RESUMO
OBJECTIVE: To assess the possibilities of fluorescent detection system in qualitative and quantitative assessment of bowel perfusion in colorectal resections. MATERIAL AND METHODS: From May to August 2023, a single-center pilot cross-sectional unblinded study with inclusion of 18 patients with colon cancer (of left-sided - 12, of right-sided - 6, mean age - 72.9 years, m/w - 61/39%) was conducted. All patients underwent laparoscopic colorectal resections with extracorporeal stage of bowel transection. The evaluation of the bowel's ICG perfusion was conducted to assist in decision making about the level of its resection. Qualitative (visual) assessment was carried out in all 18 patients, in one patient twice, quantitative assessment of perfusion was conducted in 8 patients (left-sided resections - 6, right-sided hemicolectomy - 2). The qualitative evaluation was performed in real time on the analysis of the color gradient. The time parameters and fluorescence intensity at different level proximally and distally from the resection line were quantitatively estimated: Tstart - time of occurrence of minimal fluorescence in the areas of interest after the ICG injection (sec); Tmax - time to achieve maximum fluorescence intensity after the ICG injection (sec); Tmax-start - time interval between Tstart and Tmax, Imax - level of maximum fluorescence intensity (I). RESULTS: Visual qualitative analysis of fluorescence revealed unsatisfactory perfusion characteristics (black, dark-gray color) in the area planned by the surgeon to anastomose the bowel in 3 of 18 patients (16.6%). When analyzing the quantitative data of this group of patients, there was a 2-6-fold decrease in Imax level, and one patient had an increase in Tmax-start at the level of intended resection compared to the bowel's sections in the favorable zone. In all cases, the final bowel transection was conducted in the area of good perfusion. There was no clinical evidence of anastomotic dehiscence in the study group. CONCLUSION: Intraoperative evaluation of bowel perfusion is an important component of safe anastomosis formation in colorectal surgery. The use of ICG-FA allows to conduct qualitative and quantitative assessment of tissue perfusion of the bowel in order to assist in making intraoperative decisions. Quantitative evaluation of fluorescence provides more objective information about perfusion parameters. Imax and Tmax-start are the most promising quantitative indicators of local bowel's perfusion. Nevertheless, the precise interpretation of the quantitative indicators of ICG perfusion needs to be clarified.
Assuntos
Neoplasias Colorretais , Cirurgia Colorretal , Humanos , Anastomose Cirúrgica , Fístula Anastomótica/cirurgia , Colectomia , Neoplasias Colorretais/cirurgia , Estudos Transversais , Angiofluoresceinografia , Verde de Indocianina , Perfusão , Masculino , Feminino , IdosoRESUMO
OBJECTIVE: To study diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. MATERIAL AND METHODS: The study enrolled 25 patients with breast cancer T1-2N0-1M0 between March 2023 and July 2023. Eight ones underwent neoadjuvant chemotherapy. In 3 patients, morphologically verified metastases cN1 in axillary lymph nodes regressed after treatment. After sentinel lymph node biopsy, all patients underwent standard axillary lymphadenectomy. Subareolar injection of indocyanine green 1 ml (5 mg/ml) was performed immediately before surgery. Fluorescence imaging was performed using the MARS system. RESULTS: Detection rate was 100%. Mean number of sentinel lymph nodes was 2. Metastatic lesions of sentinel lymph nodes were observed in 6 patients (24%) with micro-metastases in 2 cases. In 50% of cases, metastatic lesion did not extend beyond sentinel lymph nodes. False negative result was obtained in 1 (4%) patient. Mean number of metastases was 1.8 (max 3 in one patient). CONCLUSION: Sentinel lymph node biopsy with fluorescence lymphography is a sensitive method. The advantages of this technique are visualization of subcutaneous lymphatic vessels and skin incision for access to sentinel lymph nodes, as well as visualization of sentinel lymph nodes after skin incision.
Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/cirurgia , Linfografia , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela/métodos , Linfonodos/patologia , Excisão de LinfonodoRESUMO
OBJECTIVE: To evaluate the possibility of integrating tissue perfusion assessment techniques (ICG perfusion and imaging photoplethysmography - iPPG) into the system of intraoperative control points of laparoscopic interventions with a reconstructive component. MATERIALS AND METHODS: Quantitative assessment of ICG fluorescence and iPPG were used during 8 laparoscopically assisted interventions: gastrectomy for gastric cancer (total - 2 and distal - 1) and colorectal resections (left-sided colorectal resections - 4 and right hemicolectomy - 1). RESULTS: Four stages are presented for the assessment of tissue perfusion: initial assessment, before intestine transection, before anastomosis formation, and evaluation of anastomosis. From the point of view of the significance of clinical decision-making, the «before intestine transection¼ stage is of great importance, due to the ease of transferring the resection level to the optimal tissue perfusion zone. CONCLUSION: Integration of tissue perfusion assessment techniques into the system of intraoperative checkpoints is possible and promising.
