Стандартом лечения мышечно-инвазивного РМП является радикальная цистэктомия [1, 3]. По стати-стическим данным у 57 % больных, которым выпол-нена радикальная цистэктомия, имеется первичная мышечная инвазия [2, 16]. Около 30 % пациентов с мышечно-инвазивным РМП на момент выявления за-болевания имеют недиагностированные отдаленные метастазы, а 25 % больных подвергаются радикаль-ному оперативному лечению при уже имеющемся по-ражении лимфатических узлов [13, 14].Радикальная цистэктомия предполагает регио-нарную лимфодиссекцию. Тазовая лимфаденэктомия позволяет уменьшить риск местного рецидива и по-тенциально улучшить раково-специфическую выжи-ваемость. По данным литературы, прогностическое Проводилась оценка результатов применения преперитонеальной блокады у больных после радикальной цистэктомии.Исследовали 126 пациентов в возрасте от 31 до 74 лет с РМП, которым выполнена радикальная цистэктомия в Областном онкологическом диспансере г. Липецка в период с 2005 по 2016 год. Больные были разделены на две группы в зависимости от способа обезболивания в послеоперационном периоде. В 1-й группе (n=96) при-менялась только системная анальгезия. Во второй группе (n=30) наряду с системной анальгезией проводили преперитонеальную блокаду. Эффективность послеоперационной анальгезии определяли с помощью ВАШ.Из ранних послеоперационных осложнений в обеих группах чаще наблюдалась динамическая кишечная непроходимость. Во второй группе больных выявлено снижение динамической кишечной непроходимости до 10 %, раневые воспалительные осложнения наблюдались в 2 раза реже, чем в первой группе.Таким образом, радикальная цистэктомия позволяет получить удовлетворительные функциональные ре-зультаты. Однако количество послеоперационных осложнений остается высоким. Для снижения и профилак-тики послеоперационных осложнений у больных после радикальной цистэктомии при РМП эффективно при-менение преперитонеальной блокады. Ключевые слова: рак мочевого пузыря, радикальная цистэктомия, послеоперационные осложнения, по-слеоперационная анальгезияThe article presents the immediate results of preperitoneal blockade in patients with bladder cancer after radical cystectomy. 126 patients aged 31-74 years with bladder cancer who underwent radical cystectomy at the Lipetsk Regional Oncological Dispensary between 2005 and 2016 were examined. Patients were divided into two groups depending on the method of analgesia in the postoperative period. In the first group (n=96) only systemic analgesia was used. In the second group (n=30) along with systemic analgesia a preperitoneal blockade was performed. The efficacy of postoperative analgesia was assessed by VAS.Dynamic intestinal obstruction prevailed among early postoperative complications in both groups. The second group of patients showed a decrease in dynamic intestinal obstruction to 10 %, wound inflammatory complications were observed 2 times less often than in the first group.In conclusion, radical cystectomy in patients with bladder cancer allows obtaining satisfactory functional results. However, the number of ...
The results of the original method of colostomy formation in 67 patients with acute large bowel obstruction (ALBO) were studied. All patients underwent sigmoid colon resection with the colostomy formation. In total, postoperative complications of a purulent-inflammatory nature (skin maceration, suppuration of postoperative and paracolostomic wounds, necrosis of colostomy, abscess of the abdominal cavity, and paracolostomal fistula) in both groups were observed in 30 (44.8%) patients. In Group 1 (n=40), with the classical method of colostomy formation, purulent-inflammatory complications were observed in 21 (52.5%) patients, in Group 2 (n=27) with the original method of colostomy formation in 4 (14.8%) patients. Bleeding from colostomy and colostomy prolapse occurred only in Group 1 in 8 (20%) patients. The proposed method of applying a colostomy helps reduce purulent-inflammatory complications by more than 3 times and provides prevention of bleeding and colostomy prolapse.
