RESUMEN
Introducción: La anatomía hepática siempre ha sido un reto por su complejidad y variabilidad. En los últimos años, el abaratamiento de los costes ha permitido la generación de modelos 3D individualizados para cada paciente que pueden facilitar el abordaje quirúrgico de las lesiones. El objetivo principal fue determinar la utilidad del modelado 3D preoperatorio para la planificación quirúrgica en pacientes con lesiones hepáticas. Métodos: Se trata de un estudio de casos de 38 pacientes intervenidos por lesiones hepáticas múltiples ocupantes de espacio, en el cual, en un grupo seleccionado, en 19 pacientes se utilizó un modelo impreso 3D para planificar la cirugía (grupo 3D) y el otro grupo sin el modelo impreso 3D (grupo control). Resultados: Se observó una diferencia de medias significativa en el número de lesiones; mayor en el grupo 3D al realizar el test de Wilcoxon (p < 0,001) y un mayor número de casos con afectación vascular en este mismo grupo al realizar Chi cuadrado Pearson (p = 0,008). El resto de variables no mostraron diferencias estadísticamente significativas. A pesar de esto, la mortalidad se redujo a 0 cuando se usan modelos impresos en 3D. Conclusión: La impresión 3D permite planear, de manera más precisa, cirugías complejas del hígado, ayuda a la inclusión y exclusión de los pacientes para la cirugía, disminuyendo el tiempo de la sala de operaciones, la posterior hospitalización y las complicaciones quirúrgicas.
Introduction: Liver anatomy has always been a challenge due to its complexity and variability. In recent years, lower costs has allowed the generation of individualized 3D models for each patient, which can facilitate the surgical approach to liver lesions. The main objective was to determine usefulness of preoperative 3D modeling for surgical planning in patients with liver lesions. Methods: Quasi-experimental before-after study. 19 cases were included in which surgery was planned using a 3D printed model (13 bilobar hepatectomies, 3 of them with vascular involvement, and 6 unilobar hepatectomies, 1 of them with vascular involvement), and another 19 cases whose planning was carried out without a 3D printed model (7 bilobar segmental hepatic resections and 12 unilobar segmental resections. None of these cases had vascular involvement). Results: A significant difference in mean lesion count was observed, higher in the group of cases when performing the Wilcoxon test (p < 0.001), and a higher number of cases with vascular involvement in the same group when performing the Pearson chi-square test (p = 0.008). The rest of the variables did not show statistically significant differences. Despite this, mortality was reduced to 0 when 3D printed models were used. Conclusion: 3D printing allows for more precise planning of complex liver surgeries, helps with the inclusion and exclusion of patients for surgery, reduces operating room time, postoperative hospitalization, and surgical complications.
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Neoplasias de los Conductos Biliares/patología , Tumor Carcinoide/patología , Neoplasias de los Conductos Biliares/cirugía , Tumor Carcinoide/cirugía , Conducto Colédoco/patología , Femenino , Humanos , Laparotomía , Imagen por Resonancia Magnética , Resultado del Tratamiento , Adulto JovenRESUMEN
No disponible
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Humanos , Femenino , Adulto , Tumor Carcinoide/complicaciones , Tumor Carcinoide/cirugía , Tumor Carcinoide , Escisión del Ganglio Linfático/métodos , Laparotomía/métodos , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares , BiopsiaRESUMEN
AIM: To report our experience with long-term outcomes after multimodal management therapy. METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed. RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stageâ I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm(3). Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search. CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Hepatectomía , Hepatoblastoma/terapia , Neoplasias Hepáticas/terapia , Terapia Neoadyuvante , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Quimioterapia Adyuvante , Preescolar , Supervivencia sin Enfermedad , Femenino , Hepatectomía/efectos adversos , Hepatectomía/mortalidad , Hepatoblastoma/sangre , Hepatoblastoma/mortalidad , Hepatoblastoma/patología , Humanos , Lactante , Tiempo de Internación , Neoplasias Hepáticas/sangre , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/mortalidad , Estadificación de Neoplasias , Estudios Retrospectivos , España , Centros de Atención Terciaria , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carga Tumoral , alfa-Fetoproteínas/metabolismoRESUMEN
No disponible
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Humanos , Metástasis de la Neoplasia , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/cirugía , Diafragma/cirugíaAsunto(s)
Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Hepatectomía/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Neoplasias del Colon Sigmoide/patología , Diafragma , Femenino , Humanos , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.