Assuntos
Neoplasias Colorretais , Procedimentos de Cirurgia Plástica , Humanos , Anastomose Cirúrgica/efeitos adversos , Tomada de Decisão Clínica , Perfusão/efeitos adversosRESUMO
In the article we present clinical case of rare tumors of the pancreas - solid-pseudopapillary tumor. The stages of diagnostics and clinical-instrumental and morphological features. We performed spleen preserving distal pancreatectomy as a definitive treatment. The article provides a review of literature on this issue as well.
Assuntos
Pancreatectomia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Adulto , Feminino , HumanosRESUMO
The article analyzed the methods of suprapancretic lymph node dissection in laparoscopic gastrectomy which were devel- oped and applied in Japan. The authors described the details of operation technique. There were noted the advantages of medial approach for suprapancreatic lymph node dissection.
Assuntos
Gastrectomia/normas , Gastrectomia/tendências , Laparoscopia , Excisão de Linfonodo/normas , Excisão de Linfonodo/tendências , Linfonodos/cirurgia , Neoplasias Gástricas/cirurgia , Congressos como Assunto , Humanos , Metástase Linfática , PâncreasRESUMO
The authors present the case of diagnosis of low-grade adenocarcinoma of the pancreas, a man 34 years old, a long time to mask clinic chronic pancreatitis. Laboratory and instrumental investigations, including tumor markers CD 19-9, CEA, ultrasound, CT, MRI showed no reliable data for the presence of tumor. On the other hand, a young man of 34 years present credible evidence of chronic pancreatitis, in the form of a typical pain, a significant increase in serum am- ylase and lipase, and the presence of parenchymal and ductal signs of pancreatitis in visual research methods. Diagnosis of tumors, including obtaining morphological material, pre-operative pain relief were obtain by endoscopic methods. Histological examination of surgical specimens was detected a rare type of poorly differentiated adenocarcinoma of the pancreas tubulo-papillary structures, with predominant intraductal growth and a minimum depth of invasion due to pronounced fibrotic outcome variables, which leads to a complex disease diagnostics. After 1.5 years, after adequately performed surgery the patient was revealed metastases to the liver.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pancreatite Crônica/diagnóstico , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , Pancreatite Crônica/metabolismo , Pancreatite Crônica/patologiaRESUMO
The authors demonstrate the results of treatment (16 patients) with giant paraesophageal and posttraumatic diaphragmatic hernia. The article represents the main principles of operation management, key moments of the choice of access, operative techniques and also the features of the usage of modern reticular implants.
Assuntos
Diafragma/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endoscopia Gastrointestinal/métodos , Hérnia Diafragmática Traumática , Hérnia Hiatal , Herniorrafia , Idoso , Pesquisa Comparativa da Efetividade , Feminino , Hérnia Diafragmática Traumática/patologia , Hérnia Diafragmática Traumática/fisiopatologia , Hérnia Diafragmática Traumática/cirurgia , Hérnia Hiatal/patologia , Hérnia Hiatal/fisiopatologia , Hérnia Hiatal/cirurgia , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Polipropilenos/uso terapêutico , Resultado do TratamentoRESUMO
Effectiveness of endoscopic haemostatic methods for acute esophagogastric bleedings of portal genesis was analyzed. Under study there were indices of survival and mean life span of 157 patients divided into two groups: main and of comparison. Considerable improvement was established in indices of survival and mean life span in patients of the main group, where haemostatic methods were used for hemostasis. The patients of the main group had higher level of quality of life in long-term periods of follow-up, longer kept ability to work, physical activity and self-service.
Assuntos
Endoscopia Gastrointestinal/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Hipertensão Portal/complicações , Qualidade de Vida , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/psicologia , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/psicologia , Humanos , Hipertensão Portal/psicologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
The authors elucidate an experience with using multislice spiral computed tomography with the method of multiphase scanning (CT-angiography) in patients with suspected tumors of organs of the biliopancreatoduodenal zone. The proposed method allows getting information on the character of the pathological process, dissemination of the tumor lesion. It helps to decide on the strategy of treatment of the patient, to plan the operative intervention and assess the results of operative treatment.
Assuntos
Neoplasias do Sistema Biliar/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada Espiral/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Video capsule endoscopy is a safe and noninvasive, well-endurable method of the direct visual inspection of the whole of the small intestine. The most frequent indications for video capsule endoscopy are the diagnostics of latent gastro-intestinal bleedings, angiodysplasias, Crohn disease, celiac disease, syndromes of hereditary polyposis and tumors of the small intestine. The authors describe the first experience of using this new method in the domestic clinical practice. Data concerning the diagnostics of lesions of the small intestine by the method of video capsule endoscopy as well as the wide range of lesions of the mucous membrane in different diseases of the small intestine are presented.
