ަ״���ܵ��ó�����׷�

小肠吊置造口术是一常用的术式 ,临床应用已有百年以上的历史 ,手术操作步骤已定型 ,操作要点也已得到公认。 2 0世纪 80年代以后 ,随着微创观念的被接受与操作器械的改进 ,更有经肠镜胃空肠造口置管与小肠壁穿刺置管。小肠吊置造口主要是为了喂食或减压。 80年代后 ,临床营养支持得到广泛开展 ,更重视了肠内营养的喂养 ,“当肠道有功能且能安全应用时 ,使用它”已成为当前选择营养支持途径的准则。肠吊置造口术的应用有增多之势。肠吊置造口的优点是操作简单 ,易于管理 ,导管可更换 ,当它的作用已完成时 ,拔除导管后 ,瘘管即能自行愈合 ,无…     

Colposuspensión latero-abdominal laparoscópica: descripción,ventajas y resultados preliminares

IntroductionThere are currently various fixation or suspension techniques for pelvic organ prolapse (POP) surgery. Laparoscopic colposacropexy is considered the gold standard. We present the surgical steps of the laparoscopic latero-abdominal colposuspension (LACS) technique and the preliminary results obtained.Material and methodsPatients with anterior and/or apical compartment symptomatic POP undergoing LACS are included. The Baden-Walker scale, the Overactive Bladder Questionnaire-Short Form (OAB-q SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Patient Global Impression of Improvement (PGI-I) scale were used to assess the degree of prolapse, urinary filling and sexual symptoms and the level of satisfaction before and after surgery, respectively. Conventional laparoscopic material and a polyvinylidene fluoride (PVDF) mesh were used.ResultsEighteen patients were included with a minimum follow-up time of 6 months. The mean surgical time was 70.3 ± 23.8 min. Anatomic correction of prolapse was seen in all cases. Only one recurrence was detected. High levels of patient satisfaction were achieved.ConclusionLACS allowed the anatomical reconstruction of the pelvic floor and proved to be a minimally invasive, fast, effective, safe and reproducible technique. More series are needed to evaluate its role against laparoscopic colposacropexy.     

Evaluación del abordaje laparoscópico en la cistectomía radical desde la implantación hasta su consolidación: validación interna

Introduction and objectivesThe AEU Guidelines of 2017 consider laparoscopic and robot-assisted approaches as investigational procedures. The surgical learning curve is defined as the minimum number of cases that a surgeon has to perform in order to reproduce a technique considered as standard.The aim of this study is to analyze, within our department, the implementation of a laparoscopic radical cystectomy (LRC) program compared with a well consolidated and standardized open radical cystectomy (ORC) program.Material and methodsRetrospective cohort analysis of two cystectomy groups: LRC (n = 196) (20062016) vs. ORC (n = 96) (2003-2005).Comparison of the evolution over time of the following parameters: operative time, blood transfusion rates, resection margins, postoperative complications, hospital stay and recurrence.Three time periods have been defined for LRC: implementation (2006-09) (LRC-I), development (2010-14) (LRC-D) and consolidation (2015-16) (LRC-C); comparing each of them with the control group (ORC).The chi-square test was used for the comparison of the qualitative variables and the Anova test for the numerical ones.ResultsWhen compared to ORC, LRC presented longer operative times in LRC-I and LRC-D periods. We observed a trend toward shorter operative time than ORC in the consolidation period (LRC-C).LRC also presented lower intraoperative transfusion rates in all periods and lower postoperative rates in CRL-D and CRL-C. Overall complications in LRC-D and LRC-C were lower in LRC, having fewer major complications (Clavien≥3) in the 3 periods. A decrease in mortality and hospital stay after the LRC-I phase was also observed. These results were consolidated during the two last periods of the study.We have not observed significant differences between ORC and LRC when comparing surgical margins and recurrence rates, neither in the total series, nor in the comparison between the different periods. These results endorse the oncologic safety of LRC from the beginning of the implementation process.ConclusionsWhen compared to ORC, LRC improves perioperative transfusion rates, complications and hospital stay from its implementation period, maintaining oncological safety. On the contrary, longer operative times during implementation and development were observed. However, in our series, we observed a trend toward shorter operative times than ORC approach in the consolidation period. We have validated the laparoscopic approach for radical cystectomy in our service.     

Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo

Introduction

Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules.

Comparación entre prostatectomía laparoscópica y abierta: análisis de la evolución oncológica

IntroductionThere are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate.ObjectiveTo compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP).Material and methodsComparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of >0.4 ng/ml after surgery.To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR.ResultsGleason 7 (3+4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p=0.001), more frequent in LRP.The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D’Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR.ConclusionThe surgical approach did not influence SM status or BR.     

Resección robótica del lóbulo hepático caudado: descripción técnica y consideraciones iniciales

Introduction

Firstly described in 2002, the robotic liver surgery has not spread widely due to its high cost and the lack of a standardized training program. Still being considered as a ‘development in progress’ technique, it has however a potential to overcome the traditional limitations of the laparoscopic approach in liver interventions.

Eficacia diagnóstica del índice de inmunidad-inflamación sistémica en la biopsia de próstata por fusión

ObjectiveTo investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA < 10 ng/ml undergoing fusion prostate biopsy.MethodsThe prospective study included patients who were planned for fusion prostate biopsy and had PSA < 10 ng/ml and a PI-RADS ≥ 3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII = platelet × neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity + specificity ? 1).ResultsThe study included 508 patients with a mean age of 62.49 ± 6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/ml. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC = 0.487, P = .622), it was revealed as a significant marker in PCa patients with an ISUP grade ≥ 3 (AUC = 0.811, P < .001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII.ConclusionSII and SII combination with PI-RADS score appear to be a significant diagnostic marker in patients with high-grade PCa (ISUP grade 3-5). These values were found to be higher compared to those of patients with a benign pathology and patients with lower ISUP scores.     

Hipertensión arterial en el paciente quirúrgico. Adecuación de la medicación y criterios de suspensión

Arterial hypertension (AHT) is a modifiable risk factor for cardiovascular diseases, which may have an impact on perioperative complications, depending on the organ damage suffered by the patient. The perioperative management of treatment of arterial hypertension, is a mainstay in the preoperative assesment prior to any intervention. It doesn’t seem reasonable to delay surgery solely due to blood pressure values, although for patients with BP > 180/110 mmHg, the decision to perform scheduled surgeries should be carefully assessed.     

Dislocación testicular. aportación de 2 nuevos casos y revisión de la literatura

We report 2 new cases of testicular luxation. A review of current literature is made. Testis was located inguinal after scrotal trauma in both cases. Early close reduction was unsuccessfully. A delayed reduction was found in one case at the moment of surgery. A surgical replacement of the testis was carried out in the other patient. Follow-up control revealed a benign course in bothTesticular dislocation is a rare complication after scrotal trauma (only 152 cases reported). Physician have to be aware of this possibility following perineal trauma. Oftenly a surgery reduction is required     

Terapia de privación de andrógenos en el cáncer de próstata localizado. Situación actual y tendencias futuras

IntroductionProstate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa.ObjectiveTo summarize the current indications of ADT in localized PCa.Evidence acquisitionWe conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa.Evidence synthesisNowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT < 12 months, and either a PSA > 50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit.ConclusionsWe need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment.