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1.
Urologe A ; 59(4): 489-498, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32236687

RESUMO

Vesicovaginal fistulas are a rare problem in the western world but are frequent occurrences in developing countries. In Germany the most frequent cause is hysterectomy. Vesicovaginal fistulas can be treated by the transvaginal or transabdominal approach depending on the characteristics of the fistula and the patient. The incidence and complexity of urorectal fistulas increase with the number of cumulative sequences of prostate cancer treatment. Overall there is no clear consensus about the optimal surgical approach route. The surgical treatment of both vesicovaginal and urorectal fistulas is associated with high permanent fistula closure rates; however, for both entities if the fistula is discovered early enough, conservative treatment with a temporary catheter drainage can be tried, depending on the underlying cause. For both conditions fistula repair in irradiated patients shows a much lower success rate. A spontaneous closure of fistulas in radiogenic fistulas is also not to be expected.


Assuntos
Histerectomia/efeitos adversos , Neoplasias da Próstata/complicações , Fístula Retal/cirurgia , Procedimentos Cirúrgicos Operatórios , Fístula Vesicovaginal/cirurgia , Tratamento Conservador , Drenagem , Feminino , Alemanha , Humanos , Masculino , Fístula Retal/etiologia , Fístula Vesicovaginal/etiologia
2.
Medicine (Baltimore) ; 99(15): e19712, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282727

RESUMO

Pelvic mass onset following a hysterectomy due to benign disease is not rarely seen. Appropriate diagnosis and treatment are of great importance.This study aims to analyze the clinicopathological features of patients who have received surgery for pelvic mass following hysterectomy due to gynecological benign disease, especially endometriosis or adenomyosis.This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy from January 2012 to December 2016 in a tertiary teaching hospital.A total of 247 patients were enrolled in this study. There is a significant difference between the patients with or without a history of endometriosis/adenomyosis. Multivariate analysis showed that the pelvic mass had a higher risk of being ovarian endometrioid carcinoma, ovarian clear cell carcinoma, ovarian endometriosis, and ovarian physiological cysts in patients with a history of adenomyosis/endometriosis.The pathology of the subsequent pelvic mass inclines to be benign, includes ovarian endometriosis, ovarian physiological cysts, and pelvic encapsulated effusion. Postoperative adjuvant therapy for those received hysterectomy due to endometriosis/adenomyosis, like gonadotropin releasing hormone agonists (GnRHa), may contribute to the prevention of benign pelvic mass. Patients with a history of hysterectomy due to endometrisos/adenomyosis tend to have a shorter time interval between hysterectomy and pelvic malignant tumors onset.


Assuntos
Adenomiose/cirurgia , Endometriose/cirurgia , Hormônio Liberador de Gonadotropina/agonistas , Histerectomia/efeitos adversos , Neoplasias Pélvicas/cirurgia , Adenomiose/patologia , Adulto , Idoso , Quimioterapia Adjuvante/métodos , Endometriose/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/prevenção & controle , Neoplasias Ovarianas/cirurgia , Neoplasias Pélvicas/epidemiologia , Neoplasias Pélvicas/patologia , Cuidados Pós-Operatórios/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco
3.
Chirurgia (Bucur) ; 115(1): 112-119, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155406

RESUMO

Postoperative ileus (POI) is a complex phenomenon with important morbidity and mortality, well known in many surgical fields. POI occurs commonly after abdominal and pelvic surgery, especially in cancer patients. We report the case of a 63-year-old patient without known risk factors for POI, who underwent total hysterectomy with bilateral adnexectomy for ovarian tumor with suspicion of malignancy, invalidated by the extemporaneous pathology examination. The postoperative evolution is marked by reduced bowel movements, lack of intestinal transit for flatus and stool for 6 days. In cooperation with the general surgeon conservative treatment for POI was administered, without effect. The abdomen remained distended, with no nausea or vomiting. On the 6th postoperative day a wound dehiscence with incomplete evisceration occurred, after a CT scan of the abdomen and pelvic region was requested to make a differential diagnosis between an intestinal mass and other pathology involving the bowell. In conjunction with the General Surgery team the surgical reintervention was decided and performed. After the procedure, the patient successfully regained transit, with flatus and stool emission, but another 2 complications occurred, which were successfully treated: sepsis and deep vein thrombosis. Understanding the pathophysiology could help to prevent, diagnose, and implement protocols in order to avoid POI and its complications, to reduce hospital stay and cost burden.


