straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba
Straipsnyje retrospektyviai analizuojamos Klaipėdos universitetinėje ligoninėje atliktos pirmosios 23 totalinės histerektomijos, ...naudojant Senhance® robotinę sistemą. Pacientės operuotos dėl gimdos vėžio, miomatozės, endometriozės, profilaktiškai po krūties vėžio gydymo ir atskirais atvejais esant gimdos kaklelio patologijų ar nustačius gerybinį kiaušidžių naviką. Aptariama operacijų atlikimo technika, pateikiami rezultatai. Išvados. Roboto asistuojama totalinė histerektomija – metodas, saugus pacientėms ir komfortiškas chirurgui.
THE EFFECT OF EARLY CERVICAL CANCER DIAGNOSIS Herman Haller; Maja Krašević; Ozren Mamula ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and ...Gynecology Rijeka, Croatia. Method: Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results: Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions: Conservative surgical approach – conization alone in stage IA1 of the squamous cell car- cinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned.
Background. Postpartum haemorrhage usually occurs due to uterus atonia, adherent placenta, placenta accreta, coagulopathy or uterus rupture. In total placenta previa haemorrhage occurs more often and ...usually is more severe. Case report. We presented the example of severe postpartum haemorrhage with parturient woman after scheduled Caesarean section, due to total placenta previa, which was ended by performing hysterectomy. Conclusions. In postpartum haemorrhage, the treatment is conservative and if there is no improvement timely surgery is required. Abdominal hysterectomy is the final option and in case of severe haemorrhage it proved to be life saving for parturient woman.
Įvadas Nėštumas gimdos kaklelyje yra reta patologija, kurios tiksli etiologija nežinoma. Ši būklė gali būti gyvybiškai pavojinga ir gydoma totalia laparotomine histerektomija, tačiau tobulėjanti ...diagnostika leidžia ektopinį nėštumą gimdos kaklelyje gydyti išsaugant vaisingumą. Klinikinis atvejis 38 metų pacientė buvo paguldyta į Klaipėdos Jūrininkų ligoninę dėl kraujavimo iš makšties ir skausmo apatinėje pilvo dalyje. Nuodugniai ištyrus pacientę, buvo diagnozuotas nėštumas gimdos kaklelyje. Apsvarsčius skirtingas gydymo taktikas, totali laparotominė histerektomija buvo pasirinka kaip tinkamiausias gydymo būdas. Operacija buvo sėkminga, pooperacinis laikotarpis sklandus. Diskusija Ultragarso tyrimas yra pagrindinis nėštumo gimdos kaklelyje diagnostikos metodas. Skėtikliais ir bimanualinio tyrimo metu dažniausiai randami svarbūs pakitimai, kurie padeda pagrįsti diagnozę. Totali laparotominė histerektomija buvo pagrindinis gydymo metodas, tačiau tobulėjant diagnostikos metodams metotreksatas tapo pirmos eilės pasirinkimu kaklelinio nėštumo atveju. Kiti konservatyvūs gydymo metodai, pavyzdžiui, gimdos ir gimdos kaklelio abrazija, lydima tamponavimo Foley kateteriu, ar gimdos arterijos embolizacija, tampa vis populiaresni. Išvados Duomenys apie kaklelinį nėštumą yra riboti dėl šios patologijos retumo ir kiekvienas atvejis turi būti vertinamas individualiai. Noras išsaugoti vaisingumą ir pacientės būklė yra pagrindiniai rodikliai, į kuriuos būtina atsižvelgti nusprendžiant, kokią gydymo taktiką pasirinkti esant nėštumui gimdos kaklelyje.
