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1.
J Orthop Surg Res ; 19(1): 326, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824551

RESUMO

BACKGROUND: In the past decade, Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with a microscopic tubular technique has become a surgical procedure that reduces surgical-related morbidity, shortens hospital stays, and expedites early rehabilitation in the treatment of lumbar degenerative diseases (LDD). Unilateral biportal endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has emerged as a novel surgical technique. The present study aims to compare the clinical outcomes and postoperative complications of MIS-TLIF and Endo-TLIF for treating LDD. METHODS: A retrospective analysis of LLD patients undergoing either Endo-TLIF or MIS-TLIF was performed. Patient demographics, operative data (operation time, estimated blood loss, length of hospitalization), and complications were recorded. The visual analog scale (VAS) score for leg and back pain and the Oswestry Disability Index (ODI) score were used to evaluate the clinical outcomes. RESULTS: This study involved 80 patients, 56 in the MIS-TLIF group and 34 in the Endo-TLIF group. The Endo-TLIF group showed a more substantial improvement in the VAS for back pain at 3 weeks post-surgery compared to the MIS-TLIF group. However, at the 1-year mark after surgery, there were no significant differences between the groups in the mean VAS for back pain and VAS for leg pain. Interestingly, the ODI at one year demonstrated a significant improvement in the Endo-TLIF group compared to the MIS-TLIF group. Additionally, the MIS-TLIF group exhibited a shorter operative time than the Endo-TLIF group, with no notable differences in estimated blood loss, length of hospitalization, and complications between the two groups. CONCLUSION: Endo-TLIF and MIS-TLIF are both safe and effective for LDD. In surgical decision-making, clinicians may consider nuances revealed in this study, such as lower early postoperative back pain with Endo-TLIF and shorter operative time with MIS-TLIF.


Assuntos
Endoscopia , Degeneração do Disco Intervertebral , Vértebras Lombares , Fusão Vertebral , Humanos , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Estudos Retrospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Vértebras Lombares/cirurgia , Endoscopia/métodos , Degeneração do Disco Intervertebral/cirurgia , Idoso , Resultado do Tratamento , Adulto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Duração da Cirurgia , Microcirurgia/métodos
2.
World J Surg Oncol ; 22(1): 146, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38822349

RESUMO

BACKGROUND: Delayed epistaxis after endoscopic transnasal pituitary tumor resection (ETPTR) is a critical complication, tending to cause aspiration or hemorrhagic shock. This study assessed clinical characteristics, risk factors, and provide treatment and prevention advice of this complication. METHODS: This was a retrospective monocentric analysis of 862 patients who underwent ETPTR. Statistical analyses of clinical data revealed the incidence, sources and onset time of delayed epistaxis. Univariate analysis and binary logistic regression were used to identify risk factors. RESULTS: The incidence of delayed epistaxis was 2.78% (24/862), with an average onset time of 20.71 ± 7.39 days. The bleeding sources were: posterior nasal septal artery branch of sphenopalatine artery (12/24), multiple inflammatory mucosae (8/24), sphenopalatine artery trunk (3/24) and sphenoid sinus bone (1/24). Univariate analysis and binary logistic regression analysis confirmed that hypertension, nasal septum deviation, chronic rhinosinusitis and growth hormone pituitary tumor subtype were independent risk factors for delayed epistaxis. Sex, age, history of diabetes, tumor size, tumor invasion and operation time were not associated with delayed epistaxis. All patients with delayed epistaxis were successfully managed through endoscopic transnasal hemostasis without recurrence. CONCLUSIONS: Delayed epistaxis after ETPTR tends to have specific onset periods and risk factors. Prevention of these characteristics may reduce the occurrence of delayed epistaxis. Endoscopic transnasal hemostasis is recommended as the preferred treatment for delayed epistaxis.


