surgical management

手术管理
  • 文章类型: Journal Article
    目的:手术切除狭窄段并进行端对端吻合被认为是插管后气管狭窄的金标准。然而,这一具体病因的结果没有得到很好的描述。为了检查程度,范围,以及现有证据的特征,进行了范围审查。
    方法:数据源包括MEDLINE,Scopus,奥维德,和Cochrane数据库.纳入标准包括成人插管后气管狭窄患者的研究报告的特征,手术管理和结果。
    结果:确定了125篇文章,其中10个被列入最终分析。所有研究均为病例报告或病例系列(4级证据),对110例患者进行分组,75名男性和35名女性。年龄从15岁到71岁不等。Cotton-Myer狭窄等级为1级(1[0.9%]),2(25[22.7%]),3(70[63.6%]),和4(14[12.7%])。狭窄部位在气管上三分之一处108例(98.2%),在1中的中间三分之一(0.9%),和1中的较低三分之一(0.9%)。狭窄长度1~5.6cm。随访时间为1~60个月(最多2年)。最常见的并发症是13例(11.3%)的暂时性吞咽困难,8例肉芽肿形成(7.3%),5(4.5%)开裂或漏气,伤口感染占4人(3.6%)。再狭窄率为2%~25%。没有围手术期死亡。
    结论:气管切除术和初次吻合在插管后气管狭窄的短期和中期似乎是安全有效的;然而,发现的证据水平很低,无法得出明确的结论。
    OBJECTIVE: Surgical resection of the stenotic segment with end-to-end anastomosis is considered the gold standard in post-intubation tracheal stenosis. However, outcomes of this concrete etiology are not well described. With the aim to examine the extent, range, and characteristics of the existing evidence, a scoping review was performed.
    METHODS: Data sources included MEDLINE, Scopus, Ovid, and the Cochrane databases. Inclusion criteria consisted of studies in adult patients with post-intubation tracheal stenosis that reported characteristics, surgical management and outcomes.
    RESULTS: 125 articles were identified, of which 10 were included in the final analysis. All studies were case reports or case series (level 4 evidence) grouping 110 patients, 75 males and 35 females. The age ranged from 15 to 71 years. Cotton-Myer stenosis grade was 1 (1 [0.9%]), 2 (25 [22.7%]), 3 (70 [63.6%]), and 4 (14 [12.7%]). Stenosis location was in the tracheal upper-third in 108 (98.2%), the middle-third in 1 (0.9%), and the lower-third in 1 (0.9%). Stenosis length ranged from 1 to 5.6 cm. Follow-up ranged from 1 to 60 months (two years for the most). Most frequent complications were transitory dysphagia in 13 (11.3%), granuloma formation in 8 (7.3%), dehiscence or air leak in 5 (4.5%), and wound infection in 4 (3.6%). Restenosis rate ranged from 2% to 25%. There was no perioperative mortality.
    CONCLUSIONS: Tracheal resection and primary anastomosis in post-intubation tracheal stenosis appear to be safe and effective in the short and mid-terms; however, the very low level of evidence found prevents definitive conclusions.
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  • 文章类型: Journal Article
    Os-齿状突是一种罕见的疾病,在影像学和临床上被描述为第二颈椎(轴)的先天性异常。它是一个光滑的,大小和形状可变的独立听骨与缩短的齿状突的基部隔开一个明显的间隙,与C2的身体没有骨连接。
    本研究回顾了OO的文献,以评估其病因,临床表现,鉴别诊断,成像模式,无症状和有症状OsOdontoideum病例的治疗结果。PubMed的重要文章,EMBASE,谷歌学者,科克伦也被搜查了.
