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1.
BMC Surg ; 21(1): 74, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33541328

RESUMO

INTRODUCTION: Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value. OBJECTIVES: To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors. METHODS: Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant. RESULTS: 388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes. CONCLUSIONS: In a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.


Assuntos
Drenagem/instrumentação , Cuidados Intraoperatórios/métodos , Transplante de Rim/métodos , Complicações Pós-Operatórias/prevenção & controle , Drenagem/efeitos adversos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Transplantados , Resultado do Tratamento , Cicatrização
2.
Br J Radiol ; 94(1120): 20200879, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33529044

RESUMO

Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.


Assuntos
Cateterismo/efeitos adversos , Colestase/terapia , Drenagem/efeitos adversos , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Radiologia Intervencionista/educação , Angiografia , Ductos Biliares/diagnóstico por imagem , Cateterismo/métodos , Colangiografia , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Drenagem/métodos , Fluoroscopia , Hemorragia/etiologia , Humanos , Internato e Residência , Punções , Radiologia Intervencionista/métodos , Ultrassonografia
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431462

RESUMO

Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.


Assuntos
Adenocarcinoma Mucinoso/complicações , Antibacterianos/administração & dosagem , Colangite/terapia , Drenagem/instrumentação , Icterícia Obstrutiva/etiologia , Neoplasias Pancreáticas/complicações , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patologia , Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colangite/diagnóstico , Colangite/etiologia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Feminino , Humanos , Icterícia Obstrutiva/terapia , Pessoa de Meia-Idade , Mucinas/metabolismo , Invasividade Neoplásica , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Stents , Resultado do Tratamento
6.
Anticancer Res ; 41(1): 403-408, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419837

RESUMO

BACKGROUND/AIM: Drains are frequently placed at the time of distal pancreatectomy (DP) to evacuate pancreatic juice and intra-abdominal exudate and obtain information on abdominal cavity status. However, the timing of drain removal remains debatable. Meanwhile, prolonged drain placement might increase the risk of postoperative pancreatic fistula (POPF), with a prevalence of 5-40%. Therefore, we examined the effect of removing the drain within postoperative day (POD) 3 on the risk of POPF development. PATIENTS AND METHODS: A total of 108 consecutive patients who underwent DP between April 2015 and March 2020 were examined and divided into two groups according to the day of drain removal; hence, for some patients, the drain was removed on POD 1 (POD 1 group) and for others on POD 3 (POD 3 group). Furthermore, risk factors, including drain fluid amylase (DFA) levels, for developing POPF were investigated. RESULTS: The overall rate of clinically relevant POPF was 4.6% and did not significantly differ between the POD 1 and POD 3 groups [4.5% and 4.9%, respectively (p=0.924)]. DFA levels on POD 1 did not significantly differ between patients with and without POPF. On POD 3 and POD 5, C-reactive protein (CRP) levels were significantly higher in patients with POPF than in those without (p=0.03 and p<0.001, respectively). CONCLUSION: Early drain removal regardless of DFA level may reduce the risk of developing POPF. CRP measured on POD 3 and POD 5 appeared to be a useful predictor of clinically relevant POPF.


Assuntos
Amilases/metabolismo , Remoção de Dispositivo , Drenagem , Fístula Pancreática/etiologia , Fístula Pancreática/prevenção & controle , Complicações Pós-Operatórias , Biomarcadores , Gerenciamento Clínico , Drenagem/instrumentação , Drenagem/métodos , Humanos , Incidência , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Fístula Pancreática/diagnóstico , Fístula Pancreática/terapia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Curva ROC , Fatores de Risco , Fatores de Tempo
8.
Zhonghua Wai Ke Za Zhi ; 58(11): 870-875, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120451