Assuntos
Hérnia Ventral/cirurgia , Histerectomia/efeitos adversos , Íleus/etiologia , Hérnia Incisional/cirurgia , Neoplasias Ovarianas/cirurgia , Feminino , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Enteropatias/diagnóstico por imagem , Enteropatias/etiologia , Enteropatias/cirurgia , Pessoa de Meia-Idade , Reoperação , Deiscência da Ferida Operatória/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia
4.
Ann Surg ; 272(1): e27-e29, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32221117

RESUMO

: Little is known about surgical practice in the initial phase of coronavirus disease 2019 (COVID-19) global crisis. This is a retrospective case series of 4 surgical patients (cholecystectomy, hernia repair, gastric bypass, and hysterectomy) who developed perioperative complications in the first few weeks of COVID-19 outbreak in Tehran, Iran in the month of February 2020. COVID-19 can complicate the perioperative course with diagnostic challenge and a high potential fatality rate. In locations with widespread infections and limited resources, the risk of elective surgical procedures for index patient and community may outweigh the benefit.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Pandemias , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias , Betacoronavirus , Colecistectomia/efeitos adversos , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Diagnóstico Diferencial , Feminino , Derivação Gástrica/efeitos adversos , Herniorrafia/efeitos adversos , Humanos , Histerectomia/efeitos adversos , Irã (Geográfico)/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/virologia , Estudos Retrospectivos
5.
BJOG ; 127(7): 859-865, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32037645

RESUMO

OBJECTIVE: To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. DESIGN: Retrospective cohort study with historic control. SETTING: Single tertiary academic centre. POPULATION: Women older than 18 with primary cervical cancer staged FIGO IB1-IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation. METHOD: We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014-06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014). MAIN OUTCOME MEASURES: The occurrence of urological and specifically ureteral complications. RESULTS: Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas. CONCLUSION: The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage. TWEETABLE ABSTRACT: Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Mesentério/cirurgia , Tratamentos com Preservação do Órgão/métodos , Exenteração Pélvica , Complicações Pós-Operatórias , Ureter/lesões , Obstrução Ureteral , Neoplasias do Colo do Útero , Feminino , Alemanha/epidemiologia , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Órgãos em Risco , Avaliação de Processos e Resultados em Cuidados de Saúde , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia , Obstrução Ureteral/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
6.
Int J Gynaecol Obstet ; 148 Suppl 1: 33-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943186

RESUMO

OBJECTIVE: To analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad. METHODS: In this longitudinal study, all patients who presented for fistula repair between 2006 and 2018 were included in the study. Patient data were collected on age, parity, and type and etiology of fistula, which was classified as ischemic or iatrogenic. RESULTS: Of 634 fistula patients, 371 (58.5%) had iatrogenic fistula, while 263 (41.5%) patients developed ischemic fistula due to obstructed labor. Mean age of patients was 31.6 years. Yearly trends showed an increase in iatrogenic fistula from 43.2% in 2006-2008 to 71.4% in 2017-2018. The major etiological contributor to iatrogenic fistula was hysterectomy (52.5%), followed by cesarean hysterectomy (26.4%), and cesarean delivery (19.9%). CONCLUSION: A rising trend in iatrogenic fistula was observed. This emphasizes the need for optimization of surgical approaches and surgical skills. Moreover, gynecologic surgeries should be restricted to authorized gynecologic surgeons.


Assuntos
Cesárea/efeitos adversos , Histerectomia/efeitos adversos , Doença Iatrogênica/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adulto , Feminino , Ginecologia/educação , Ginecologia/normas , Humanos , Estudos Longitudinais , Paquistão/epidemiologia , Gravidez , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
7.
Fisioter. Pesqui. (Online) ; 27(1): 28-33, jan.-mar. 2020. tab
Artigo em Português | LILACS | ID: biblio-1090415

RESUMO

RESUMO O objetivo deste artigo é avaliar o índice de função sexual de mulheres submetidas à histerectomia total com ooforectomia bilateral (HT-OB), a prevalência de incontinência urinária por esforço (IUE) e sua associação com a realização desse procedimento cirúrgico em um hospital de referência em Belém (PA). Foram incluídas 162 mulheres, com vida sexual ativa, alocadas em dois grupos: aquelas que realizaram HT-OB em período superior a 12 meses (n=68), e aquelas que não realizaram (n=94). Utilizou-se o questionário female sexual function index (FSFI) para avaliação da função sexual, e um questionário desenvolvido pelos pesquisadores para coletar dados sociais, econômicos e clínicos, incluindo informações quanto à presença de IUE. O valor de significância foi definido como p<0,05. Houve diferença significativa no índice de função sexual entre o grupo HT-OB e o grupo-controle, com escore geral do FSFI de 23,56 e 28,68, respectivamente (p=0,0001). Os domínios desejo, excitação, lubrificação (p<0,0001), orgasmo (p=0,04), satisfação (p=0,0006) e dor (p=0,015) apresentaram escores inferiores em mulheres histerectomizadas. A prevalência de sintomas de IUE no grupo HT-OB foi de 35,3%, sendo observada associação significativa entre a presença desses sintomas e a realização da histerectomia (p=0,02). Mulheres que realizam HT-OB têm maior risco de disfunção sexual, e este procedimento cirúrgico é associado ao desenvolvimento de IUE.


