Objective. Studying of possibilities of procedure of the left atrium triangular plasty while doing correction of mitral failure, coexisted with left atriomegaly. Materials and methods. There were analyzed results of surgical treatment of 330 patients, suffering mitral failure in combination with left atriomegaly, who were operated in Amosov National Institute of Cardiovascular Surgery in period from 1 Jan 2005 to 1 Jan 2021 yr. The main group have consisted of 143 patients, to whom correction of mitral failure together with original procedure of triangular plasty of left atrium was performed. The control group have consisted of 187 patients, to whom correction of mitral failure was done only, although they suffered concurrent left atriomegaly. Results. Of 143 patients operated in the main group 3 died (lethality have constituted 2.1%). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle – (69.1 ± 12.1) ml/m2 before the operation, (59.3 ± 8.5) ml/m2 postoperatively, (48.4 ± 9.5) ml/m2 in late period; the left ventricle ejection fraction – 0.51 ± 0.05 preoperatively, 0.54 ± 0.05 postoperatively 0.56 ± 0.04 in late period. The left atrium diameter dynamics was following: (65.8 ± 4.1) mm preoperatively, (52.3 ± 2.1) mm postoperatively, and (53.5 ± 2.2) mm in late period. Of 187 оperated patients of control group 6 have died, (lethality have constituted 3.2%). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle – (68.3 ± 11.3) ml/m2 before the operation, (60.4 ± 9.3) ml/m2 postoperatively, (52.7 ± 7.2) ml/m2 in late period; the left ventricle ejection fraction – 0.52 ± 0.05 preoperatively, 0.53 ± 0.05 postoperatively, 0.5 ± 0.04 in late period. Diameter of left atrium: (66.5 ± 3.7) mm preoperatively, (63.5 ± 2.3) mm postoperatively, (71.5 ± 2.4) mm in late period. Conclusion. Triangular plasty of left atrium is a low-traumatic and effective procedure, leading to significant improvement in its morphometry and accompanied by low risk of hospital lethality.
Злокачественные опухоли надпочечников, такие как адренокортикальный рак (АКР) и злокачественная феохромоцитома (ЗФХЦ), имеют особо агрессивное течение, обусловливающее высокую летальность у данной категории пациентов, особенно на поздних стадиях заболевания. В связи с этим существует статистически значимая разница в выживаемости больных в зависимости от сроков выявления и начала лечения. Цель исследования. Анализ результатов хирургического лечения больных опухолями надпочечников. Пациенты и методы. 55 пациентам в возрасте от 17 до 75 лет (медиана-50 ± 13 лет) с первичными опухолевыми образованиями надпочечников в период с 1999 по 2014 гг. в отделении онкоурологии МНИОИ им. П. А. Герцена проведено хирургическое лечение. 18 адреналэктомий (32,7%) выполнены лапароскопическим доступом, 36 (65,5%)-открытым, 1 (1,8%)-видеоассистированным. Среди них: забрюшинная лимфаденэктомия с ипсилатеральной стороны выполнена в 14 (25,5%), комбинированные операции с резекцией соседних органов-7 (12,7%), тромбэктомия с резекцией нижней полой вены-в 3 (5,5%) случаях. Медиана времени операций составила 100 ± 73 минут, при открытых хирургических вмешательствах-183 ± 55 минут, лапароскопических-60 ± 30 минут. Объем кровопотери-300 ± 1136 мл. По данным планового морфологического исследования, у 24 (43,6%) пациентов опухоли имели доброкачественный характер, у остальных 31 (56,4%)-злокачественный. Результаты. Отдаленные результаты удалось проследить у 84% больных в группе АКР. Время наблюдения за больными варьирует от 2 до 167 месяцев, с медианой 64,5 (IQR 22-111) месяцев. Медиана выживаемости без прогрессирования и 5-летняя общая и опухолеспецифическая выживаемости составили: I ст.-93 мес и 67 ± 13%, II ст.-30 мес и 75 ± 21%, III ст.-18 мес и 67 ± 27%, IV ст.-10 мес и 25 ± 21%. Время наблюдения за больными с ЗФХЦ варьирует от 12 до 102 месяцев, с медианой 60 (IQR 18-102) месяцев. Медиана выживаемости без прогрессирования составила 26 (IQR 15-38) месяцев, 5-летняя общая и опухолеспецифическая выживаемости составили 33 ± 27%. Заключение. В настоящее время основной задачей является выявление и оперативное лечение злокачественных опухолей надпочечников на ранних стадиях заболевания, что позволяет улучшить результаты безрецидивной и общей выживаемости. По нашему мнению, целесообразно расширение показаний к объемам хирургического лечения при первично выявленных генерализованных формах с наличием солитарных метастазов, а также активная хирургическая тактика при прогрессировании опухолевого процесса.
Objective. Studying the possibilities of the method of the left atrium arch-like plasty while correcting of a mitral failure in combination with the left atrium dilatation. Materials and methods. Into the analysis of the surgical treatment results in 190 patients, suffering mitral failure in combination with the left atrium dilatation, who were operated in the National Institute of Cardio-Vascular Surgery named after N. M. Amosov NAMS of Ukraine in a period from 01.01.2012 to 01.01.2021 yr, were included. The main group consisted of 103 patients, to whom correction of a mitral failure in combination with original procedure of the arch-like plasty of left atrium was performed. Into a control group 87 patients were included, to whom the correction of a mitral valve failure was done without concomitant plasty of left atrium. Results. Of 103 operated patients of the main group on the hospital stage 1 have died (0.9% lethality). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of the left ventricle - (63.1 ± 11.3) ml/m2 (preoperatively), (58.3 ± 8.4) ml/m2 (postoperatively), (49.4 ± 9.2) ml/m2 (remote period); the left ventricle ejection fraction: 0.52 ± 0.04 (preoperatively), 0.55 ± 0.04 (postoperatively), 0.57 ± 0.03 (remote period). Diameter of left atrium: (58.8 ± 6.4) mm (preoperatively), (41.4 ± 5.3) mm (postoperatively), (43.9 ± 2.3) mm (remote period). Sinus rhythm in a remote period was stable in 75 (78.9%) of 95 patients. Of 87 operated patients of a control group 2 died (lethality 2.3%). Dynamics of the echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle- (67.3 ± 11.3) ml/m2 (preoperatively), (60.4 ± 9.3) ml/m2 (postoperatively), (52.7 ± 7.2) ml/m2 (remote period); the left ventricle ejection fraction: 0.52 ± 0.05 (preoperatively), 0.54 ± 0.05 (postoperatively), 0.54 ± 0.03 (remote period). Diameter of left atrium: (59.5 ± 2.3) mm (preoperatively), (57.5 ± 3.7) mm (postoperatively), (68.5 ± 3.4) mm (in remote period). Sinus rhythm was stable in 18 (22.5%) of 80 patients, followed in the remote period. Conclusion. The arch-like plasty of left atrium is a low-traumatic and effective procedure, leading to significant improvement of the left atrium morphometry and accompanied by low risk for postoperative lethality.
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