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Resumen: ANTECEDENTES: El carcinoma intraepitelial tubárico seroso es una lesión precursora del carcinoma invasivo de las trompas de Falopio que con frecuencia se diagnostica en el contexto de una salpingooforectomía bilateral profiláctica por patología ginecológica benigna. CASO CLÍNICO: Paciente nulípara, de 51 años, con cuadro clínico de dolor abdominal y elevación de marcadores tumorales CA-125 y CA-19.9, diagnosticada con útero polimiomatoso y sospecha de endometrioma en el ovario derecho. Después de la histerectomía subtotal con anexectomía bilateral, el estudio histológico de la pieza tubárica extirpada reportó focos microscópicos de carcinoma intraepitelial tubárico seroso, sin signos de invasión estromal. Por los hallazgos se solicitaron pruebas de imagen mamarias y el estudio genético de mutación BRCA 1 y 2. CONCLUSIÓN: La salpingooforectomía bilateral profiláctica es un procedimiento que reduce el riesgo de carcinomas peritoneales, tubáricos y serosos de ovario. Las pacientes con carcinoma intraepitelial tubárico seroso deben tener seguimiento basado en controles ecográficos, pruebas de imagen mamarias, determinación de marcadores tumorales y estudios genéticos, debido a su asociación con mutaciones en los genes BRCA 1 y 2.
Abstract: BACKGROUND: Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of invasive high-grade tubal and serous carcinoma of the ovary, frequently diagnosed in the context of prophylactic bilateral salpingoophorectomy for benign gynecological pathology. The objective of this work is to carry out a literature review on the most relevant aspects of the follow-up of this injury, after its incidental diagnosis in gynecological surgery. CLINICAL CASE: A 51-year-old nulliparous patient who, in the context of a clinical situation of abdominal pain with elevation of tumor markers CA125 and CA19.9, was diagnosed with polymomatous uterus and suspected endometrioma in the right ovary. After a subtotal hysterectomy with bilateral adnexectomy, the histological study of the excised tubal specimen found microscopic foci of STIC without signs of stromal invasion. Given this finding, breast imaging tests and a genetic study of the BRCA 1/2 mutation was requested. CONCLUSION: Prophylactic bilateral salpingoophorectomy in gynecological surgery is a procedure that can reduce the risk of developing peritoneal, tubal, and serous ovarian carcinomas. Patients diagnosed with STIC should be subsidiaries of follow-up based on ultrasound controls, mammary imaging tests, tumor markers, and genetic studies, due to their association in many cases with mutations in the BRCA 1/2 genes. It is necessary to establish a series of standardized clinical protocols for the management of patients with STIC and to continue advancing our understanding of this pathology and its subsequent evolution to high-grade serous carcinoma.
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Resumen ANTECEDENTES: El embarazo ectópico cornual es poco común. La prevalencia estimada es de 2% y debido a su ubicación cercana a las arterias uterinas, el índice de mortalidad materna es de 10%. CASO CLINICO: Paciente de 42 años, con embarazo de 20.2 semanas, quien acudió al servicio de Urgencias por dolor pélvico opresivo, intenso, de 24 horas de evolución. A la exploración física se encontraron: tensión arterial 80-70 mmHg, frecuencia cardiaca de 112 latidos por minuto y signo de Murphy positivo. La biometría hemática reportó leucocitosis de 22.4/mL y hemoglobina de 10.7 g/dL. El ultrasonido evidenció un feto vivo de 21 semanas, con frecuencia cardiaca de 152 latidos por minuto, placenta grado 0-1, líquido amniótico normal, con abundante líquido libre en el espacio retroperitoneal. Los estudios de control de hemoglobina mostraron descenso a 5.38 g/dL, por lo que se decidió efectuar una laparotomía exploradora, en la que se encontró un embarazo ectópico cornual izquierdo; se extrajo el feto. Se practicó histerectomía subtotal, se trasladó a la paciente a la unidad de cuidados intensivos, donde su evolución fue satisfactoria. CONCLUSION: El diagnóstico de embarazo ectópico cornual sigue siendo difícil de establecer, su cuadro clínico puede simular otras alteraciones, con posibilidad de falla en 50-90% de los casos, dependiendo de la destreza del médico ultrasonografista y la sospecha clínica.
