ESPECIALIDAD EN CIRUGÍA GENERAL

Permanent URI for this collectionhttp://201.159.223.65:4000/handle/123456789/1044

Browse

Now showing 1 - 20 of 38

UTILIDAD DE LA ESCALA DE ALVARADO EN EL DIAGNÓSTICO TEMPRANO DE LA APENDICITIS AGUDA, EN EL SERVICIO DE URGENCIA DEL HOSPITAL ABEL GILBERT PONTÓN DESDE ENERO DEL 2016 A DICIEMBRE 2018
(2018-12-13) Cordero Jurado, Carlos Xavier; Miñan Arana, Fernando David
To determine the usefulness of the Alvarado Scale in the Early Diagnosis of Acute Appendicitis, in the emergency service of the Abel Gilbert Pontón Hospital from January 2016 to December 2018 Methods: An observational, prospective and analytical study was conducted in which a sample of 218 patients was selected who presented abdominal pain to the emergency department of the Guayaquil Abel Gilbert Pontón Hospital in the period between February 2016 and February 2018. Result: The sex with greater incidence was the masculine with 53%, the primitive age was between 21-30 years of age. The most frequent pathological type was the purulent fibrin with 73 case with alvarado values of 5-7, the Symptoms more freceunte was abdominal pain in the right iliac fossa and the study obtained a sensitivity of 74% and a specificity of 35%. Conclusion: The strength of the study is in identifying patients with acute appendicitis with a cut-off point> 4, but it does not have the capacity to completely rule out acute appendicitis in those who presented a cutoff point <4 points on the scale of Alvarado.
UTILIDAD DE LA ESCALA DE ALVARADO EN EL DIAGNÓSTICO TEMPRANO DE LA APENDICITIS AGUDA, EN EL SERVICIO DE URGENCIA DEL HOSPITAL ABEL GILBERT PONTÓN DESDE ENERO DEL 2016 A DICIEMBRE 2018
(2018-12-13) Cordero Jurado, Carlos Xavier; Miñan Arana, Fernando David
To determine the usefulness of the Alvarado Scale in the Early Diagnosis of Acute Appendicitis, in the emergency service of the Abel Gilbert Pontón Hospital from January 2016 to December 2018 Methods: An observational, prospective and analytical study was conducted in which a sample of 218 patients was selected who presented abdominal pain to the emergency department of the Guayaquil Abel Gilbert Pontón Hospital in the period between February 2016 and February 2018. Result: The sex with greater incidence was the masculine with 53%, the primitive age was between 21-30 years of age. The most frequent pathological type was the purulent fibrin with 73 case with alvarado values of 5-7, the Symptoms more freceunte was abdominal pain in the right iliac fossa and the study obtained a sensitivity of 74% and a specificity of 35%. Conclusion: The strength of the study is in identifying patients with acute appendicitis with a cut-off point> 4, but it does not have the capacity to completely rule out acute appendicitis in those who presented a cutoff point <4 points on the scale of Alvarado.
“EVALUACIÓN DEL TRATAMIENTO QUIRÚRGICO DEL ADENOCARCINOMA EN LA UNIÓN GASTROESOFÁGICA EN SOLCA DESDE 1 ENERO 2011 – 30 ABRIL 2018”.
(2018-12-13) Ulloa Ochoa, Pablo Paúl; Palomeque Bueno, John Paúl; Panchana Eguez, Guido
Worldwide gastric cancer has a high incidence and morbidity and mortality, in Ecuador it is the third cause of cancer death and its therapeutic approach conceives different spheres, both because of its location and its prognosis and this goes hand in hand with the possibility of be surgically resectable. The objective was to determine the surgical technique before an adenocarcinoma of the gastroesophageal junction according to the stage that provides the greatest survival. A cross-sectional, non-experimental design correlation study was conducted at the National Oncology Institute - SOLCA * "Guayaquil", from January 2011 to April 2018. All patients who underwent surgery with a diagnosis of malignant stomach tumor were included. (Adenocarcinoma) of the gastroesophageal junction with curative intent. Variables such as age, gender, oncological stage, neoadjuvant treatment, surgical, adjuvant, location, differentiation and tumor infiltration, postoperative complications and current patient situation were taken into consideration. With a population, comprised of 17 patients. The results obtained showed that, the most frequent location was Siewert Type III in eleven patients (64.7%), the majority of patients attended was stage IIII, total gastrectomy was the most used technique with 10 patients (67.9%), the reconstruction was in Roux-en-Y 70.59%, the complications were not related to the surgery, 4 patients (23.5%) had a survival of 27 months being the highest in the present study. It is concluded that total gastrectomy is the technique of choice for cancer of the gastroesophageal junction Siewert III and stages I, II and III, since after it was shown greater survival and a lower morbidity and mortality surpassing superior or polar partial gastrectomy, however, we can indicate that the forecast will be not only of the technique, but will be accompanied by the initial stage
COLECISTECTOMÍA TARDÍA POSTERIOR A PANCREATITIS AGUDA BILIAR LEVE MEDIANTE CRITERIOS ATLANTA 2012 EN EL HOSPITAL LUIS VERNAZA. PERIODO ENERO 2016 - ENERO 2018.
