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1.
Khirurgiia (Mosk) ; (2): 33-38, 2016.
Article in Russian | MEDLINE | ID: mdl-26977865

ABSTRACT

AIM: To improve immediate and long-term results of delayed coloesophagoplasty in cancer patients. MATERIAL AND METHODS: We presented three case reports of coloesophagoplasty in difficult clinical situations including technical impossibility of primary plasty, extraordinary anesthetic situation, transplant necrosis after primary plasty. RESULTS: Gastrointestinal tract integrity was restored in all cases and patients returned to nutrition per os, that provided good quality of life and compensated nutritional deficiencies. Only one patient had bleeding in postoperative period that required relaparotomy. There were no postoperative complications in two other patients. CONCLUSION: Delayed coloesophagoplasty should be performed in all patients who underwent esophagogastrectomy if progression of primary disease is absent. Graft placement and colic segment are chosen individually. However left half of colon with retrosternal location of transplant is preferable for plasty.


Subject(s)
Colon/transplantation , Esophageal Neoplasms/surgery , Esophagectomy , Esophagoplasty/methods , Gastrectomy , Postoperative Complications , Quality of Life , Stomach Neoplasms/surgery , Esophageal Neoplasms/pathology , Esophagectomy/adverse effects , Esophagectomy/methods , Esophagectomy/rehabilitation , Female , Gastrectomy/adverse effects , Gastrectomy/methods , Gastrectomy/rehabilitation , Humans , Male , Middle Aged , Patient Selection , Perioperative Period/methods , Perioperative Period/rehabilitation , Postoperative Complications/diagnosis , Postoperative Complications/psychology , Postoperative Complications/rehabilitation , Stomach Neoplasms/pathology , Treatment Outcome
2.
Khirurgiia (Mosk) ; (11): 17-25, 2014.
Article in Russian | MEDLINE | ID: mdl-25589179

ABSTRACT

It is presented the treatment results of abdominal and intraabdominal desmoid fibromas. Group of abdominal localization included 19 patients. 15 of them had primary tumors, 4 - recurrent tumors after surgical treatment. Radical (R0) operations were performed in all cases. Tumor removal was associated with plastic of abdominal wall by synthetic implant in 17 patients. Wide excision of surrounding tissues and musculo-aponeurotic layer of anterior abdominal wall allows to achieve long-term disease-free period. There weren't recurrent symptoms in terms from 4 to 60 months of observation. The second group included 28 patients with intraabdominal desmoid fibromas. Operations were performed in 11 (35.2%) patients including 3 cases of reoperations. There were 14 operations. Radical (R0) volume was applied in 11 (78.6%) operations, cytoreductive (R2) volume - in 1 (7%) operation. Explorative laparotomy was used in 3 (21.4%) cases because of involvement of mesenteric vessels. Combined treatment was performed in 4 (14.3%) patients. 14 (50%) patients received conservative therapy because of unresectable tumor including chemo-, hormone- and radiotherapy. Operated patients were under observation in terms from 11 to 156 months, median was 63.2 months. Recurrence developed in 4 of 10 (40%) patients after R0-surgery. Cytoreductive (R1/R2) volume is admitted for intraabdominal desmoid fibromas. But even in case of unresectable process and explorative intervention stabilization and regression of tumor is possible by means of chemo-, hormone- and radiotherapy in different combination. It allows to preserve a good life quality.


Subject(s)
Abdominal Cavity , Cytoreduction Surgical Procedures , Dissection , Fibromatosis, Abdominal , Laparotomy , Neoplasm Recurrence, Local , Postoperative Complications/prevention & control , Abdominal Cavity/pathology , Abdominal Cavity/surgery , Abdominal Wall/pathology , Abdominal Wall/surgery , Abdominal Wound Closure Techniques , Adult , Combined Modality Therapy , Cytoreduction Surgical Procedures/adverse effects , Cytoreduction Surgical Procedures/methods , Dissection/adverse effects , Dissection/methods , Female , Fibromatosis, Abdominal/pathology , Fibromatosis, Abdominal/surgery , Humans , Laparotomy/adverse effects , Laparotomy/methods , Male , Moscow , Postoperative Complications/classification , Retrospective Studies , Treatment Outcome
3.
Anesteziol Reanimatol ; (3): 29-33, 2010.
Article in Russian | MEDLINE | ID: mdl-20734844

ABSTRACT

A procedure has been developed and tested to prevent and treat postoperative pain syndrome during extensive thoracoabdominal surgery for esophageal cancer. The procedure is based on the preventive (12 hours before anesthesia and surgery) application of Durogesic (fentanyl transdermal therapeutic system (TTS)) at an opioid release rate of 50 microg/h for 72 hours. By the end of surgery and anesthesia when intravenous injection of fentanyl is stopped, analgesia continues to be maintdined due to its therapeutic dose coming from TTS. This prevents the development of acute opioid tolerance, hyperalgesia, and destabilization state in the early postanesthetic period and creates the basis for continuous multimodal postoperative analgesia in combination with nonopioid components (lornoxicam, perfalgan) and with none or minimal need for the injectable opioid. This allows an operated patient to have a comfort and stable state. A further investigation on the comparative assessment of the developed procedure with other variants of perioperative systemic and combined anesthesia-analgesia is to be conducted.


Subject(s)
Analgesics, Opioid/therapeutic use , Esophageal Neoplasms/surgery , Esophagectomy/methods , Fentanyl/therapeutic use , Pain, Postoperative/prevention & control , Thoracic Surgical Procedures/methods , Abdomen/surgery , Administration, Cutaneous , Adult , Aged , Analgesics, Opioid/administration & dosage , Delayed-Action Preparations , Drug Administration Schedule , Drug Tolerance , Female , Fentanyl/administration & dosage , Humans , Injections, Intravenous , Male , Middle Aged , Pain, Postoperative/drug therapy , Preoperative Care/methods , Syndrome , Treatment Outcome
4.
Khirurgiia (Mosk) ; (4): 12-6, 2009.
Article in Russian | MEDLINE | ID: mdl-19491754

ABSTRACT

The predictive role of submucosal invasion and metastatic spread to local lymph nodes at early gastric cancer was analyzed. Material from 32 patients was morphologically and immunohistochemically analyzed. The prognostic value of the depth of invasion, tenascin and positive MMP2 and MMP9 staining, proliferative activity and microvascular solidity in the lesion were studied. Watch lymph nodes were detected in 22 patients with the diagnosed early gastric cancer. The method is appropriate only by early cancer and in combination with other macro- and microscopic factors. Its' efficacy was 100% in the group of the early cancer (n=15), whereas in the group with the locally spread cancer the sensitivity, accuracy and specificity were 76, 71 and 100%, respectively. Though larger series are necessary to make definite conclusions about the predictive value of watch nodes in gastric cancer.


Subject(s)
Lymph Node Excision/methods , Lymph Nodes/surgery , Stomach Neoplasms/surgery , Humans , Lymphatic Metastasis , Prognosis , Stomach Neoplasms/secondary
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