ABSTRACT
RESUMEN OBJETIVO: Presentar la experiencia de la unidad de mama de nuestro hospital con la utilización de la ecografía intraoperatoria en el tratamiento de las lesiones no palpables de mama. PACIENTES Y MÉTODO: Se incluyeron aquellas pacientes con lesiones no palpables de mama y ecovisibles. Intraoperatoriamente se localizó la lesión con la ecografía y se procedió a su exéresis, con comprobación ecográfica de su correcta extirpación con márgenes de seguridad. Se realizó estudio macroscópico en fresco de los márgenes marcados con tinta intraoperatoriamente. En caso de que los márgenes no fueran correctos se procedía a una ampliación de márgenes en el mismo acto quirúrgico. RESULTADOS: Desde el año 2012 se han intervenido 52 pacientes. En todas las pacientes se localizó la lesión con la ecografía. Se realizó tumorectomía a 24 pacientes y a 28 pacientes se les asoció la biopsia del ganglio centinela. El resultado patológico definitivo fue de 19 lesiones benignas y 33 lesiones malignas. A una paciente se le realizó mastectomía simple por presentar un carcinoma in situ extenso con microinfiltración no diagnosticado con las pruebas radiológicas preoperatorias. El resto de pacientes presentaron márgenes libres de tumor. CONCLUSIONES: La ecografía intraoperatoria es una técnica simple y fácil de desarrollar. Presenta una baja tasa de afectación de márgenes y es enteramente cirujano-controlada. Es confortable para el paciente y conlleva un bajo riesgo de complicaciones relacionadas con la técnica.
ABSTRACT OBJETIVE: To present the results of our hospital's experience with the utilization of intraoperative ultrasound in the treatment of non-palpable breast lesions. PATIENTS AND METHOD: We included those patients whose breast lesions were non-palpable yet simultaneously visible on ultrasound. The lesions were located intraoperatively with ultrasound and were removed with ultrasound verification of the proper security margins. An examination of the intraoperative macroscopic margins with ink was done. In cases with incorrect margins, a re-excision was done utilizing the same technique but with amplified margins. RESULTS: Dating from 2012, we have operated on 52 patients. In all cases, the lesions were discovered and localized by means of ultrasound. Lumpectomy was performed on 24 patients and we associated the sentinel node biopsy in 28 cases. Subsequent pathology reports determined that 19 lesions were benign and 33 lesions were malignant. There was one patient with a mastectomy because a long extensive ductal carcinoma in situ with microinfiltration that was not seeing during the preoperative study. CONCLUSIONS: Intraoperative ultrasound is an easy and simple technique that is entirely surgeon controlled and results in a low rate of positive margins. The procedure is comfortable for the patient and carries with it a low rate of complications.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms/surgery , Breast Neoplasms/diagnostic imaging , Ultrasonography, Mammary/methods , Ultrasonography, Interventional/methods , Breast Diseases/surgery , Breast Diseases/pathology , Breast Diseases/diagnostic imaging , Breast Neoplasms/pathology , Margins of Excision , MastectomyABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Neurilemmoma/surgery , Neurilemmoma , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms , Vagus Nerve/pathology , Vagus Nerve/surgery , Vagus Nerve , Adenoma/pathology , Adenoma/surgery , AdenomaABSTRACT
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Subject(s)
Humans , Female , Adult , Recurrent Laryngeal Nerve/pathology , Recurrent Laryngeal Nerve/surgery , Thyroid Neoplasms/complications , Thyroid Neoplasms/surgery , Thyroid Neoplasms , Thyroidectomy/methods , Thyroidectomy , Lymph Node Excision/methods , Deglutition Disorders/complications , Hypocalcemia/complicationsSubject(s)
