V posledních 10 letech se objevila možnost využít k odstranění vhodně lokalizovaných T1 a T2 spinocelulárních karcinomů orofaryngu, zejména kořene jazyka, tonzily a supraglotis, miniinvazivní robotický přístup skrze ústní dutinu - TORS (TransOralRoboticSurgery). Lokalizací a tvarem jsou pro TORS nejlépe vhodné povrchově uložené a ohraničené spinocelulární karcinomy, dostupné pro robotické nástroje. Rozhodující úlohu při indikaci k TORS hraje zobrazení karcinomů hlavy a krku pomocí magnetické rezonance.
In the last 10 years, it became possible to be used by appropriately localized T1 and T2 squamous cell carcinomas of oropharynx and supraglottis robotic minimally invasive approach trough oral cavity – TORS (TransOralRoboticSurgery). Localization and shape best suited tumors for TORS are surface stored and bounded squamous cell carcinomas available for robotic tools. Decisive role in indication for removal of cancers by the TORS plays magnetic resonance imaging and computer tomography of the head and neck.
- MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- miniinvazivní chirurgické výkony MeSH
- nádory hrtanu * diagnostické zobrazování chirurgie MeSH
- nádory orofaryngu * diagnostické zobrazování chirurgie MeSH
- počítačová rentgenová tomografie využití MeSH
- roboticky asistované výkony metody MeSH
- tonzilární nádory diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: This study compared the adverse effects of open surgery (OS) including lateral pharyngotomy and supraglottic laryngectomy vs. transoral robotic surgery (TORS) in the treatment of stage T1 and T2 carcinomas of the tongue base and supraglottis. METHODS: A retrospective study involving a 49 (13 female and 36 male) patients with untreated T1 or T2 carcinomas. Twenty two were operated on using TORS and 27 underwent conventional OS. The indicators for comparison were: total blood loss during surgery, post-operative pain measured with the Visual Analog Scale (VAS); global, emotional and physical post-operational states assessed with the standardized M.D. Anderson Dysphagia Inventory (MDADI) and psychosocial distress (PD) questionnaire. Apart from blood loss, subjective symptoms were evaluated 1 and 6 weeks and 6 months after surgery. The differences in indicators between groups were analyzed using Fisher's Least Significant Difference (LSD) test at the 5% significance level. RESULTS: Mean general OS and TORS associated blood loss were 405 and 29 ml, respectively. The mean MDADI score in TORS vs. OS patients one week, six weeks and six months postoperatively was 60.01 vs. 44.93, 91.01 vs. 62.19 and 94.18 vs. 93.56. The mean VAS score in the TORS vs. OS group at the same time intervals were 5.09 vs. 5.56, 2.09 vs. 3.11 and 1.27 vs. 1.33. All differences between TORS and OS were statistically significant with the exception of 6 month values for particular scores. The mean PD score in TORS vs. OS patients in one week, six weeks and 6 months was 26.82 vs. 25.11, 39.95 vs. 29.22 and 44.73 vs. 44.52. Only the six week distinctions were significant. The both methods were comparable in terms of the risk of locoregional tumour recurrence. CONCLUSIONS: The study confirmed the assumption of the TORS as a minimally invasive procedure significantly reducing the intraoperative blood loss, pain, swallowing and psychosocial distress as late as 6 weeks postoperatively in patients with early staged carcinomas of the tongue base and supraglottis.
- MeSH
- dospělí MeSH
- epiglotis chirurgie MeSH
- farynx chirurgie MeSH
- krvácení při operaci statistika a číselné údaje MeSH
- laryngektomie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hrtanu chirurgie MeSH
- nádory jazyka chirurgie MeSH
- pooperační bolest etiologie MeSH
- psychický stres etiologie MeSH
- retrospektivní studie MeSH
- roboticky asistované výkony škodlivé účinky MeSH
- senioři MeSH
- spinocelulární karcinom chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
The polyhydroxylated derivatives of 6-keto,7-dehydrocholesterol (ecdysone, ecdysteroids, Ecd) are natural compounds widely distributed in plants. They exhibit strong anabolic, vitamin D-like, pharmacological effects in vertebrate animals and in the human body. In the larval stages of insects, injections of pure Ecd cause serious pathophysiological, "hyperecdysonic" syndromes associated with neuromuscular paralysis, premature cuticular apolysis and complete inhibition of ecdysis. Ecds do not penetrate insect cuticle. For this reason, all previous attempts to induce ecdysone responses by topical applications of Ecd failed. In this work, we tried to induce the topical effects of Ecd by preparation of more lipophilic complexes, with 2 or 4 molecules of 20-hydroxyecdysone (E20) attached to a relatively large nucleus of the porphyrin. The resulting porphyrin-E20 complexes (ecdysogens) have been subjected to standardised assays for ecdysone activity in the ligatured larvae ("dauerlarvae") of the greater waxmoth (Galleria mellonella). Similarly like the free E20 alone, porphyrin-E20 complexes had no effect when applied on the body surface or administered in the larval diet. When injected, however, they exhibited delayed effects, but the adverse ("hyperecdysonic") pathophysiological syndromes were reduced or abolished. It is concluded, therefore, that the replacement of pathophysiological, precocious or "hyperecdysonic" moults by the larval-pupal transformation, was due to successive metabolic liberation of the biologically active, free E20 from the porphyrin-E20 complex. The biological status of Ecd does not agree with their definition as the prothoracic gland (PG) hormone of insects, nor with the assumptions about a growth hormone of plants. A possibility that the most important status of Ecd may depend on the pharmacological properties of a sterolic D6 vitamin has been discussed.
- MeSH
- aplikace lokální MeSH
- aplikace orální MeSH
- biologická proměna účinky léků MeSH
- ekdysteron aplikace a dávkování chemie farmakologie fyziologie MeSH
- kukla účinky léků MeSH
- larva účinky léků MeSH
- Lepidoptera účinky léků fyziologie MeSH
- porfyriny chemie farmakologie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- otorinolaryngologické chirurgické výkony * MeSH
- roboticky asistované výkony * využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- zprávy MeSH
