35 research outputs found
Suvremeno kirurÅ”ko lijeÄenje raka rektuma
Surgical treatment is a method of choice in treating patients with resectable primary form of rectal cancer. An important step in treatment is the multidisciplinary approach from different medical specialties in the fields of radiology, gastroenterology, oncology and surgery. In recent years, several minimally invasive surgical procedures have been developed that improve postoperative recovery while still preserving oncological principles, such as laparoscopic low anterior resection, transanal total mesorectal excision and robotic surgery. Surgical and oncological principles that must be respected in all cases are wide resection of the tumor with histologically free resection margins and the use of total mesorectal excision with anal sphincter preservation and preservation of the continuity of the intestine whenever possible.Kirurgija je metoda izbora u lijeÄenju bolesnika s resektabilnim rakom rektuma. Važan korak u lijeÄenju je multidisciplinarni pristup razliÄitih medicinskih specijalnosti iz podruÄja radiologije, gastroenterologije, onkologije i kirurgije. U posljednjih nekoliko godina razvijeno je nekoliko minimalno invazivnih kirurÅ”kih postupaka s ciljem poboljÅ”anja postoperativnog oporavka uz oÄuvanje svih onkoloÅ”kih principa, kao Å”to su laparoskopske niske prednje resekcije, transanalne totalne mezorektalne resekcije i robotske operacije. KirurÅ”ka i onkoloÅ”ka naÄela koja se moraju poÅ”tivati u svim sluÄajevima su Å”iroka resekcija tumora s histoloÅ”ki slobodnim resekcijskim rubovima i totalna mezorektalna ekscizija s oÄuvanjem analnog sfinktera kao i oÄuvanje kontinuiteta crijeva kad god je to moguÄe
Kirurgija raka debelog crijeva s obzirom na razlike u prognozi izmeÄu desnostranih i lijevostranih tumora
Human colon is derived from the embryological midgut and hindgut resulting in the developement of the right and left colon respectively. Right-sided and left-sided colon cancers are not differentiated only based on the embryological origin, anatomical position and clinical manifestations, but there are also numerous studies which prove that heterogeneous genotype features exsist in right and left-sided colon cancers,with distinguishing types of chromosome and microsatellite instability and gene expression patterns. Accumulating evidence suggests that gut microbiota, which differs in right and left colon, also plays an important role in the development of colon cancer. Although the systemic oncologic treatment has changed recently for disseminated left and right colon cancer, the current surgical treatment of both cancer locations for stages I-III follows the same principles of radical surgical oncology and should be executed in the same manner.Ljudsko debelo crijevo nastaje iz embrioloÅ”kog srednjeg i stražnjeg crijeva, odakle se formira desno- i lijevostrano debelo crijevo. Desno- i lijevostrani zloÄudni tumori debelog crijeva ne razlikuju se samo prema embrionalnom podrijetlu, anatomoskoj lokalizaciji i kliniÄkim manifestacijama, nego i prema heterogenim genotipskim znaÄajkama, s razliÄitim vrstama kromosomskih i mikrosatelitskih nestabilnosti te razliÄitim uzrocima ekspresije gena, Å”to je i dokazano brojnim studijama. Sve veÄi broj istraživanja sugerira da i crijevna mikrobiota, koja je razliÄita u desnom i lijevom debelom crijevu, takoÄer igra znaÄajnu ulogu u razvoju zloÄudnih tumora debelog crijeva. Iako se sistemno onkoloÅ”ko lijeÄenje za metastatski proÅ”ireni karcinom debelog crijeva nedavno promijenilo, ovisno da li je primarna lokalizacija desno- ili lijevostrani karcinom debelog crijeva, sadaÅ”nje kirurÅ”ko lijeÄenje za stadije I-III slijedi principe radikalnog onkoloÅ”kog lijeÄenja i trebalo bi biti isto za obje lokacije karcinoma debelog crijeva
Otpust iz bolnice nakon elektivne nekomplicirane laparoskopske kolecistektomije: može li se skratiti poslijeoperacijski boravak u bolnici?
The aim of the study was to reevaluate the safety and feasibility of discharge 24 h after elective uncomplicated laparoscopic cholecystectomy. Since the introduction of laparoscopic cholecystectomy in our hospital, the minimum postoperative stay was considered to be two days based on surgeonsā experience. The study included 337 operations performed by 21 surgeons during 2016 in the Sestre milosrdnice University Hospital Centre. Conversion to open technique and cases of acute cholecystitis were excluded, while 15 patients had insufficient postoperative data. The mean length of stay was 2.38 (range 1 to 6) postoperative days, median two postoperative days. Serious complications involving suspected drain bile leakage and postoperative hemorrhage occurred in two (0.59%) patients, both in the first 24 h following surgery. One patient required emergency laparotomy on the first postoperative day. Readmission rate was 1.2%. The postoperative minor complication rate was 42 of 337 (12.46%); these included wound infections, urinary tract infections, symptoms included in postcholecystectomy syndrome, etc. The onset of these complications was mostly after postoperative day 3. The data obtained suggest that discharge on the first postoperative day after elective uncomplicated laparoscopic cholecystectomy should be considered safe and can be practiced in our hospital.Cilj studije bio je reevaluirati sigurnost i izvodljivost otpusta bolesnika u prva 24 sata nakon elektivnih laparoskopskih kolecistektomija. Od uvoÄenja laparoskopske metode u naÅ”oj ustanovi, prema iskustvu kirurga smatralo se kako je minimalni poslijeoperacijski boravak 2 dana. Studija je obuhvatila 337 operacija koje je proveo 21 kirurg u 2016. godini u KBC āSestre milosrdniceā. IskljuÄeni su sluÄajevi konverzije u otvorene operacije kao i sluÄajevi akutnog kolecistitisa. Kod 15 bolesnika nije bilo dovoljno podataka o poslijeoperacijskom tijeku. Prosjek poslijeoperacijskog boravka bio je 2,38 (1 do 6) dana, medijan je bio 2 dana. Ozbiljne komplikacije u vidu suspektnog curenja žuÄi i poslijeoperacijskog krvarenja pojavile su se kod dvoje (0,59%) bolesnika; oba sluÄaja dogodila su se unutar 24 sata od operacije. Kod jednog bolesnika indicirana je hitna reoperacija prvog poslijeoperacijskog dana. Stopa ponovnog prijma u bolnicu bila je 1,2%. Manje poslijeoperacijske komplikacije dogodile su se kod 42 (12,46% operiranih) bolesnika; ove komplikacije ukljuÄivale su infekcije rane, uroinfekcije, simptome postkolecistektomijskog sindroma itd. Ove komplikacije dogaÄale su se uglavnom nakon 3. poslijeoperacijskog dana. Prikupljeni podaci ukazuju na to da se otpust prvog poslijeoperacijskog dana nakon elektivne nekomplicirane laparoskopske kolecistektomije može smatrati sigurnim i provoditi tu praksu u naÅ”oj ustanovi
Usporedba vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije anastomoze nakon kirurgije debeloga crijeva
In colorectal surgery, anastomotic leakage is a serious complication, leading to
higher postoperative morbidity and mortality. The aim of this study was to evaluate the accuracy of serum
and intraperitoneal C-reactive protein (CRP) in early diagnostics of anastomotic leakage on the
first four postoperative days after colorectal surgery. From January to October 2019, fifty-nine patients
with colorectal carcinoma were operated on, with formation of primary anastomosis. Anastomotic
leakage was diagnosed in eight patients. Comparing the levels of serum and intraperitoneal CRP, our
study showed that serum CRP was a better predictor of anastomotic leakage. Serum CRP levels lower
than 121 mg/L on postoperative day 4 were predictive of good healing of anastomosis.U kirurgiji debelog crijeva dehiscencija crijevne anastomoze je ozbiljna komplikacija koja dovodi do poveÄanja pobola i
smrtnosti nakon operativnog zahvata. Cilj ove studije bio je utvrditi toÄnost serumskog i intraperitonealnog C-reaktivnog