Assuntos
Epistaxe , Neoplasias Hipofisárias , Humanos , Epistaxe/etiologia , Epistaxe/prevenção & controle , Epistaxe/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Fatores de Risco , Adulto , Idoso , Seguimentos , Prognóstico , Incidência , Endoscopia/métodos , Endoscopia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Adulto Jovem , Fatores de Tempo , Adolescente , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos
3.
Acta Neurochir (Wien) ; 166(1): 243, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38822878

RESUMO

BACKGROUND: Trigeminal schwannoma is a rare type of tumor that arises from the Schwann cells of the trigeminal nerve. METHOD: We present a case of a patient with a giant V2 trigeminal schwannoma with painful swelling in the left maxilla. A complete resection using a combined open maxillectomy and endoscopic endonasal approach was performed. CONCLUSION: This case highlights the importance of a multidisciplinary approach to perform a combined open and endoscopic approach for safe resection while preserving adequate speech and swallowing.


Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Humanos , Neurilemoma/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Doenças do Nervo Trigêmeo/cirurgia , Doenças do Nervo Trigêmeo/patologia , Maxila/cirurgia , Maxila/diagnóstico por imagem , Masculino , Feminino , Resultado do Tratamento , Endoscopia/métodos , Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/patologia , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos
4.
Arch Esp Urol ; 77(4): 418-425, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38840286

RESUMO

BACKGROUND: Kidney stones, a common urinary system ailment, often necessitate surgical intervention. Endoscopic combined intrarenal surgery (ECIRS) and multi-channel percutaneous nephron lithotripsy (MPCNL) are key modalities for treating complex renal stones, prompting the need for a comparative analysis to enhance clinical decision-making. METHODS: Patients undergoing surgical treatment for complex kidney stones from April 2018 to April 2022 were divided into the control (MPCNL) and observation (ECIRS) groups. Propensity score matching was used to balance baseline data, and t-tests and chi-square tests were employed to compare the perioperative indicators between the two groups. RESULTS: A total of 210 patients were enrolled in this study for pre-observational comparison, and they were divided into the control group (110 patients) and observation group (100 patients). Following matching, each group comprised 85 patients. Pre-observational comparison revealed significant differences between the groups in age, disease duration, and stone diameter (p < 0.05). However, after matching, baseline data comparison showed no statistically significant differences (p > 0.05). Surgery-related parameters, including operation time, intraoperative blood loss, postoperative activity duration and hospital stay, did not significantly differ between the groups (p > 0.05). The observation group exhibited a significantly higher stone retention-free rate after initial treatment compared with the control group (p < 0.05), although overall stone clearance rates did not significantly differ between the groups (p > 0.05). We found no significant differences in perioperative complications between the two groups (p > 0.05). Moreover, the observation group experienced significantly lower postoperative pain levels at 6, 24 and 48 h compared with the control group (p < 0.001). CONCLUSIONS: Conclusively, ECIRS and MPCNL are viable options for treating complex renal calculi, with similar operation times, complication rates and stone clearance rates. ECIRS may offer advantages including lower postoperative pain and higher initial stone clearance rates than MPCNL. However, large-scale studies with long follow-up times are needed for validation.


Assuntos
Cálculos Renais , Litotripsia , Humanos , Cálculos Renais/cirurgia , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Litotripsia/métodos , Resultado do Tratamento , Adulto , Endoscopia , Procedimentos Cirúrgicos Urológicos/métodos , Idoso , Néfrons
5.
J Orthop Surg Res ; 19(1): 341, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38849922

RESUMO

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back pain persists as a troubling issue for surgeons following the procedure. In the treatment of discogenic back pain, sinuvertebral nerve radiofrequency ablation has shown promising results. Nevertheless, the potential benefit of simultaneously implementing sinuvertebral nerve radiofrequency ablation during PELD surgery to address residual back pain has not been thoroughly investigated in current literature. METHODS: This retrospective study reviewed Lumbar disc herniation (LDH) patients with low back pain who underwent combined PELD and sinuvertebral nerve ablation in our department between January 2021 and September 2023. Residual low back pain post-surgery was assessed and compared with existing literature. RESULTS: A total of 80 patients, including 53 males and 27 females, were included in the study. Following surgical intervention, patients demonstrated remarkable improvements in pain and functional parameters. One month post-operatively, the VAS score for low back pain exhibited a 75% reduction (6.45 ± 1.3 to 1.61 ± 1.67), while the VAS score for leg pain decreased by 85% (7.89 ± 1.15 to 1.18 ± 1.26). Notably, the JOA score increased from 12.89 ± 5.48 to 25.35 ± 4.96, and the ODI score decreased form 59.48 ± 9.58 to 20.3 ± 5.37. These improvements were sustained at three months post-operatively. According to the modified Mac Nab criteria, the excellent and good rate was 88.75%. Residual low back pain is observed to be comparatively reduced compared to the findings documented in earlier literature. CONCLUSION: The combination of percutaneous endoscopic lumbar discectomy and sinuvertebral nerve ablation demonstrates effective improvement in low back pain for LDH patients.