(2018-12-13) Morales Marín, Francisco Xavier; Rivas Bermeo, Paola Alexandra; Barciona Simón, Carla Elizabeth
The objective of this study was to determine the results of late cholecystectomy after mild biliary acute pancreatitis using Atlanta 2012 criteria Method: This is an epidemiological, observational, descriptive, cross-sectional, retrospective study of late cholecystectomy after acute biliary pancreatitis using criteria Atlanta 2012, in the General Surgery Service of the Luis Vernaza Hospital in the city of Guayaquil, from January 2016 to January 2018. Results: A total of 70 patients with mild acute biliary pancreatitis were treated during the study period. All the patients were operated on by laparoscopic technique after 48 hours of clinical evolution. The average age of the study was 45 years and the female sex predominated with 80%. The most prevalent intraoperative complications were conversion in 10% of the patients, caused by anatomy not accurate in 8.6% of cases and scleroatrophic vesicle in 1.4% of cases. The second complication in 2.86% was due to hemorrhage. The surgical time that prevailed was between 30-60 minutes and was not related to more hospital stay, unlike those patients where the surgical time exceeded 120 minutes, where everyone exceeded more than 10 days of hospitalization. The most frequent postoperative complications were infection on the surgical site with 15,71% of the cases, pneumonia en 4,29% and biliary fistula 2,86%, all of which were associated with longer hospital stay. Mortality was 0% independent of the association with some comorbidity. Conclusions: Late cholecystectomy in mild acute biliary pancreatitis can cause intraoperative or postoperative complications, but it remains safe with no mortality even with the association of comorbidities, however it is associated with longer hospital stay
“LESIONES DE LA VÍA BILIAR EN COLECISTECTOMÍA LAPAROSCÓPICA. HOSPITAL LUIS VERNAZA. FEBRERO 2016–JULIO 2018”
(2019-01-13) Layedra Torres, Andrés; Ortíz Zambrano, Luis; Zuñiga Bohórquez, José
Lesions of the bile duct is the most frequent and worrisome complication of laparoscopic surgery, with clinical, labor, judicial, economic and social repercussions that are very important for the individual.Objectives: the main objective is to determine the lesions of the bile duct that are produced during laparoscopic cholecystectomy at the Luis Vernaza Hospital in the city of Guayaquil in the period from February 2016 to July 2018. Materials and Methods: A retrospective, descriptive and transversal study was carried out. Design of non-experimental research. The universe was constituted by patients in whose surgery protocol evidence of biliary tract complication was found in the Luis Vernaza Hospital in the indicated period. It was not sampled since the entire study population was used. Subsequently, we worked with patients who presented biliary tract complications. Data were taken from the patients' medical records, the data collection sheet was filled out and then the results were tabulated. Results: the most frequent gender is the female 65.7%; the vulnerable age was from 31 to 50 years of age with 33.57%; the degree of biliary tract complication is 4.86%, the most frequent complication was type I (Strasberg classification) in 58%, the hospital stay of the patients in the study was 1 to 15 days with 73.53% , mortality was 14.7%, the conversion rate to traditional surgery was 58.82%.Conclusions: The most frequent gender is feminine; the vulnerable age was 31 to 50 years of age; The complication of the bile duct in laparoscopic cholecystectomy is high, the most frequent complication was type I (Biliary leak in small duct in continuity with the common hepatic, in cystic duct or Luschka canal); the hospital stay of the study patients was from 1 to 15 days; the mortality is considerable; the conversion rate to traditional surgery is high.
COLOSTOMÍA TREPHINE VS COLOSTOMÍA CONVENCIONAL EN PACIENTES CON OBSTRUCCIÓN INTESTINAL DE ETIOLOGÍA TUMORAL EN EL SERVICIO DE CIRUGÍA DEL ION SOLCA GUAYAQUIL, ENERO DEL 2015 – DICIEMBRE DEL 2017
(2018-12-13) Pazmiño Palacios, Juan Bermeo; Idrovo Murillo, Luis Andrés; Miñan Arana, Fernando David
"TREPHINE COLOSTOMY VS CONVENTIONAL COLOSTOMY IN PATIENTS WITH INTESTINAL OBSTRUCTION OF TUMOR ETIOLOGY IN THE SURGERY SERVICE OF THE ION SOLCA GUAYAQUIL, JANUARY 2015 - DECEMBER 2017".