RESUMO

Objective: To examine the feasibility of small drain in transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods: A prospective research was performed in Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, from October 2018 to March 2019. Totally 103 patients who met the inclusion and exclusion criteria, signed the operation agreement of TOETVA, had their surgery completed and followed-up over 6 months, were enrolled in analysis. A central venous catheter was used as a drain tube in all cases (outer diameter 1.7 mm, inner diameter 1.0 mm). Visual analogue scale (VAS) was applied for assessing pain scores during the first 24 hours after the operation. Vancouver scar scale (VSS) was used for assessing the scar left by the drainage. The drainage volume (minimum scale:10 ml, approximate read: 1 ml) was recorded every 2 hours during the first postoperative 12 hours, every 4 hours during 12 to 24 hours, every 8 hours during 24 to 48 hours, and once from 48 hours until extubation. The volume of drainage, the cumulative volume and the percentage of cumulative volume accounting for the total volume were calculated. The data of residual volume (subtract the cumulative volume from the total volume) in the postoperative 24, 32 and 40 hours were analyzed, and their upper one-side P(95) was calculated by percentile method. Results: There were 12 males and 91 females. The age was (36.6±9.7) years (range: 18 to 58 years). The intraoperative tube-inserting time was (10.1±2.6) minutes (range: 6 to 18 minutes). The pain score on the first day was 2.7±1.1 (range: 1 to 5). The extubation time was (2.7±0.5) days (range: 2 to 4 days). VSS scores in the postoperative 1(st) month and 6(th) month were 2.9±1.3 (range: 0 to 7) and 0(2)(M(Q(R))), respectively. The size of the scar was 0 (2.5) mm in the postoperative 6(th) month. Sixty-four patients had no visible scars. There were 5 patients who had postoperative drain-related complications (1 for air leakage, 1 for tube blockage, 3 for subcutaneous hydrop, 2 for regional infection), who were all cured after proper treatment. The total volume of drainage for 98 patients without postoperative drain-related complications was (80.1±12.2) ml (range: 58 to 131 ml). The cumulative drainage within 8 hours accounted for (53.8±4.2)% (range: 41.0% to 62.9%) of the total drainage. The volume of residual fluids in the postoperative 32 hours was estimated to (5.8±2.7) ml (range: 0 to 12 ml,P(95)=10.0 ml). Conclusions: The small drain tubecan be applied in TOETVA, providing a satisfied cosmetic appearance and a reliable drainage. The main exudation period of the wound is within 8 hours after the operation. If a residual volume less than 10 ml is considered to be self-absorbable, the shortest safe extubation point for 95% patients without drain-related complications should be 32 hours after the operation.


Assuntos
Drenagem/instrumentação , Endoscopia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural , Esvaziamento Cervical , Estudos Prospectivos , Tireoidectomia/métodos , Adulto Jovem
9.
J Vasc Interv Radiol ; 31(10): 1587-1591, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32951970

RESUMO

Intraductal cooling via a percutaneous transhepatic biliary drainage tube holds great promise in facilitating thermal ablation of liver tumors adjacent to the central bile ducts. However, the difficulties and complications associated with puncturing nondilated bile ducts are greater than those associated with puncturing dilated bile ducts. As reported here, percutaneous transcholecystic contrast-enhanced ultrasound was performed in 7 patients to visualize the nondilated bile ducts and guide percutaneous transhepatic biliary drainage, thus facilitating the intraductal cooling-assisted thermal ablation process. The procedures were technically successful in all 7 patients, and no major complications were recorded during the follow-up period.


Assuntos
Traumatismos Abdominais/prevenção & controle , Ductos Biliares/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Drenagem , Neoplasias Hepáticas/cirurgia , Fosfolipídeos/administração & dosagem , Ablação por Radiofrequência , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia de Intervenção , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Ductos Biliares/lesões , Meios de Contraste/efeitos adversos , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Microbolhas , Pessoa de Meia-Idade , Fosfolipídeos/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Hexafluoreto de Enxofre/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
10.
J Vasc Interv Radiol ; 31(10): 1675-1681, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32948387

