{"id":16813,"date":"2024-05-10T06:48:38","date_gmt":"2024-05-10T06:48:38","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=16813"},"modified":"2024-05-16T12:13:19","modified_gmt":"2024-05-16T12:13:19","slug":"llr-policy-for-the-use-of-surgical-biological-mesh","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/pl\/llr-policy-for-the-use-of-surgical-biological-mesh\/","title":{"rendered":"Polityka LLR dotycz\u0105ca stosowania siatek chirurgicznych"},"content":{"rendered":"

Kategoria<\/strong><\/p>\n\n\n\n

Kryteria progowe<\/p>\n\n\n\n

Bezkom\u00f3rkowe matryce sk\u00f3rne to uznany wyr\u00f3b medyczny stosowany w Wielkiej Brytanii w r\u00f3\u017cnych interwencjach chirurgicznych, zapewniaj\u0105cy lepsze wyniki dla pacjent\u00f3w. Istnieje znaczna ilo\u015b\u0107 dowod\u00f3w na to, \u017ce siatki biologiczne mog\u0105 znacz\u0105co poprawi\u0107 wyniki estetyczne i rozszerzy\u0107 wskazania do rekonstrukcji piersi, a tak\u017ce skutkowa\u0107 wi\u0119kszym, zmniejszonym skurczem torebki i wi\u0119kszym zadowoleniem pacjentki po operacji.<\/p>\n\n\n\n

Uprawnienia<\/strong><\/p>\n\n\n\n

LLR ICB zostanie sfinansowany tylko wtedy, gdy spe\u0142nione zostan\u0105 nast\u0119puj\u0105ce kryteria CHIRURGII REKONSTRUKCJI PIERSI<\/strong>
\u00a0<\/strong>
\u2013 Pacjenci z rakiem piersi, rakiem przewodowym in situ oraz u kt\u00f3rych zidentyfikowano geny wysokiego ryzyka, np. BRCA 1\/2, TP53, PTEN
I<\/strong>
\u2013 Pacjent ma odpowiedni\u0105 otoczk\u0119 sk\u00f3ry, aby zmniejszy\u0107 ryzyko martwicy sk\u00f3ry
\u00a0
Regularny audyt pacjentek poddawanych rekonstrukcji piersi z u\u017cyciem siatki biologicznej, zgodnie z zaleceniami wsp\u00f3lnych wytycznych ABS i BAPRAS. Bezwzgl\u0119dnym wymogiem jest utrata implantu <10%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
LLR ICB NIE b\u0119dzie finansowa\u0107 stosowania siatki biologicznej u nast\u0119puj\u0105cych pacjent\u00f3w<\/strong>
\u00a0<\/strong>
\u2013 Pacjenci, kt\u00f3rzy byli wcze\u015bniej poddani radioterapii klatki piersiowej
\u2013 Pacjenci, kt\u00f3rzy obecnie pal\u0105<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
ICB zaleca ostro\u017cno\u015b\u0107 w nast\u0119puj\u0105cych sytuacjach<\/strong>
\u00a0<\/strong>
\u2013 Pacjenci z BMI > 30
\u2013 Rozmiar piersi wi\u0119kszy ni\u017c 600mg (zwi\u0119kszone ryzyko infekcji)
\u2013 Pacjenci ze \u017ale kontrolowan\u0105 cukrzyc\u0105<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
LLR ICB zostanie sfinansowany tylko wtedy, gdy spe\u0142nione zostan\u0105 nast\u0119puj\u0105ce kryteria NAPRAWY PRZEPUKLIKI PARA prze\u0142yku<\/strong>
\u00a0<\/strong>
Pacjent ma du\u017ce szczeliny w przeponie, kt\u00f3re nie nadaj\u0105 si\u0119 do prostej naprawy chirurgicznej<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Siatka biologiczna NIE jest zlecana<\/strong>
- Operacja klatki piersiowej
\u2013 APER\/eLAPE
\u2013 Operacja przepukliny inna ni\u017c wymieniona powy\u017cej
\u2013 Wszelkie inne wskazania<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Przewodnictwo<\/strong><\/p>\n\n\n\n