COMPLICACIONES DE LA CIRUGÍA COLORRECTAL EN EL SERVICIO DE CIRUGÍA GENERAL DEL HOSPITAL GENERAL LUIS VERNAZA PERÍODO FEBRERO 2015 – DICIEMBRE 2017.
(2018-12-13) Bermeo Ortega, Juan Carlos; Chusán Cordovilla, Mayling Bethzabé; Barciona Simón, Carla
Every year in the USA 250,000 colorectal resections are developed and 24% to 35% will present postoperative complications; with an incidence of readmission from 7% to 27% during the first 30 days, persisting a considerable percentage of morbidity and mortality. The objective of this work is to identify the complications in the Colorectal Surgery by describing presurgical risk factors, to determine the complications in elective or emergent surgery, and their management. Methodology: Observational, descriptive, cross-sectional, retrospective study. The population was made up of patients from the General Surgery area of HLV who underwent emergency or elective colorectal surgical procedures between February 2015 and December 2017. Dependent variables of the patient were evaluated as sex, age, comorbidities, and factors dependent on surgery as a type of surgery, the different complications and their management. Results: Patients undergoing colorectal surgeries, 22% presented complications; with surgical site infection being the most frequent 54%, followed by abscesses or intra-abdominal collections 14%, the most common management of surgical site infection was with cures 52% followed by antibiotic therapy 2%, arterial hypertension was the most common pre-surgical risk factor 74%, the surgery performed more frequently and with more complications was appendectomy by laparotomy 53%. Conclusions: The colorectal procedures lead to different complications but their appearance rate is not high, most were present in the emergent surgeries, the management is very wide depending on the experience of each surgeon.
CITOLOGÍA POR PUNCIÓN ASPIRACIÓN CON AGUJA FINA TIROIDEA Y SU CORRELACIÓN DIAGNÓSTICA CON EL RESULTADO HISTOPATOLÓGICO DEFINITIVO EN LOS PACIENTES SOMETIDOS A TIROIDECTOMÍA UNIDAD DE CIRUGÍA GENERAL HOSPITAL DR. TEODORO MALDONADO CARBO - GUAYAQUIL, 2015 - 2016
(2016-12-15) Wellington Oswaldo, Wellington Oswaldo; Huamán Arboleda, Luis Alfredo; Zambrano Medina, Luís Alberto
Background: Thyroid conditions are common in Ecuador, and goiter was an endemic disease in the last century. Diagnosis has been improved with diagnostic techniques, but identification of malignant thyroid nodules remains a challenge for pathologists, endocrinologists, and surgeons. Objective: To establish the diagnostic relationship between fine needle aspiration cytology and the definitive histopathological outcome of patients undergoing thyroidectomy at Teodoro Maldonado Carbo Hospital. Methods: A descriptive, retrospective study of 101 patients with nodular thyroid disease who underwent surgery, who underwent a cytological study by PAAF and 15 BIO were performed. Results: 85% were female and 14.85% male. The PAAF report was negative for malignancy in 65 patients (64.35%) and positive 36 (35.64%); False negatives 25 (24.76%) The effectiveness indicators identified were: sensitivity (30.60%), specificity (100%), accuracy (72.20%), VVP and NPV (100.00 and 72.20 %, respectively). In patients undergoing BIO the sensitivity 77,80%, specificity 83.8%, PPV 94.9% accuracy 80.0%. It is concluded that thyroid PAAF is a low sensitivity and high specificity method for the diagnosis of thyroid cancer and BIO has a higher sensitivity than PAFF.
DOSIFICACIÓN DE PARATOHORMONA Y CALCIO POSTOPERATORIO, TEMPRANO Y TARDÍO, EN PACIENTES SOMETIDOS A TIROIDECTOMÍA RADICAL, EN SOLCA GUAYAQUIL DESDE NOVIEMBRE 2014 HASTA NOVIEMBRE 2016.