Adenoma/diagnosis , Cranial Nerve Neoplasms/diagnosis , Diagnostic Errors , Head and Neck Neoplasms/diagnosis , Neurilemmoma/diagnosis , Parathyroid Neoplasms/diagnosis , Vagus Nerve Diseases/diagnosis , Vagus Nerve/pathology , Adenoma/diagnostic imaging , Cranial Nerve Neoplasms/diagnostic imaging , Cranial Nerve Neoplasms/surgery , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/surgery , Humans , Hyperparathyroidism, Primary/surgery , Intraoperative Period , Male , Middle Aged , Neurilemmoma/diagnostic imaging , Neurilemmoma/surgery , Parathyroid Neoplasms/diagnostic imaging , Parathyroidectomy , Reoperation , Tomography, X-Ray Computed , Ultrasonography , Vagus Nerve/diagnostic imaging , Vagus Nerve/surgery , Vagus Nerve Diseases/diagnostic imaging , Vagus Nerve Diseases/surgerySubject(s)
Carcinoma, Papillary/surgery , Recurrent Laryngeal Nerve/abnormalities , Thyroid Neoplasms/surgery , Adult , Carcinoma, Papillary/complications , Female , Goiter, Nodular/complications , Goiter, Nodular/surgery , Humans , Incidental Findings , Intraoperative Complications/prevention & control , Laryngeal Nerve Injuries/prevention & control , Thyroid Neoplasms/complications , Vocal Cord Paralysis/prevention & controlABSTRACT
Objetivo: La analgesia postoperatoria en cirugía de la mama sigue siendo un reto. Presentamos la técnica de colocación de un catéter para la perfusión continua de anestésicos locales en cirugía de mama como alternativa a los métodos analgésicos actuales. Casos clínicos: Caso 1. Mujer de 59 años con un carcinoma en la mama derecha con ganglios axilares negativos. Se realizó mastectomía derecha y se colocó catéter de analgesia interpectoral. Caso 2. Mujer de 52 años con un carcinoma en la mama derecha y ganglios axilares positivos. Se realizó mastectomía tipo Madden y se colocó catéter de analgesia interpectoral y axilar derecho. Se retiró el catéter a las 48 horas sin complicaciones. Conclusiones: El uso de perfusión continua de anestésico local en la herida quirúrgica mediante catéter multiperforado es una alternativa eficaz para el control del dolor postoperatorio en cirugía de la mama, lo cual disminuye los requerimientos y los efectos secundarios de antiinflamatorios sistémicos y opioides(AU)
Introduction: Postoperative analgesia in breast surgery is still a challenge. We present a technique for continuous perfusion of anaesthetics through an "in situ" placed catheter, as an alternative to the current analgesic methods in breast surgery. Case reports: Case 1. A 59 year old woman with carcinoma in the right breast and negative axillary nodes had a right mastectomy and an interpectoral analgesia catheter was inserted. Case 2. A 52 year old woman with carcinoma in the right breast and positive axillary nodes. A right Madden mastectomy was performed and an interpectoral and right axillary analgesia catheter was inserted. The catheter was removed 48 hours later with no complications. Conclusions: The use of continuous perfusion in surgical wounds by means of a multiperforated catheter is an effective option for the treatment of post-surgical pain in breast surgery. This technique reduces the requirements, and potential side effects, of systemic anti-inflammatory drugs and opioids(AU)
Subject(s)
Humans , Female , Middle Aged , Catheters , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Postoperative Period , Breast Neoplasms/surgery , Analgesia , /trends , Anesthesia, Local/instrumentation , Anesthesia, Local/methods , Anesthetics, Local/therapeutic use , Pain, Postoperative/complications , Catheterization , Pain, Postoperative/physiopathology , Anesthesia, Local/trends , Anesthesia, LocalSubject(s)
Humans , Male , Aged, 80 and over , Gallbladder/pathology , Gallbladder , Appendicitis/complications , Abdomen, Acute/diagnosis , Cholecystectomy , Acalculous Cholecystitis/complications , Acalculous Cholecystitis/diagnosis , Acalculous Cholecystitis , Cholecystitis, Acute/complications , Laparoscopy , Appendicitis/pathology , Appendicitis/diagnosis , Appendicitis , Abdomen, Acute/physiopathology , Abdomen, Acute , Abdominal Pain/etiology , Abdominal PainSubject(s)
Appendicitis/diagnosis , Diagnostic Errors , Gallbladder Diseases/diagnosis , Torsion Abnormality/diagnosis , Abdomen, Acute/etiology , Acute Disease , Aged, 80 and over , Cholecystectomy , Cholecystitis/complications , Cholecystitis/surgery , Emergencies , Gallbladder Diseases/complications , Gallbladder Diseases/surgery , Humans , Male , Torsion Abnormality/complications , Torsion Abnormality/surgeryABSTRACT
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