\u00a0
\u2013 Ocena skuteczno\u015bci bezkom\u00f3rkowej macierzy sk\u00f3rnej w rekonstrukcji piersi w oparciu o protez\u0119
Plast Reconstr Surg . marzec 2018 r.;141(3):541-549. doi: 10.1097\/PRS.0000000000004109.
\u00a0
\u2013 Bezkom\u00f3rkowa matryca sk\u00f3rna byd\u0142a w natychmiastowej rekonstrukcji piersi: retrospektywne badanie obserwacyjne z udzia\u0142em SurgiMend
Plast Reconstr Surg . stycze\u0144 2018 r.;141(1):1e-10e. doi: 10.1097\/PRS.0000000000003982
\u00a0
\u2013 Bezkom\u00f3rkowe matryce sk\u00f3rne w rekonstrukcji piersi: dane z 5-letniego badania CARE dotycz\u0105ce wynik\u00f3w dla ponad 9500 pacjent\u00f3w
Plast Reconstr Surg Glob Otwarty. 14 kwietnia 2022 r.;10(4):e4258.
doi: 10.1097\/GOX.0000000000004258. eKolekcja 2022 kwiecie\u0144
\u00a0
\u2013 Nowatorska tr\u00f3jwymiarowa bezkom\u00f3rkowa matryca sk\u00f3rna do rekonstrukcji piersi w okolicy przedpiersiowej: Przegl\u0105d pierwszego roku z BRAXON\u00ae Fast
Chirurg przedni. 2022 wrze\u015bnia 5:9:970053. doi: 10.3389\/fsurg.2022.970053. eKolekcja 2022.
\u00a0
\u2013 Bezkom\u00f3rkowa rekonstrukcja protetyczna piersi wspomagana sk\u00f3r\u0105 w\u0142a\u015bciw\u0105: systematyczny i krytyczny przegl\u0105d skuteczno\u015bci i zwi\u0105zanej z ni\u0105 zachorowalno\u015bci
Plast Reconstr Surg. grudzie\u0144 2011;128(6):1162-1169. doi: 10.1097\/PRS.0b013e318230c29e.
\u00a0
\u2013 Profil bezpiecze\u0144stwa i czynniki predykcyjne wynik\u00f3w estetycznych po rekonstrukcji piersi w okolicy przedpiersiowej za pomoc\u0105 siatkowej bezkom\u00f3rkowej matrycy sk\u00f3rnej
Anna Plast Surg. 1 czerwca 2021 r.; 86 (6S dodatek 5): S585-S592. doi: 10.1097\/SAP.0000000000002764.
\u00a0
\u2013 Natychmiastowa rekonstrukcja piersi bezpo\u015brednio na implant z bezkom\u00f3rkow\u0105 macierz\u0105 sk\u00f3rn\u0105: ocena powik\u0142a\u0144 i bezpiecze\u0144stwa
Pier\u015b. Grudzie\u0144 2021:60:192-198. doi: 10.1016\/j.breast.2021.10.006. EPUB 2021, 15 pa\u017adziernika.
\u00a0
\u2013 Bezkom\u00f3rkowe matryce sk\u00f3rne jako uzupe\u0142nienie rekonstrukcji piersi za pomoc\u0105 implant\u00f3w: analiza wynik\u00f3w i powik\u0142a\u0144
Eur J Surg Oncol. 2020 kwietnia;46(4 pkt A):511-515. doi: 10.1016\/j.ejso.2019.10.042. EPUB 2019, 1 listopada.
\u00a0
\u2013 Zaktualizowane dowody na zastosowanie bezkom\u00f3rkowej matrycy sk\u00f3rnej w rekonstrukcji piersi w oparciu o implanty: metaanaliza
Ann Surg Onkol. 2016 luty;23(2):600-10. doi: 10.1245\/s10434-015-4873-9.
\u00a0
\u2013 Jednoetapowa rekonstrukcja przedpiersiowa bezpo\u015brednio na implant za pomoc\u0105 ADM: bezpiecze\u0144stwo i wyniki u \u201eszczup\u0142ych pacjent\u00f3w\u201d
Rak piersi Clina. 2023 grudzie\u0144;23(8):e507-e514. doi: 10.1016\/j.clbc.2023.08.007. EPUB 2023, 25 sierpnia.
\u00a0
\u2013 Rekonstrukcja piersi przedpiersiowej za pomoc\u0105 ekspandera tkankowego w ca\u0142o\u015bci pokrytego bezkom\u00f3rkow\u0105 macierz\u0105 sk\u00f3rn\u0105: wykonalno\u015b\u0107, bezpiecze\u0144stwo i cechy histologiczne wynikaj\u0105ce z pierwszych 64 zabieg\u00f3w
Chirurg gruczo\u0142\u00f3w. 2024 27 marca;13(3):297-306. doi: 10.21037\/gs-23-432. EPUB 2024, 22 marca.

\u2013 Mavros, M., Athanasiou, S., Alexiou, V., Mitsikostas, P., Peppas, G. i Falagas, M (2011) Czynniki ryzyka dla infekcji zwi\u0105zanych z siatk\u0105 po operacji naprawczej przepukliny: metaanaliza kohorty Studia, \u015awiatowy Dziennik Chirurgii<\/em>, tom 11, s. 2389-2398.
\u00a0<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Data przegl\u0105du ARP 90: 2027 r<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

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