(2017-01) Roman Proaño, Gustavo A; Ullauri Torres, Luis A; Leone Pignataro, Mario
Papillary thyroid cancer requires surgery to achieve efficient, effective and effective treatment. It is conditioned by tumor conditions such as size or capsular infiltration. Electrical injury, involuntary or necessary extirpation of the parathyroid glands can reveal specific paresthesias, cramps or semiologic signs, including cardiac problems that arise as a result of hypoparathyroidism that will result in hypocalcemia. JUSTIFICATION Thyroid cancer is a common pathology in our setting. Our aim is to define early the patient, to present alterations of calcium metabolism, through the study of calcium and paratohormone in blood whose serial post-surgical levels will give a prognostic result of the calcium metabolism of the patient. Determining patients with indefinite consumers of exogenous calcium, and those able to dispense with exogenous calcium and could perform their life without complications incorporating the necessary calcium from the general diet. OBJECTIVES Avoid hypocalcemias and rationalize the dose of calcium in patients undergoing radical thyroidectomy. Identify early postoperative hypoparathyroidism. To establish postoperative parathormone levels as an indicator to classify patients as transient or definitive hypocalcaemic patients. To establish that levels of paratohormone, calcium and ionic calcium, within the normal range at 60 days of the intervention are candidates to not receive support of indefinite calcium.Descriptive, observational, prospective study. The study area will include all patients within the department of skin, thyroid, soft tissue and sarcomas of the hospital SOLCA - Guayaquil; Undergoing radical thyroidectomy between November 2014 and November 2016. A nonprobabilistic sampling will be used for convenience. RESULTS Tumor size and tumor infiltration of the thyroid capsule are associated with hypoparathyroidism and with this indefinite hypocalcemia. Paratohormone values at 60 days postoperatively can be used as a reliable indicator to remove exogenous calcium mediation. CONCLUSIONS AND RECOMMENDATIONS Hypoparathyroidism and hypocalcemia complications of radical thyroidectomy, a serial study of calcium levels and paratohormone in the immediate and late postoperative period, allows knowing the calcium metabolism and establishing who will require exogenous mediation of calcium indefinitely and who does not. Follow-up is recommended 6 months after surgery and the institution provides the reagent to perform paratohormone examination as a routine in the control of thyroidectomized patients.
USO DEL SISTEMA DE PRESIÓN NEGATIVA EN EL MANEJO DE LOS PACIENTES CON FÍSTULAS ENTEROCUTÁNEAS POSTOPERATORIAS EN EL HOSPITAL TEODORO MALDONADO CARBO DE LA CIUDAD DE GUAYAQUIL EN PERIODO MARZO 2014 - MARZO 2016
(2016) Correa Bravo, Roberto Manuel; Ferrín Viteri, Mario Eduardo; Zambrano Manzur, Steven
Objective: To determine the benefits of using the negative pressure wound therapy for the management of wounds with enterocutaneuos fistulas. Materials and methods: Approval of the Teaching and Research Coordination of Teodoro Maldonado Carbo Specialties Hospital to study patients diagnosed with enterocutaneous fistula of the city of Guayaquil during the period from March 2014 to March 2016. We analyzed 80 cases (46 men, 34 women, mean age 54.26 years). Three different negative pressure wound therapy, Barker type, VAC and VACCUM PACK were used according to availability of hospital supplies. The evolution of the patients was monitored and a database was made. Results: There was a statistically significant difference (p = 0.0000) between the group of patients who did not use the negative pressure wound therapy and the group that used it, since it allows the days of hospitalization to decrease markedly compared to Non-use of system. The 80.85% (38/47) patients with negative pressure wound therapy have a hospitalization time of less than 30 days, 19.14% (9/47) more than 30 days; with a minimum of 15 days and a maximum of 33 days, and an average of 24.04 days. Conclusion: Negative pressure wound therapy is a highly effective and safe therapeutic method in patients with enterocutaneous fistulas. The healing of the wounds presents a rapid evolution, decreasing the hospital stay and producing a high percentage of success in premature closure and the prevention of the proliferation of bacteria.
EVALUACIÓN DE LOS RESULTADOS DE LAS REPARACIONES LAPAROSCÓPICAS DE LAS HERNIAS INGUINALES VERSUS TÉCNICA CONVENCIONAL SIN TENSIÓN DE LICHTENSTEIN. HOSPITAL TEODORO MALDONADO CARBO 2014-2016
(2017-01) Toala Mosquera, Oliver Joel; Plua Marcillo, William
Description of the problem: The Lichtenstein technique, being the goldstand technique in inguinal hernioplasties, still presents complications such as postoperative inguinodynia, this may be incapacitating in some cases, laparoscopic repairs of inguinal hernias offer advantages such as: minor pain, rapid labor reintegration and lower incidence of postoperative inguinodynia. Rationale: In our hospital, few laparoscopic hernioplasties are performed, due to the preconceived idea, that laparoscopic surgery with general anesthesia is not justified, and it can be performed with conductive anesthesia using conventional technique, obtaining the same results. This thesis evaluates the results of laparoscopic inguinal hernioplasties. Objectives: To evaluate the results of laparoscopic inguinal hernioplasties versus lichtenstein repairs. Methodology: Non-intervention, descriptive, observational study with prospective follow-up was carried out at Hospital Teodoro Maldonado Carbo between 2014-2016, with a non-probabilistic sample for convenience, 50 patients with Lichtenstein hernioplasty and 46 with TAPP. Results: Relative risk of 0.28 to 1 (TAAP/Lichtenstein) correlating the presence of complications in the first week of surgery, the 95% confidence interval is 0.55 to 1.42 with a p-value of 0.11 obtained using chi-square and the relative risk was 0.32 to 1 (TAAP/Lichtenstein), with a 95% confidence interval of 0.80 to 1.26 with p value 0.08 obtained. Conclusions: The hypothesis test indicates that there are no statistically significant differences between the two surgical procedures and the presence of complications during the first week and first month of surgery
COMPLICACIONES EN LAS TIROIDECTOMÍAS EN EL SERVICIO DE CIRUGÍA GENERAL DEL HOSPITAL TEODORO MALDONADO CARBO EN EL PERIODO ENERO – DICIEMBRE 2015.
