Lietuvos chirurgija
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Video-assisted Treatment of Rectal Fistulas: the Experience and Treatment Results
Get PDFAim. Evaluation of the effectiveness and identification of the benefits of a video-assisted fistula treatment method using fistuloscopy, in comparison with traditional methods of surgical treatment of complex forms of chronic paraproctitis, trans- and extrasphincteric, relapsing rectal fistulas. Patients and methods. A complex analysis of the results of surgical treatment was carried out in 228 patients with chronic paraproctitis, transphincteric, ectrasphincteric, including recurrent rectal fistulas, divided into three groups (main and two control), depending on the surgical methods of chronic paraproctitis used. Results. The result of surgical treatment of pararectal fistulas in the three study groups was compared. The effectiveness of treatment was assessed by the results of immediate and long-term postoperative period. It has been established that the use of a video-assisted fistula treatment method using fistuloscopy excludes the presence of an extensive postoperative wound in the perianal region, which significantly reduces the likelihood of its secondary infection, and the sphincter trauma, and in fact virtually eliminates its insufficiency. The use of video-assisted method of treatment of fistulas made it possible to reduce the number of postoperative complications. Conclusion. The final results (92.7% of favorable outcomes) allow us to recommend a video-assisted treatment for fistulas for wide practical implementation
Primary Myeloid Sarcoma of the Ileum and Mesentery Causing Small Bowel Obstruction: Case Report and Literature Review
Get PDFMyeloid sarcoma (extramedullary myeloblastoma, granulocytic sarcoma, chloroma) is an extramedullary isolated malignant tumor of myeloblasts and immature myelocytes. It can occur anywhere in the body as a solitary tumor or can be accompanied with acute myeloid leukemia. We are presenting a case of a young male patient that presented with sings of a small bowel obstruction and a palpable tumor mass in the abdomen. After uneventful postoperative period, the immunohistochemistry analysis reported an extramedullary myeloid sarcoma since a normal bone marrow biopsy was revealed
Plyšusios Achilo sausgyslės rekonstrukcija: atvirosios ir minimaliai invazyvios chirurginio gydymo metodikų artimųjų rezultatų palyginimas. Perspektyvusis randomizuotas tyrimas
Get PDFBackground. The optimal treatment of acute Achilles tendon ruptures is still under debate. The purpose of this randomized controlled trial was to evaluate outcomes of open repair comparing with percutaneous procedure for Achilles tendon ruptures. Methods. 100 patients with acute Achilles tendon rupture were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). Absorbable suture was used in both groups. 87 patients were available for the mean follow up of 6 months. Results. No statistically significant difference was observed between groups in ATRS (Achilles Tendon Total Rupture Score), leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. Conclusions. Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.Įvadas. Vis dar nėra žinoma, kuris chirurginis metodas geriausias ūmiems Achilo sausgyslės plyšimams gydyti. Straipsnyje pristatomo randomizuoto tyrimo tikslas – palyginti ūmaus Achilo sausgyslės plyšimo chirurginio gydymo rezultatus, taikant atvirąjį ir minimaliai invazyvų rekonstrukcijos metodus. Metodai. 100 pacientų atsitiktinės atrankos būdu įtraukti į vieną iš dviejų grupių: A grupę sudarė pacientai, kuriems plyšusios Achilo sausgyslės rekonstrukcija atlikta taikant atvirąjį „karūnos“ tipo metodą, B grupę – pacientai, kurių plyšusi Achilo sausgyslė susiūta taikant minimaliai invazyvią Bunnell’io metodiką. Abiejose grupėse naudoti tirpstantys siūlai. 87 pacientai stebėti 6 mėn. Rezultatai. Statistiškai reikšmingo skirtumo tarp tiriamųjų grupių, lyginant ATRS (angl. Achilles Tendon Total Rupture Score) klausimyno įverčius, blauzdos apimtis, pasistiebimą ant vienos kojos, pėdos ramybės padėtį, paciento pasitenkinimą, laiką iki grįžimo į darbą ar sportą, nenustatyta. Taikant minimaliai invazyvų metodą, operacijos buvo daug trumpesnės. Iš viso registruota 13 komplikacijų (5 A grupėje ir 8 B grupėje). Giliosios infekcijos atvejų neregistruota. Dėl kilusių komplikacijų nereikėjo atlikti nė vienos pakartotinos operacijos. Išvados. Nustatyta, kad tiek atvirasis, tiek ir minimaliai invazyvus rekonstrukcijos metodai yra efektyvūs ir saugūs, naudojant tirpstančius siūlus. Vis dėlto, palyginti su atviruoju metodu, taikant minimaliai invazyvų metodą plyšusi Achilo sausgyslė susiuvama daug greičiau