RESUMEN El presente artículo tuvo el objetivo de evaluar el índice de función sexual de mujeres sometidas a histerectomía total con ooforectomía bilateral (HT-OB), la prevalencia de incontinencia urinaria de esfuerzo (IUE) y su asociación con la realización de este procedimiento quirúrgico en un hospital de referencia en Belém (Brasil). Se incluyeron a 162 mujeres con vida sexual activa, que fueron divididas en dos grupos: las que se sometieron a HT-OB durante el período superior a 12 meses (n=68) y las que no lo había hecho (n=94). Se les aplicaron el cuestionario female sexual function index (FSFI), para evaluar la función sexual, y un cuestionario desarrollado por investigadores para recopilar datos sociales, económicos y clínicos, con informaciones en cuanto a la presencia de IUE. El valor de significación fue de p<0,05. Hubo una diferencia significativa en el índice de función sexual entre el grupo HT-OB y el grupo control, con un puntaje general de FSFI de 23,56 y 28,68, respectivamente (p=0,0001). Los dominios deseo, excitación, lubricación (p<0,0001), orgasmo (p=0,04), satisfacción (p=0,0006) y dolor (p=0,015) tuvieron puntajes más bajos en mujeres histerectomizadas. La prevalencia de síntomas de IUE fue del 35,3% en el grupo HT-OB, además se observó una asociación significativa entre la presencia de estos síntomas y la realización de la histerectomía (p=0,02). Las mujeres que se someten a HT-OB tienen un mayor riesgo de disfunción sexual, y este procedimiento quirúrgico está asociado al desarrollo de IUE.


ABSTRACT The objective of this article was to evaluate the sexual function index of women submitted to total hysterectomy with bilateral oophorectomy (THBO), the prevalence of urinary incontinence (SUI) and its association with the performance of this surgical procedure in a reference hospital in Belém, Pará. One hundred sixty-two women with active sexual life were included in two groups: those who have undergone THBO for more than 12 months (n=68), and those who have not (n=94). The Female Sexual Function Index (FSFI) questionnaire was used to evaluate sexual function along with a questionnaire developed by the researchers to collect social, economic and clinical data, including information on the presence of SUI. The significance level was defined as p<0.05. There was a significant difference in the sexual function index between THBO group and the control group, with an FSFI overall score of 23.56 and 28.68, respectively (p=0.0001). Desire, arousal, lubrication (p<0.0001), orgasm (p=0.04), satisfaction (p=0.0006) and pain (p=0.015) domains had lower scores in hysterectomized women. The prevalence of SUI symptoms in THBO group was 35.3%, and a significant association was observed between the presence of SUI and hysterectomy (p=0.02). Women who undergo THBO have a higher risk of sexual dysfunction, and this surgical procedure is associated with the development of SUI.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/etiologia , Incontinência Urinária/etiologia , Histerectomia/efeitos adversos , Histerectomia/métodos , Complicações Pós-Operatórias , Qualidade de Vida , Incontinência Urinária/epidemiologia , Prevalência , Inquéritos e Questionários , Sexualidade , Estudo de Avaliação
8.
Int J Gynecol Cancer ; 30(2): 227-232, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31911537