    考虑到病因,根据最近关于OO的文献,创伤性假设优于先天性假设。临床表现从无症状到轻度颈部疼痛到严重的脊髓病和神经缺陷不等。各种C1-C2仪器和融合技术,如布线,已描述了经关节螺钉和椎板螺钉的成功率。
    齿状牙体是一种罕见的疾病,现有文献有限。考虑到如果保守的管理层选择会带来巨大的风险,比如严重的神经缺陷导致轻微创伤导致猝死,以及最近对成像工具的改进,有助于了解疾病的病理学,即使在偶然发现的齿状牙体中也可以进行手术。然而,根据年龄等因素,可以考虑对稳定的无症状患者进行逐案处理,活动水平,合并症,综合征协会,和射线照相结果。
    UNASSIGNED: Os-odontoideum is a rare condition described radiographically and clinically as a congenital anomaly of the second cervical vertebra (axis). It is a smooth, independent ossicle of variable size and shape separated from the base of a shortened odontoid process by an obvious gap, with no osseous connection to the body of C2.
    UNASSIGNED: This study reviewed the literature on OO to evaluate its etiology, clinical presentations, differential diagnosis, imaging modalities, and outcomes in the management of asymptomatic and symptomatic cases of Os Odontoideum. Key articles from PubMed, EMBASE, Google Scholar, and Cochrane were searched.
    UNASSIGNED: Considering etiology, the traumatic hypothesis is favoured over the congenital hypothesis as per recent literature on OO. Clinical presentation varies from asymptomatic to mild neck pain to severe myelopathy and neurodeficit. Various C1-C2 instrumentation and fusion techniques like wiring, trans articular screw and laminar screws have been described with success rates.
    UNASSIGNED: Os odontoideum is a rare condition with limited existing literature. Considering the significant risks involved if conservative management opts, like severe neuro deficit to sudden death on trivial trauma and the recent improvement of imaging tools helping to understand the pathology of the disease, surgery can be indicated even in an incidentally detected os odontoideum. However, a case-by-case approach can be considered for stable asymptomatic patients depending on factors such as age, activity level, comorbidities, syndromic association, and radiographic findings.
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  • 文章类型: Journal Article
    目的:探讨侧脑室三角区或腹周肿瘤切除后颞角受困(TTH)的手术治疗方法和结果。
    方法:回顾性研究了2012年至2022年在三个不同的三级中心接受TTH手术治疗的患者。主要结果是再手术率。
    结果:31例患者被纳入分析。17例患者病理基础为脑膜瘤,中枢神经细胞瘤7例,神经胶质瘤4例,室管膜瘤2例,海绵状畸形1例。KPS评分中位数为50(范围为10-90),TTH的平均体积为53.1±29.9cm3(范围为14.8-118.6)。六名患者(19.3%)需要多次手术。总共进行了39次手术,包括28个脑脊液分流,2内窥镜鼻中隔造口术,3显微外科开窗术或开颅颞叶切除术,2个去骨瓣减压术(DC),和4次分流修订。根据程序再次手术率如下:脑脊液分流10.7%(3/28),50%(1/2)用于内窥镜鼻中隔造口术,100%(2/2)用于DC,0(0/3)用于显微外科开窗术或颞叶切除术。与其他手术方法相比,CSF分流的再手术率较低(p=0.079)。DC的再手术率明显高于其他手术技术(p=0.025)。
    结论:CSF分流是最常用的技术,其翻修率相对较低。在选定的患者中,通过内窥镜鼻中隔造口术可以实现长期通畅。对于难治性病例,应保留显微外科开窗术或颞叶切除术。DC的有效性有限,不应推荐。
    OBJECTIVE: To investigate the surgical management and outcomes of trapped temporal horn (TTH) following resection of lateral ventricle trigonal or peritrigonal tumors.
    METHODS: Patients who underwent surgical treatment for TTH in three different tertiary centers between 2012 and 2022 were retrospectively studied. The primary outcome was reoperation rate.