proteina u ranoj dijagnostici dehiscencije crijevne anastomoze u prva Äetiri poslijeoperacijska dana nakon operacije debelog
crijeva. Od sijeÄnja do kolovoza 2019. godine operirano je 59 bolesnika s rakom debelog crijeva uz uspostavu primarne
crijevne anastomoze. Kod osam bolesnika dijagnosticirana je dehiscencija crijevne anastomoze. UsporeÄujuÄi vrijednosti
serumskog i intraperitonealnog C-reaktivnog proteina naŔa studija je pokazala da je serumski C-reaktivni protein bolji biljeg
u predviÄanju dehiscencije crijevne anastomoze. Vrijednosti serumskog C-reaktivnog proteina manje od 121 mg/L Äetvrtog
poslijeoperacijskog dana pokazatelj su dobrog cijeljenja anastomoze
LijeÄenje polipa žuÄnoga mjehura: prijedlog optimalne strategije
Polypoid lesions of the gallbladder can be divided into benign and malignant lesions. Benign polypoid lesions of the gallbladder are divided into tumors and pseudotumors. Pseudotumors make up the majority of polypoid lesions of the gallbladder. They can occur in the form of polyps, hyperplasia or other miscellaneous lesions. Adenomas are the most common benign neoplasms of the gallbladder. Ultrasound has been demonstrated to be significantly better in detecting polypoid lesions of the gallbladder as compared with computed tomography and cholecystography. Recommendations for an optimal strategy in the management of gallbladder polyps are presented. Generally, no treatment is required in a young patient with very small gallbladder polyps, who is completely free from symptoms. In patients with unequivocal recurrent biliary colic, elective cholecystotomy is warranted, especially in case of coexistence of stones and polyps. Cholecystectomy is also indicated in patients with gallbladder polyps greater than 10 mm, irrespective of symptomatology. In patients with gallbladder polypoid lesions smaller than 10 mm, cholecystectomy is only indicated if complicating factors are present, e.g., age Ā³ 50 and coexistence of gallstones. If a gallbladder polyp is smaller than 10 mm and if complicating factors are absent, the āwatch-and-waitā strategy seems to be recommendable.Polipoidne lezije žuÄnoga mjehura mogu se podijeliti u benigne i maligne. Benigne polipoidne lezije dijele se na prave tumore i pseudotumore. Pseudotumori Äine veÄinu polipoidnih lezija žuÄnoga mjehura, a mogu se oÄitovati kao polipi, hiperplazija ili druge razliÄite lezije. Adenomi predstavljaju najÄeÅ”Äe benigne neoplazme žuÄnoga mjehura. Pokazalo se da je ultrazvuk znaÄajno bolji u otkrivanju polipoidnih lezija žuÄnoga mjehura u usporedbi s kompjutoriziranom tomografijom i kolecistografijom. U ovom su radu prikazane preporuke za optimalnu strategiju praÄenja i obrade polipa žuÄnoga mjehura. OpÄenito, u mladog bolesnika s polipima žuÄnoga mjehura manjim od 10 mm i bez simptoma nije potrebna nikakva terapija. U bolesnika s jasnim kolikama elektivna kolecistektomija je opravdana, poglavito ako su uz polipe prisutni i žuÄni kamenci. Kolecistektomija je takoÄer indicirana u bolesnika s polipima veÄim od 10 mm, bez obzira na simptomatologiju. U bolesnika s polipima manjim od 10 mm kolecistektomija je indicirana samo ako se radi o bolesnicima starijim od 50 godina i/ili ako su istodobno prisutni i žuÄni kamenci. Kad su polipi žuÄnoga mjehura manji od 10 mm i ako se radi o bolesnicima mlaÄim od 50 godina u kojih nije moguÄe dokazati žuÄne kamence, preporuÄujemo strategiju āpratiti i Äekatiā
Gigantski liposarkom mezenterija mijeŔanog tipa