Background. Since 2005 we have been used new treatment methods for pelvic organs prolapse with polypropylene mesh systems. These methods have been shown as successful, reliable and had minor post ...treatment complications. In the following study we showed the results of operative treatment of pelvic organs prolapse with mesh placement at Department of Gynecology and Obstetrics at Celje General Hospital in 2008. Methods. We analysed a group of 80 female patients who had PERIGEE, APOGEE or PROLIFT mesh placement for pelvic organs prolapsed repair. The complications during the operation, 14 days and 4 weeks after operation, possible reoperations and women satisfaction after procedure were followed. We used data from patient’s medical documentation. Results. 80 women with pelvic organs prolapse were operated at the Department of Gynecology and Obstetrics in 2008 at Celje General Hospital. We placed the PERIGEE system to 40 (50.0 %), APOGEE to 11 (13.7 %), PERIGEE and APOGEE to 23 (28.8 %) and PROLIFT system to 6 (7.5 %) of them. The mesh systems were placed either alone or with another surgical procedure (hysterectomy, cervix removal, tension free vaginal tape – TVT, laparoscopy). 13 (16.2 %) operated women did have complications during or after surgical procedure. 4 weeks after the operation 8 (10.0 %) women complained about symptoms similar to those before the operation. The treatment failure was obvious as well. 2 (2.5 %) women had the same symptoms as before the operation and also voiding problems (urinary incontinence or retention). 11 (13.7 %) women had voiding problems as well. The other complications were: vaginal erosio, unclear abdominal pain and obstipatio. 54 (67.5 %) women were completely satisfied with procedure and had no complications. They were well after check up as well. Conclusions. The patients in this study mostly had complications when we used both – mesh placement and another surgical procedure (hysterectomy, TVT, elongated cervix removal). It is necessary to follow results of the study in the future in order to show success of pelvic organs prolapsed repair with polypropylene mesh.
Background. Radical hysterectomy is performed on woman with cervical cancer or endometrial cancer that has spread to the cervix. Aims. To find whether our modified radical hysterectomy represents ...nerve sparing. Methods. In 28 patients, modified radical hysterectomy was applied (study group) and the width of the parametria and vaginal cuff were measured. Using a point-counting technique, nerve areal density was determined in cross sections of resected parametria at 0.5 cm (A), 1 cm (B), and 1.5 cm (C) from the cervix. The results were compared with 26 control patients who underwent classic radical hysterectomy. In the study group urodynamic measurements were performed after operation, and correlations with histologic data were calculated. The survival rates and adjuvant treatment were compared between the groups. Results. Adjuvant treatment was given to 53.57 % in the study and 65.38 % of patients in the control group (P > 0.3). The survival rate after 3 years was 92.85 % in the study and 84.61 % in the control group after more than 5 years. The width of the resected parametria was smaller in the study (mean: right 15.50 mm, left 15.71 mm) compared with the control group (mean: right 22.69 mm; P < 0.013; left 22.96 mm; P < 0.011). The nerve areal density in the lateral part of the right parametrium (C right 6.2 %) was lower in the study than in the control group (C right 9.7 %; P < 0.01). There were several correlations between parametrial width, nerve areal density and urodynamic parameters. Conclusions. Modified radical hysterectomy is less radical, and apparently also nerve sparing. It does not influence survival rates and does not impair the urinary tract function.
Prikazan je rijedak slučaj u kojem parazitski miom oponaša adneksalni tumor u prethodno histerektomizirane, postmenopauzalne
žene. Dvije godine nakon vaginalne histerektomije (zbog rastućeg mioma) ...asimptomatski tumor u predjelu desnih adneksa je uočen tijekom redovitog preventivnog pregleda. Pomoću ultrazvuka prikazan je solidan tumor veličine 4-5 cm u predjelu desnih adneksa, dok su tumorski biljezi kod ovarijskih neoplazmi (CA 125, HE4) bili negativni. Intraoperacijski je otkriven još jedan solidan tumor veličine oko 3 cm smješten iznad svoda rodnice. Oba tumora su odstranjena pomoću laparoskopije, pri čemu je patohistološki nalaz potvrdio da se radi o miomima.
