Q112456989
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Purpose: After endoscopic polypectomy, the risk factors for malignancy include positive margin, poor tumor differentiation, deep submucosal and lymphovascular invasion. Even in the presence of high-risk factors, residual disease is observed in less than 15% of samples, and even less in lymph nodes. Study aimed to evaluate results of patients after radicalization in a non-curative polypectomy in 10 year follow-up period, and to compare classical and transanal approach and their impact on quality of life and disease-free survival. Results: Cohort include 45 patients, three patients had adenocarcinoma in situ, one of them positive lymphatic nodes. Only seven (23 %) patients had 12 and more lymph nodes described. TEM cohort had significantly shorter hospital stay (median 7 vs. 11 days, p < 0.0001), significantly lower incidence of herniation (0% vs. 30%, p = 0.020), shorter distance of tumor from the anal verge (median 7 vs. 23.5, p < 0.0001), and lower number of lymph nodes (median 0 vs. 5, p < 0.0001). Overall survival was without statistical significance (p = 0.690). The group of classically operated had higher proportion of subsequent procedures and limitations (p=0.149, and p=0.540). Conclusion: Following malignant polypectomy, surgery should be considered in medically fit patients if the polypectomy margin is positive, unknown, or if the lymphovascular invasion is present. TEM surgery is an acceptable option for high-risk patients . Identifying patients requiring surgery for possible lymph node metastases is still the most important problem.
Úvod: 3D tisk ve zdravotnictví je inovativní technologie, která má obrovský potenciál. Spektrum využití je široké, od tvorby náhrad tkání a nástrojů přes detailní plánovaní složitých operaci až po využití ve výuce mediků nebo mladších kolegů. Využití ve výuce bylo primárním cílem naší studie, kdy jsme srovnávali výuku s a bez 3D modelů a hodnotili její přínos ve smyslu vědomostí a zpětné vazby studentů. Výsledky: Studenti využívající 3D modely po celu dobu výuky, měli z obecné chirurgie 8.5 bodů (85%), z anatomie 8.4 bodů (84%) a ze znalosti chirurgických postupů 7.2 bodů (72%). Naopak studenti klasické výuky dosahovali průměrné znalosti z obecné chirurgie 7.8 bodů (78%), z anatomie 6.6 bodů (66%) a z chirurgických postupů jen 4.5 bodů (45%). V první uvedené skupině je významné zlepšení. Závěr: Celkově lze říct, že 3D modely obohacují výukový proces, podporují kreativitu, aktivní učení a přibližují abstraktní koncepty studentům. Tato technologie je stále více dostupná a stává se důležitým nástrojem v pedagogickém prostředí.
Introduction: 3D printing in healthcare is an innovative technology that has enormous potential. The spectrum of applications is wide, from the creation of tissue and instrument replacements to the detailed planning of complex surgeries to the use in teaching medical students or junior colleagues. The use in teaching was also the primary aim of our study, where we compared teaching with and without 3D models and evaluated its benefits in terms of knowledge and also feedback from students. Results: Students with 3D models available throughout the entire course had 8.5 points (85%) in general surgery, 8.4 points (84%) in anatomy, and 7.2 points (72%) in knowledge of surgical procedures. On the other hand, students in regular lessons had the average knowledge score 7.8 points (78%) in general surgery, 6.6 points (66%) in anatomy, and only 4.5 points (45%) in surgical procedures. We can observe a significant improvement compared to students with 3D models available throughout the entire course. Conclusion: This technology is becoming increasingly available and is becoming an important tool in the pedagogical environment.
PURPOSE: The study aimed to determine a simple diagnostic test that could predict the risk of anastomotic leakage in early postoperative period. METHODS: A single-center, retrospective study was conducted. The electronic medical records of patients who underwent resection for rectal tumor between January 1, 2016, and December 31, 2021, in University Hospital Olomouc, were reviewed. The data included risk factors for leakage and laboratory parameters commonly obtained. RESULTS: The decrease in platelets was significant as for the possibility of being a marker of anastomotic leakage; OR = 0.980 (p = 0.036). A decrease of 34 or higher predicts leakage with a sensitivity of 45 % (95 % CI: 23.1–68.5 %) and specificity of 81.1 % (95 % CI: 75.2–86.1 %). Postoperative leukocyte blood level (OR = 1.134; p = 0.019) and leukocyte level on postoperative day 1 (OR = 1.184; p = 0.023) were significant predictors for leakage. WBC values ≥ 8.8 predict leakage with a sensitivity of 70.0 % (95 % CI: 45.7–88.1 %) and specificity of 55.3 % (95 % CI: 48.4–62.0 %). Hemoglobin blood level ≤ 79.5 predicts leakage with a sensitivity of 70.0 % (95 % CI: 45.7–88.1 %) and specificity of 62.2 % (95 % CI: 55.5–68.7 %). CONCLUSION: Despite the fact that the specificity and sensitivity of the followed parameters are low, they could serve as markers useful for early diagnosis or suspicion for leakage (Tab. 5, Fig. 3, Ref. 14).