    RESULTS: Thirty-one patients were included for analysis. The underlying pathology was meningioma in 17 patients, central neurocytoma in 7, glioma in 4, ependymoma in 2, and cavernous malformation in 1. The median KPS score was 50 (range 10-90) and the mean volume of TTH was 53.1 ± 29.9 cm³ (range 14.8-118.6). Six patients (19.3 %) required multiple operations. A total of 39 procedures were performed, including 28 CSF shunting, 2 endoscopic septostomy, 3 microsurgical fenestration or temporal tip lobectomy via craniotomy, 2 decompressive craniectomy (DC), and 4 shunt revisions. Reoperation rates according to procedure were as follows: 10.7 % (3/28) for CSF shunting, 50 % (1/2) for endoscopic septostomy, 100 % (2/2) for DC, and 0 (0/3) for microsurgical fenestration or temporal tip lobectomy. CSF shunting tended to have a lower reoperation rate compared to other surgical approaches (p = 0.079). The reoperation rate was significantly higher for DC than for other surgical techniques (p = 0.025).
    CONCLUSIONS: CSF shunting was the most frequently used technique with a relatively low revision rate. Long-term patency can be achieved through endoscopic septostomy in selected patients. Microsurgical fenestration or temporal tip lobectomy should be reserved for refractory cases. DC has limited effectiveness and should not be recommended.
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  • 文章类型: Case Reports
    背景:球形血栓罕见且危及生命。正确的诊断和及时的管理是改善患者预后的关键。这里,现报告1例球栓并文献复习。
    方法:一名75岁的妇女因心悸和胸闷而到我们的门诊就诊8个月。她被诊断为二尖瓣狭窄,经胸超声心动图(TTE)显示一个圆形肿块附着在左心房(LA)壁上。麻醉诱导前,TTE发现质量已经从洛杉矶的墙上掉下来了,并在洛杉矶旋转,导致瓣膜间歇性阻塞。然后在TTE监测下进行麻醉诱导,经食管超声心动图在插管后发现洛杉矶附件另一个肿块。她接受了洛杉矶肿块切除和二尖瓣置换术,顺利出院。组织病理学证实了血栓的诊断。我们的文献回顾确定了2015年至2024年之间的19例球血栓。平均年龄为54.8(范围3-88)岁。11例患者以心力衰竭为首发症状,大多数患者患有二尖瓣疾病或伴有心房颤动。12例接受手术,7只接受了治疗。2人死亡,一种是由于左心室流入道阻塞,另一种是由于心力衰竭恶化。
    结论:球形血栓在临床上很少见。应尽快进行紧急的血栓切除术,超声心动图可用于手术过程中的实时监测。
    BACKGROUND: Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus.
    METHODS: A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3-88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure.
    CONCLUSIONS: Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery.
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  • 文章类型: Case Reports
    胃肠道间质瘤(GIST)是胃肠道最常见的间质瘤,通常以KIT或PDGFRA基因突变为特征。该病例报告详细介绍了一名71岁女性的复杂临床过程,该女性患有HIV和转移性GIST,表现为腹部急性症状,表明内脏穿孔。最初的成像显示大量的气腹和一个大的腹部肿块,需要立即手术干预。病人接受了多次手术,包括肠切除和结肠造口术,以解决广泛的肿瘤负担和并发症。术后,她需要重症监护管理,包括机械通气,血管加压药支持,和血液透析治疗急性肾损伤。病理检查证实转移性GIST伴有广泛的肠系膜和网膜受累。免疫组织化学染色CD117(c-KIT)和DOG-1阳性。尽管采取了积极的手术和支持措施,患者的病情凸显了在处理带有穿孔的高级GIST方面的重大挑战。这个案例突出了多学科方法的重要性,整合外科,medical,和重症监护以优化结果。GIST的预后差异很大,局部肿瘤切除后有良好的结果,尽管靶向治疗取得了进展,但转移性病例的预后往往较差。此案例说明了个性化治疗计划和正在进行的研究以改善GIST患者的管理和预后的迫切需要。
    Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, frequently characterized by mutations in the KIT or PDGFRA genes. This case report details the complex clinical course of a 71-year-old female with a history of HIV and metastatic GIST presenting with acute abdominal symptoms indicative of perforated viscus. Initial imaging revealed a massive pneumoperitoneum and a large abdominal mass, necessitating immediate surgical intervention. The patient underwent multiple surgeries, including bowel resections and colostomy creation, to address the extensive tumor burden and complications. Postoperatively, she required intensive care management, including mechanical ventilation, vasopressor support, and hemodialysis for acute kidney injury. Pathological examination confirmed metastatic GIST with extensive mesenteric and omental involvement. Immunohistochemical staining was positive for CD117 (c-KIT) and DOG-1. Despite aggressive surgical and supportive measures, the patient\'s condition highlighted the significant challenges in managing advanced GIST with perforation. This case highlights the importance of a multidisciplinary approach, integrating surgical, medical, and intensive care to optimize outcomes. The prognosis of GIST varies widely, with localized tumors having favorable outcomes following resection, while metastatic cases often face a poorer prognosis despite advances in targeted therapies. This case exemplifies the critical need for personalized treatment plans and ongoing research to improve the management and prognosis of GIST patients.
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  • 文章类型: Case Reports
    本研究旨在强调细粒棘球蚴引起的眶内包虫病的罕见性,强调全面探索和文件编制对有效管理的重要性。
    临床表现包括眼球突出,视觉恶化,眼运动中断,和化学.提出了一个8岁男孩的案例研究,该男孩患有眶后包虫囊肿,该包虫囊肿通过右经穿骨眼眶切开术成功切除,强调手术复杂性和手术前后阿苯达唑治疗的疗效。
    成功切除和治疗眶内包虫囊肿强调了准确诊断和精确手术干预的重要性。这个案例强调了扩大对这种罕见表现的知识的重要性,有助于加强诊断和治疗策略,以实现管理全球健康问题的最佳结果。
    UNASSIGNED: This study aims to underscore the rarity of intraorbital hydatid disease caused by Echinococcus granulosus, emphasizing the importance of comprehensive exploration and documentation for effective management.
    UNASSIGNED: Clinical presentations include proptosis, visual deterioration, ocular motility disruptions, and chemosis. A case study of an 8-year-old boy with a retroorbital hydatid cyst successfully resected through a right transcaruncular orbitotomy approach is presented, highlighting surgical complexities and the efficacy of pre and post-operative albendazole therapy.
    UNASSIGNED: The successful excision and management of the intraorbital hydatid cyst underscore the significance of accurate diagnosis and precise surgical intervention. This case emphasizes the importance of expanding knowledge about this rare manifestation, contributing to enhanced diagnostic and treatment strategies for optimal outcomes in managing global health concerns.
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  • 文章类型: Case Reports
    腰椎管狭窄是一种广泛的疾病,严重影响老年人的生活质量。保守治疗对主要症状为疼痛的患者具有积极作用。然而,在存在感觉减退和轻瘫的严重病例中,考虑手术治疗。手术的目的是减压被狭窄的椎管压缩的神经血管元素,同时保持脊柱的稳定性。常规椎板切除术,有或没有融合,被认为对这种病理的治疗有效,但是它的缺点很大,包括组织创伤,次生不稳定,以及相当比例的并发症导致的再次手术。近年来,各种微创脊柱手术技术已经出现,在缓解症状性椎管狭窄方面,显示出与椎板切除术减压相当的结果。此外,这些技术提供了显著的好处,如最小的组织创伤,降低并发症发生率,缩短手术时间和恢复期。随着不断的发展和完善,微创手术有望在未来广泛取代传统的开放手术治疗腰椎管狭窄症。在这篇文章中,我们介绍了退行性腰椎管狭窄症患者的手术治疗经验,详细介绍了我们利用的微创手术技术,并重点介绍了应用该技术的一些临床病例。
    Lumbar spinal stenosis is a widespread condition that significantly affects the quality of life in elderly individuals. Conservative therapy has a positive effect on patients whose primary symptom is pain. However, in severe cases with the presence of hypesthesia and paresis, surgical treatment comes into consideration. The aim of surgery is to decompress the neurovascular elements compressed by the narrowed spinal canal while preserving spinal stability. Conventional laminectomy, with or without fusion, has been considered effective for the treatment of this pathology, but its drawbacks are significant, including tissue trauma, secondary instability, and a substantial percentage of reoperations due to complications. In recent years, various minimally invasive spine surgery techniques have emerged, showing comparable results to laminectomy decompression in terms of relieving symptomatic spinal stenosis. Additionally, these techniques offer significant benefits such as minimal tissue trauma, reduced complication rates, and shorter operative time and recovery periods. Given the continuous development and improvement, minimally invasive surgery is expected to widely replace traditional open surgery for the treatment of lumbar stenosis in the future. In this article, we present our experience in the surgical treatment of patients with degenerative lumbar stenosis, detailing the technique of the minimally invasive procedure we utilize and highlighting some of the clinical cases in which it has been applied.
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  • 文章类型: Case Reports
    包虫囊肿病,由细粒棘球蚴幼虫期引起,是许多地区特有的寄生虫感染,包括南亚。我们介绍了一个36岁的南亚女性并发肝和腹膜包虫囊肿的病例,强调与这种情况相关的诊断挑战和管理复杂性。病人出现腹痛,恶心,食欲下降,影像学检查显示肝脏和腹膜的特征性囊性病变。由于对治疗的反应不足,最初使用阿苯达唑进行医疗管理后进行手术切除。术后护理包括预防性阿苯达唑以防止复发。该案例强调了多学科方法的重要性,该方法涉及针对个体患者的需求和疾病表现的药物治疗和手术干预。
    Hydatid cyst disease, caused by the larval stage of Echinococcus granulosus, is a parasitic infection endemic in many regions, including South Asia. We present a case of a 36-year-old South Asian female with concurrent liver and peritoneal hydatid cysts, emphasizing the diagnostic challenges and management complexities associated with this condition. The patient presented with abdominal pain, nausea, and decreased appetite, and imaging studies revealed characteristic cystic lesions in the liver and peritoneum. Initial medical management with albendazole was followed by surgical excision due to inadequate response to therapy. Postoperative care included prophylactic albendazole to prevent recurrence. This case highlights the importance of a multidisciplinary approach involving medical therapy and surgical intervention tailored to the individual patient\'s needs and disease presentation.
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  • 文章类型: Letter
    目的:提高本研究的科学性和准确性。
    方法:我们通过仔细阅读作者的文章并查阅相关文献,对文章的研究方法进行了研究。
    结果:作者完成了出色而有意义的工作,发现FNS在哈里斯髋关节得分(HHS)中似乎优于CCS,手术时间,和再手术率,为临床医生选择内固定方法提供依据。这是一个有用的参考,但是仍然存在一些问题。
    结论:为了提高研究的科学性,我们认为有些方面可能需要改进。
    OBJECTIVE: To improve the scientificity and accuracy of this study.
    METHODS: We studied the research methods of the article by carefully reading the author \'s article and consulting the relevant literature.
    RESULTS: The authors performed an excellent and meaningful work, finding that FNS appeared advantageous over CCS in Harris Hip Scores (HHS), operative time, and reoperation rates, providing clinicians with a basis for selecting internal fixation methods. It is a useful reference, but there are still some problems.
    CONCLUSIONS: In order to improve the scientific nature of the study, we believe that some aspects may need to be improved.