Med številnimi nalogami, ki jih medicinska sestra izvaja v perioperativnem obdobju zdravljenja pacientke z izrezano maternico, ima psihična priprava pomembno vlogo. Teoretični del članka na osnovi ...pregleda literature osvetljuje terapevtski odnos med medicinsko sestro in pacientko, telesno podobo – samopodobo ginekološke pacientke, kot pomembna dejavnika v okviru psihične priprave. V empiričnem delu so podatki pridobljeni s pomočjo anonimnega anketnega vprašalnika na naključnem vzorcu 75 pacientk, ki so jim leta 2002 izrezali maternico zaradi benignega obolenja. Raziskava je pokazala, da se psihična priprava izvaja, vendar ne vedno. Dobra polovica (57 %) vprašanih je mnenja, da imajo medicinske sestre dovolj znanja za kakovostno psihično pripravo. Večina vprašanih je ocenila delo medicinskih sester pozitivno. Kar 53 % vprašanih je imelo v povezavi z obolenjem najtežje obdobje v času hospitalizacije. V tej zvezi se postavlja novo raziskovalno vprašanje. Nasploh rezultati ankete kažejo, da je psihična priprava pomemben del zdravstvene nege.
Članek predstavlja rezultate raziskave o svetovanju medicinskih sester v zvezi s spolnostjo pacientkam, ki jim je bila operativno izrezana maternica v Splošni bolnišnici Celje. Osnovni cilji ...raziskave so bili ugotoviti, koliko poznajo medicinske sestre vpliv histerektomije na spolno življenje pacientk, kakšno je dejansko izvajanje svetovanja o spolnosti po histerektomiji pri delu medicinskih sester tega oddelka in kaj po njihovem mnenju vpliva na pogovor o spolnosti po histerektomiji, tako s strani medicinske sestre kot pacientke. V raziskavi je sodelovalo 33 medicinskih sester. Podatki so bili zbrani s pomočjo anketnega vprašalnika. Rezultati raziskave so pokazali, da medicinske sestre poznajo vplive histerektomije na spolno življenje pacientk, vendar kljub temu, da sprejemajo svetovanje o spolnosti kot del zdravstvene nege, pri svojem delu le občasno svetujejo pacientkam o spolnosti po histerektomiji.
Cilj: Ispitati podudarnost histološkog gradusa endometrioidnog karcinoma endometrija u uzorcima dobivenim frakcioniranom kiretažom i histerektomijom te ispitati utječe li količina materijala ...dobivenog frakcioniranom kiretažom na podudarnost histoloških gradusa. Materijal i metode: U istraživanje su bile uključene 102 pacijentice oboljele od endometrioidnog karcinoma endometrija. Iz dostupne medicinske dokumentacije prikupljeni su arhivski podatci o patohistološkom nalazu tkiva maternice dobivenog metodom frakcionirane kiretaže i histerektomijom. Iz uputnice za patohistološki pregled tkiva dobiveni su podatci o dobi i uputnim kliničkim dijagnozama. Podatci o količini materijala dobiveni su iz opisa makroskopske procjene prikupljenog materijala. Rezultati: Najveći broj ispitanica imao je gradus II endometrioidnog karcinoma endometrija (47,1 % i 50 %). Najveći dio ispitanica imao je srednje obilan materijal dobiven frakcioniranom kiretažom (40,2 %). Nije uočena statistički značajna razlika između histološkog gradusa utvrđenog nakon frakcionirane kiretaže i nakon histerektomije, kao ni u histološkom gradusu između uzoraka dobivenih frakcioniranom kiretažom i histerektomijom s obzirom na količinu kiretiranog materijala. Zaključci: Nije bilo statistički značajne razlike u određenim gradusima karcinoma endometrija u uzorcima dobivenima metodom frakcionirane kiretaže i histerektomije. Podudarnost je veća u višem gradusu tumora (III), a manja u nižem gradusu tumora (I, II). Količina materijala nije utjecala na odstupanje gradusa u uzorku dobivenom frakcioniranom kiretažom i histerektomijom.
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