Defecation problems affect up to 30% of the adult population. Women are affected 3x more often than men. Diagnosis is complex, and is performed in cooperation with other medical specialties, such as urology, gynecology and neurology. Nonetheless, a proctologist is the first specialist, which patients with defecation problems most often seek out. Treatment includes dietary measures, rehabilitation techniques, and surgical procedures. The most common causes include ventral rectocele, anorectal prolapse, and rectorectal intussusception. In the majority of cases, III. and IV. degree hemorrhoids also present. A number of surgical techniques have been developed to treat static and dynamic disorders of the small pelvis. The new resection technique using the TST high-capacity stapler seems promising. This method is based on segmental resection of the rectal wall. Between January 2016 and October 2017, 34 patients were operated on using the TST stapler. Surgery using the TST stapler led to treatment of the underlying disease in all patients. Stapler failure did not occur in any of the cases. The introduction of high-capacity circular staplers (TST 36) creates new possibilities for treating anorectal prolapse and rectocele. Based on our experience, this method is able to treat rectal prolapse protruding 3cm past the anus. The surgery is always performed using only one stapler.
- Klíčová slova
- TST stapler,
- MeSH
- chirurgické staplery * klasifikace MeSH
- defekace MeSH
- intususcepce chirurgie komplikace MeSH
- lidé MeSH
- prolaps rekta chirurgie komplikace MeSH
- pseudoobstrukce tlustého střeva * chirurgie diagnóza etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Endoscopic resection methods are the gold standard in the treatment of early colorectal neoplasms with specific indications. Limitations of endoscopic therapy are mainly determined by histological findings, size, difficult localization, and depth of invasion or by the presence of non-lifting phenomena. Limitations of mini-invasive surgery are introduced by difficult localization of lesions or an advance TNM stage of lession. Mini-invasive laparoendoscopic intervention has considerable advantages for the patients, nevertheless, colonic resection is still accompanied by certain morbidity. In selected patients with benign or lowrisk malignant polyps non-resectable by endoscopy, the combined approach is a possible alternative to segmental bowel resection. Currently, there are evolving specifications in indication for endoscopic and combined surgical-endoscopic treatment to provide specifically tailored therapy to the patient.
- Klíčová slova
- polypektomie,
- MeSH
- endoskopie trávicího systému klasifikace metody MeSH
- kolorektální nádory chirurgie diagnóza klasifikace MeSH
- laparoskopie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- polypy tlustého střeva * chirurgie diagnóza MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Úvod: Hemoroidální nemoc v současnosti patří již mezi tzv. civilizační choroby. Příčinou vzniku hemoroidálních uzlů jsou změny v cévním řečišti, v submukozních tkáních řitního kanálu a pravděpodobně také změny v napětí análního svěrače. U obrovských cirkulárních prolabujících uzlů navíc s prolapsem anu jsme dříve prováděli operaci dle Whiteheada. Výsledky této metody provází komplikace v podobě anální striktury, ektropii anální sliznice, análního dyskomfortu s pocitem “vlhké řiti” a úniky stolice na vrub zásahu do senzitivní sliznice análního kanálu. Vzhledem k neuspokojivým výsledkům této metody jsme zavedli modifikovaný operační postup. Materiál a metoda: Od ledna 2015 a konce prosince 2017 jsme na našem pracovišti odoperovali 176 pacientů s pokročilým stupněm hemoroidů. Metodou dle Milligana-Morgana jsme provedli operaci u 123 pacientů (skupina A) a modifikovanou metodou u 53 pacientů(skuina B). Ve skupině A byli pacienti s hemoroidy III. a IV. stupně, navíc s prolabující anální tkání (kožně-slizniční duplikatury) v typických lokalizacích. Ve skupině B byli pacienti s hemoroidy III. a IV. stupně navíc s cirkulárním prolabováním anu. Princip modifikované metody exstirpace hemoroidů spočívá v exstirpaci hemoroidálních uzlů a prolabované tkáněna pravé a levé cirkumferenci anu až cévním stopkám, které jsou podvázány. Na čísle 6 a 12 ponecháváme slizničních můstky k následné epitelizaci. Výsledky: V pooperačním období jsme sledovali dobu hospitalizace, dobu hojení, což je doba vedoucí k epitelizaci pooperačních defektů. Dále pak vznik anální striktury, případněektropium anální sliznice a poruchu kontinence stolice. Doba hospitalizace byla ve skupiněoperovaných dle Milligana- Moranga (skupina A) 3.7 dne, ve skupině operovaných modifikovanou metodou (skuina B) 4.1 dne. Dalším sledovaným parametrem byla doba hojení. Ve skupině A došlo ke kompletní epitelizaci za 21 dní, ve skupině B za 26 dní. Jako anální strikturu jsme považovali stav, kdy byl anus těsně a bolestivě průchodný na prst, při digitálním vyšetření. Ve skupině A jsme anální strikturu pozorovali u 10 (8%) pacientů, ve skupině B u 6 (11%) pacientů. Ektropium anální sliznice bylo pozorováno u 4 (3%) pacientůoperovaných dle Milligana-Morgana a u 2 (4%) pacientů operovaných modifikovanou metodou. Závěr: V pokročilých stádiích hemoroidální nemoci a to objemných hemoroidů s prolapsem jsou staplerové metody neefektivní a musíme provést exstirpaci hemoroidů klasickým způsobem. K dispozici máme metodu dle Milligana-Morgana, nebo u cirkulárněprolabovaných hemoroidů metodu dle Whiteheada. Tato metoda má však řadu komplikací, které omezují použití této metody. Jsou to především strikury anu, ektropium, inkontinence stolice, píštěle a abscesy. Proto jsme zavedli modifikovanou metodu operace hemoroidů s ponecháním slizničních můstků na čísle 6 a 12, čímž minimalizujeme komplikace metody dle Whiteheada a dostáváme se na úroveň metody dle Milligana-Morgana.