Assuntos
Discotomia Percutânea , Endoscopia , Deslocamento do Disco Intervertebral , Dor Lombar , Vértebras Lombares , Humanos , Feminino , Masculino , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/cirurgia , Discotomia Percutânea/métodos , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Vértebras Lombares/cirurgia , Endoscopia/métodos , Resultado do Tratamento
6.
J Orthop Surg Res ; 19(1): 342, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38849945

RESUMO

BACKGROUND: Endoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high rates of nerve damage, a steep learning curve, and prolonged surgical times, often occurring during the creation of the operative channel. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety. We aimed to analyse the anatomical data of Kambin's triangle via CT imaging to define the parameters of the safe operating area for transforaminal posterior lumbar interbody fusion (TPLIF), providing crucial insights for clinical practice. METHODS: We selected the L4-L5 intervertebral space. Using three-dimensional (3D), we identified Kambin's triangle and the endocircle within it, and recorded the position of point 'J' on the adjacent facet joint as the centre 'O' of the circle shifts by angle 'ß.' The diameter of the inscribed circle 'd,' the abduction angle 'ß,' and the distances 'L1' and 'L2' were measured from the trephine's edge to the exiting and traversing nerve roots, respectively. RESULTS: Using a trephine with a diameter of 8 mm in TPLIF has a significant safety distance. The safe operating area under the TPLIF microscope was also clarified. CONCLUSIONS: Through CT imaging research, combined with 3D simulation, we identified the anatomical data of the L4-L5 segment Kambin's triangle, to clarify the safe operation area under TPLIF. We propose a simple and easy positioning method and provide a novel surgical technique to establish working channels faster and reduce nerve damage rates. At the same time, according to this method, the Kambin's triangle anatomical data of the patient's lumbar spine diseased segments can be measured through CT 3D reconstruction of the lumbar spine, and individualised preoperative design can be conducted to select the appropriate specifications of visible trephine and supporting tools. This may effectively reduce the learning curve, shorten the time operation time, and improve surgical safety.


Assuntos
Imageamento Tridimensional , Vértebras Lombares , Fusão Vertebral , Tomografia Computadorizada por Raios X , Humanos , Fusão Vertebral/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imageamento Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Endoscopia/métodos , Modelos Anatômicos , Idoso
7.
World J Surg Oncol ; 22(1): 148, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840176

RESUMO

BACKGROUND: Gasless transaxillary endoscopic thyroidectomy (GTET) and endoscopic thyroidectomy via the areola approach (ETA) have emerged as minimally invasive surgical techniques for managing papillary thyroid carcinoma (PTC). This study aimed to assess the surgical efficacy of endoscopic thyroidectomy (ET) as compared to conventional open thyroidectomy (COT) in PTC patients. METHODS: Between 2020 and 2022, 571 PTC patients underwent unilateral thyroidectomy accompanied by ipsilateral central lymph node dissection. This cohort comprised 72 patients who underwent GTET, 105 ETA, and 394 COT. The analysis encompassed a comprehensive examination of patient clinicopathologic characteristics and postoperative complaints. Furthermore, the learning curve of GTET was evaluated using the cumulative summation (CUSUM) method. RESULTS: Patients in the ET group exhibited a lower mean age and a higher proportion of female individuals. Operation time in the ET group was significantly longer. No significant differences were observed in the incidence of postoperative complications among the three groups. With regard to postoperative complaints reported three months after surgery, GTET demonstrated superior alleviation of anterior chest discomfort and swallowing difficulties. Patients who underwent ET reported significantly higher cosmetic satisfaction levels. Additionally, the learning curve of GTET was 27 cases, and the operation time during the mature phase of the learning curve exhibited a significant reduction when compared to ETA. CONCLUSIONS: The findings of this study affirm the safety and feasibility of employing GTET and ETA for the surgical management of PTC. GTET presents an attractive surgical option, particularly for patients with unilateral PTC who place a premium on cosmetic outcomes.


