никунонии ҳолатҳои стоматогенӣ ва соматикии беморон гузаронида шуд. Усули интегративии баҳо додан ба беморони вайронаҳои ҳамҷояи маҷмӯи пулпаю периодонт дар якҷоя бо вайрониҳои байнисистемавӣ дошта ба табиб имкон медиҳад, ки дар асоси воқеъона баҳогузорӣ намудан ба патологияҳои сифати эндопериодонталидошта дар ковокии даҳон, нақшаи маҷмуавии табобати эндодонтӣ ва проексионӣ-периапикалиро тартиб дода, таҳлили самаранокии чорабиниҳои табобатӣпрофилактикиро муайян созад.Калимаҳои асосӣ: вайрониҳои ҳамҷояи пулпаю периодонт, коморбидӣ, табобати дохили ҷӯякӣ, табобати проексионӣ-периапикалӣ, вайрониҳои байнисистемавӣ, индекси стоматологиии полиморбидӣ.
Background: Improving the results of treatment of postoperative bleeding in hepatobiliary surgery by choosing a rational method of conservative and surgical correction. Methods: Over the past 18 years, the clinic has performed 6,548 surgical interventions on the liver and biliary tract. Postoperative intra-abdominal complications were observed in 643 (9.8%) patients. At the same time, in 420 (6.4%) cases, various options for repeated surgical interventions were resorted to in order to correct the developed intra-abdominal complication. Among them, postoperative bleeding, expressed as intra-abdominal bleeding (n = 97) and acute esophageal-gastrointestinal bleeding (n = 58), amounted to 155 (36.9%) patients. In 29 (29.9%) cases, videolaparoscopy was used to diagnose and treat intra-abdominal bleeding in patients of the main group. At the same time, in 6 (6.2%) cases, laparoscopy was transformed into minilaparotomy, and in 13 (6.2%) cases, minimally invasive methods of correction and relaparotomy were performed with various types of hemostasis. 55 (56.7%) of the control group had traditional relaparotomy. Results: Postoperative intra-abdominal bleeding after surgery on the liver was observed in 63 (64.9%) patients out of 97. After various options for echinococcectomy in 32 patients, in 23 (71.9%) cases, intra-abdominal bleeding was observed after various options for liver resection and pericystectomy. Postoperative intra-abdominal bleeding after operations on the biliary tract was observed in 24 (70.6%) patients of the main group and in 10 (29.4%) patients in the control group. In the postoperative period after relaparoscopic interventions, complications were observed in 2 (6.9%) cases with 2 (6.8%) deaths. The cause of deaths was progressive liver failure (n = 1) and acute myocardial infarction (n = 1). After performing relaparotomy in patients of the control group, postoperative complications of a purulent-septic nature occurred in 12 (21.8%) cases with 7 (12.7%) deaths. Conclusions: Thus, relaparoscopy for postoperative intra-abdominal bleeding, regardless of the nature of the previous operation, allows, with minimal aggression of re-intervention, to reliably stop bleeding and eliminate its causes.
