Objective. To ground from clinical, topographo-anatomical positions the choice of the most rational techniques of parathyroidectomy in patients with hyperparathyroidism, which permit to reduce the intraoperative injury, to minimize operative complications, persistence and hyperparathyroidism relapse rates, to elevate the quality of life. Materials and methods. The research had two stages. Topographo-anatomical stage was realized at two levels: 1) on the anatomical material including 15 dead bodies; 2) on the plated end-grain cuttings of the dead bodies necks (n = 4). During a clinical stage, the results of examination and treatment of 182 patients with hyperparathyroidism, operated with traditional and different minimally invasive techniques, were studied. Results. The analysis of short-term results of surgical treatment of hyperparathyroidism patients in the retrospective group allowed determining the starting points for the topographo-anatomical stage of the research. The data received during the topographo-anatomical stage permitted to substantiate the choice of minimally invasive endoscopically-assisted technique for parathyroidectomy as the most rational and safety one. Introduction of the study results into surgical treatment of patients of the prospective group showed the efficiency of MIVAP technique in the form of decrease in the frequency of surgical complications from 12.1 to 6.0 % (all complications are attributed to I and II degree by Clavien-Dindo classification and had transitory character) with the reduction of the time of operative intervention and average duration of hospital treatment after the surgery. Conclusions. Minimally invasive endoscopically-assisted parathyroidectomy with the lateralization of the lobe of the thyroid gland, preservation of the upper and lower thyroid vessels in conditions of intraoperative neuromonitoring and photodynamic visualization of the parathyroid gland can be considered an optimal surgical technique.
Aim.Present a program of examination and treatment of patients with biliary duct injury, corresponding to the level of the international protocol and modern requirements for the quality of medical care.Material and methods.The results of examination and treatment of 77 patients with bile ducts injuries are analyzed. The analysis of the main surgical interventions for the elimination of bile ducts injuries is given: reconstructive operations in 44.3% of patients, recovery operations – in 36.7% and external drainage – in 19%.Results.A program approach has been developed to assist patients with bile duct injuries in civil health care at various levels of surgical care.Conclusions.The implementation of this program provides timely diagnosis of damage to the bile duct and minimizing the number of postoperative complications at the second and third levels of surgical care. It was determined that a rational approach to reduce the number of injuries of the bile ducts is their prevention by perfect adherence to the technique of surgical intervention on the organs of the upper floor of the abdominal cavity, and to reduce the number of negative consequences, the proposed algorithm for diagnosis and treatment.
The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research. Purpose of the study: based on the topographical and anatomical features of the structure of the anterior neck region, determine the most rational methods of minimally invasive interventions on the parathyroid glands, evaluate their clinical effectiveness and justify their use in the implementation of a treatment and diagnostic algorithm in patients with hyperparathyroidism. Material and methods: The design of the study consisted of two stages – anatomical and clinical. Anatomical stage is performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross-cuts of the neck (n=3) of human cadavers. During the clinical stage, the results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34%); Minimally Invasive Video Assisted Parathyroidectomy (n=32/60%) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6%). Results: at the anatomical stage, the validity and safety of minimally invasive video-assisted Parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the traditional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7% to 6.3% with an acceptable increase in the duration of surgery from 42.8±15.7 to 64.4±23.5 minutes and maintaining the average duration of inpatient treatment after surgery at the level of 3.4±0.6 days. Conclusion: minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the upper and lower thyroid vessels, as well as the use of intraoperative neuromonitoring and Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.
Purpose of the study: To present the program of diagnosis and treatment of patients with injuries of the bile ducts, corresponding to modern requirements of medical care. Materials and methods: The results of examination and treatment of 77 patients with bile ducts injuries (BDI) are analyzed. The analysis of the main surgical interventions for the elimination of BDI is given: reconstructive operations in 44.3% of patients, recovery operations - in 36.7% and external drainage - in 19%. Results: A program approach was developed to provide care to patients with BDI. The implementation of this program will provide timely diagnostics of BDI and minimize the number of postoperative complications. A rational approach to reducing the number of injuries is the prevention and prevention of the occurrence of BDI. Conclusion:The choice of a rational option for surgical intervention, taking into account modern classification positions that take into account the integral assessment of the leading criteria: the patient’s general somatic condition, the presence of infectious purulent complications, the scale of damage, the diameter of the crossed main bile duct, the damage mechanism (thermal or mechanical), makes it possible to justify the choice of a rational surgical option interventions and significantly reduce the number of complications, mortality and improve the quality of life of patients with BDI.
The main treatment method of primary and tertiary hyperparathyroidism is surgery. However, surgical interventions on the parathyroid glands can lead to formidable complications such as laryngeal paresis and hypocalcemia. With this background, a comprehensive study examined the effectiveness of modern methods of diagnosis and surgical treatment of hyperparathyroidism to increase the safety level in surgery of the thyroid gland. The results of a comprehensive examination and treatment of 53 patients with hyperparathyroidism who underwent surgery using three methods were analyzed: traditional (n = 18/34); minimally invasive endoscopically assisted (n = 32/60), and endoscopic (transoral) (n = 3/6). Intraoperative neuromonitoring was also performed in all surgical interventions. Parathyroidectomy was performed under parathyroid monitoring for intraoperative topical diagnosis of parathyroid tumors in nine patients. The use of minimally invasive endoscopically assisted access to the parathyroid glands, as an alternative to the traditional approach, indicated that the preoperative potential in the diagnosis of parathyroid disorders. Moreover, intraoperative neuromonitoring and parathyroid monitoring demonstrated efficiency based on the decline in the incidence of specific postoperative complications with a tolerable increase in operative time, maintenance of the average duration of stationary treatment after surgery, and increased safety level of surgical treatment of hyperparathyroidism.
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