(2017-01) Vélez Rodríguez, Miguel Angel; Vivas Lara, Alex
Background: Thyroidectomy is the total or partial surgical removal of the thyroid gland. It is indicated in certain diseases of the thyroid, and can present several postoperative complications, being certain factors of risk associated to the presence of these. Objective: To identify the main complications related to thyroidectomies, in order to demonstrate association with certain predisposing risk factors. Methodology: a uni - centric, observational, cross - sectional, case - control study of patients in the General Surgery service of Teodoro Maldonado Carbo Hospital during the period 2014-2015. Results: A total of 105 cases were studied, Whose average age was 48 ± 15 years, 93 (88.6%) female. In the study population, there is an incidence of 28.6% of complications related to thyroid surgery, of which we have: recurrent laryngeal nerve section (19; 63.3%), calcium and / Or hypocalcemic crises (14, 46.7%), post-surgical hematomas (4; 13.3%), postsurgical infections (2; 6.7%) and haemorrhages (1, 3.3%). The highest Odds Ratio was diabetes mellitus, with the development of a laryngotracheal section (OR 3.95, 95% CI 1.20-12.96) and calcium alteration (OR 4.50, CI 95% 1.26-16.11), followed by multinodular thyroid, for the presence of hematomas (OR 19,20; 95% CI 2.22 - 165.88). Conclusion: Diabetes mellitus and the presence of multinodular thyroid are a risk factor associated with the presence of complications following thyroid surgery, in the context of the development of hematomas and hemorrhages.
RELACIÓN ENTRE LA ECOGRAFÍA Y ANATOMOPATOLOGÌA EN LA APENDICITIS AGUDA EN EL HOSPITAL LUIS VERNAZA 2014- 2016
(2016) Morocho España, Paola; Correa Vega, Hernan
Introduction: Acute appendicitis is a very common pathology in emergency services worldwide, which requires quick and accurate decision making to avoid complications. Abdominal ultrasound has become a very useful tool in the management of patients with abdominal pain. Ultrasound can establish the diagnosis of acute appendicitis, but above all, show complications and eliminate differential diagnoses. Objectives: To establish the correlation of ultrasound and pathology in the diagnosis of acute appendicitis. Histopathologically, the cases of acute appendicitis are present. To determine the value of ultrasound as the method of acute appendicitis. Correlate the ultrasound findings with the histopathological diagnosis in acute appendicitis. Methods and materials: The present study was a retrospective, nonexperimental descriptive study performed in the patients of the Hospital de Lucha with the diagnosis of acute appendicitis in the emergency department. Data tabulation and analysis are performed using the statistical program Microsoft Office Excel 2010 program. Results: Ultrasound showed a sensitivity of 68.8%, specificity of 40%, predictive value of 91.1%, negative predictive value of 12.5%, false positives Of 6%, false negatives of 28%, a value p: 0.5, and a chi-square value of 0.32. : Of the 100 patients that participated in the study, 43 (43%) presented Fibrinopurulent phase, 26 (26%) Necrotica, 15 (15%) Catarral and 6 (6%) Perforated and 10 (10%) without alterations. Conclusions: Ultrasonography is a rapid and inexpensive method in the diagnosis of acute appendicitis presents a high sensitivity but low specificity and should be interpreted with great caution in patients with classic symptomatology
CORRELACIÓN ENTRE LA BIOPSIA ASPIRACIÓN CON AGUJA FINA Y LA BIOPSIA POR CONGELACIÓN INTRAOPERATORIA EN EL DIAGNÓSTICO Y MANEJO QUIRÚRGICO DEL NÓDULO TIROIDEO EN EL SERVICIO DE CIRUGÍA DEL INSTITUTO ONCOLÓGICO NACIONAL “SOCIEDAD DE LUCHA CONTRA EL CÁNCER” (ION – SOLCA) GUAYAQUIL, DURANTE EL PERIODO 01 DE MAYO DEL 2014 AL 31 DE MAYO DEL 2016
(2017-01) Morejón Naranjo, Luis Javier; Solórzano Morales, Hollwuin
