ABSTRACT
Antecedentes: las estenosis benignas, la ruptura del tracto digestivo y las fístulas digestivas son condiciones que ponen en riesgo la vida y que por lo general son tratadas quirúrgicamente. Ahora, ha surgido la colocación de stents metálicos parcial o totalmente cubiertos como una opción de manejo con mínima invasión. Se pretende determinar la efectividad clínica de un nuevo diseño de stent de nitinol totalmente cubierto para el tratamiento de las perforaciones digestivas y las fístulas anastomóticas, con especial énfasis en la evaluación de la hiperplasia reactiva. Métodos: en el período 2012-2013 se colocó un stent de nitinol autoexpandible totalmente cubierto en 15 pacientes con perforaciones benignas de esófago, fístulas anastomóticas, estenosis después de cirugía gastrointestinal alta o baja. Se utilizó un stent de mayor diámetro en su centro (20 mm) y en su porción proximal (28 mm). Se recolectaron datos demográficos, tipo de lesión, ubicación del stent y remoción, éxito clínico y complicaciones. Resultados: a un total de 15 pacientes se les puso 15 nuevos stents por fístulas anastomóticas (n = 8), estenosis esofágica (n = 2), estenosis en anastomosis colorrectal (n = 2), estenosis de anastomosis gastroyeyunal (n = 1), ruptura iatrogénica de esófago (n = 1), y estenosis pilórica (n = 1). La remoción endoscópica del stent fue exitosa en todos los pacientes, y una fue particularmente difícil por hiperplasia reactiva. El éxito clínico se logró en 9 pacientes (73%), con una media de permanencia del stent de 10 semanas (rango 7 a 12 semanas). En total, ocurrieron 7 complicaciones en 15 pacientes (47%): hiperplasia reactiva (n = 1), migración (n = 3), dolor severo (n = 2), ulceración esofágica (n = 1), y solo 1 paciente requirió cirugía después del fallo del stent. Ningún paciente falleció como consecuencia de la colocación del mismo. Conclusiones: un stent totalmente cubierto, con nuevo diseño, dejado por 10 semanas, puede ser una alternativa ...
Background: Benign stenoses, digestive tract ruptures and fistulas are conditions that endanger life and are often treated surgically. Recently, the placement of partially or fully covered metal stents has emerged as a minimally invasive treatment option. This article looks at a new design for stents to determine its clinical effectiveness. The new stent is a completely covered nitinol stent for treatment of gastrointestinal perforations and anastomotic leaks. This article places special emphasis on evaluating reactive hyperplasia. Methods: Fifteen had the new completely covered self-expanding nitinol stent placed for treatment of benign esophageal perforations, anastomotic leaks, and stenoses following upper or lower gastrointestinal surgery during 2012 and 2013. The stents are 20 mm in diameter in the middle and 28 mm in diameter at the proximal end. Information about patient demographics, type of lesion, lesion locations, stent removal, clinical success and complications was collected. Results: A total of 15 stents were placed in 15 patients to treat anastomotic leaks (n = 8), esophageal stenoses (n = 2), colorectal stenoses (n = 2), a gastrojejunostomy stenosis (n = 1), an esophageal iatrogenic rupture (n = 1), and a pyloric stenosis (n = 1). Endoscopic removal of the stent was successful in all patients. Although it was particularly difficult in one case because of reactive hyperplasia. Clinical success was achieved in nine patients (73%). Average duration of time between stent placement and removal was 10 weeks with a range of 7 to 12 weeks. In total, seven complications occurred in 15 patients (47%): reactive hyperplasia (n = 1), migration (n = 3) severe pain (n = 2) esophageal ulceration (n = 1) only one patient required surgery after stent failure. No patients died as the result of stenting. Conclusions: A redesigned completely covered stent kept in place for 10 weeks may be an alternative to surgery for treating gastrointestinal ...
