open surgery

开放手术
  • 文章类型: Case Reports
    下腔静脉滤器通常使用血管内手术取回。然而,在出现与过滤器相关的并发症或血管内修复变得具有挑战性的情况下,可以考虑开放手术。
    一名65岁的女性因进行性静脉血栓栓塞(VTE)接受了下腔静脉滤器置入手术。两个月后,在外部医院进行了一次失败的血管内取回尝试,她经历了腹痛,并被转移到我们的设施进行进一步治疗。检查显示,她遇到了并发症,下腔静脉过滤器在植入后同时穿透了腔静脉和十二指肠。但幸运的是,患者的血液检查结果在正常范围内。最终,我们的机构通过开放手术成功移除过滤器,患者出院,没有任何并发症。
    这种情况下,随着我们的文献综述,说明了通过开放手术去除十二指肠穿透过滤器的可行性和安全性,为患者带来有利的结果和有希望的预后。
    UNASSIGNED: Inferior vena cava filters are typically retrieved using endovascular procedures. However, in cases where complications related to the filter arise or when endovascular retrieval becomes challenging, open surgery could be considered.
    UNASSIGNED: A 65-year-old woman underwent inferior vena cava filter placement surgery for progressive venous thrombosis embolism (VTE). Following an unsuccessful endovascular retrieval attempt at an external hospital two months later, she experienced abdominal pain and was transferred to our facility for further treatment. Examination revealed that she was encountered a complication where the inferior vena cava filter penetrated both the vena cava and the duodenum post-implantation. But fortunately, the patient\'s blood test results were within normal range. Ultimately, our institution successfully removed the filter through open surgery and the patient was discharged without any complications.
    UNASSIGNED: This case, along with our literature review, illustrates the viability and safety of duodenal-penetrated filter removal via open surgery, resulting in favorable outcomes and a promising prognosis for the patient.
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  • 文章类型: Case Reports
    胃平滑肌瘤是良性的,在无关的影像学检查或尸检过程中偶然发现的粘膜下肿瘤。大多数平滑肌瘤无症状;然而,患者可在病变上形成中心性溃疡,导致上消化道(GI)出血。一位75岁的女性,有高血压病史,高脂血症,脑血管意外,面对黑便的投诉,近晕厥事件,头昏眼花,弱点,还有呕血.腹部的计算机断层扫描(CT)在胃底内和胃食管(GE)交界处附近发现了4×4×3cm3的异质低衰减质量。在开放性胃造口术和切除活检后,肿块被鉴定为平滑肌瘤。本病例报告回顾了演示文稿,诊断评估,和治疗胃食管交界处近端的复杂位置的胃平滑肌瘤。胃平滑肌瘤应被视为上消化道出血患者的鉴别诊断。
    Gastric leiomyomas are benign, submucosal tumors found incidentally on unrelated imaging or during autopsy. The majority of leiomyomas are asymptomatic; however, patients can develop central ulcerations on the lesions leading to upper gastrointestinal (GI) bleeding. A 75-year-old female, with a past medical history of hypertension, hyperlipidemia, and a cerebrovascular accident, presented with complaints of melena, near-syncope events, lightheadedness, weakness, and hematemesis. A computed tomography (CT) of the abdomen with contrast found a heterogeneous low-attenuation mass of 4×4×3 cm3 within the gastric fundus and near the gastroesophageal (GE) junction. After an open gastrostomy and excisional biopsy, the mass was identified as a leiomyoma. This case report reviews the presentation, diagnostic assessments, and treatment of a gastric leiomyoma in a complex location proximal to the gastroesophageal junction. Gastric leiomyomas should be considered as a differential diagnosis for patients presenting with an upper gastrointestinal bleed.
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  • 文章类型: Case Reports
    腔静脉后输尿管是一种罕见的异常,输尿管经过下腔静脉后。开放手术一直是治疗的金标准。我们正在介绍一例腔静脉后输尿管伴输尿管结石,这是通过开放手术有效管理。一名27岁的男性,有9个月的侧腹疼痛史。他没有慢性病史。体格检查和实验室检查结果正常。进行计算机断层扫描(CT)扫描以确认腔静脉后输尿管伴输尿管结石的诊断。做肋下切口。然后,输尿管近端和下段在腔后横断。石头被提取出来;然后,进行了水密吻合。用于患者随访6个月的超声显示无肾积水。腔静脉后输尿管可能没有症状或与非特异性症状有关。腔静脉后输尿管的诊断经常延迟。在大多数情况下使用手术管理。
    The retrocaval ureter is an uncommon anomaly where the ureter passes behind the inferior vena cava. Open surgery had been the gold standard for treatment. We are presenting a case of the retrocaval ureter with ureteral calculi, which was effectively managed by open surgery. A 27-year-old male presented with a nine-month history of flank pain. He had no history of chronic illnesses. Physical examinations and laboratory findings were within normal. A computed tomography (CT) scan was done to confirm the diagnosis of retrocaval ureter with ureteral stones. The subcostal incision was made. Then, the proximal and lower ureter was transected at the point where it went retrocaval. The stones were extracted; then, watertight anastomosis was done. Ultrasound used for the follow-up of the patient for six months showed no hydronephrosis. Retrocaval ureteral may have no symptoms or be linked to nonspecific symptoms. The diagnosis of the retrocaval ureter is frequently delayed. Surgical management is utilized in the majority of cases.