Abstract BACKGROUND: The cornual ectopic pregnancy has an unusual location representing 2% of the prevalence and because of its location close to the uterine arteries it has a maternal mortality of 10%. CLINICAL CASE: A 42-year-old patient with a pregnancy of 20.2 weeks of gestation attended the emergency department for oppressive, intense pelvic pain of 24 hours of evolution; physical examination: blood pressure of 80/70 mmHg and heart rate 112 beats per minute in addition to Murphy positive, laboratory studies were collected with blood count that reported leukocytes: 22.4/mL) and hemoglobin of 10.7 g/dL. An ultrasonographic scan was performed, finding a single 21-week live product with a heart rate of 152 beats per minute, placental grade 0-1, normal amniotic fluid, with abundant free fluid in the retroperitoneal space. Control of hemoglobin was requested with decrease to 5.38 g/dL, so it was decided to go to exploratory laparotomy, finding broken left cornual ectopic pregnancy, which was extracted product of conception and subtotal hysterectomy was performed and subsequently moved to the Intensive Care Unit achieving an adequate evolution. CONCLUSION: The diagnosis of cornual ectopic pregnancy continues to be difficult to perform among medical entities, its clinical picture can simulate other entities with possibility of failure in the diagnosis by 50-90% depending on the skill of the ultrasonographer and clinical suspicion.
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Placenta percreta is an uncommon and potentially fatal condition in pregnancy. It can invade the adjacent structures of uterus including the urinary bladder, rectum, and small bowel. The invasion of bladder is common but that of small bowel is extremely rare. This report presents a case of placenta percreta with small bowel invasion which was managed without intestinal resection.
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Objective To explore the influence of continuing nursing care on sexual quality of patients after laparoscopic subtotal hysterectomy.Methods Seventy-eight patients with selective laparoscopic subtotal hysterectomy enrolled from March 2014 to April 2015 were numbered according to their enrollment date,and divided into control group and intervention group randomly.Both groups were conducted laparoscopic subtotal hysterectomy under general anesthesia.After the surgery,the control group was treated with standard nursing care and the intervention group received continuing nursing care beyond the standard nursing care.Participants' sexual quality of 3 months and 6 months after surgery were evaluated using the female sexual function index (FSFI) Results The scores of FSFI of intervention group were significantly higher than those of the control group.Conclusion The continuing nursing care of patients after laparoscopic subtotal hysterectomy can effectively improve patient's short-term sexual quality,which is worth of being applied in gynecology nursing care in the future.
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La controversia entre todas las formas de histerectomías y sus diferentes abordajes se ha agudizado, ha llegado a las propias pacientes que con frecuencia creciente solicitan información del ginecólogo, llegan a exigir la histerectomía subtotal abdominal (HSTA) por la ventajas que han oído o leído sobre ella. OBJETIVO: Analizar comparativamente resultados obtenidos entre la histerectomía total abdominal (HTA) y la histerectomía subtotal abdominal (HSTA), según variables seleccionadas. MÉTODOS: Se realizó un estudio descriptivo retrospectivo longitudinal en el periodo comprendido entre enero 2002 a diciembre 2004 en el Hospital Ginecoobstérico Docente Ramón González Coro. La muestra estuvo constituida por un total 310 pacientes histerectomizadas con el diagnóstico de mioma uterino para lo cual seleccionamos dos grupos. Para investigar la posible asociación entre variables cualitativas se utilizó la prueba chi², se consideraron diferencias significativas en aquellos casos donde p = 0,05. RESULTADOS: La HSTA tuvo menor tiempo quirúrgico para un 83,9 por ciento (p=0,000), así como una menor estadía hospitalaria para un 58,1 por ciento, el sangramiento moderado fue de un 5,1 por ciento en la HSTA, no se encontraron lesiones a órganos vecinos en ambos grupos, y la morbilidad febril e infecciosa fue mayor para el grupo de la HTA para un 22,4 por ciento y 5,7 por ciento respectivamente. CONCLUSIONES: En nuestro estudio la histerectomía subtotal abdominal comparativamente con la histerectomía total abdominal tuvo menor tiempo quirúrgico, estadía hospitalario y menor número de complicaciones transoperatorias y posoperatorias
Controversy among all the ways of hysterectomies and the different approaches has increased is known by patients that frequently request information to gynecologists on their criterion of an abdominal subtotal hysterectomy (ASTH) due its advantages of this technique. OBJECTIVE: To analyze comparatively the results obtained among the abdominal total hysterectomies (ATH) and the ASTH according the variables selected. METHODS: A cross-sectional, retrospective and descriptive was conducted from January, 2002 to December, 2004 in the Ramón Pando Ferrer Genecology-Obstetricts Hospital. Sample included 310 patients with hysterectomy diagnosed with a uterine myoma divided into two groups. To research the possible association among qualitative variable the chi² test was used with significant differences en those groups where (p =0.05). RESULTS: The ASTH had less surgical time for a 83.9 percent (p = 0,000), as well as a lower hospital stay for 58.1 percent; moderate bleeding was of a 5.1 percent in the ASTH without lesions of surrounding organs in both groups and febrile and infectious morbidity was greater for the ATH group for a 22.4 percent and 5.7/5, respectively. CONCLUSIONS: In our study the abdominal subtotal hysterectomy (ASBH) compared with the abdominal total hysterectomy (ATH) has less surgical time, hospital stay and a lesser number of transoperative and postoperative complications
Subject(s)
Humans , Female , Hysterectomy/methods , Myoma/surgery , Myoma/complications , Epidemiology, Descriptive , Longitudinal Studies , Retrospective StudiesABSTRACT
Iatrogenic endometriosis and leiomyoma are rare complication of laparoscopic subtotal hysterectomy. I experienced a case of pelvic endometriosis and leiomyoma concurrently arising after laparoscopic subtotal hysterectomy 2 years ago. The patient was a 43-year-old woman, and her chief complaint was palpable mass with pelvic pain in pelvis. Contrast-enhanced computed tomography image showed multiple well enhanced masses. She underwent laparoscopic surgery which revealed pelvic endometriosis and leiomyomas. The solid masses in cul-de-sac and on the surface of rectum were revealed endometriosis. The solid masses on the surface of anterior abdominal wall and descending colon were revealed leiomyoma. Implantation of viable endometrial and leiomyoma tissues could occur during uterine morcellation at time of laparoscopic subtotal hysterectomy in some patients. Vigorous irrigation and meticulous inspection should be performed.