Background: Despite advances in the diagnostic tools used, identification of malignant thyroid nodules remains a challenge for pathologists, endocrinologists, and surgeons. There is controversy over the use of fine needle biopsy (FNB) and freezing biopsy (FB) to be elucidated by this study. Aim: To determine the diagnostic correlation between FNAB and BCIO; the sensitivity and specificity of both, leading to a more rational use of these diagnostic tests, optimizing resources and reducing costs. Methods: A prospective study involving 128 patients who underwent surgery for thyroid nodules, who underwent FNB and FB, from May 2014 to May 2016. In the FNB, the malignant pattern was Bethesda 6. The sections of FNB, FB and paraffin blocks, the gold standard being the paraffin block. Results: Of 128 patients, 117 (91.4%) women and 11 (8.6%) men, with mean age of 47 years; 77 (60.2%) had benign lesions and 51 (38.8%) had malignant lesions, 38.5% (45/117) of women had cancer and 54.5% (6/11) men, with papillary carcinoma predominating in 88.2 %. The FNB and FB reported a separate sensitivity of 54.90%, 93.48%, specificity 98.70%, 98.59%, and diagnostic concordance 81.25%, 96.58% respectively; Bethesda 5 being 50% (5/10) malignant. The FNB and FB together reported a sensitivity of 93.75%, specificity 95.83%, and diagnostic concordance 90%. The surgical reintervention if only BCIO would be performed would be 6.3% (8/128), and when the two diagnostic procedures were applied, it was reduced to 4.7% (6/128), with an unnecessary radical thyroidectomy increase of 0, 8% to 1.6% respectively. Conclusions: FNB is a reliable method with high specificity to diagnose malignancy in thyroid pathology; with results indicating Bethesda 3, 4, 5 and even 2 BCIO is very useful and can reduce surgical reoperations and unnecessary radical thyroidectomies.
CARACTERÍSTICAS EPIDEMIOLÓGICAS DE LA HIPERTENSIÓN INTRAABDOMINAL Y EL SÍNDROME COMPARTIMENTAL EN PACIENTES POST-QUIRÚRGICOS CRÍTICOS POR ABDOMEN AGUDO
(2017-01) Alvarado Mattos, José Luis; Solorzano Loor, Wilson Ramon
En los pacientes postquirúrgicos críticos por abdomen agudo la hipertensión Intra-abdominal (HIA) y el síndrome Compartamental abdominal (SCA), se presentan como causa importante de morbi-mortalidad, el problema en la actualidad radica en la determinación a tiempo de los cambios de presión Intra-abdominal, factores de riesgo, y complicaciones que podrían llevar a la muerte de los pacientes. Objetivo: Determinar la prevalencia, complicaciones y mortalidad de los pacientes postquirúrgicos críticos por abdomen agudo ingresados en las áreas de UCI y P.O. Metodología: El presente trabajo de investigación es un estudio de tipo descriptivo, observacional, desarrollado en la unidad de cuidados intensivos y post-operatorio de pacientes postquirúrgicos críticos por abdomen agudo en el hospital “Luis Vernaza". Resultados: Durante el año 2016 desde febrero hasta octubre, se registraron 414 pacientes intervenidos por Abdomen Agudo, de aquellos pacientes se seleccionaron por criterios de inclusión y exclusión 43 (postquirúrgicos críticos), en las unidades de Cuidados Intensivos y Post-operatorio, del grupo seleccionado 34 pacientes desarrollaron presiones Intra-abdominales por encima de 12 mmHg, lo que determina una prevalencia del 8,21%, la mortalidad hospitalaria fue de 1,45 %, el 37,21% de la población fueron mujeres y el 62.79 %, la media se ubicó en 59 años de edad, la estancia en UCI y P.O, presento una media de 8,02 días, se realizó Laparotomía exploratoria en el 93,02% de los pacientes. En lo referente al hallazgo quirúrgico, se observó que un 41,86%, presentaron abdomen agudo perforatívo y un 30,23%, presento abdomen agudo obstructivo, los factores de riesgo, que se presentaron fueron; ventilación mecánica en el 100% de los pacientes, la acidosis metabólica en el 55,81%, Sepsis grave con un 51.16%; el 79,07% presentaron PIA>12 mmHg, y el 20,93% PIA<12 mmHg, los grados de PIA que mayormente XI se presentaron fue del 51,16% (grado I) y del 18,60% (grado II), el 11,63%, de los pacientes presento PPA por debajo de los 60 mmHg, el 4,65% de los pacientes de este estudio desarrollo SCA. Las complicaciones más comunes fueron el shock hipovolémico (no hemorrágico), insuficiencia renal aguda, shock Séptico e isquemia intestinal, aquellos pacientes con grado II y III de HIA mas una PPA<60 presentan mayor riesgo de mortalidad. Conclusiones: La prevalencia de la hipertensión Intra-abdominal y del síndrome Compartamental abdominal se mantuvo en el 8,21, la ventilación mecánica, acidosis metabólica y sepsis grave se presentan como factor de riesgo, las complicaciones fueron: shock hipovolémico (no hemorrágico), insuficiencia renal aguda, shock séptico e isquemia intestinal, los grados de PIA que se relacionaron con mayor mortalidad y complicaciones fueron los grados II y III. La tasa de mortalidad especifica fue del 14,5 %, la PIA aumentada se relaciona con mayor estancia hospitalari