Sarkopenija – skrandžio vėžio chirurgijoje neįvertintas rizikos veiksnys
Get PDFSurgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.Chirurgija yra pagrindinis skrandžio vėžio gydymo metodas, leidžiantis tikėtis visiško pasveikimo. Operacijos dėl skrandžio vėžio yra didelės apimties, jos susijusios su didele pooperacinių komplikacijų rizika. Maždaug pusei sergančiųjų skrandžio vėžiu nustatoma sarkopenija. Tai reikšmingas pooperacinių komplikacijų rizikos veiksnys, lemiantis prastesnius atokiuosius gydymo rezultatus.Sarkopenija vis dar yra tik klinikinių tyrimų objektas, šiandienos rutininėje klinikinėje praktikoje ji nevertinama. Sarkopenijos diagnostika apima tyrimus, kuriais siekiama nustatyti raumenų jėgą, masę ir kokybę, tačiau diagnostikos metodika nėra galutinai standartizuota. Diagnostikai taikomi plaštakos griebimo jėgos, „sėsti – stoti“ testo, kompiuterinės tomografijos, magnetinio rezonanso, ultragarso, bioimpedanso ir densitometrijos tyrimai.Sarkopenijos reikšmė skrandžio vėžiui gydyti vis labiau auga. Tikėtina, kad netolimoje ateityje sarkopenijos vertinimas ir gydymas taps kasdienės klinikinės praktikos dalimi. Taigi tikslinga atlikti papildomus klinikinius tyrimus, kurie padėtų standartizuoti diagnostiką ir rasti efektyvius gydymo metodus
Skirtingo tipo polipropileniniai tinkleliai kirkšnies išvaržai chirurgiškai gydyti, atliekant hernioplastiką pagal Lichtenšteino metodiką: lyginamoji studija
No full textBackground / Objective. In our clinical study we have compared the results of intraoperative and postoperative period in patients with inguinal hernia treated operatively with Lichtenstein technique, where one of three different polypropylene meshes has been applied: polypropylene monofilament light mesh, polypropylene monofilament heavy mesh and self gripping polypropylene mesh. Follow up period have been one year. Methods. This study represents randomized, retrospective-prospective, comparative clinical study where 243 patients have been divided into three groups depends of prosthetic mesh that was applied with Lichtenstein technique. We have evaluated the connection between types of used mesh with some of followed parameters: postoperative pain intensity, postoperative patient mobilization, postoperative surgical site occurrences, duration of hospitalization, chronic pain, filling of foreign body in inguinal area and development of recurrences. Results. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay and lowest duration of surgical procedure than other two groups of patients. In term of chronic pain, only statistically significance we confirmed between the groups of heavy monofilament mesh and self griping polypropylene mesh, where higher number of patients from group with monofilament polypropylene light mesh reported chronic pain. In our study we confirmed that working status and patient age have significant influence on the intensity of postoperative pain in all three patients group. There is no statistical correlation between type of the mesh and surgical site occurrence rate. Conclusion. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay, lowest duration of surgical procedure and less number of patients experienced feeling of “foreign body” in their groin than other two groups of patients
Complications after Laparoscopic Appendectomy for Complicated Appendicitis
Get PDFBackground. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis
Pacientų, turinčių lėtinių žaizdų kojose, gyvenimo kokybės vertinimas: ar gali padėti gydymas trombocitų praturtinta plazma?