RESUMO

INTRODUCTION: Poor baseline functional status is associated with adverse surgical outcomes. Additionally, decline in the postoperative setting may result in the delay of additional treatments, impacting overall survival. This study assesses the incidence and risk factors for functional decline following primary ovarian cancer debulking surgery in previously independent women using discharge location as a surrogate. METHODS: All patients with a postoperative diagnosis of ovarian cancer who underwent surgical debulking and had documentation of discharge location were identified using the 2011-2012 American College of Surgeons National Surgical Quality Improvement Program database. Patients were excluded if their baseline functional status was dependent or partially dependent, or if they died before discharge. Discharge destination was dichotomized as home versus non-home. Descriptive data included demographics, comorbidities, and perioperative outcomes. Multivariable logistic regression was used to evaluate the association of clinical and surgical factors on discharge destination. RESULTS: 1786 patients met the criteria for analysis; 120 (6.7%) patients were discharged to non-home. Differences between home and non-home discharges included age (53.2% vs 83.3% ≥60), body mass index (26.5 vs 27.8 median), comorbidities (45.2% vs 64.2% with ≥1), and complications (8.6% vs 30.0% with ≥1, all p<0.05). In multivariable logistic regression analyses, only increasing age and complications were independently associated with discharge to non-home. Those age ≥70 had 9.0 times the risk (95% CI 3.5 to 23.4; p<0.001) as age <50. The presence of one or more postoperative complications carried 4.5 times (95% CI 2.9 to 7.0; p<0.001) the risk of those without complications. 30 day mortality was also increased in patients discharged to non-home. DISCUSSION: 6.7% of previously independent ovarian cancer patients were discharged to non-home following surgery. Major risk factors for non-home include older age, comorbidities, and postoperative complications. Efforts to optimize baseline functional status and minimize surgical complications may improve discharge rates to non-home and postoperative functional status.


Assuntos
Neoplasias Ovarianas/fisiopatologia , Neoplasias Ovarianas/cirurgia , Fatores Etários , Idoso , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Modelos Logísticos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Período Pós-Operatório , Fatores de Risco
9.
Gynecol Oncol ; 156(2): 511, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31892416

RESUMO

OBJECTIVE: Cisterna chyli is a pearl-shaped elongated lymphatic structure located at the level of L1-L2 vertebra just beneath the aorta (Hsu and Itkin, 2016 [1]). It receives lymphatic drainage of intestines and lower body structures (Loukas et al., 2007 [2]). Size, shape and location are all highly variable and in some autopsy series CC was identified in only half of the cases (Song, 2016 [3]). During the laparoscopic paraaortic lymphadenectomy inadvertent injury to otherwise unidentified CC could lead to refractory chylous ascites (Favero et al., 2010 [4]). The objective of this video is to demonstrate the anatomic localization and consequences of inadvertent injury to CC in laparoscopic paraaortic lymphadenectomy. METHODS: Two different patients undergoing laparoscopic paraaortic lymphadenectomy were presented. RESULTS: The first case is a 51 year old woman with grade III endometrioid adenocarcinoma of uterus who was subjected to laparoscopic staging (laparoscopic hysterectomy + BSO + pelvic and paraaortic lymphadenectomy). Intraoperatively an injury to cisterna chyli occurred which was sealed and repaired immediately. The second case is a woman with stage IIB clear cell cervical cancer undergoing laparoscopic staging (pelvic and paraaortic lymphadenectomy). In this case cisterna chyli could be recognized and preserved. CONCLUSION: Cisterna chyli is an important anatomic structure which should be identified and preserved during laparoscopic paraaortic lymphadenectomy. Any iatrogenic injury to cisterna chyli could lead to chylous ascites and indeed in minority of these cases surgical intervention is required.


Assuntos
Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Ducto Torácico/lesões , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias
10.
Am J Obstet Gynecol ; 222(3): 249.e1-249.e10, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31586602

RESUMO

BACKGROUND: Standard treatment of early cervical cancer involves a radical hysterectomy and retroperitoneal lymph node dissection. The existing evidence on the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer is either nonrandomized or retrospective. OBJECTIVE: The purpose of this study was to compare the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer. STUDY DESIGN: The Laparoscopic Approach to Carcinoma of the Cervix trial was a multinational, randomized noninferiority trial that was conducted between 2008 and 2017, in which surgeons from 33 tertiary gynecologic cancer centers in 24 countries randomly assigned 631 women with International Federation of Gynecology and Obstetrics 2009 stage IA1 with lymph-vascular invasion to IB1 cervical cancer to undergo minimally invasive (n = 319) or open radical hysterectomy (n = 312). The Laparoscopic Approach to Carcinoma of the Cervix trial was suspended for enrolment in September 2017 because of an increased risk of recurrence and death in the minimally invasive surgery group. Here we report on a secondary outcome measure: the incidence of intra- and postoperative adverse events within 6 months after surgery. RESULTS: Of 631 randomly assigned patients, 536 (85%; mean age, 46.0 years) met inclusion criteria for this analysis; 279 (52%) underwent minimally invasive radical hysterectomy, and 257 (48%) underwent open radical hysterectomy. Of those, 300 (56%), 91 (16.9%), and 69 (12.8%) experienced at least 1 grade ≥2 or ≥3 or a serious adverse event, respectively. The incidence of intraoperative grade ≥2 adverse events was 12% (34/279 patients) in the minimally invasive group vs 10% (26/257) in the open group (difference, 2.1%; 95% confidence interval, -3.3 to 7.4%; P=.45). The overall incidence of postoperative grade ≥2 adverse events was 54% (152/279 patients) in the minimally invasive group vs 48% (124/257) in the open group (difference, 6.2%; 95% confidence interval, -2.2 to 14.7%; P=.14). CONCLUSION: For early cervical cancer, the use of minimally invasive compared with open radical hysterectomy resulted in a similar overall incidence of intraoperative or postoperative adverse events.