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  • 文章类型: Journal Article
    背景:子宫平滑肌肉瘤是子宫恶性肿瘤中一个罕见的子集。子宫平滑肌肉瘤中阑尾骨骼转移的发生很少。在这项研究中,我们检查了患者调查,以阐明子宫平滑肌肉瘤患者的临床特征和结果,这些患者表现为转移扩散到这些解剖区域.我们假设姑息性手术治疗对诊断为阑尾骨转移的子宫肌瘤患者的生存率没有影响。
    方法:2004年至2021年在XXX医院肿瘤科诊断为子宫平滑肌肉瘤并接受治疗的114例患者符合纳入本回顾性队列研究的标准。该研究特别包括经组织病理学证实继发于子宫平滑肌肉瘤的阑尾骨转移患者。接受手术干预或保守治疗的患者。排除标准涉及专有椎体骨转移的患者,以及那些缺乏必要检查和后续数据的人。值得注意的是,该研究纳入了9例随访期至少2年的患者,这些患者在随访期间发生了阑尾骨转移.
    结果:在9例患者中,3有肱骨转移,2有股骨转移,1例股骨和弥漫性骨盆转移,另外3例盆腔转移。诊断后平均33.3±32.4个月(范围3-108)发生骨转移。骨转移后,6例患者死亡时间12~84个月,平均40.3±26.7个月。一名肱骨近端病理性骨折患者接受了关节切除术,1例股骨近端转移瘤患者行关节切除术,2例股骨干转移患者行刮治-骨水泥(C&C)和髓内钉,1例持续性盆腔疼痛患者行C&C其他患者未进行手术。
    结论:在诊断为子宫平滑肌肉瘤的患者中,阑尾骨转移后姑息性手术和保守治疗的生存率无差异.患者评估应个性化,在进行姑息性手术之前,应评估整体健康状况。
    方法:IV.
    BACKGROUND: Uterine leiomyosarcoma represents a seldom-encountered subset within the spectrum of uterine malignancies. Occurrences of appendicular skeletal metastases in uterine leiomyosarcomas are infrequent. In this study, we examined patient surveys to elucidate the clinical characteristics and outcomes of individuals with uterine leiomyosarcoma exhibiting metastatic dissemination to these anatomical regions. We hypothesized that palliative surgical treatment would have no effect on survival in patients diagnosed with uterine leimyosarcoma with appendicular bone metastases.
    METHODS: One hundred fourteen patients diagnosed with uterine leiomyosarcoma and treated at the Department of Oncologic Orthopedics at XXX hospital from 2004 to 2021 met the criteria for inclusion in this retrospective cohort study. The study specifically encompassed patients with histopathologically confirmed appendicular bone metastases secondary to uterine leiomyosarcoma, who underwent either surgical intervention or conservative treatment. Exclusion criteria involved patients with exclusive vertebral bone metastases, as well as those lacking essential examination and follow-up data. Notably, the study included nine follow-up patients with at least 2 years of follow-up who developed appendicular skeletal metastases during the follow-up period.
    RESULTS: Of the 9 patients, 3 had humeral metastases, 2 had femoral metastases, 1 had femoral and diffuse pelvic metastases, and the other 3 had pelvic metastases. Bone metastases occurred at a mean of 33.3 ± 32.4 months (range 3 - 108) after the diagnosis. After bone metastasis, 6 patients died after an average of 40.3 ± 26.7 months (range 12-84 months). One patient with a pathologic fracture in the proximal humerus underwent resection arthroplasty, 1 patient with metastases in the proximal femur underwent resection arthroplasty, 2 patients with metastases to the femoral shaft underwent curettage-cementation (C&C) and intramedullary nailing, and 1 patient with persistent pelvic pain underwent C&C. No surgery was performed in the other patients.
    CONCLUSIONS: In patients diagnosed with uterine leiomyosarcomas, survival did not differ between palliative surgery and conservative treatment after appendicular bone metastases. Patient assessment should be individualized, and overall health should be evaluated before palliative surgery is performed.
    METHODS: IV.
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