Assuntos
Endoscopia , Complicações Pós-Operatórias , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Feminino , Masculino , Câncer Papilífero da Tireoide/cirurgia , Câncer Papilífero da Tireoide/patologia , Endoscopia/métodos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Pessoa de Meia-Idade , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Seguimentos , Estudos Retrospectivos , Prognóstico , Duração da Cirurgia , Axila
8.
JBJS Case Connect ; 14(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38848407

RESUMO

CASE: A 37-year-old man American Society of Anesthesiologists grade 1 patient with lumbar canal stenosis at the L4-L5 level underwent endoscopic decompression. Toward the end of the procedure, the patient developed sudden-onset bradycardia, followed by ventricular arrhythmia and acute pulmonary edema. The patient was successfully managed with resuscitation and supportive management and recovered uneventfully thereafter. A diagnosis of perioperative stress cardiomyopathy was subsequently made after evaluation of the patient. CONCLUSION: The possibility of takotsubo cardiomyopathy should be considered in cases of acute perioperative cardiac decompensation and pulmonary edema in patients undergoing spinal surgery.


Assuntos
Estenose Espinal , Cardiomiopatia de Takotsubo , Humanos , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Adulto , Masculino , Estenose Espinal/cirurgia , Endoscopia/efeitos adversos , Vértebras Lombares/cirurgia , Descompressão Cirúrgica/efeitos adversos , Complicações Intraoperatórias/etiologia
9.
Artigo em Chinês | MEDLINE | ID: mdl-38858108

RESUMO

Endoscopic skull base surgery presents significant technical challenges and high surgical risks, requiring collaboration among multiple disciplines such as otolaryngology, neurosurgery, ophthalmology, and oral maxillofacial surgery. In recent years, there has been rapid development in endoscopic skull base surgery, characterized by flourishing anatomical research and an expanding range of surgical indications. The future brings both opportunities and challenges, and endoscopic skull base surgery must grasp new directions in medical development, actively providing patients with safer and more effective treatment options.


Assuntos
Endoscopia , Base do Crânio , Humanos , Base do Crânio/cirurgia , Endoscopia/métodos , Endoscopia/tendências , Neoplasias da Base do Crânio/cirurgia
10.
Artigo em Chinês | MEDLINE | ID: mdl-38858116

RESUMO

Objective:To summarize the procedures and efficacy of surgical treatment for Andrew stage Ⅰ-Ⅲ juvenile nasopharyngeal angiofibroma(JNA). Methods:A total of 12 patients with JNA who underwent surgery from 2016 to 2021 were enrolled, including 1 case in stage Ⅰ, 3 cases in stage Ⅱ, and 8 cases in stage Ⅲ. JNA was resected by transnasal endoscopic approach alone, or combined with transoral approach or Caldwell-Luc approach was performed. Results:Eleven cases underwent complete resection without recurrence and 1 case had residual tumor. There were no serious complications. The median intraoperative blood loss was 200 mL, and 1 patient received blood transfusion. The median operative time was 110 minutes. Conclusion:JNA in Andrew stage Ⅰ-Ⅲ can be quickly and completely resected by standardized surgical procedures using endoscopy and coblation technology.