Assuntos
Histerectomia/efeitos adversos , Histerectomia/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Índice de Massa Corporal , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Complicações Intraoperatórias/classificação , Laparoscopia , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/classificação , Fatores de Risco , Procedimentos Cirúrgicos Robóticos , Neoplasias do Colo do Útero/patologia
11.
Int J Clin Oncol ; 25(2): 384-390, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31552530

RESUMO

BACKGROUND: The standard treatment for cervical cancer is chemoradiation although some patients showed treatment resistance. The purpose of this study was to investigate the clinical efficacy of surgery after chemoradiation for cervical cancer. METHODS: Patients with FIGO stage IB2 to IIB cervical cancer were included in the study between 2005 and 2015. A total of 50 patients who underwent surgery after neoadjuvant chemoradiation and 76 patients who received only chemoradiation were compared. Baseline differences between the two groups were adjusted with inverse probability of treatment weighting method using propensity scores composed of the following independent variables: age, stage, tumor size, lymph node metastasis, and histological subtypes. RESULTS: Median follow-up was 64.8 (range 4.8-143.9) months. After adjustment with inverse probability of treatment weighting, Kaplan-Meier curves showing adjusted progression-free survival and overall survival were significantly longer in the neoadjuvant chemoradiation compared with the chemoradiation-only group (p = 0.027 and p = 0.017, respectively). Moreover, in patients with squamous cell carcinoma, recurrence in previously irradiated field and recurrence both in and out of previously irradiated field were significantly decreased in the neoadjuvant chemoradiation compared with the chemoradiation-only group (3.1% and 18.4%, respectively; OR 0.142, p = 0.001]. Adverse events of surgery after chemoradiation were acceptable, although temporary hydronephrosis was frequently observed (23.1%). CONCLUSIONS: Surgery after chemoradiation reduced pelvic recurrence, and as a result, patients who underwent neoadjuvant chemoradiation showed more favorable survival outcomes compared with those who only underwent chemoradiation.


Assuntos
Quimiorradioterapia/métodos , Histerectomia/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Histerectomia/efeitos adversos , Estimativa de Kaplan-Meier , Metástase Linfática , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Complicações Cognitivas Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
12.
Gynecol Oncol ; 156(1): 115-123, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31806399

RESUMO

OBJECTIVES: To report the trends in surgical approaches and compare the major surgical complication rates of laparoscopic and abdominal radical hysterectomy for cervical cancer. METHODS: From the major surgical complications of cervical cancer in China (MSCCCC) database, we obtained the demographic, clinical, treatment hospital and complication data of patients with cervical cancer who underwent radical hysterectomy from 2004 to 2015 at 37 hospitals. The patients were assigned to the laparoscopic and abdominal surgery groups. The differences in the complication rates were analyzed using univariate and multivariable logistic regression models. RESULTS: We identified a total of 18447 patients; 5491 (29.8%) underwent laparoscopic surgery and 12956 (70.2%) underwent abdominal surgery. The proportion of laparoscopic surgery rose from 0.35% in 2004 to 49.31% in 2015. In the multivariate analysis, the laparoscopic group had increased odds of intraoperative and postoperative complications (OR = 3.88, 95% CI = 2.47-6.11; OR = 1.42, 95% CI = 1.11-1.82). A more detailed analysis showed that laparoscopic surgery was associated with increased rates of intraoperative ureteral injury (OR = 3.83, 95% CI = 2.11-6.95), bowel injury (OR = 14.83, 95% CI = 1.32-167.25), vascular injury (OR = 3.37, 95% CI = 1.18-9.62), postoperative vesicovaginal fistula (OR = 4.16, 95% CI = 2.08-8.32), ureterovaginal fistula (OR = 4.16, 95% CI = 2.08-8.32), rectovaginal fistula (OR = 8.04, 95% CI = 1.63-39.53), and chylous leakage (OR = 10.65, 95% CI = 1.18-95.97), while abdominal surgery was more likely to cause bowel obstruction (OR = 0.55, 95% CI = 0.35-0.87). The two groups had similar rates of bladder injury, obturator nerve injury, pelvic hematoma, rectovaginal fistula and venous thromboembolism (P > 0.05). CONCLUSION: Laparoscopic surgery was associated with more major surgical complications, especially intraoperative ureteral injury and postoperative fistula, than abdominal surgery among women with cervical cancer.