Background: Lung cancer is one of the most common cancers in the world. The main objective of our study was to analyze the results of the surgical treatment of non-small cell lung cancer (NSCLC) in patients of different age groups. Methods and Results:We examined 280 patients (262/93.6% men and 18/6.4% women) aged from 39 to 75 years with NSCLC who underwent surgical treatment in the Ulyanovsk Regional Oncology Center in the period from 2010 to 2016. The mean age of patients was 64.9±10.1 years. Concomitant diseases were identified in 256(91.4%) patients: cardiovascular diseases in 170(60.7%), chronic obstructive pulmonary disease in 147(52.5%), lower extremity peripheral artery disease (stages II and III chronic ischemia) in 49(17.5%), a combination of concomitant pathology in 110(39.3%) patients. A total of 85(30.4%) pneumonectomies were performed, 56 of them in patients of young and middle age. Among early postoperative complications, the most frequent complications were purulent-inflammatory complications of the soft tissues of wounds (38.5%) and bronchopleural fistula (31.1%). The most severe complications, such as myocardial infarction, acute stroke, and acute limb ischemia, developed in patients with concomitant cardiovascular diseases, which caused the postoperative mortality of 4.6%. There were no statistically significant differences in the structure of postoperative complications depending on sex and age.
In the current study, we describe a clinical case of the right upper lobectomy at Situs inversus totalis (SIT). Our report is the first described case in the domestic literature of SIT in a patient with multiple primary metachronous cancer, when a patient with SIT had primary lung cancer and successful surgical treatment. SIT is a complex and extremely rare clinical situation for the surgeon. In all such patients, it is advisable to use all available methods of imaging and diagnosis in the preoperative period, to clarify the anatomical structure of the vascular bed and bronchial tree.
Background.In 30% of acute destructive appendicitis, the disease is accompanied by typhlitis, which makes it difficult to perform classical methods of appendiceal stump treatment.Aim of study.To improve the way of appendiceal stump treatment in the destructive form of acute appendicitis complicated by significant typhlitis.Material and methods.We studied 57 cases of acute destructive appendicitis complicated by typhlitis, which were divided into two groups depending on the method of treatment. The first group (comparison group) consisted of 30 patients who underwent a standard method for treating the appendiceal stump after appendectomy, such as ligation at the base and putting the stump into the cupula of the cecum and fixing it with interrupted serous-muscular sutures or with a purse and Z-shaped sutures. The second (main) group included 27 patients, who were treated by the method we proposed. The essence of the method is successive U-shaped stitching of the stump. After that, the stump curls in the form of a cochlea, peritonizes, reaching the necessary tightness without going into the cupula of the cecum. In this case, the abdominal cavity of patients in both groups was adequately sanitized and drained.Results.In the first group of patients there were technical difficulties associated with immersion of the appendiceal stump, which caused the serous damage, hematoma of the cupula of the cecum in 7 (23.3%) patients. In the second group of patients, due to the developed method of forming the appendiceal stump, technical difficulties did not arise, there were no complications. The duration of appendectomy in the first group of patients with standart treatment (interrupted serous-muscular sutures or purse and Z-shaped stiches) was 28.7±5.4 minutes, and in the second group of patients appendectomy with stump management with the suggested method lasted 20.3±6.1 minutes, p <0.05, which reduced the operation time by 8 minutes on the average. Purulent-inflammatory wound complications in the first group were detected in 7 patients (23.3%), and in 1 (3.7%) patient of the second group, which is significantly less by 19.6%.Conclusion.The proposed method is technically simple, as peritonization of the stump is performed without putting it into the cupula of the cecum. The use of this method is indicated in destructive forms of acute appendicitis complicated by severe typhlitis, which significantly reduces the operation trauma and contributes to reduction in the number of postoperative wound purulent-inflammatory complications by 19.6%. Findings The proposed method for treating the appendiceal stump during appendectomy for acute destructive appendicitis complicated by typhlitis is simple enough, reliable, characterized by low traumatism and shortens the duration of surgery by 8 minutes on the average (p <0.05).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.