Assuntos
Angiofibroma , Endoscopia , Neoplasias Nasofaríngeas , Humanos , Angiofibroma/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Masculino , Endoscopia/métodos , Adolescente , Resultado do Tratamento , Feminino , Duração da Cirurgia , Adulto Jovem , Perda Sanguínea Cirúrgica , Adulto
11.
Artigo em Chinês | MEDLINE | ID: mdl-38858110

RESUMO

Objective:To investigate the differences in the therapeutic effects of endoscopic surgery combined with chemotherapy and endoscopic surgery combined with radiotherapy in the treatment of early nasopharyngeal carcinoma, and to select individualized treatment strategy for early nasopharyngeal carcinoma. Methods:The clinical data of 68 patients with early nasopharyngeal carcinoma(T1-2N0M0) who received surgical treatment in a high-incidence area were retrospectively analyzed. According to different treatment methods, they were divided into the surgery + chemotherapy group(n=34, treated with endoscopic surgery combined with chemotherapy) and the surgery + radiotherapy group(n=34, treated with endoscopic surgery combined with radiotherapy). Propensity score matching was used to match the patient data between the two groups at a 1∶1 ratio. Patients were followed up, and the survival rates and hematological toxicities were compared between the two groups. Results:Twenty-four cases in the surgery + chemotherapy group and 24 cases in the surgery + radiotherapy group were successfully matched. After matching, there was no statistically significant difference in T stage, and clinical stage between the two groups(all P>0.05). The 3-year OS and DFS in the surgery + chemotherapy group were 100.0% and 95.8%, respectively, while the 3-year OS and DFS in the surgery + radiotherapy group were 100.0% and 100.0%, respectively, with no significant difference in survival rates between the two groups(both P>0.05). After treatment, there was no statistically significant difference in bone marrow suppression between the surgery + chemotherapy group and the surgery + radiotherapy group (all P> 0.05) Conclusion:Endoscopic surgery combined with chemotherapy and surgery combined with radiotherapy have comparable clinical efficacy in the treatment of early nasopharyngeal carcinoma, but without radiotherapy-related complications, which is worth further investigation.


Assuntos
Carcinoma , Endoscopia , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Humanos , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/radioterapia , Carcinoma Nasofaríngeo/terapia , Carcinoma Nasofaríngeo/radioterapia , Estudos Retrospectivos , Masculino , Prognóstico , Feminino , Terapia Combinada , Carcinoma/terapia , Taxa de Sobrevida , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Incidência , Resultado do Tratamento , Adulto
12.
Artigo em Chinês | MEDLINE | ID: mdl-38858111

RESUMO

Objective:To describe the road map of the lateral and endoscopic ventral approaches for the pharyngeal segment of the internal carotid artery, propose a sub-segmentation scheme, systematically and comprehensively understand its anatomical details and relationships with the surrounding structures. Methods:Five fresh cadaveric head specimens(10 sides in total) were dissected through lateral and endoscopic ventral approaches to evaluate the anatomical details of the parapharyngeal internal carotid artery and its relationship with the surrounding structures. Results:From the bifurcation of the common carotid artery to the vertical part of the internal carotid artery, alongside the direction of blood flow, the parapharyngeal internal carotid artery passes through four distinct anatomical tissues. Based on this, the parapharyngeal internal carotid artery can be divided into four sub-segments: nerve, muscle, fascia and osseous sub-segments. The boundaries and important adjacent structures of each segment are described in detail. Conclusion:The anatomical road map of the parapharyngeal internal carotid artery and the sub-segmentation scheme serving as a practical guide to navigate modular endoscopic skull base surgery of the parapharyngeal space while reduce the risk of internal carotid artery injury.


Assuntos
Cadáver , Artéria Carótida Interna , Endoscopia , Espaço Parafaríngeo , Humanos , Artéria Carótida Interna/anatomia & histologia , Espaço Parafaríngeo/anatomia & histologia , Base do Crânio/anatomia & histologia
13.
Artigo em Chinês | MEDLINE | ID: mdl-38858119

RESUMO

Objective:To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Methods:Using sagittal and coronal CT images, the following lines were delineated: the F-line(a horizontal line passing nasofrontal beak), the M-line(a vertical line passing paries medialis orbitae), and the P-line(a vertical line passing the center of the pupil). Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Results:Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. Conclusion:For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.