Subject(s)
Humans , Male , Female , Digestive System Fistula , Drug-Eluting Stents , Esophageal Perforation , Esophageal StenosisABSTRACT
RACIONAL: A gastrectomia total é considerada um procedimento de alto nível de complexidade, apresenta taxas de complicações elevadas, tanto locais como gerais, pois os doentes na sua maioria estão com as condições clínicas e nutricionais comprometidas pela doença. OBJETIVOS: analisar os resultados imediatos e complicações da gastrectomia total no período de 1972 a 2007. MÉTODOS: Foram revisados os prontuários médicos de 300 doentes portadores de adenocarcinoma gástrico, subdivididos em dois períodos: 1972 a 1992 - compreendendo 108 doentes (36 por cento) e 1993 a 2007 - compreendendo 192 doentes (64 por cento). Eram 67,3 por cento do sexo masculinos, 70,7 por cento brancos e com faixa etária variando de 25 a 86 anos (média de 63,4 anos). As lesões estavam localizadas em cárdia - 40 casos (13,3 por cento); fundo gástrico - 83 casos (27,6 por cento); corpo gástrico - 77 casos (25,6 por cento); linite plástica - 45 casos (15 por cento); côto gástrico - 33 casos (11 por cento) e antro/corpo gástrico - 22 casos (7,3 por cento). A gastrectomia total ampliada com linfadenectomia até nível D2 foi realizada em 246 casos (82 por cento). RESULTADOS: A técnica de reconstrução mais utilizada foi a anastomose esôfago-jejunal término-lateral em Y-Roux em 257 doentes (86,7 por cento). As complicações gerais no período de 1972-92 totalizaram 47 casos (43,5 por cento), compreendendo principalmente as respiratórias (28 casos - 25,9 por cento) e as urinárias (10 casos - 9,2 por cento). No período 1993-2007 totalizaram 48 casos (25 por cento), principalmente complicações respiratórias (27 casos - 14 por cento), seguidas também das urinárias (12 casos - 6,2 por cento). No período de 1972-92 estas complicações locais totalizaram 45 casos (30,8 por cento) e no período de 1993-2007 atingiram 28 casos (14,5 por cento), sendo as fistulas digestivas as mais frequentes. A mortalidade operatória até o 30º dia foi de 18 casos (6 por cento), sendo que no período de 1972-92 totalizou...
BACKGROUND: A total gastrectomy is considered a procedure with a high level of complexity, has high complication rates, both local and general, because patients are mostly with clinical conditions and nutritional compromised by disease. AIM: To analyse the results and complications of the total gastrectomy in gastric cancer in the period from 1972 to 2007. METHODS: Were reviewed the medical records of 300 patients with gastric adenocarcinoma, divided into two periods: from 1972 to 1992 - comprising 108 patients (36 percent) and from 1993 to 2007 - comprising 192 patients (64 percent). They were 67.3 percent males, 70.7 percent whites, with ages ranging from 25 to 86 years (mean 63.4 years). The lesions were located in cardia - 40 cases (13.3 percent), gastric fundus - 83 cases (27.6 percent), gastric body - 77 cases (25.6 percent); plastic linitis- 45 cases (15 percent); gastric stump - 33 cases (11 percent) and antrum and body gastric - 22 cases (7.3 percent). A total gastrectomy with extended lymphadenectomy to level D2 was performed in 246 cases (82 percent). RESULTS: The reconstruction technique used was the esophagus-jejunal anastomosis end-to-side Roux-en-Y in 257 patients (86.7 percent). The general complications in the period from 1972 to 1992 totalized 47 cases (43.5 percent), mainly involving the respiratory (28 cases - 25.9 percent) and urinary tract (10 cases - 9.2 percent). In the period from 1993 to 2007 amounted to 48 cases (25 percent), mainly respiratory complications (27 cases - 14 percent), followed by urinary (12 cases - 6.2 percent). The local complications from 1972 to 1992 totalized 45 cases (30.8 percent) and in the period from 1993 to 2007 amounted to 28 cases (14.5 percent), being the most frequent the digestive fistulas. The operative mortality through 30 days was 18 cases (6 percent), while in the period from 1972 to 92 a total of 12 cases (11.1 percent) and in the period from 1993 to 2007 were 7 cases (3.6 percent)...