Assuntos
Cápsulas Endoscópicas , Endoscopia por Cápsula/métodos , Enteropatias/diagnóstico , Intestino Delgado , Adulto , Idoso , Diagnóstico Diferencial , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto JovemAssuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Cirrose Hepática/complicações , Reoperação/métodos , Angiografia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Humanos , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Falha de PróteseRESUMO
The results of prophylactic endoscopic treatment of 22 patients with extrahepatic portal hypertension (main group--EPH) and 76 patients with cirrhosis of the liver (a comparison group--CL) who had had variceal bleedings were analyzed. In the EPH group permanent eradication was obtained in 14 patients (63.6%), in the CL group--in 46 patients (50.5%). With the average duration of achieving the eradication the number of sessions before achieving it proved to be greater than that for CL. Recurrent bleeding during the first month of observations was noted in 7 out of 22 patients. In most cases the sources of bleedings were postligational and postinjectional ulcers of the cardial part of the stomach. Long-term results (1-5 years) were followed-up in 14 patients. In 9 patients there was no recurrent bleeding during 2-5 years of observation. Thus, it is expedient to use endoscopic interventions as the methods of the "first line" in the complex program of secondary prophylactics of variceal bleedings in extrahepatic portal hypertension.
Assuntos
Endoscopia Gastrointestinal/métodos , Varizes Esofágicas e Gástricas/prevenção & controle , Hemorragia Gastrointestinal/prevenção & controle , Hipertensão Portal/complicações , Escleroterapia/métodos , Adolescente , Adulto , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Ligadura/métodos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
The aim of the work was to make a comparative analysis of results of treatment of patients with varicose esophago-gastric bleeding depending on using the endoscopic technologies--ligation and sclerotherapy. The investigation included 161 patients. The main group consisted of 65 patients treated with using the endoscopic technologies--ligation and sclerotherapy due to emergency indications. The comparison group included 96 patients given conservative treatment with the application of Blackmoor probe. The endoscopic methods of surgery allowed to get arrest of bleeding reliably more often (92.3 vs 67.7%, p < 0.05). The number of patients having recurrent bleedings in the main group was 2.7 times less, the intrahospital lethality--3.4 times less than in the group of comparison (p < 0.05).
Assuntos
Endoscopia , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/terapia , Escleroterapia , Doença Aguda , Algoritmos , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/cirurgia , Humanos , Hipertensão Portal/complicações , Ligadura , RecidivaRESUMO
Results of endoscopic treatment of 39 patients with acute bleeding from varicose veins of the esophagus and cardia and of 46 patients as prophylaxis of bleeding recurrence are presented. Rate of primary hemostasis in acute bleeding was 92.3%. In 3 patients with bleeding from varicose veins of cardia endoscopic treatment was not effective. In prophylactic treatment rate of bleeding recurrence during 1 year was 15.2%. A 6 month--survival was 93.3%, it depended on functional group by Child. Endoscopic methods (sclerotherapy, ligation) are effective for arrest and prophylaxis of portal bleedings.
Assuntos
Cárdia/irrigação sanguínea , Cárdia/cirurgia , Esofagoscopia/métodos , Esôfago/irrigação sanguínea , Esôfago/cirurgia , Escleroterapia/métodos , Varizes/terapia , Feminino , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Varizes/cirurgiaRESUMO
Pilot experience in Russia of transjugular intrahepatic portosystemic shunting is presented. Results of endovascular shunting in 14 patients with cirrhosis of the liver were analyzed. Four patients underwent emergency endovascular shunting when conservative treatment was not effective. Ten patients underwent elective surgery. Repeated esophagealgastric bleedings were indications for shunting. Relapse of bleeding was seen in 1 patient 5 days after surgery. Regular dopplerography permitted to reveal timely stenotic process. When stenosis of portosystemic shunt was diagnosed, ambulatory balloon dilatation of anastomosis through transjugular approach was performed. It was enough for opening of anastomosis lumen and decrease of pressure gradient.
Assuntos
Cirrose Hepática/cirurgia , Fígado/irrigação sanguínea , Derivação Portocava Cirúrgica/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portocava Cirúrgica/efeitos adversosRESUMO
The method of heterotopic transplantation of the bone marrow was used to study the influence of splenectomy and autotransplantation of the spleen onto the hemopoietic and osteogenic tissues of the bone marrow in mice. After splenectomy at early stages of the formation of the heterotopic hemopoiesis focus the amount of myelokaryocytes increased while in the stationary bone marrow population (the femur bone) their amount dropped by the same time. Autotransplantation of the spleen made the amount of myelokaryocytes equal to the level of control, but did not eliminate the effect of decrease of the mass of osteogenic tissue in the heterotopic hemopoiesis focus arising after splenectomy, which might be related with the influence of splenectomy on the stem osteogenic cells-precursors of the bone marrow.