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  • 文章类型: Case Reports
    我们报告了一名85岁的男子,他因感染的内动脉动脉瘤而接受了经动脉栓塞(TAE)。患者出现发热和左下腹疼痛。计算机断层扫描(CT)显示左内髂动脉瘤扩张。我们计划对感染的髂内动脉瘤进行手术治疗;然而,患者的年龄和一般情况使手术风险很高。因此,我们进行了紧急TAE.患者服用抗生素4周,手术后第33天出院,进展良好。3年的随访CT扫描显示动脉瘤减少且无复发感染。该病例报告强调,TAE可以成为感染动脉瘤患者的治疗选择。
    We report an 85-year-old man who underwent transarterial embolization (TAE) for an infected internal iliac artery aneurysm. The patient presented with fever and left lower abdominal pain. Computed tomography (CT) revealed the expansion of a left internal iliac artery aneurysm. We planned surgical treatment for an infected internal iliac artery aneurysm; however, the patient\'s age and general condition made the surgery high-risk. Therefore, we performed emergency TAE. The patient was administered antibiotics for 4 weeks and discharged on day 33 after the procedure with good progression. A 3-year follow-up CT scan showed aneurysm reduction and no recurrent infections. This case report highlights that TAE can be a treatment option for patients with an infected artery aneurysm.
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  • 文章类型: Case Reports
    囊性淋巴管瘤是一种罕见的疾病,主要在儿童时期诊断。确诊时,由于存在严重并发症的风险,该病变是手术的指征。在这里,我们报告了一例32岁的患者,他因腹痛出现在急诊室2天前,在最后24小时内症状恶化和腹痛。计算机断层扫描显示空肠和回肠近端弥漫性壁增厚,肠系膜脂肪浸润,肠系膜集合,和适量的腹水延伸到骨盆。进行了剖腹手术,显示弥漫性化学性腹膜炎,空肠肠系膜有火山口样病变,分泌淋巴液.然后切除肠系膜病变,组织学检查显示囊性淋巴管瘤破裂。小肠系膜淋巴管瘤很少见,可能与肠闭塞或腹膜炎异常相关。
    Cystic lymphangioma is a rare disease that is mainly diagnosed in childhood. When diagnosed, the lesion presents an indication for surgery due to the risk of serious complications. Herein, we report the case of a 32-year-old patient who presented to the emergency room for abdominal pain that developed 2 days before with worsening symptoms and abdominal pain in the last 24 hr. The computed tomography showed diffuse wall thickening of the jejunum and proximal ileum with mesenteric fat infiltration, a mesenteric collection, and a moderate volume of ascites extending into the pelvis. A laparotomy was performed, revealing diffuse chemical peritonitis with a crater-like lesion in the jejunal mesentery, secreting lymphatic fluid. The mesenteric lesion was then excised, and the histological examination showed a ruptured cystic lymphangioma. Lymphangiomas of the small bowel mesentery are rare and may be exceptionally associated with bowel occlusion or peritonitis.
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  • 文章类型: Journal Article
    感染或霉菌性主动脉瘤(MAAs)是一种罕见的动脉瘤。由于破裂的风险很高,MAAs是危及生命的疾病。早期诊断和治疗是必要的,然而MAAs通常是偶然发现的。我们报告了10例MAAs患者,他们在宏观上,在所有病例中均见主动脉内壁大小相似的病变.当在主动脉瘤的开放手术修复期间看到主动脉内壁上的硬币大小的病变时,外科医生应该考虑感染原因。应收集微生物组织样本,应开始额外的靶向抗生素治疗.
    Infected or mycotic aortic aneurysms (MAAs) are a rare type of aneurysms. Due to the high risk of rupture, MAAs are life-threatening conditions. Early diagnosis and treatment are necessary, yet MAAs are usually found coincidentally. We report 10 patients with MAAs in whom macroscopically, similar coined-sized lesions of the inner aortic wall were seen in all cases. When a coin-sized lesion in the inner aortic wall is seen during open surgical repair of an aortic aneurysm, the surgeon should consider an infectious cause. Microbiological tissue samples should be collected, and additional targeted antibiotic therapy should be started.
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  • 文章类型: Case Reports
    尽管血管内治疗越来越多地用于脾动脉瘤(SAAs)的治疗,而不是开放手术,关于紧急混合方法的信息有限,选择性。我们介绍了使用紧急血管内球囊进行流入控制和开放切除的混合疗法的经验。
    方法:一名34岁的妇女在另一个医疗机构报告她的脾动脉有假性动脉瘤后被带到急诊室。患者血流动力学稳定。然后我们接受了血管内和开放手术的组合,采用球囊近端控制和开放动脉瘤切除术。她在术后第五天出院。
    关于如何治疗SAA患者尚无共识。血管内手术,如血管内介入也被使用,将手术风险降至最低,缩短患者住院时间,但并发症依然存在。我们建议尝试SAA的紧急混合策略操作,预后良好,并发症少。
    结论:看来,与不可能进行血管内手术的单独开放手术相比,在稳定的患者中,选择性混合手术更安全,更有效,并且可以使手术更容易,而无需更多的解剖来控制脾动脉。
    UNASSIGNED: Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection.