Assuntos
Neoplasias do Colo do Útero/cirurgia , China/epidemiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
13.
Obstet Gynecol ; 135(1): 123-132, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809429

RESUMO

OBJECTIVE: To assess variables associated with opioid prescriptions filled perioperatively after hysterectomy and the risk of prolonged opioid use through 1 year after hysterectomy. METHODS: In this retrospective cohort study, we used the 2005-2015 IBM MarketScan databases to identify women aged at least 18 years who underwent hysterectomy. For opioid use, we identified filled prescriptions for opioid medications. We excluded women with prevalent opioid use, defined as an opioid prescription filled 180 to 30 days preoperatively or at least two prescriptions filled in the 30 days before surgery. We defined perioperative opioid use as any opioid prescription filled within 30 days before or 7 days after surgery. We used log-binomial regression to identify independent predictors of perioperative opioid prescription fill. To assess the risk of long-term opioid use, we estimated the proportion of women with ongoing monthly opioid prescriptions through 12 months after surgery and the proportion of women with any opioid prescription 3-6 months after surgery, mimicking published estimates. RESULTS: Among 569,634 women who underwent hysterectomy during the study period, 176,537 (30.9%) were excluded owing to prevalent opioid use. We found that 331,322 (84.3%) women filled a perioperative opioid prescription, with median quantity of 30 pills (interquartile range 25-40), and that younger (adjusted risk ratio [adjRR]18-24 0.91) and older (adjRR65-74 0.84; adjRR75+ 0.70) patients were less likely to receive a perioperative prescription compared with women aged 45-54. The proportion of women with continuous monthly fills of opioids through 2, 3, 6, and 12 months after surgery was 1.40%, 0.34%, 0.06%, and 0.02%, respectively. CONCLUSION: Most women who underwent hysterectomy in the United States from 2005 to 2015 filled a perioperative opioid prescription with a median quantity of 30 pills. The risk of prolonged opioid use through 6 months is quite low, at 0.06% or 1 in 1,547.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Histerectomia/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
14.
Int J Gynecol Cancer ; 30(1): 41-47, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31780567

RESUMO

OBJECTIVES: It is unclear if sentinel lymph node biopsy is associated with improved surgical outcomes compared with lymphadenectomy in patients with endometrial cancer. In this study we aimed to compare peri-operative surgical outcomes and treatment-related morbidity in patients who underwent robotic-assisted sentinel lymph node biopsy versus systematic pelvic lymphadenectomy or hysterectomy alone for apparent early-stage endometrial cancer. METHODS: Records were reviewed of consecutive patients with International Federation of Gynecology and Obstetrics stages I-III endometrial cancer undergoing robotic-assisted staging from January 1, 2009, through June 30, 2016. For the purpose of this analysis we focused on the actual patients who had sentinel node biopsy only (ie, excluding those who had an associated lymphadenectomy either for failed mapping or during the learning curve). We also excluded patients who had para-aortic lymph node dissection from the lymphadenectomy group. Perioperative and 30-day surgical outcomes were compared between patients who underwent sentinel lymph node assessment and those who had pelvic lymphadenectomy or hysterectomy alone, respectively. Inverse probability of treatment weighting derived from propensity scores was used to minimize allocation bias in the comparison of outcomes between groups. RESULTS: A total of 621 patients were analyzed: 188 (30.3%) with sentinel lymph node biopsy, 198 (31.9%) with pelvic lymphadenectomy, and 235 (37.8%) with hysterectomy alone. Inverse probability of treatment weights analysis balanced for baseline characteristics (age, body mass index, American Society of Anesthesiologists score, Charlson co-morbidity index, parity, prior cesarean section, and previous abdominal operation) showed no significant differences in intra-operative and post-operative complications, re-admissions, and re-operations between the groups. Compared with pelvic lymphadenectomy, the sentinel lymph node biopsy group had a shorter mean operative time (138.0 vs 222.8 min, p<0.001) and less median blood loss (50 vs 100 mL, p<0.001). Sentinel lymph node biopsy also was not associated with worse morbidity compared with hysterectomy alone. CONCLUSIONS: Introduction of sentinel lymph node biopsy reduces operative times and improves peri-operative surgical outcomes of robotic-assisted staging for apparent early-stage endometrial cancer without worsening the morbidity of hysterectomy alone.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Biópsia de Linfonodo Sentinela/métodos , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Perioperatório , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Salpingo-Ooforectomia/efeitos adversos , Salpingo-Ooforectomia/métodos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Resultado do Tratamento
15.
BMJ Case Rep ; 12(12)2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31852688

RESUMO

Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.