Subject(s)
Adult , Female , Humans , Abdominal Wall , Colon, Descending , Endometriosis , Hysterectomy , Laparoscopy , Leiomyoma , Myoma , Pelvic Pain , Pelvis , RectumABSTRACT
Objective To probe into the treating method for 8 patients with amniotic fluid embolism and summarize the cognition and experience.Methods A retrospective analysis was made on the treatment of 8 patients with amniotic fluid embolism and the prognosis clinical material of mother and baby.Results All of them had the drop of blood pressure and shock.7 cases had premonitory symptom.7 cases had survived and 1 case had been dead.Conclusion It is very important for the successful rescuing that the symptom is found out in early period, diagnosis is correctly made, adrenocortical hormones and heparin are used in time, amount of blood and fibrinogen level were supplied quickly, pathogenic factors are removed and subtotal hysterectomy can be carried out early, which has absolutely clinical value for the successful rescuing patients with amniotic fluid embolism.
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Background: Endoscopic surgery is widely applied in the treatment and widening complex surgical indications by many hospitals. However, to assess and apply effectively a new endoscopic method into treatment requires professional surgeons with modern, advanced, synchronous devices. Objective: To evaluate the effects of the new endoscopic method, using common medical devices to support and overcome the lack of advanced and specialized endoscopic tools in endoscopy. Subject and methods: A prospective intervention study was conducted on 12 cases of subtotal hysterectomy and uterus sub-excision, performed at the Obstetric Department of Vietnam \u2013 Cu Ba Friendship Hospital in Dong Hoi, Quang Binh province from October, 2006 to January, 2007. This initiative was done with flexible pozzi which could be bent to 120 degree. Pozzi was put into the abdominal cavity through the posterior culdesac with the control of lens to fix the uterus into the pozzi at one point. Thanks to, the surgeons we were able to control the uterus as well as to take specimens easily. Results: Among 12 endoscopic cases, 6 cases of subtotal hysterectomy and 6 cases of uterus sub-excision. 100% of these cases were made successfully. Average time for each case was 120-150 minutes. The time to fix pozzi within 3-5 minutes. The time to remove the specimens was 5-6 minutes. There is no case of complications. Conclusion: Although the number of surgeries, which were applied by new constant uterus method in endoscopic surgery for the first time at Dong Hoi Vietnam \u2013 CuBa Hospital was still small, the method was very successful. This new method could overcome the shortage of highly specialized techniques in endoscopic surgery in many hospitals in Vietnam.
Subject(s)
EndoscopyABSTRACT
Objective To investigate the clinical value of artery-sparing high-site transvaginal subtotal hysterectomy(TVSH) for the treatment of uterine body leiomyoma.Methods High-site transvaginal subtotal hysterectomy with the preservation of bilateral uterine arteries was performed in 23 patients with uterine body leiomyoma from January 2002 to December 2004 in this hospital.The vesicouterine peritoneum was opened through the vagina to mobilize the uterus outside.With bilateral uterine arteries preserved,the muscular layer was opened 1 cm medial to the uterine horn until the site 3 cm above the isthmus of the uterus.Then wedge resection of the anterior and posterior uterine wall was conducted with the endometrium 2 cm in thickness preserved.Results All the operations were successfully completed without conversions to open surgery.The operating time was 45~80 min(mean,55 min),and the intraoperative blood loss was 80~250 ml(mean,150 ml).The time to first passing flatus was 6~27 h(mean,11 h).The length of postoperative hospital stay was 3~8 d(mean,4 d).The pyrexia rate after operation was 8.7%(2/23). Normal sexual life recovered within 3 months in 18 patients.Conclusions Artery-sparing high-site TVSH has advantages of high safety,effectiveness,minimal invasion,rapid recovery,and fewer complications.