Primary mesenteric liposarcomas are very rare, especially when they are of mixed histologic pattern. Patient prognosis is based upon the most aggressive histologic type of liposarcoma. A case is reported of a 77-year-old man with a history of slowly increasing abdominal volume over 3 years. The diagnosis of giant intra-abdominal mass suspect of liposarcoma was confirmed by computed tomography and ultrasound scans. The patient underwent resection of 24 tumor masses weighing together 23.5 kg. The microscopic diagnosis was mixed-type liposarcoma of the mesentery. Although this type of tumor is rare, tumor tissue should be thoroughly collected and analyzed on histologic examination to reach definitive diagnosis. Recognition of the underappreciated subtype of liposarcoma is important for proper prognosis and treatment of the patient. According to our knowledge, this is the largest size of mixed-type mesenteric liposarcoma described in the English literature.Primarni liposarkomi mezenterija su rijetki, osobito ako su mijeÅ”anog histoloÅ”kog izgleda. Prognoza pacijenta ovisi o najagresivnijem histoloÅ”kom tipu liposarkoma. Prikazujemo sluÄaj 77. godiÅ”njeg muÅ”karca s anamnezom spororastuÄeg volumena abdomena tijekom 3 godine. Dijagnoza ogromne intra-abdominalne mase suspektne na liposarkom potvrÄena je CT-om i ultrazvukom. Pacijentu su resecirane 24 tumorske mase koje su zajedno težile 23.5 kg. HistoloÅ”ka dijagnoza je bila mijeÅ”ani tip liposarkoma mezenterija. Iako je ovaj tip tumora rijedak, tumorsko tkivo treba pomno preuzeti i pregledati histoloÅ”ki kako bi se postavila ispravna zakljuÄna dijagnoza. Pronalazak nepovoljnog tipa liposarkoma je važan zbog toÄne prognoze i daljnjeg lijeÄenja pacijenta. Prema naÅ”im saznanjima, ovo je najveÄi opisani liposarkom mezenterija mijeÅ”anog tipa u engleskoj literaturi
Vaskularna hibridna dvorana ā operacijaska dvorana buduÄnosti
The last two decades have seen a paradigm shift in the treatment of vascular related diseases from once traditional open surgical repairs to the entire vascular tree being amenable to percutaneous interventions. Neither the classic operating room nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues for the vascular hybrid operating room include quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. The most important feature of working in a dedicated hybrid vascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. Establishment of an endovascular operating room suite has the benefit of a sterile environment, and the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. Consequently, better quality and service can be provided to the individual patient. These changes in the treatment of vascular disease require that a new type of vascular specialist, named āvascular hybrid surgeonā, trained to perform both endovascular and open surgical procedures in this highly complex patient group.U posljednja dva desetljeÄa primjeÄuje se pomak u lijeÄenju vaskularnih bolesti od tradicionalno otvorenih kirurÅ”kih zahvata prema perkutanoj intervenciji cijelog vaskularnog stabla. Niti klasiÄne operativne dvorane, a niti konvencionalne angio dvorane nisu optimalne za izvoÄenje otvorene operacije ili za endovaskularne zahvate. Glavne znaÄajke vaskularne hibridne operativne dvorane obuhvaÄaju kvalitetnu opremu za snimanje, radijacijski Å”tit, opremu za jednostavnu upotrebu, potrebu za dobro izuÄenim kadrom, ergonomiÄnost, moguÄnost odvijanja otvorenih i perkutanih zahvata, sterilnu okolinu, kao i kvalitetu i uÄinkovitost bolesniÄke skrbi. NajznaÄajnija znaÄajka rada u hibridnoj vaskularnoj operacijskoj dvorani trebala bi biti moguÄnost pružanja najbolje operacije bolesniku s krvožilnom boleÅ”Äu. Manje je važno tko Äe opremu upotrebljavati, intervencijski radiolog ili vaskularni kirurg. Uspostava jedne endovaskularne operativne dvorane ima prednost sterilne okoline, moguÄnost izvoÄenja hibridnih zahvata, te ako je potrebno i konverzije. TakoÄer, angiografija uÄinjena neposredno prije operativnog zahvata pruža toÄnije anatomske informacije, a nakon zahvata pruža bolju kontrolu kvalitete. PosljediÄno, bolja kvaliteta i usluga može se ponuditi svakom pojedinaÄnom bolesniku. Takve promjene u lijeÄenju bolesnika s boleÅ”Äu krvnih žila zahtijevaju i novi profil vaskularnog kirurga nazvan āvaskularni hibridni kirurgā koji mora biti osposobljen u izvoÄenju endovaskularnih, ali i otvorenih operativnih zahvata kod iznimno složene skupine bolesnika