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5.4 Role of ultrasonic research in planning of treatment of patients with tumours and opuholepodobnymi formations of soft tissues in the conditions of a day surgical hospital

Together with surgeons of clinic of the out-patient-polyclinic help criteria of operability of patients with good-quality tumours and opuholepodobnymi formations in the conditions of a day surgical hospital have been defined.

Them concern:

1) an accessible locating on depth;

2) localisation in possible for operative treatment topografoyoanatomicheskih zones;

3) a locating of formations out of zones main sosudistoyonervnyh fascicles;

4) absence of communication or diligence of formations to a bone and other organs;

5) ultrasonic signs (complex research)

High quality of formations;

6) absence of ultrasonic signs zlokachestvennosti

Formations;

7) the cytologic acknowledgement of high quality of formations at research punktsionnogo bioptata;

8) possibility of carrying out of operation without the general narcosis and a hemotransfusion;

9) absence of the general contraindications to oprerativnomu to treatment.

Part of criteria defined at complex ultrasonic. To number of these criteria carried:

- Locating - superficial (deep, but accessible);

- Localisation (accessible to operation in out-patient conditions);

- The form, characteristic for good-quality formations;

- The size of formation to 5 sm;

- Hyper-an - or gipoehogennost formations;

- Uniformity ehostruktury without additional includings (inspissation, kaltsinaty, petrifikaty);

- As a rule, the accurate equal; occasionally indistinct rough contours (at the cytologic acknowledgement of high quality);

- Blood supply, characteristic for good-quality formations (more often absence of blood supply or a blood flow, characteristic for normal tissues) at dopplerografii;

- I, II, III types of colour cards, low factors of rigidity - at elastografii.

Superficial formations of soft tissues to 5 sm in diameter, as a rule, deleted in out-patient conditions.

Superficial or subfascial formations of soft tissues more in diameter - deleted than 5 sm in the conditions of a day hospital in clinic, but thus considered their localisation. Absence of necessity of round-the-clock medical observation over the patient was an obligatory condition.

(n=28) for more exact characteristic of formations of soft tissues it was necessary for some patients to carry out additional radial researches. For an estimation of osteal structures, in the field of a locating of a tumour of soft tissues, 11 patients carried out a X-ray inspection. At patients, after ultrasonic carrying out, taped formations of the big sizes (more than 5 sm); the wrong form; muscles extending in depth or with an intermuscular locating;
Squeezing vital structures; with sites of calcifications in structure. These patients referred on additional researches: KT or MRT.

The computer tomography has been executed to 16 patients:

- To 6 patients with lipomas in the field of the shoulder which size was more than 5 sm in a diameter (KT spent for comparison of results with MRT) (the Drawing 49);

- To one patient with a fibromatosis desmoidnogo type in subcostal area;

- 3rd patient with formations in top kvadrantah a rump (a lipogranuloma with obyzvestvlennymi capsules (n=2), a lipoma in the size more than 5 sm (n=1));

- To 2nd patients with formations on anticnemion which were characterised by the expressed blood supply at TSDK and a close locating to a bone;

- To one patient with formation near to a humeral joint and possible germination in a joint capsule;

- To 3rd patients with formations from a fatty tissue in the field of a breast bone and intercostal spaces - for their exception zagrudinnogo germinations (one patient spent KT for comparison of results with MRT) (the Drawing 50).

Drawing 49.

Patient A, 59 years. A lipoma of the right shoulder of the big sizes, prilezhashchaja to a bone

Ultrasonic, power dopplerografija - deeply extending formation, the big sizes, the isoechoic structure, (finger) limited to a capsule and weakly expressed signs of vascularization

KT the right shoulder after contrast intensifying - formation of soft tissues with the accurate contours, not accumulating contrast agent

Photo - a macropreparation (a lipoma, the sizes 12х13х10 sm).


Drawing 50. Patient N, 55 years. A lipoma of a thoracal wall with diffusion to depth of muscles.

Ultrasonic, dopplerografija in a power regimen; formation of the big sizes of the isoechoic structure, limited to a capsule (marksman), blood supply signs is not taped

The Kt-image of the right half of thoracal wall after intravenous introduction of a contrast agent - formation of soft tissues with the accurate contours, not accumulating contrast agent


Photo; a macropreparation (a lipoma, the sizes 9х8х7 sm).

The magnitno-resonant tomography has been executed to 19 patients:

- One sick lipoma of a rump (the Drawing 51)

- To one patient with a lipoma in subcutaneously-fatty tissue abdominal wall which extended in retroperitoneal space and prilezhala to a sigmoid intestine and the left wing of an ileal bone;

- 3rd patient with formations in the field of a neck for specification of their sizes (at diffusive lipomatoze necks for a condition estimation sosudistoyonervnyh fascicles);

- To 5 patients with lipomas in the field of a shoulder which than 5 sm were more;

- To 6 patients with tumours in the field of a hip, with an intermuscular locating of fibromas, lipomas, fibrolipomas in the sizes more than 5 sm;

- To 2nd patients with anticnemion formations;

- To one patient with the deep organised hematoma of an anticnemion, the size more than 4 sm, characterised by moderately expressed signs of blood supply.

Drawing 51. Patient S, 59 years. A rump lipoma, with

Diffusion deep into the big cluneal muscle.

Ultrasonic, elastografija; II type colour kartirovanija, low factor of rigidity

Ultrasonic, V-mode - deep formation of the isoechoic structure, (finger) limited to a capsule, the sizes to 6х4х4,5 sm

The Mr-tomogram of the right rump after intravenous introduction of a paramagnetic contrast agent - the formation of soft tissues which is not accumulating a contrast agent, badly discernible from surrounding tissues

Photo; the histological sample of formation painted by hematoxylin-eosine; lipocytes without signs of atypia of cells (marksman)


By results of additional radial researches, operative treatment of 5 patients (with deep lipomas of a shoulder - at 3 patients, lipogranulomas of the big cluneal muscles - at 2) spent in the conditions of a day surgical hospital. For the prevention of relapses of tumours, their surgical excision was as much as possible full with use of an intravenous narcosis.