RESUMO

PURPOSE: To explore the safety and efficacy of double-needle lavage (DNL) in the treatment of difficult aspiration thyroid cystic nodules. MATERIALS AND METHODS: This single-center, prospective, randomized controlled trial was conducted using 100 thyroid cysts from 100 patients who were treated in our hospital from January 2018 to August 2019. These patients were placed into 2 groups; group A including 40 patients treated with single-needle aspiration (SNA), and group B including 60 patients treated with DNL. The safety and efficacy of these 2 aspiration methods were compared. RESULTS: Ten patients in group A that did not benefit from SNA were transferred to group B. No complication occurred in either group. Notably, DNL showed significantly higher efficacy than SNA. This was evidenced by the higher extraction rate of materials in the capsule (A vs B, 91 ± 6.51% vs 98.45 ± 1.74%, P < .001) and overall nodule volume reduction rate in group B (A vs B, 87.54 ± 7.84% vs 95.62 ± 3.66%, P < .001). In group B, patients who received DNL treatment with 2 needles pointed at the upper and lower extremes of the cystic nodules (B2) exhibited significantly better aspiration effects compared to patients in which the 2 needles were pointed at the same ultrasound plane (B1) (P < .05), especially for patients with maximum diameter of nodules ≥3 cm (P < .01). CONCLUSIONS: DNL treatment could efficiently and safely replace cystic material from thyroid gland. Moreover, our results indicate that DNL treatment in which 2 needles are pointed at the 2 extremes of cystic nodules yields higher efficacy in patients with maximum diameter of nodules ≥3 cm.


Assuntos
Drenagem/métodos , Cisto Mediastínico/terapia , Nódulo da Glândula Tireoide/terapia , Adulto , Idoso , China , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Masculino , Cisto Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Agulhas , Estudos Prospectivos , Sucção , Nódulo da Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento
11.
J Vasc Interv Radiol ; 31(10): 1578-1586, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32861570

RESUMO

PURPOSE: To demonstrate that temporary organ displacement (TOD) by drainage catheter placement and hydrodissection is feasible and reproducible for simulation (SIM) and stereotactic body radiation treatment (SBRT). MATERIALS AND METHODS: Between February 2010 and December 2018, 31 consecutive patients (20 men and 11 women; median age, 59 years; range 20-80 years) received both SIM and SBRT with TOD. The minimum required displacement was 10 mm between the gross tumor volume (GTV) and the organ at risk (OAR). Complete displacement was defined as the ability to displace the OAR from the GTV a minimum of 10 mm across the entire boundary. SIM was performed with hydrodissection on the same day. On the day of SBRT, displacement was reproduced by hydrodissection. Displacement was measured on computed tomography images of TOD, SIM, and SBRT. The drain was removed after SBRT. RESULTS: TOD (hydrodissection) was significantly associated with successful displacement of the OAR from a GTV greater than 10 mm (median, 20 mm vs 4.1 mm, P < .001) and maintained displacement at SIM and SBRT (SIM: 29.4 mm vs 4.1 mm, P < .001; SBRT: 32.4 mm vs 4.1 mm, P < .001). The OAR-GTV boundary showed a median reduction of 35 mm (95% confidence interval, 27.5-37.5 mm) after TOD. TOD achieved complete displacement in 22 of 31 (71%) patients, and 25 of 31 (81%) patients were able to undergo single-fraction ablative SBRT. No patients developed procedure-related complications within 30 days. SIM and SBRT were successful without OAR toxicities within a median of 33 months (range, 3-92 months). CONCLUSIONS: TOD with placement of drain and hydrodissection is technically feasible and safe and maintains displacement for SIM and SBRT.


Assuntos
Cateteres de Demora , Drenagem/instrumentação , Órgãos em Risco , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Radiocirurgia , Neoplasias Retroperitoneais/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Neoplasias Retroperitoneais/diagnóstico por imagem , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
BMC Surg ; 20(1): 166, 2020 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-32711482

RESUMO

BACKGROUND: Anastomotic leakage (AL) is one of the most severe early complications after rectal cancer surgery. Many studies and meta-analysis results show that the indentation of transanal drainage tubes (TDT) can prevent and reduce the incidence of AL. However, the size and material of drainage tubes are rarely reported. Herein, we compare the effect of three kinds of TDT and analyze the use of TDT material and size to prevent AL, which may better prevent the occurrence of AL. METHODS: The clinical data of 182 patients who underwent laparoscopic anterior resection of rectal cancer were retrospectively analyzed between January 2016 and March 2019. According to the types of indwelling TDT after the operation, they were divided into Fr32 silicone tubes (81 cases), Fr24 silicone tubes (54 cases), Fr24 latex tubes (47 cases). The first drainage, exhaust, defecation, abdominal distension and anastomotic leakage of the patients with three different types of TDT were compared. RESULTS: There was no significant difference in the degree of first exhaust, abdominal distension and anastomotic leakage among three different types of TDT; the time of first drainage and defecation of the Fr32 silicone tube was significantly earlier than that of Fr24 silicone tube and Fr24 latex tube. CONCLUSION: The drainage effect of the Fr32 silicone tube is better than that of Fr24 silicone tube and Fr24 latex tube after anterior resection for rectal cancer, Fr32 silicone may better prevent the occurrence of AL, but randomized controlled studies are needed.