Assuntos
Endoscopia , Seio Etmoidal , Seio Frontal , Osteoma , Neoplasias dos Seios Paranasais , Tomografia Computadorizada por Raios X , Humanos , Osteoma/cirurgia , Osteoma/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Seio Frontal/cirurgia , Seio Frontal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/diagnóstico por imagem , Adolescente , Tomografia Computadorizada por Raios X/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Endoscopia/métodos , Adulto Jovem
14.
Artigo em Chinês | MEDLINE | ID: mdl-38858115

RESUMO

Objective:To investigate the clinical characteristics of esthesioneuroblastoma and the efficacy of endonasal endoscopic surgery combined with radiotherapy/chemotherapy. Methods:The clinical and surgical data of 17 patients with esthesioneuroblastoma who underwent endonasal endoscopic surgery in our department from September 2009 to June 2023 were retrospectively analyzed. Results:Among all patients, the modified Kadish stage B was identified in 4 patients, C in 10 patients, and D in 3 patients. Ten of them underwent endonasal endoscopic surgery without neck dissection in one day, whose average operation time is (5.2±2.5) hours and average blood loss is (192±162)mL. Skull base reconstructions were performed in 15 patients, postoperative complications were observed in 3 patients, and negative margins were obtained in 13 patients. All 17 patients were followed up for an average of (49.7±40.2) months. Three patients died and 6 had recurrence and/or metastasis. The 1-year, 2-year and 5-year overall survival rates were 88.2%, 80.2%, and 80.2%, respectively, and the 1-year, 2-year and 5-year disease-free survival rates were 82.4%, 82.4%, and 50.8%, respectively. The 2-year overall survival rates of patients with negative and positive margins were 100% and 25%, respectively, while the 2-year disease-free survival rates were 61.5% and 25.0%, respectively. Conclusion:Endonasal endoscopic surgery combined with radiotherapy/chemotherapy can achieve satisfactory effect in esthesioneuroblastoma, and the prognosis of patients with positive margins is poor.


Assuntos
Estesioneuroblastoma Olfatório , Neoplasias Nasais , Humanos , Estesioneuroblastoma Olfatório/cirurgia , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias Nasais/cirurgia , Adulto , Endoscopia/métodos , Cavidade Nasal , Taxa de Sobrevida , Resultado do Tratamento
15.
Artigo em Chinês | MEDLINE | ID: mdl-38858122

RESUMO

Objective:To evaluate the subjective olfactory function in chronic sinusitis(CRS)patients with asthma after nasal endoscopic surgery and associated factors that may affect olfactory function. Methods:The study included 90 CRS patients with asthma from January 2008 to December 2020,and all of them underwent endoscopic sinus surgery(ESS). VAS score of olfactory function before and after surgery were collected,and the data at baseline,3 months,6 months,1 year,3 years,5 years,8 years and 10 years after surgery were compared. Factors affecting olfactory function were analyzed in a generalized mixed linear model,which including age,surgical procedure,allergic rhinitis and so on.Results: The olfactory VAS scores were significantly lower at 3 months,6 months,1 year,3 years,and 5 years postoperatively compared with baseline,and the difference was statistically significant(P<0.05).Olfactory VAS scores at 8 and 10 years postoperatively were not statistically different from baseline(P>0.05).Age(≥60 years),aspirin intolerance syndrome,Lund-Kennedy score,modified sinus CT olfactory cleft score,and follow-up time were risk factors, and radical sinus surgery is a protective factor.Conclusion:Subjective olfactory scores in CRS patients with asthma after ESS remain relatively stable for 5 years postoperatively.Prior history of surgery did not affect postoperative subjective olfactory scores. Age,aspirin intolerance syndrome, Lund-Kennedy score,modified sinus CT olfactory cleft score, follow-up time,and surgical approach were strongly associated with subjective olfactory scores in CRS patients with asthma,and radical surgery had a protective effect on olfaction.