Introduction: Hemorrhoidal disease is currently considered a so-called disease of civilization. Hemorrhoids are caused by changes in the vascular network, in the submucosal tissues of the anal canal and probably also changes in tension of the anal sphincter. In patients with enormous circular prolapsed hemorrhoidal nodes with additional anal prolapse, we used to perform the Whitehead procedure. Results of this method are accompanied by complications such as anal stricture, ectropion of the anal mucosa, anal discomfort with a sense of excessive moisture and incontinence due to intervention to the sensitive mucosa of the anal canal. Due to the unsatisfactory results of this method, we introduced a modification of this procedure. Material and methods: From January 2015 to the end of December 2017, we operand 176 patients with advanced hemorrhoidal disease. The Milligan-Morgan procedure was performed in 123 patients (group A) and the modified method in 53 patients (group B). Group A consisted of patients with hemorrhoids grade III. and IV. with anal prolapse (skin-mucosal duplicatures) in typical locations. Group B consisted of patients with hemorrhoids grade III. and IV. with circular anal prolapse. The principles of the modified hemorrhoidectomy include extirpation of the hemorrhoidal nodes and prolapsed tissue on the right and left anal circumference up to the vascular peduncles which are ligated. At numbers 6 and 12, mucosal bridges are preserved for subsequent epithelization. Results: Postoperatively we evaluated hospital stay, healing time- which is the time leading up to the epithelization of postoperative defects. Furthermore we evaluated the development of anal stricture, ectropion of the anal mucosa, and fecal incontinence. Hospital stay in group A, patients operated by the Milligan-Morgan procedure, was 3.7 days, in the group operated by the modified method (group B) 4.1 days. The other studied parameter was healing time. Complete epithelization occurred after 21 days in group A, after 26 days in group B. We reported anal stricture in patients in which the anus was too tight and painful to pass a finger during digital examination. In group A, anal stricture was observed in 10(8%) patients, in group B in 6 (11%) patients. Ectropion of the anal mucosa was seen in 4 (3%) patients operated by Milligan-Morgan method and in 2 (4%) patients operated by modified method. Conclusion: In advanced stages of hemorrhoidal disease, such as enormous hemorrhoids with prolapse, stapler methods are ineffective and the hemorrhoids must be extirpated by classical methods. Available operations include the Milligan- Morgan procedure, or, in cases of circular prolapsed hemorrhoids, the Whitehead procedure. However, these methods are accompanied by a number of complications, which limit their utilization. These include anal stricture, ectropion, incontinence, fistulas and abscesses. This is why we introduced a modified method of hemorrhoidectomy where mucosal bridges are preserved at numbers 6 and 12, which minimizes the complications of the Whitehead method and brings us to the level of the Milligan-Morgan method.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- cévní protézy * MeSH
- infekce spojené s protézou * ekonomika farmakoterapie chirurgie komplikace mortalita MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- paliativní péče MeSH
- patogeny v krvi MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
The role of gut microbiota in the development of sporadic colorectal cancer (CRC) is supported by a number of studies, however, the conclusiveness of published metagenomic studies is questioned by technical pitfalls and limited by small cohort sizes. In this review, we evaluate the current knowledge critically and outline practical solutions. We also list candidate CRC risk markers that are - in our opinion - well supported by available data and thus deserve clinical validation. Last but not least, we summarise available knowledge useful for improving care for patients immediately.