Assuntos
Fístula Anastomótica/prevenção & controle , Drenagem/instrumentação , Protectomia/métodos , Neoplasias Retais , Canal Anal/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Estudos Retrospectivos
13.
J Vasc Interv Radiol ; 31(8): 1256-1262.e3, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32654961

RESUMO

PURPOSE: To evaluate feasibility, procedural outcomes, and safety aspects of implantation of the alfapump system for management of refractory ascites by interventional radiology (IR) methods. MATERIALS AND METHODS: The multicenter open-label prospective MOSAIC study included 29 patients (mean age 60.0 y ± 9.9; range, 32-72 y, 17 [56.7%] male) with cirrhotic refractory ascites who received an alfapump system implanted by IR. The fully subcutaneous alfapump system consists of a pump and 2 silicone catheters, whose distal ends are inserted in the peritoneum and the bladder, respectively. The device moves ascites from the peritoneum to the bladder, reducing the requirement of paracentesis. Pumped volume and speed can be customized as required. The implant procedure was performed under general or local anesthesia. Both catheters were placed under ultrasound guidance. The pump was inserted in a subcutaneous pocket on the upper abdomen. Incidence and severity of procedure-related serious adverse events up to 3 months after implantation were recorded. RESULTS: Technical success was achieved in 29 (100%) IR implant procedures. The pump was usually implanted on the right abdomen (76.7%). In 5 patients, deviation from the Instructions for Use was required. Adverse events (requirement of additional incisions, postoperative bleed) occurred in 3 patients. At 3 months after implantation, 3 possibly procedure-related serious adverse events (ascites leakage, bacterial peritonitis, postoperative bleeding) had occurred. Two explantations (2/29; 6.8%) (cellulitis, pump pocket infection) and 4 reinterventions (pump or catheter replacement) were required, corresponding to an adverse event incidence rate of 9/29 (31.0%). CONCLUSIONS: Placement of the alfapump using IR methods is both feasible and technically successful.


Assuntos
Ascite/terapia , Cateteres , Drenagem/instrumentação , Fontes de Energia Elétrica , Cirrose Hepática/terapia , Radiografia Intervencionista , Adulto , Idoso , Ascite/diagnóstico por imagem , Ascite/epidemiologia , Canadá/epidemiologia , Remoção de Dispositivo , Drenagem/efeitos adversos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Incidência , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Surgery ; 168(3): 457-461, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32680749

RESUMO

BACKGROUND: Postoperative infectious complications after a pancreaticoduodenectomy remain a significant cause of morbidity. Studies have demonstrated that a preoperative biliary stent increases the risk of postoperative infectious complications. Few studies have investigated the specific preoperative biliary stent bacterial sensitivities to preoperative antibiotics and the effect on infectious complications. The goal of this study was to investigate if the presence of a preoperative biliary stent increases the risk of postoperative infectious complications in patients undergoing a pancreaticoduodenectomy. Additionally, we aimed to investigate biliary stent culture sensitivities to preoperative antibiotics and determine if those sensitivities impacted postoperative infectious complications after a pancreaticoduodenectomy. METHODS: A retrospective chart review of patients who had undergone a pancreaticoduodenectomy at a single institution tertiary care center from 2007 to 2018 was performed. Perioperative variables including microbiology cultures from biliary stents were collected and analyzed. RESULTS: A total of 244 patients underwent a pancreaticoduodenectomy. A preoperative biliary stent was present in 45 (18%) patients. Infectious complications occurred in 25% of those patients with a preoperative biliary stent, and 19% of those without (P = .37). Of those patients with a stent that was cultured intraoperatively, 92% grew bacteria and 61% of those were resistant to the preoperative antibiotics administered. Of the patients with a preoperative biliary stent and bacteria resistant to the preoperative antibiotics, 17% developed a postoperative infectious complication, compared with 20% if the bacteria cultured was susceptible to the preoperative antibiotics (P = .64). CONCLUSION: Infectious complications after pancreaticoduodenectomy are a significant cause of morbidity. Stent bacterial sensitivities to preoperative antibiotics did not reduce the postoperative infectious complications in the preoperative biliary stent group suggesting a multifactorial cause of infections.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Cuidados Pré-Operatórios/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Antibioticoprofilaxia/estatística & dados numéricos , Sistema Biliar/microbiologia , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Procedimentos Cirúrgicos do Sistema Biliar/estatística & dados numéricos , Drenagem/instrumentação , Feminino , Humanos , Cuidados Intraoperatórios/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Stents/microbiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(29): e21305, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702925

