Introduction. The problem of improving early diagnosis and prognosis of breast cancer remains one of the most actual for current oncological practice. Taking into account a close correlation between the general prevalence of breast neoplasms and mortality from breast cancer, this problem is not only of professional interest, but also has medical-social and socio-economic significance. The purpose of the study is to improve the quality of the sentinel lymph node detection in patients with breast cancer using ICG. Material and methods. At the period 2009–2016, 400 patients with T1-T3N0M0 breast cancer were operated on. All the patients were divided into two groups using two dyes – Patent Blue and ICG. The patients after mastectomy with a sentinel lymph node biopsy had a clinical diagnosis of T2-T3N0M0 breast cancer more often. In group I, 100 patients had the sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye. In group II, sentinel lymph nodes biopsy was conducted with the Patent Blue dye and another fluorescent dye — ICG, which was also injected on the affected side of the breast. After ICG dye introduction, in 15 minutes the stained green lymph nodes were detected using special equipment. Criteria for inclusion of patients in the clinical trial: 1) breast cancer patients of any age with T1-3N0M0, I-II AB disease stage; 2) patients with clinically unaffected lymph nodes N0 after examination. Criteria for exclusion of patients from the clinical trial: The exceptions were T3-T4 tumors > 5 cm in diameter, or the skin and chest wall invasion, as well as palpable axillary lymph nodes, 3 or more affected lymph nodes with sentinel lymph node biopsy; 3) patients after radiation therapy. Results. The tumor histology was performed after the node trephine biopsy. The main aims of sentinel nodes detection were staging and improving the breast cancer patients’ life quality after surgical treatment. The post-mastectomy syndrome, the main manifestation of which is swelling of the upper extremity is a big problem for patients because it affects their life quality and disturbs their usual lifestyle. The sentinel lymph node detection, in contrast to axillary lymph node dissection of I-II level, significantly minimizes all the risks of postmastectomy syndrome, in particular, impaired lymphatic drainage in the form of lymphatic edema of the upper extremity, impaired venous outflow in the form of stenoses or the axillary and/or subclavian veins occlusion, rough scars which limit the function of the extremity in the shoulder joint, and brachioplexitis. Conclusions. The study of sentinel lymph nodes significantly improves the results of surgical treatment of breast cancer patients. Based on the clinical-laboratory and histological examinations, new data were obtained concerning the sentinel lymph node detection using two dyes, the choice of the surgical intervention volume and reduction of complications rate at the postoperative period. We found that fluorescent lymphography is highly effective, which allows to recommend it for implementation into the clinical practice. The frequency of sentinel lymph node detection in breast cancer patients is 98% in the control group, 100% – in the main group. On the basis of the obtained results, the sentinel lymph node detection algorithm and the surgical management of patients with breast cancer was developed and implemented into practice, which allowed to reduce the number of complications with using two dyes for the sentinel lymph node detection from 19% to 2% (χ2 =15.37, p<0.001). Recurrence of breast cancer fell from 13% to 8%.
Introduction. Colorectal cancer (CRC) remains relevant occupying one of the leading places in morbidity and mortality among oncological diseases. It reaches 13.5% in the structure of tumor diseases tending to increase. The aim of the work to improve the choice of surgical treatment management and reduce the number of intraoperative and postoperative complications in rectal cancer patients. Materials and methods. 184 operated patients with rectal cancer (RC) were divided into 2 groups: 1 group (patients with stage I RC (T1-2N0M0) and 2 group (stage II RC (T3N0M0)) who were carried out intraoperative detection and examination of sentinel lymph nodes. The volume and surgical approach depended on the stage and the presence of metastases (MTS). The average period of postoperative observation was 12–60 months, taking into account early (purulent-septic complications, bleeding, intestinal perforation) and distant (recurrence of rectal cancer) complications. Results. The patients of the 1 group had no MTS lesions of sentinel lymph nodes, due to this fact the surgical intervention was limited to transanal microsurgery. Among the complications were the following: bleeding – 2.2%; intraoperative perforation of the intestinal wall – 5.6%. No purulent-septic cases, no recurrences of rectal cancer were detected. In group 2, of 94 patients, 36 (38.3%) had MTS detected intraoperatively in sentinel lymph nodes which required a low anterior rectal resection with total mesorectomectomy. Among the complications was bleeding – 6.3%. No intraoperative perforations of the intestinal wall and no purulent-septic complications were detected. Recurrence of rectal cancer was detected in 12 (13.8%) patients. Conclusions. Performing transanal endoscopic resections in patients with RC I and especially stage II is possible only under the conditions of mandatory intraoperative staining and emergency histological examination of "sentinel" lymph nodes. The extent of surgical intervention is determined on the operating table based on the results of an emergency histological examination. When MTS lesions of the mesorectal "sentinel lymph nodes" are detected, the operation should be continued with mandatory mesorectomectomy.