    METHODS: A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation.
    UNASSIGNED: There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient\'s hospital stay, but complications remain. We propose to try SAA\'s emergency hybrid strategy operation with a good prognosis and fewer complications.
    CONCLUSIONS: It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.
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  • 文章类型: Journal Article
    背景:关于在开放手术领域中使用荧光引导手术(FGS)的论文很少。本研究旨在评估FGS在儿科人群开放环境中的有用性,并报告我们使用Rubina®Lens系统的初步经验。
    方法:所有在2022年9月至2023年9月期间接受ICG荧光辅助开放手术的患者均被纳入。使用Rubina®透镜进行每个外科手术以进行ICG荧光可视化。
    结果:共有25名患者,14名男孩和11名女孩,手术年龄中位数为5.8岁(0-15岁),已注册。手术指征为头皮样/表皮样囊肿(n=7),头/颈部淋巴管瘤(n=2),甲状舌管囊肿(n=7),男性乳房发育症(n=3),耳前瘘(n=2),第二branch裂瘘(n=1),肩纤维瘤(n=1)和臀区/会阴区肌纤维瘤(n=2)。在所有程序中,使用30号针头进行病灶内注射2.5mg/mLICG溶液.无ICG不良反应发生。中位手术时间为68.6分钟(范围35-189)。在所有情况下,使用Rubina®透镜实现ICG-NIRF的可视化。术中无并发症。术后并发症发生率为3/25(12%),男性乳房发育症(n=1),甲状舌管囊肿(n=1)和颈部淋巴管瘤(n=1),在手术部位收集了液体,在门诊治疗中需要针吸(Clavien-Dindo2)。完整肿块切除经病理报告证实。
    结论:根据最初的经验,使用Rubina®镜片的FGS在开放手术中非常有帮助,提供增强的解剖可视化和边缘识别,实时可靠性和低并发症发生率。它很容易使用,节省时间,可行且临床安全。采用该技术需要MIS的先前经验。注射阶段的准确性对于避免ICG扩散到病灶周围组织中是重要的。
    BACKGROUND: There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina® Lens system.
    METHODS: All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina® Lens for ICG fluorescence visualization.
    RESULTS: A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports.
    CONCLUSIONS: Based on this initial experience, FGS using the Rubina® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.
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  • 文章类型: Case Reports
    复发性肩关节脱位是一种常见的骨科疾病,但是双边参与很少,并且在管理方面提出了独特的挑战。Latarjet手术是一种有效的手术技术,可通过在前关节盂边缘上形成骨块来解决不稳定性。该病例强调了使用双侧肩关节开放Latarjet手术成功治疗双侧复发性肩关节脱位,并强调了在这种情况下早期干预的重要性。
    Recurrent shoulder dislocation is a common orthopedic condition, but bilateral involvement is rare and presents unique challenges in management. The Latarjet procedure is an effective surgical technique that addresses instability by creating a bony block on the anterior glenoid rim. This case highlights the successful management of bilateral recurrent shoulder dislocation using the bilateral shoulder open Latarjet procedure and emphasizes the importance of early intervention in such cases.
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  • 文章类型: Case Reports
    目的:报道一例布鲁氏菌病感染引起的颈动脉假性动脉瘤,诊断和治疗这种疾病。
    方法:病因,回顾性分析假性动脉瘤的临床资料和治疗方法。一位75岁的男性患者通过增强CT发现左颈总动脉假性动脉瘤的可能性较高。进行了开放性手术。细菌培养返回是布鲁氏菌。常规口服药物治疗后,病人恢复得很好。
    结果:患者术后恢复良好,定期口服用药3个月,无复发。
    结论:布鲁氏菌感染引起的颈动脉假性动脉瘤非常罕见,正确诊断和开放手术结合药物治疗是最佳选择。
    OBJECTIVE: To report a patient of pseudoaneurysm of carotid artery caused by brucellosis infection and improve the recognition, diagnosis and treatment of this disease.
    METHODS: The etiology, clinical data and treatment of false aneurysm were reviewed A 75-year-old man with a high probability of pseudoaneurysm of the left common carotid artery was found by enhanced CT. Open surgery was performed. Bacterial culture return was Brucella. After regular oral drug treatment, the patient recovered well.
    RESULTS: The patient recovered well after surgery and took oral medication regularly for 3 months without recurrence.
    CONCLUSIONS: Pseudoaneurysms of the carotid artery caused by brucella infection are very rare, and correct diagnosis and open surgery combined with drug therapy are the best choices.
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