Assuntos
Asma , Rinite , Sinusite , Humanos , Sinusite/cirurgia , Feminino , Masculino , Pessoa de Meia-Idade , Doença Crônica , Período Pós-Operatório , Estudos Longitudinais , Rinite/cirurgia , Olfato , Endoscopia , Adulto , Transtornos do Olfato/etiologia , Fatores de Risco , Rinossinusite
16.
Cir Cir ; 92(3): 287-297, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38862105

RESUMO

OBJECTIVE: This study aimed to investigate the limitations, barriers, and complications in the early transition from the microscopic transsphenoidal approach (MTA) to the endonasal endoscopic approach (EEA) to the skull base in our institution. METHODS: Technical challenges, as well as clinical features and complications, were compared between MTA, EEA, and mixed cases during the early surgical curve. RESULTS: The period from the early learning curve was 1 year until the EEA protocol was used routinely. A total of 34 patients registered a resection using a transsphenoidal approach. Eighteen patients underwent EEA, 11 underwent MTA, and five underwent a mixed endonasal and microscopic approach. Non-significant differences were found in endocrine outcomes between the three groups. Patients with unchanged or improved visual function were higher in the EEA group (p = 0.147). Non-significant differences were found in terms of the extent of resection (EOR) between groups (p = 0.369). Only 1 (2.9%) patient in the whole series developed a post-operative CSF leaking that resolved with medical management, belonging to the EEA group (5.5%). CONCLUSIONS: The early phase of the learning curve did not affect our series significantly in terms of the EOR, endocrine status, and visual outcomes.


OBJETIVO: Investigar las limitaciones, las barreras y las complicaciones en la transición del abordaje transesfenoidal microscópico (ATM) al abordaje endonasal endoscópico (AEE) para la base del cráneo en nuestra institución. MÉTODO: Se compararon las características clínicas y las complicaciones entre ATM, AEE y casos mixtos durante la curva quirúrgica temprana. RESULTADOS: El periodo desde la curva de aprendizaje inicial fue de 1 año hasta que se utilizó el protocolo AEE de forma sistemática. Un total de 34 pacientes tuvieron una resección por vía transesfenoidal. A 18 pacientes se les realizó AEE, a 11 ATM y a 5 abordaje mixto endonasal y microscópico. Se encontraron diferencias no significativas en los resultados endocrinos entre los tres grupos. Los pacientes con función visual sin cambios o mejorada fueron más en el grupo AEE (p = 0.147). No se encontraron diferencias significativas respecto a la extensión de la resección (p = 0.369). Solo 1 (2.9%) paciente desarrolló una fístula de líquido cefalorraquídeo que se resolvió con manejo médico, perteneciente al grupo AEE (5.5%). CONCLUSIONES: La fase inicial de la curva de aprendizaje no afectó significativamente a nuestra serie en términos de extensión de la resección, estado endocrino y resultados visuales.


Assuntos
Curva de Aprendizado , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Neoplasias Hipofisárias/cirurgia , Idoso , Estudos Retrospectivos , Microcirurgia/métodos , Sela Túrcica/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Cavidade Nasal/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Endoscopia/métodos
17.
Acta Neurochir (Wien) ; 166(1): 252, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38842720

RESUMO

BACKGROUND: An ACTH-secreting pituitary adenoma is the most common cause of excessive endogenous glucocorticoid production resulting in Cushing's Syndrome. A multidisciplinary approach is paramount. Selective adenomectomy is the treatment of choice. METHOD: Endoscopic transnasal transsphenoidal approach to the tumour, along with techniques for resection, are demonstrated. CONCLUSION: Endoscopic transsphenoidal approaches with its magnified view of the pituitary gland allows precise microsurgical dissection during selective adenomectomy. This technique increases the possibility of proving a gross total resection, leading to clinical and biochemical cure in these patients.


