RESUMO
ABSTRACT Background: Laparoscopic retroperitoneal simple nephrectomy (LRSN) has been widely accepted as a mainstay option for benign non-functioning kidney. The complexity of the procedure, however, differs and remains a subject of controversy. Objective: To develop a standardised Harbin Medical University nephrectomy score (HMUNS) system for evaluating LRSN complexity. Subjects and methods: A total of 6 variables with different factors comprising primary diseases, history of upper urinary tract surgery, body mass index (BMI), surgeon's learning curve, kidney volume, and Mayo Adhesive Probability (MAP) scores were included in the HMUN score. 95 consecutive patients who underwent LRSN at our institution were divided into low (2 to 6 points) and high (7 to 17 points) complexity groups with HMUNS and investigated the differences of operative time (OT), estimated blood loss (EBL), postoperative hospitalisation time (PHT), rate of intraoperative conversion to open surgery, and the Clavien-Dindo classification (CDC) between both groups. Results: Longer mean operative times (193.2±69.3 min vs. 151.9±46.3 min, p <0.05), more median estimated blood loss (100.0mL vs. 50.0mL, p <0.05), and higher rates of conversion to open surgery (1.2% vs. 25%, p <0.05) were observed in the high-complexity group (n=12) than in the low-complexity group (n=83). However, there were no remarkable differences between the two groups related to the baseline characteristics, post-surgical hospitalisation times, and postoperative complications. Conclusions: The HMUNS can effectively reflect LRSN complexity, thus providing a quantitative system for risk estimation and treatment decisions. Because of some limitations, further well-designed studies are necessary to confirm our findings. Patient summary: The HMUNS, including primary diseases, history of upper urinary tract surgery, BMI, surgeon's learning curve, kidney volume, and MAP score, can provide an effective quantitative tool to evaluate the complexity of LRSN.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Laparoscopia/métodos , Medição de Risco/métodos , Nefrectomia/métodos , Complicações Pós-Operatórias , Valores de Referência , Espaço Retroperitoneal/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Laparoscopia/normas , Estatísticas não Paramétricas , Duração da Cirurgia , Tempo de Internação , Pessoa de Meia-Idade , Nefrectomia/normasRESUMO
SUMMARY Endometriosis is a chronic gynecological disease characterized by sustained painful symptoms that are responsible for a decline in the quality of life of sufferers. Conventional treatment includes surgical and pharmacological therapy aiming at reducing painful symptoms. This study aimed to evaluate pain levels in women with endometriosis, focusing on the influence of conventional treatment in controlling this variable. To do so, a literature search was conducted in the Medline/Pubmed databases, with 119 scientific articles found. After applying the inclusion and exclusion criteria, 27 were selected for reading and elaboration of this review. Thus, 9 studies evaluated the contribution of surgery, 17 the use of drugs to reduce pain levels in patients with endometriosis and one assessed surgical and medical treatment. The main results of these searches are presented and discussed in this revision. Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages, such as risk of recurrence and side effects, respectively. Treatment of endometriosis is, therefore, a challenge for gynecologists and patients, as they must select the best therapeutic approach for this disease. However, improved quality of life in these patients has been obtained with the use of conventional treatment.
RESUMO A endometriose é uma doença ginecológica crônica caracterizada por quadros álgicos constantes responsáveis pela redução da qualidade de vida das portadoras. O tratamento convencional, que inclui o cirúrgico e farmacológico, tem por finalidade reduzir os sintomas de dor. Este estudo teve por objetivo avaliar os níveis de dor nas mulheres com endometriose, com enfoque na influência do tratamento convencional no controle dessa variável. Para isso, foi realizada uma pesquisa bibliográfica no Medline/PubMed e foram encontrados 119 artigos científicos, sendo que, após a aplicação dos critérios de inclusão e exclusão, 27 foram selecionados para leitura e elaboração desta revisão. Desse modo, nove estudos avaliaram a contribuição da cirurgia; dezessete, o uso de medicamentos para redução nos níveis de dor em pacientes com endometriose; e um, o tratamento cirúrgico e medicamentoso. Os principais resultados dessas pesquisas estão apresentados e discutidos nesta revisão. A cirurgia e o uso de medicamentos proporcionaram redução nos escores de dor nas pacientes com endometriose, no entanto, exibem desvantagens como risco de recorrência e efeitos colaterais, respectivamente. Assim, o tratamento para endometriose é um desafio para ginecologistas e pacientes, uma vez que é necessário selecionar a melhor abordagem terapêutica para essa doença. Entretanto, melhora na qualidade de vida das pacientes foi obtida com o emprego do tratamento convencional.