EVOLUCIÓN POSTQUIRÚRGICA DEL PACIENTE GERIÁTRICO CON DIAGNÓSTICO DE ABDOMEN AGUDO NO TRAUMÁTICO INTERVENIDO POR EMERGENCIA DEL HOSPITAL TEODORO MALDONADO CARBO. PERIODO 2014 - 2015
(2017-01) Hinojosa Guerrero, Jennifer; Montesinos Sánchez, María José; Zambrano Manzur, Steven
Introduction: abdominal acute in geriatric patients is difficult to treat, since the absence of signs and symptoms typical of aging and existing previous diseases increases the number of complications and their mortality. In the HTMC, a study has not been conducted tending to know the postoperative evolution of the non-traumatic acute abdomen in geriatric patients, and by simple observation complications and mortality are above the international average. Objective: To evaluate the postoperative evolution in geriatric patients with acute non-traumatic abdomen diagnosed with HTMC emergency. Period 2014 - 2015. Materials and method: Information was obtained from 278 patients through clinical expedient of the statistical department prior to the completion of a data collection sheet. Results: 30.2% had 3 risk factors, with DM being the most frequent with 57.9%, 52,9% had a clinical expedient lasting > 96 hours and 75.5% had complications. The acute obstructive abdomen is the most frequent with 49.6%, with incarcerated hernia being the most prevalent diagnosis. Conclusion: The risk factor most associated with mortality is DM2. Having 3 or more risk factors is associated with longer hospital stay and higher mortality. The most frequent type of acute abdomen with a higher mortality rate is the obstructive one. The most frequent diagnosis is incarcerated hernias and the most common complication associated with mortality is intra-abdominal sepsis.
COMPLICACIONES DE TRAQUEOSTOMIA PERCUTANEA COMPARADA CON TRAQUEOSTOMIA EN QUIROFANO EN EL PERIODO 2014-2015 EN EL HOSPITAL TEODORO MALDONADO CARBO
(2017-01) Estevez Muñoz, Carlos Alberto; Zambrano Manzur, Franklin Steven
El manejo de vía aérea es crucial para la salud de los pacientes sobretodo en unidades de cuidados críticos y áreas de emergencia, con el fin de precautelar la permeabilidad de la vía aérea desde hace siglos se ha implementado la traqueostomía, este procedimiento quirúrgico consiste en el abordaje de la pared anterior de la tráquea donde posterior a realizar una incisión se coloca una cánula que permita el adecuado flujo de aire hacia la porción distal de la tráquea. Las tendencias recientes hacia las intervenciones mínimamente invasivas conllevó al desarrollo de la técnica percutánea para traqueostomía, si bien ambos procedimientos pueden ser considerados como intervenciones de mediano nivel de complejidad, estos no están exentos de complicaciones. Objetivo: como objetivo principal se busca establecer cual técnica entre traqueostomía percutánea y traqueostomía abierta produce menor desarrollo de complicaciones tanto inmediatas como tardías. Metodología: Estudio observacional, de no intervención directa por parte de los investigadores, descriptivo, retrospectivo. Resultados: para establecer la relación entre el tipo de procedimiento utilizado para realizar traqueostomía y el desarrollo de complicaciones se utilizó riesgo relativo reportando para las complicaciones inmediatas riesgo relativo de 0.92 (IC 95%: 0.364 a 2.324) valor p: 0.860, para las complicaciones tardías el riesgo relativo es 0.533 (IC95%: 0.181 a 1.572) valor p: 0.249 Conclusión: No existe diferencia estadísticamente significativa para asociar la presencia de complicaciones sean inmediatas o tardías con el tipo de traqueostomía a realizar entre procedimiento percutáneo y procedimiento quirúrgico abierto.
MANEJO QUIRÚRGICO DEL CÁNCER GÁSTRICO, EN PACIENTES DEL HOSPITAL ION SOLCA – GUAYAQUIL. 2014-2015.