RESUMO

To explore the necessity of indwelling drainage in dual-plane breast augmentation mammoplasty patients.Female patients (123 in total) were selected from June 2015 to June 2018 in the Department of Plastic Surgery at Peking Union Medical College Hospital and were randomly divided into 2 different groups: the with drainage group (WD group, 57 patients) and the without drainage group (WOD group, 66 patients). In the 2 groups, the operation time, postoperative stay, and hospitalization expenses were recorded. The BREAST-Q Version 2.0 Augmentation Module Pre- and Postoperative Scales (Chinese Version) were used to evaluate psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts preoperatively and postoperatively (1 year after operation).Before the operation, no significant differences were found in psychosocial well-being, sexual well-being, physical well-being, or satisfaction with breasts between these 2 groups. In the WOD group, postoperative stay and hospitalization expenses were remarkably decreased, but the operation time was similar, compared with the WD group. Compared with before the operation, both groups had significantly increased scores in psychosocial well-being, sexual well-being, and satisfaction with breasts after the operation. However, no significant differences were found between the 2 groups. No complications were found in any of the patients.Although the operation time was not significantly decreased, patients without drainage could save much more time and money and simultaneously reach similar postoperative effects in psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts. Therefore, drainage may not be necessary in patients who undergo dual-plane breast augmentation mammoplasty.


Assuntos
Cateteres de Demora , Drenagem/métodos , Mamoplastia/métodos , Adolescente , Adulto , Implante Mamário/métodos , Implantes de Mama , Drenagem/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Psicologia , Adulto Jovem
16.
PLoS One ; 15(6): e0234471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520972

RESUMO

Abdominal spacers are useful for maintaining the distance between the target tumors and surrounding tissues, such as the gastrointestinal tract, in patients treated with carbon ion radiotherapy. Surgical intervention to remove the spacers is sometimes necessary because of abdominal infections triggered by long-term spacer placement or intestinal perforation. Therefore, spacers that do not require surgical removal and provide effective drainage against abdominal infections are urgently needed. This study aimed to develop a spacer that could be removed non-surgically and one that provides the therapeutic effect of drainage in patients who receive carbon ion radiotherapy for abdominal tumors. A novel fan-shaped spacer was constructed from a film drain that was folded along the trigger line. Simple withdrawal of the trigger line caused the film drain to fold and the holding lines to become free. We performed laparoscopy-assisted insertion with pneumoperitoneum and blind removal of the spacer fourteen times using a porcine model. Saline in the abdominal cavity was effectively aspirated using the spacer. Our novel fan-shaped spacer could be removed safely without surgery and was able to drain fluid effectively from the abdominal cavity.


Assuntos
Neoplasias Abdominais/radioterapia , Cateteres , Drenagem/métodos , Radioterapia com Íons Pesados/métodos , Abdome/fisiopatologia , Neoplasias Abdominais/cirurgia , Animais , Drenagem/instrumentação , Suínos
17.
Am J Otolaryngol ; 41(4): 102557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497952

RESUMO

PURPOSE: To evaluate the prophylactic, protocolized, and standardized use of a Montgomery tube in preventing pharyngocutaneous fistulas after total laryngectomy and neck dissection. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral centre. SUBJECT AND METHODS: A Montgomery salivary bypass tube was placed in 44 patients undergoing total laryngectomy and neck dissection, observing the percentage of fistula appearance and the time of start of deglutition. Comparison was made with a group of 28 patients prior to the implantation of the protocol in whom the tube was not used. RESULTS: There was a statistically significant decrease in the percentage of fistulas and an earlier onset of deglutition in the salivary bypass tube patients compared to those in whom the tube had not been used. CONCLUSION: Prophylactic and standardized use of the Montgomery salivary bypass tube in patients undergoing total laryngectomy and neck dissection might decrease the incidence of pharyngocutaneous fistula and improve the course of one that is already established.