Get PDFAim. The aim of the study was to evaluate and compare the quality of life (QoL) using platelet-rich plasma gel (PRP) and conventional treatment of chronic leg wounds. Methods. Randomized clinical trial was carried out in Hospital of Lithuanian University of Health Sciences Kaunas Clinics during 2014–2018. Patients (n = 69) included in the study were randomly grouped into 2 groups: 1) PRP, 2) Control. SF-36 questionnaire was used to evaluate QoL, visual analog scale was used to evaluate persistent pain associated with ulcer and wound exudate volume was also evaluated. Statistical analysis were performed with SPSS 23.0 package. Results. Patients in PRP group at the end of the treatment rated their QoL over control group patients (p < 0.05). Wound associated pain (PRP – 1.54; control – 2.85; p = 0.015) and pain associated sleep disturbance (p < 0.001) was lower in PRP group patients. Wound exudate volume was lower in PRP group patients at the end of the treatment (p < 0.05). Conclusion. The treatment with PRP is associated with less wound associated pain, less-common sleep disturbance, reduced wound secretion and improved quality of life compared to conventional treatment.Tikslai. Įvertinti ir palyginti pacientų, turinčių lėtinių žaizdų kojose, gyvenimo kokybę, žaizdas gydant trombocitų praturtintos plazmos geliu (PRP) ir įprastiniu lėtinių žaizdų gydymo metodu. Tyrimo metodai. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikos Plastinės ir rekonstrukcinės chirurgijos klinikoje 2014–2018 m. atliktas randomizuotas klinikinis tyrimas, vertinantis pacientų, turinčių lėtinių žaizdų kojose, gyvenimo kokybę (SF-36 klausimynas), su žaizda susijusį skausmą ir žaizdos sekreciją, taikant gydymą PRP ir įprastiniu metodu. Į tyrimą įtraukti 69 tiriamieji. Statistinė analizė atlikta IBM SPSS 23.0 programa. Rezultatai. PRP metodika gydyti pacientai gydymo pabaigoje gyvenimo kokybę vertino palankiau negu įprastiniu metodu gydyti pacientai (p < 0,05), žaizdos skausmas, palyginti su kontroline grupe, gydymo pabaigoje buvo mažesnis (PRP – 1,54; kontrolinė grupė – 2,85; p = 0,015), skausmas rečiau trikdė miegą (p < 0,001). PRP grupėje nustatyta mažesnė žaizdų sekrecija (p < 0,05). Išvados. Gydymas PRP metodika susijęs su mažesniu žaizdos skausmu, miego trikdymu, žaizdos sekrecija ir geresne pacientų gyvenimo kokybe gydymo metu
Dirbtinės odos Integra™ naudojimas gydant didelius melanocitinius apgamus
Get PDFMelanocytic nevi are congenital, benign, pigmented proliferations. They have high risk of malignancy, most frequently transform to malignant skin melanoma and 70% it occurs in the first life decade. The risk of malignant transformation increases proportionately to their size. The best way to avoid those risks is early and radical excision. In 1996 on the market appeared the Integra™ artificial skin, has made it possible to improve the methods for the elimination of large congenital nevi and significantly reduce the risk of malignant melanoma, at an early age.
2011–2019, in Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Clinics, the Integra™ was used to treat congenital melanocytic nevi in four children. Implantation of the skin substitute Integra™ has been successful for all the patients, the prognosis was good.
The treatment of congenital melanocytic nevi is a necessity to avoid the risk of developing malignant melanoma. The rarity of this condition has led to the fact that so far there is no universal approach for all the cases. Integra™ artificial skin is an excellent choice for the treatment of congenital melanocytic nevi, especially for paediatric patients.Melanocitiniai apgamai – įgimti gerybiniai pigmentiniai dariniai, turintys didelę piktybinio naviko išsivystymo riziką. Šie dariniai dažniausiai transformuojasi į piktybinę odos melanomą. 70 proc. atvejų tai įvyksta per pirmąjį gyvenimo dešimtmetį.
Apgamų piktybiškumo rizika didėja proporcingai jų dydžiui. Norint transformacijos išvengti, būtinas ankstyvas ir radikalus šių darinių pašalinimas. 1996 m. rinkoje pasirodžiusi dirbtinė oda Integra™ suteikė galimybę patobulinti didelių įgimtų apgamų pašalinimo metodus ir jau ankstyvoje vaikystėje smarkiai sumažinti piktybinės melanomos riziką.
2011–2019 m. Vaikų ligoninėje, Vilniaus universiteto ligoninės Santaros klinikos filiale, Integra™ panaudota gydant įgimtus melanocitinius apgamus keturiems vaikams. Odos pakaitalo Integra™ implantacija visiems pacientams buvo sėkminga, prognozė gera.
Įgimtų melanocitinių apgamų gydymas reikšmingai sumažina piktybinės melanomos išsivystymo riziką. Būklė gana reta, todėl iki šiol nėra nė vieno visiems tinkamo metodo. Integra™ dirbtinė oda yra puikus pasirinkimas gydant įgimtus melanocitinius apgamus, ypač pediatriniams pacientams