(2017-01) Baldeón Alcívar, Andrés Armando; Reyes Cáceres, José Luis; Villacis Muñoz, Margarita
Gastric cancer is a pathology that worldwide is the second cause in men and the fifth in women in developing countries. At the country level, the incidence of gastric cancer is in line with international data, and the mortality rate for both men and women in our country is among the highest. OBJECTIVE: To evaluate the surgical management of patients diagnosed with gastric cancer at the ION Solca Guayaquil Hospital during the period from January 2014 to December 2015. METHODOLOGY: It was carried out with a quantitative approach, a cross - sectional analytical study was carried out, in a non - experimental field, with retrospective data. With a non-probabilistic sample for convenience, comprised of 129 participants. RESULTS: A subtotal gastrectomy was performed in 52% of the patients, with the Braun type intestinal shunt being the most used in 62% of the cases. CONCLUSIONS: The most frequent postoperative complication is operative site infection in 25 patients, 61% of the cases being treated were already diagnosed at an advanced stage of the disease, and the most frequent type of gastric cancer is The intestinal type adenocarcinoma with 52% of frequency.
HISTERECTOMÍA LAPAROSCÓPICA EN EL HOSPITAL ION SOLCA – GUAYAQUIL, 2010 – 2016.
(2017-01) Albán Rivas., Andrés; Péndola Gómez., Luis
INTRODUCCIÓN: La descripción de nuevos métodos de laparoscopía como alternativa a la cirugía ginecológica convencional ha propiciado un aumento de los procedimientos realizados por esta vía en los últimos años, no es la excepción en el hospital ION – Solca de Guayaquil – Ecuador con la experiencia en la realización de histerectomía laparoscópica. OBJETIVOS: Evaluar los resultados de la histerectomía por vía laparoscópica en el hospital ION Solca – Guayaquil, describir las características generales de los actos quirúrgicos realizados y determinar la frecuencia de complicaciones derivadas de la realización de histerectomía laparoscópica. METODOLOGÍA: El presente es un estudio descriptivo retrospectivo que incluyó a todas las pacientes sometidas a histerectomía laparoscópica entre los años 2010 y 2016, se estudiaron las variables referentes a sus características biológicas, antecedentes personales y patológicos, diagnóstico, características del procedimiento, complicaciones y resultados obtenidos. RESULTADOS: Se estudiaron 174 pacientes, la edad media fue de 53±12 años. Las indicaciones más frecuentes para la cirugía fueron: carcinoma escamocelular de cérvix (35.63%), carcinoma epidermoide de cérvix (31.03%) y miomatosis uterina (10.92%). El tiempo quirúrgico fue en promedio de 165.44±56.32 minutos. La estadía hospitalaria promedio fue de 2.97±0.72 días. La tasa de conversión alcanzó el 1.72% y no se reportaron complicaciones posquirúrgicas.
COMPLICACIONES TARDÍAS DE LAS PACIENTES SOMETIDAS A CIRUGÍA CONSERVADORA DE MAMA, ION SOLCA GUAYAQUIL 2014-2016”
(2017-01) Vargas Sänchez, Rómulo D; Garcia Orellana, Cristian G; Malatay Andrade, Carlos
Fundamento: El cáncer de mama es un problema de salud a escala internacional el cual ha aumentado en los últimos años las tasas de morbilidad y mortalidad, se plantea que cada quince minutos fallece una mujer por esta causa. Objetivo: Describir las complicaciones tardías de las pacientes sometidas a cirugía conservadora de mama en ION SOLCA Guayaquil en el periodo 2014-2016. Método: Se realiza un análisis de periodo libre de enfermedad y supervivencia, basado en un estudio descriptivo, para determinar la recidiva y complicaciones frecuentes en pacientes con Cáncer de Mama, sometidas a cirugía conservadora en el Hospital Oncológico Dr. Juan Tanca Marengo SOLCA – Guayaquil en el período 2014 - 2016. El análisis se lo realiza en función de la recidiva y complicaciones derivadas del procedimiento quirúrgico. La muestra fue de 50 mujeres que se realizaron cirugía conservadora de mama durante los años 2014 a 2016. Resultados: El grupo de pacientes mayormente afectado fue el comprendido entre los 40 y 49 años con 21 pacientes. El tipo histológico más frecuente fue el carcinoma ductal infiltrante encontrándose en un 76% de las pacientes al momento del diagnóstico. El estadio clínico usual fue el IIA con un total de 24 individuos. La recurrencia general fue de 4%, para el estadio clínico I y IIA. Conclusiones: La cirugía conservadora es una opción quirúrgica la cual ofrece los mismos beneficios de la mastectomía en lo que respecta a control de la enfermedad, presenta una recurrencia aceptable y comparable a series mundiales.

Browse

Recent Submissions