Assuntos
Fístula Cutânea/prevenção & controle , Drenagem/instrumentação , Fístula/prevenção & controle , Intubação/instrumentação , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Doenças Faríngeas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Saliva , Idoso , Estudos de Coortes , Fístula Cutânea/etiologia , Deglutição , Feminino , Fístula/etiologia , Humanos , Neoplasias Laríngeas/fisiopatologia , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Doenças Faríngeas/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
18.
J Cardiothorac Surg ; 15(1): 112, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448351

RESUMO

Enhanced recovery after lobectomy surgery (ERAS) concept has been greatly developed between clinical implementation and minimally invasive surgery. In addition to the minimally invasive surgery, the management of the perioperative catheter has also attracted everyone's attention. Tubeless minimally invasive treatment includes no urinary catheter placement during the operation and no chest tube after the operation. Here, we summarized all the reports on no urinary catheterization and no chest tube in patients with thoracic surgery and the impact of postoperative length of stay (LOS) and postoperative complications. We find that avoiding chest drain and urinary catheter placement after the surgery appears to be safe and beneficial for patients.


Assuntos
Tubos Torácicos , Drenagem/instrumentação , Recuperação Pós-Cirúrgica Melhorada , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Torácicos/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos
19.
J Vasc Interv Radiol ; 31(6): 1000-1004, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376172

RESUMO

Transhepatic placement of a metallic biliary stent for internal drainage of persistent liver abscesses was performed in 9 patients (males; median age, 65 years; range, 57-82 years) with refractory liver abscess. The median follow-up period was 2.8 months (range, 0.4-50.3 months). Technical success was achieved in all cases without any major complications. Clinical success, defined as the removal of the drainage tube without recurrent symptoms of infection, was achieved in 8 cases. Median duration until removal of the drainage tube from stent placement was 7 days (range, 0-36).


Assuntos
Ductos Biliares , Drenagem/instrumentação , Abscesso Hepático/terapia , Stents , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares/diagnóstico por imagem , Remoção de Dispositivo , Drenagem/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Abscesso Hepático/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
20.
Stroke Vasc Neurol ; 5(1): 40-49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411407

RESUMO

Intracerebral haemorrhage (ICH) describes haemorrhage into the brain parenchyma that may result in a decline of the patient's neurological function. ICH is a common cause of morbidity and mortality worldwide. Aggressive surgical treatment for ICH has remained controversial as clinical trials have failed to demonstrate substantial improvement in patient outcome and mortality. Recently, promising mechanical and pharmacological minimally invasive surgery (MIS) techniques for the treatment of ICH have been described. MIS was designed with the objective of reducing morbidity due to complications of surgical manipulation. Mechanical MIS includes the use of tubular retractors and small diameter instruments for ICH removal. Pharmacological methods consist of catheter placement inside the haematoma cavity for the passive drainage of the haematoma over the course of several days. One of the most favourable approaches for MIS is the use of natural corridors for reaching the lesion, such as the transsulcal parafascicular approach. This approach provides an anatomical dissection of the subjacent white matter tracts, causing the least amount of damage while evacuating the haematoma. A detailed description of the currently known MIS techniques and devices is presented in this review. Special attention is given to the transsulcal parafascicular approach, which has particular benefits to provide a less traumatic MIS with promising overall patient outcome.


Assuntos
Hemorragia Cerebral/cirurgia , Drenagem , Procedimentos Neurocirúrgicos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/fisiopatologia , Circulação Cerebrovascular , Tomada de Decisão Clínica , Drenagem/efeitos adversos , Drenagem/instrumentação , Drenagem/mortalidade , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/mortalidade , Medição de Risco , Fatores de Risco , Resultado do Tratamento
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