Objective. To study the efficacy of miniinvasive video-assisted interventions on the thyroid and parathyroid glands. Materials and methods. In a frame of the investigation accomplished in 2012-2018 yrs 50 patients were operated for nodular goiter (40) and primary hyperparathyrosis with solitary adenoma of a parathyroid gland (10). In all the patients miniinvasive video-assisted interventions were performed in accordance to procedure, proposed by P. Miccoli. Results. A pain syndrome was minimal in all the patients. Stable paresis of nn. Recurrens and parathyrosis were not observed. Transitory paresis of n. Recurrens have occurred in 2 patients. The wound infection was absent. In all the patients with primary hyperparathyrosis the calcium content have lowered down to normal or subnormal value. Stationary stay after miniinvasive operations have been reduced down to (2.2 ± 0.3) bed-days, while after open operations they constituted (5/7 ± 1.2) bed-days. While further follow-up of the patients during one year the disease recurrence was not registered. Excellent cosmetic result was obtained in majority of the patients. In 3 of them only keloid cicatrices have formatted, causing a cosmetic effect lowering. Conclusion. The procedure for miniinvasive video-assisted interventions on thyroid gland was proposed by P. Miccoli, and is still actual. It may be applied also in patients with primary parathyrosis and solitary adenoma of parathyroidal gland. But the patients must be thoroughly selected for this operative interventions.
Objective. To analyze the results of treatment of patients with retrosternal goiter. Materials and methods. During the period from 2010 to 2019, 62 patients with thoracic goiter were operated on, which was 6.2% of all patients operated in relation to goiter. There were 48 women (77.4%) and 14 men (22.6%). Age of patients varied from 21 to 87 years (average age - 47 years). Computed tomography was mandatory in terms of research. The size of the sternal goiter and the degree of operative risk were determined by G. Mercante (2011). Results. In 39 patients (1st group) the operation was performed by cervicotomy according to standard techniques. Video endoscopic support was used in 23 patients, thanks to which in 15 patients (group 2) it was able to cross all blood vessels with the help of an electro coagulator and isolate nerve structures and parathyroid glands. In 8 patients (group 3) there was a massive bleeding after attempts of finger dissection. They underwent tamponade and temporarily stopped bleeding. After that, a video endoscope was inserted into the wound and hemostasis was performed with the help of an electrocoagulation. Bleeding from the surgical wound, which required revision, was not observed. Temporary tracheostomy in the postoperative period was imposed in 3 patients, later it was closed. Hypocalcemia occurred in 12 (19.3%) patients (in 11 it was transient). Transient paresis of the recurrent nerves was observed in 3 patients of the 1st, 2 of the 2nd and 2 of the 3rd groups. Permanent paresis of the recurrent nerve occurred in only 1 patient of the 3rd group. According to histological examination, 21 patients were diagnosed with cancer (19 - papillary, 2 - follicular). They subsequently underwent standard treatment for highly differentiated thyroid cancer. Conclusions. The use of cervical access with video endoscopic support during surgery for thoracic goiter avoids performing a sternotomy, reduces blood loss and operational trauma, improves the nerve structures and parathyroid glands identification, and reduces the duration of surgery. The use of modern methods of electrocoagulation significantly expands the capabilities of endoscopic techniques.
The widely used traditional method of surgical treatment of patients with widespread purulent peritonitis failed to establish itself as universal and has a large number of disadvantages, which prompts the use of new methods of managing patients in the postoperative period in surgical practice. The case described in the work illustrates the possibilities of a successful integrated approach in the treatment of diffuse purulent peritonitis against the background of Abdominal Compartment Syndrome, which includes the «Open abdomen» and «VAC-therapy» techniques, the use of which leads to a persistent decrease in both IАP and relief of the phenomena of purulent inflammation in the abdominal cavity. Conclusions. The use of VAC-therapy in combination with the «Open abdomen» technique leads to a persistent decrease in both ICP and relief of the phenomena of purulent inflammation in the abdominal cavity.
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