахеи за счет при-менения в лечебном комплексе различных способов реканализации в сочетании с циркулярной резекцией. Материал и методы. Оперированы 57 пациентов с рубцовыми стенозами трахеи, из которых у 2 был посттравматический стеноз, у 27 -постинтубационный, у 25 -посттрахеостомический и у 3 -рестеноз, развившийся в различные сроки после циркулярной резекции, выполненной ранее. в 5 наблюдениях стеноз трахеи сочетался с трахеопищеводным свищом, в 1 -с загрудинным узловым зобом, в 8 -с незакрывшейся трахеостомой и в 3 -с длительно существовавшей ларин-готрахеофиссурой. Среди больных было 25 женщин и 32 мужчины в возрасте от 15 до 65 лет. у 66,6% протяженность стеноза составляла от 3,0 до 4,5 см. Со стенозом в стадии субкомпенсации (d=0,5-0,7 см) поступило 13 (22,8%) больных и с декомпенсированным стенозом (d<0,5 см), в сочетании с гнойным трахеобронхитом -44 (77,2%), что потребовало эндохирургической реканализации с эндостентированием либо баллонной дилатации. 45 пациентам выполнена резекция верхней трети трахеи, 9 -средней трети, 3 -верхней трети и резекции перстневидного хряща. протяженность резеци-рованного участка составила от 2,5 до 9,5 см. в 5 наблюдениях одномоментно ушит дефект передней стенки пищевода. Результаты. полного восстановления просвета трахеи удалось добиться у 54 (93%) пациентов, у 4 (7%) развился рестеноз (3 выполнена ререзекция с хорошими результатами и 1 -эндостентирование). Выводы. Оптимальным методом лечения рубцового стеноза трахеи является ее циркулярная резекция. Эндохирургическая реканализация сохраняет свое значение как метод подготовки к радикальной операции. Aim. to improve treatment of patients with cicatricial tracheal stenosis using different methods of recanalization and circular resection. Material and methods. Analysis involved 57 patients with cicatricial tracheal stenosis including 2 post-traumatic cases, 27 post-intubation cases, 25 cases after tracheostomy and 3 restenoses after previous circular resection. there were 5 cases of tracheal stenosis combined with tracheoesophageal fistula, 1 p...
The current military-political situation around Russia demonstrates how important a well-coordinated, effective mechanism for preparing replacements is for the active army. The study of historical experience in creating a system of training a military-trained reserve is more relevant than ever and is of fundamental importance for the defense capability of our state. The article is devoted to the study of regional aspects of the formation of spare parts and units for the Red Army on the territory of the Middle Volga region during the Civil War of 1918-1920. The choice of time and territorial framework is not accidental, the fact is that the Eastern Front was the main one for the young Soviet Republic from 1918 to 1919. It was there, in the extreme conditions of war, economic devastation, surrounded by white armies and interventionist troops, local military authorities, army command, civil and party organizations tested government decisions to create a system of training and manning the active army with human reserves. In the course of the analysis, it was established how significant the influence of personalities on this process was. The author comes to the conclusion that it was possible to ensure not only quantitative, but also qualitative indicators of the replenishments sent to the front, to eliminate the problems associated with their provision with everything necessary only with the formation of the Reserve Army of the Republic.
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