According to MRT, borders of superficial lipomas of soft tissues not always managed to be visualised precisely. The form, the sizes, localisation of tumours of other tissues or tumours with a combination of different types of tissues taped at carrying out MRT (the Drawing 52) more accurately.

Drawing 52. Patient I, 67 years. Sinovialnaja a shoulder sarcoma

Ultrasonic, dopplerografija in a power regimen - formation of the big sizes non-uniform ehostruktury, with signs of pathological blood supply (marksman)

The Mr-tomogram of the right shoulder after intravenous introduction of a paramagnetic contrast agent - formation of soft tissues with accurate contours, the non-uniform structure, the accumulating contrast agent having communication with a capsule of a joint and komprimirujushchee of a muscle of a shoulder.


For planning of operative measures at patients with formations of soft tissues in the conditions of a day surgical hospital, it is necessary to consider data of the anamnesis, clinical and radial diagnostics.

In the presence of ultrasonic signs of malignant formation of the soft tissues confirmed, as a rule, cytologically, the further inspection and treatment of such patients spent in oncologic hospitals.

Ouses-signs of a bagged parasite of soft tissues caused necessity of full excising subcutaneously-fatty tissue with a capsule of a parasite (for the prevention of damage of a capsule of a parasite). The patient has been operated in the conditions of a hospital (n=1).

Besides, in the conditions of specialised clinics have been operated:

- The patient with a "chronic" hematoma in a cicatrisation stage (n=1);

- Women of genital age with endometrioidnymi heterotopias in postoperative cicatrixes (n=3);

- 22 patients with cysts Bejkera;

- 2 patients with fascial (muscular) hernias;

- 17 big sizes sick by good-quality tumours, difficultly accessible localisation, with diligence to osteal structures and neurovascular fascicles.

Sick by malignant tumours (n=11) have been referred to the oncologic centres for definition of a method of treatment. Signs zlokachestvennosti tumours have been confirmed by a puncture biopsy and at inspection and treatment in oncologic hospitals.

On the basis of the received results of scientific research the algorithm of radial inspection of patients with mjagkotkannymi formations for planning and a choice of tactics of treatment (the Drawing 53) has been developed.

Drawing 53. Algorithm of preoperative radial inspection of patients with tumours and opuholepodobnymi formations of soft tissues, for planning and a choice of tactics of treatment.

For planning and a choice of conditions of operative measures to patients with tumours and opuholepodobnymi formations of soft tissues after obshcheklinicheskogo inspections the US with complex application of techniques (is necessary to execute the V-mode, dopplerografija, elastografija). According to ultrasonic define a locating of formations, their localisation, the form, the sizes, structure, blood supply, elastograficheskie signs. A puncture biopsy expediently
To spend under the ultrasonic control. Sick of tumours and opuholepodobnymi formations of soft tissues with signs of high quality, the small sizes and an accessible locating spend surgical treatment it is out-patient or in the conditions of a day surgical hospital. To patients with deeply located good-quality tumours of soft tissues in the sizes more than 5 sm, for specification of the sizes of formations, their fabric uniformity, an adhering to anatomically important structures - after carrying out of complex ultrasonic it is necessary to carry out KT or MRT. By results of radial researches, attending physicians plan treatment of such patients in out-patient conditions or in the conditions of a hospital. At revealing of signs zlokachestvennosti tumours of soft tissues according to complex ultrasonic and their acknowledgement cytologically, treatment of such patients should be spent in the oncologic centres.

Thus, results of ultrasonic of soft tissues sick of "tumours" have allowed to receive their basic characteristics necessary in planning and in a choice of conditions of operative treatment.

Presence of characteristic Ouses-signs of good-quality formations and favorable results of the cytologic researches allowed to spend surgical treatment of patients in the conditions of a day surgical hospital.

At definition of Ouses-signs of tumours of the big sizes, with their diligence to osteal structures or to neurovascular fascicles - it is necessary to spend Mr - or Kt-researches for definition of tactics of treatment of soft tissues sick of tumours.

87 % of patients (n=376) have been treated in the conditions of a day surgical hospital. 10,5 % of patients (n=46) are referred on treatment to specialised clinics. In the oncologic centres for carrying out of radical operations and complex treatment, 2,5 % (n=11) patients are referred.

Thus, complex ultrasonic with application dopplerografii and elastografii, in aggregate with clinical and cytologic diagnostics, allows to specify topiku tumours of soft tissues, to define volume and possibility of operative treatment of patients in the conditions of a day surgical hospital.

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Scientific source VETSMADJAN Elena Anatolevna. ROLE of ULTRASONIC DIAGNOSTICS And ELASTOGRAFII In DEFINITION of TACTICS of SURGICAL TREATMENT of TUMOURS And OPUHOLEPODOBNYH FORMATIONS of SOFT TISSUES In OUT-PATIENT CONDITIONS. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2014. 2014

Other medical related information 5.4 Role of ultrasonic research in planning of treatment of patients with tumours and opuholepodobnymi formations of soft tissues in the conditions of a day surgical hospital:

  1. THE TABLE OF CONTENTS
  2. INTRODUCTION
  3. 5.4 Role of ultrasonic research in planning of treatment of patients with tumours and opuholepodobnymi formations of soft tissues in the conditions of a day surgical hospital
  4. THE CONCLUSION