Background: Improving the results of diagnosing acute biliary pancreatitis (BP) using modern instrumental research methods. Methods: The work is based on the analysis of the diagnostic results of 126 patients with acute BP. The age of the patients ranged from 21 to 82 years. Among the patients, there were 92 (73.0%) women and 34 (27.0%) men. In 5 patients, against the background of choledocholithiasis, stenosis of the major duodenal papilla was diagnosed, in 7 -stricture of the terminal section of the common bile duct, and in 4 -chronic pancreatitis. In 7 patients, endoscopy revealed a strangulated major duodenal papilla (MDP) calculus. Results: Ultrasound is the main instrumental method for diagnosing acute BP. If necessary, 36 (28.6%) patients underwent endoscopic ultrasonography (EUS). Regarding EUS, we have developed a method for predicting the risk of developing BP. The essence of the method was to identify direct and indirect ultrasonic criteria for BP. Direct signs included: sludge in the choledochus, choledocholithiasis or microcholedocholithiasis, strictures or dilatation of the choledochus (more than 8 mm), indicating biliary hypertension. Indirect: an isolated increase in the head of the pancreas, the presence of echo in the gallbladder and the diameter of the choledochus is more than 5 mm. Out of 36 patients, 33 (91.7%) observations showed the presence of a triad of main signs, in the form of a diameter of the choledochus of 6 mm or more, an increase in the head of the pancreas, the presence of an echo in the gallbladder or the absence of a gallbladder, which indicated BP. With a combination of two direct and one of the indirect signs, it also confirmed the presence of BP in 96% of cases. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 93 (73.8%) patients, which revealed pathological changes in the major duodenal papilla, common bile and pancreatic ducts. In 18 cases, papillotomy and EPST were performed simultaneously. Given that ERCP is ineffective in the presence of calculi in the common bile duct less than 5 mm in diameter and with sludge, EUS was effectively used in these groups of patients. In 54 (42.8%) cases, magnetic resonance cholangiopancreatography (MRCP) was used, which, in terms of its diagnostic value, corresponds to the methods of direct X-ray cholangiography. Conclusions: Instrumental research methods such as EUS, ERCP and MRCP are considered the methods of choice in the diagnosis of acute biliary pancreatitis.
Background: Improvement of the results of surgical treatment of acute biliary pancreatitis (BP), using combined mini-invasive technologies. Methods: The work is based on an analysis of the results of diagnosis and treatment of 126 patients with acute BP. The age of the patients ranged from 21 to 82 years. Among the women patients there were 92 (73.0%), men-34 (27.0%). In the diagnosis of acute BP, the complex was approached, including an analysis of complaints, anamnesis data, an objective examination, laboratory and instrumental methods of investigation. Results:The study of cytokine status in patients with BP in the presence of purulent cholangitis against a background of conservative therapy revealed an increase in the concentration in the blood plasma of TNF-a, IL-6 and IL-8 in the first 3-4 days, and IL-4-7 days after surgery with further decrease. The combination of minimally invasive interventions with conservative therapy effectively reduced the levels of TNF-a, IL-4 and IL-6 in the bile of patients with BP forms that compared with the preoperative period in bile the concentration of TNF-a, IL-4 and IL-6 was significantly less at 71.0, 47.7 and 70.6% respectively. In order to predict the risk of BP development, a method of endoscopic ultrasonography was developed, which in 96% of the observations confirmed the presence of BP. In the postoperative period after the combined minimally invasive interventions against the background of the therapy, for the first 3 days, the improvement of the condition was noted in all 60 patients. The average bed-day, at the same time, was 8.4 ± 1.2 days, compared with the patients in the second group, which amounted to 26.6 ± 2.4 days. Postoperative complication was noted in 5 (8.3%) patients, in contrast to 12 (18.2%) in the group of patients after traditional operations. Two (3.0%) patients died after the traditional operation from the progressive phenomena of multi-organ failure. Conclusions: Modern laboratory and instrumental research methods can characterize and predict complications of biliary pancreatitis. And combined minimally invasive interventions allow to improve the immediate results of treatment of BP.
Aim. To improve the immediate results of surgical treatment of injuries, and diseases of the liver and biliary tract through the rational use of minimally invasive technologies. Material and methods. Over the past 18 years, 6548 surgical interventions on the liver and biliary tract were performed. Postoperative intra-abdominal complications were observed in 643 (9.8 %) patients. At the same time, in 420 (6.4 %) cases, various options for repeated surgical interventions were used. Results. In 46 (23.4 %) cases, patients of the main group underwent laparoscopic cholecystectomy with endoscopic papillosphincterotomy (n = 10). In 5 (2.5 %) cases, percutaneous transhepatic cholangiography was performed to stop obstructive jaundice. Traditional surgical interventions with the formation of various variants of biliodegistic anastomoses were performed in 103 (52.5 %) patients. Postoperative complications in the main group were 23.0 %, and mortality was 9.6 %, while in the control group of patients, these figures were 36.0% and 19.3%, respectively. Conclusion. In the treatment of early postoperative intra-abdominal complications after surgical interventions on the liver and biliary tract, minimally invasive technology per indication is certainly considered the method of choice.
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