Assuntos
Dor Abdominal/cirurgia , Depressão/psicologia , Histerectomia/efeitos adversos , Procedimentos Desnecessários/efeitos adversos , Adulto , Terapia de Casal , Depressão/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Terapia de Reposição Hormonal , Humanos , Histerectomia/psicologia , Hérnia Incisional/tratamento farmacológico , Hérnia Incisional/etiologia , Índia
16.
Rev Bras Ginecol Obstet ; 41(12): 718-725, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31856291

RESUMO

OBJECTIVE: To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital. METHODS: A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program. RESULTS: A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p = 0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p = 0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p = 0.030), logistic regression did not find any association between uterine volume and surgical time (p = 0.103). CONCLUSION: The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.


Assuntos
Competência Clínica , Histerectomia/educação , Laparoscopia/educação , Técnicas de Sutura/educação , Adulto , Brasil , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia
17.
Medicine (Baltimore) ; 98(44): e17742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689824

RESUMO

Placenta previa and accreta with prior cesarean section is an extremely serious condition that is associated with maternal morbidity and mortality from obstetric hemorrhage. The aim of our study was to evaluate the efficacy and advantages of a novel surgical technique, parallel transverse uterine incisions (PTUI), during conservative cesarean delivery in patients with placenta previa and accreta.This was a retrospective cohort study including 124 pregnant women, who had at least 1 prior cesarean section and were diagnosed with anterior placenta previa and accreta between January 2014 and October 2017. Using the hospital's information system, patients were retrospectively classified into undergoing either the PTUI surgery (Group A) or the ordinary cesarean section (Group B). Surgical outcomes and maternal complications during hospitalization were collected. The results from 2 groups were compared and analyzed statistically. Multivariable regression analyses were further used to assess the effect of PTUI on severe maternal outcomes.Patients who underwent PTUI were not statistically different from patients who underwent the ordinary cesarean section in terms of maternal and infants' characteristics. However, PTUI was associated with remarkably reduced intraoperative blood loss (P = .005), related vaginal blood loss after surgery (P = .026), and transfusion requirement of packed red cells (P = .000), compared to the ordinary cesarean section. Moreover, cesarean hysterectomy (3.3% vs 21.9%; P = .002) and intensive care unit admission (1.7% vs 29.7%; P = .000) were significantly fewer among patients who underwent PTUI. Multivariable regression analyses further showed that the risk of intraoperative hemorrhage (ß = -2343.299, P = .000) and cesarean hysterectomy (odds ratio = 0.027, P = .018) were both significantly decreased by PTUI.PTUI is a novel approach that may significantly reduce maternal complications, while preserving the uterus for patients with anterior placenta previa and accreta.


Assuntos
Cesárea/métodos , Histerectomia/métodos , Histeroscopia/métodos , Tratamentos com Preservação do Órgão/métodos , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Útero/cirurgia
18.
Int J Med Sci ; 16(11): 1439-1446, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31673234

RESUMO

Background: Fentanyl is one of the most widely used opioids for intravenous patient-controlled analgesia (IV-PCA). Sufentanil, a fentanyl analog, is suitable for postoperative pain control because it has no active metabolites and shows a higher therapeutic index and lower frequency of respiratory suppression than fentanyl. This study aimed to compare the two opioids for postoperative pain relief on the basis of analgesic efficacy, adverse effects, and patient satisfaction. Methods: Sixty-four patients undergoing total laparoscopic hysterectomy were randomly allocated into a fentanyl group (n = 31) or a sufentanil group (n = 33). The patients received 50-µg fentanyl or 10-µg sufentanil before induction of anesthesia and 5 minutes after uterine incision during surgery in the fentanyl and sufentanil group, respectively. After arriving at the post-anesthesia care unit (PACU), verbal pain score (VPS) and sedation score were assessed. IV-PCA (fentanyl 1250 µg or sufentanil 250 µg with ondansetron 8 mg; total volume, 60 ml) was connected and continued for 48 h postoperatively. Postoperative pain was evaluated by using the numeric rating scale (NRS; at rest/during cough) at 6, 12, 24, 36, and 48 hours after surgery. The cumulative PCA consumption, patient satisfaction scores, and adverse effects were measured. Results: In the PACU, VPS was significantly higher and rescue fentanyl consumption was higher in the fentanyl group than in the sufentanil group, while the sedation score and adverse effects were comparable between the groups. No significant differences were observed in the NRS scores for pain (at rest/during cough) in the ward over 48 hours postoperatively, but the cumulative PCA consumption was significantly higher in the fentanyl group (47.4 ± 9.9 ml vs. 36.2 ± 14.6 ml, P = 0.01). There were no significant intergroup differences in patient satisfaction score and the incidence of adverse effects in the ward, except for a higher incidence of dry mouth in the fentanyl group. Conclusions: In comparison with fentanyl, sufentanil showed comparable analgesic efficacy and safety with less analgesic consumption (under a potency ratio of 1:5) in IV-PCA after total laparoscopic hysterectomy. Therefore, we suggest that sufentanil can be a useful alternative to fentanyl for IV-PCA.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Fentanila/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/administração & dosagem , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Histerectomia/efeitos adversos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/fisiopatologia
19.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(5): 630-635, 2019 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-31699193