Assuntos
Adenoma , Hipersecreção Hipofisária de ACTH , Humanos , Adenoma/cirurgia , Adenoma/diagnóstico por imagem , Hipersecreção Hipofisária de ACTH/cirurgia , Endoscopia/métodos , Adenoma Hipofisário Secretor de ACT/cirurgia , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neuroendoscopia/métodos , Resultado do Tratamento , Procedimentos Neurocirúrgicos/métodos , Feminino , Osso Esfenoide/cirurgia
18.
Acta Neurochir (Wien) ; 166(1): 246, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38831229

RESUMO

BACKGROUND: Endoscopic spine surgery has recently grown in popularity due to the potential benefits of reduced pain and faster recovery time as compared to open surgery. Biportal spinal endoscopy has been successfully applied to lumbar disc herniations and lumbar spinal stenosis. Obesity is associated with increased risk of complications in spine surgery. Few prior studies have investigated the impact of obesity and associated medical comorbidities with biportal spinal endoscopy. METHODS: This study was a prospectively collected, retrospectively analyzed comparative cohort design. Patients were divided into cohorts of normal body weight (Bone Mass Index (BMI)18.0-24.9), overweight (BMI 25.0-29.9) and obese (BMI > 30.0) as defined by the World Health Organization (WHO). Patients underwent biportal spinal endoscopy by a single surgeon at a single institution for treatment of lumbar disc herniations and lumbar spinal stenosis. Demographic data, surgical complications, and patient-reported outcomes were analyzed. Statistics were calculated amongst treatment groups using analysis of variance and chi square where appropriate. Statistical significance was determined as p < 0.05. RESULTS: Eighty-four patients were followed. 26 (30.1%) were normal BMI, 35 (41.7%) were overweight and 23 (27.4%) were obese. Patients with increasing BMI had correspondingly greater American Society of Anesthesiologist (ASA) scores. There were no significant differences in VAS Back, VAS Leg, and ODI scores, or postoperative complications among the cohorts. There were no cases of surgical site infections in the cohort. All cohorts demonstrated significant improvement up to 1 year postoperatively. CONCLUSIONS: This study demonstrates that obesity is not a risk factor for increased perioperative complications with biportal spinal endoscopy and has similar clinical outcomes and safety profile as compared to patients with normal BMI. Biportal spinal endoscopy is a promising alternative to traditional techniques to treat common lumbar pathology.


Assuntos
Índice de Massa Corporal , Descompressão Cirúrgica , Endoscopia , Vértebras Lombares , Obesidade , Estenose Espinal , Humanos , Obesidade/cirurgia , Obesidade/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/efeitos adversos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Idoso , Resultado do Tratamento , Adulto , Estudos Retrospectivos , Endoscopia/métodos , Endoscopia/efeitos adversos , Deslocamento do Disco Intervertebral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos de Coortes
20.
J Vis Exp ; (207)2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38829141

RESUMO

Oncoplastic breast surgery, with its focus on improving cosmetic outcomes while maintaining oncological safety, has fundamentally transformed the landscape of breast cancer surgical treatment, giving rise to an array of techniques for breast reconstruction. Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) has emerged as a cornerstone in managing early breast cancer. Aligned with the principles of minimally invasive surgery, recent years have witnessed the widespread integration of endoscopic approaches in breast surgery, encompassing procedures like endoscopic breast-conserving surgery (E-BCS) and endoscopic nipple-sparing mastectomy (E-NSM), among others. Capitalizing on the advantages of inconspicuous and shorter incisions, improved visibility, and the avoidance of radiation therapy, the popularity of E-NSM with IBBR is on the rise. However, conventional E-NSM with IBBR often requires two or more incisions, which can result in suboptimal cosmetic outcomes and even prosthesis loss.This paper presents a comprehensive account of the intricate surgical procedures involved in endoscopic bilateral nipple-sparing mastectomy with immediate pre-pectoral implant-based breast reconstruction. The insights shared are drawn from the collective experience of our institution. Notable benefits associated with the described surgical approach encompass enhanced cosmetic outcomes, improved postoperative quality of life, and enhanced physiological functions attributable to the application of pre-pectoral implant-based breast reconstruction through a single incision.


Assuntos
Neoplasias da Mama , Endoscopia , Mamilos , Humanos , Feminino , Endoscopia/métodos , Neoplasias da Mama/cirurgia , Mamilos/cirurgia , Mamoplastia/métodos , Mamoplastia/instrumentação , Mastectomia/métodos , Axila/cirurgia , Implantes de Mama
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