RESUMO

Objective To explore the correlation between asymptomatic bacteriuria(AB)and surgical site infection(SSI)in middle-aged and elderly women undergoing open hysterectomy.Methods The clinical data of 1469 middle-aged and elderly women undergoing open hysterectomy in the Third Affiliated Hospital of Guizhou Medical University from June 2011 to August 2018 were retrospectively analyzed.Factors associated with SSI after operation were analyzed by univariate and multivariate regression models to identify the relationship of AB with SSI after open hysterectomy.Results Of these 1469 patients,101(6.88%)had SSI and 124 had AB[including 14 patients(11.29%)with infections].In addition,1345 patients had no AB,among whom 87(6.47%)had infections.Thus,the infection rate in patients with AB was significantly higher than that in patients without AB(χ 2=4.123,P=0.042).Univariate analysis showed AB,history of diabetes mellitus,surgical procedure,length of stay(>15 d),season(summer and autumn),body mass index(≥25 kg/m 2),nature of lesions(malignant tumors),ASA grade(>grade Ⅱ),incision length(≥10 cm),and operative time(≥3 h),bleeding volume(≥1000 ml),serum albumin concentration(<30 g/L),blood glucose(≥10 mmol/L),and hemoglobin concentration(<90 g/L)were associated with SSI(all P <0.05).Multivariate analysis showed that AB,nature of lesions(malignant tumors),blood glucose(≥10 mmol/L),operative time(≥3 h),and ASA grade(>grade Ⅱ)were risk factors for SSI in these patients(all P <0.05). Conclusions AB is one of the risk factors for SSI in middle-aged and elderly women undergoing open hysterectomy.Screening and treatment of AB before surgery can reduce the risk of SSI.ASA grading shall be performed before surgery before corresponding preparation was offered.Effective control of blood glucose,improved surgical skills,and shorter operative time are helpful for lowering postoperative SSI.


Assuntos
Bacteriúria/complicações , Histerectomia/efeitos adversos , Infecção da Ferida Cirúrgica/complicações , Idoso , Glicemia , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco
20.
Medicine (Baltimore) ; 98(48): e18058, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770221

RESUMO

Studies on the relationship between gynecologic surgery and subsequent ovarian cancer have been carried out in limited Western ethnic groups. We aim to evaluate whether receiving hysterectomy and/or salpingectomy associated with ovarian cancer risk in Taiwan.From the Taiwan National Health Insurance Research Database, we identified a gynecologic surgery cohort consisting of women who had newly received hysterectomy (N = 181,151), salpingectomy (N = 45,410) or both hysterectomy and salpingectomy (N = 11,875) in 2000 to 2013. A comparison cohort of 953,744 women was randomly selected from women without the surgeries, frequency-matched by age and index date of the surgery case. They were followed up to identify subsequent ovarian cancer by the end of 2013.The overall ovarian cancer incidence was 4.4-fold greater in the gynecologic surgery cohort than in the comparison cohort (41.5 vs 9.43 per 10 person-years) with an adjusted hazard ratio of 3.86 (95% confidence interval = 2.56-5.84). Women with both hysterectomy and salpingectomy had the highest incidence and followed by women with hysterectomy or salpingectomy (52.5, 45.5, or 23.3 per 10 person-years, respectively). No ovarian cancer was noted in the subgroup with bilateral salpingectomies.We conclude that women with gynecologic surgery of hysterectomy and/or salpingectomy are at an increased risk of developing ovarian cancer, particularly among women who have had other gynecologic comorbidity. Women with gynecologic surgery and comorbidity deserve greater attention to prevent and screen for ovarian cancer.


Assuntos
Histerectomia/efeitos adversos , Neoplasias Ovarianas/etiologia , Complicações Pós-Operatórias/etiologia , Salpingectomia/efeitos adversos , Adulto , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Neoplasias Ovarianas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Salpingectomia/métodos , Taiwan/epidemiologia
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