Summary. Purpose: to improve the results of surgical treatment of patients with perforated pyloroduodenal ulcer. Materials and methods. The results of treatment of 101 patients operated on for perforated pyloroduodenal ulcer, which were treated in the surgical department for the period from 2015 to 2020, were analyzed. Results and discussion. Laparoscopic interventions were performed in 56 (55.4 %) patients with perforated ulcer. Excision of perforated ulcer by traditional laparotomy without vagotomy was used in 26 (25.7 %) patients. Suturing of perforated ulcer by traditional method without vagotomy was performed in 19 (18.8 %) patients. Complications of the early postoperative period in 8 (7.9 %) patients were surgical in nature. In 27 (26.7 %) patients postoperative complications were specific associated with the performance of dilated pyloroduodenoplasty. The largest number of postoperative complications was observed in patients who underwent suturing of the ulcer using traditional laparotomy access – 17 (16.8 %), of which general surgery – 6 (5.9 %), specific – 11 (10.9 %). Conclusions. Laparoscopic suturing of perforated ulcers is accompanied by less pronounced pain, a decrease in the number of postoperative complications, which requires greater use of endovideo-surgical technologies in this complication of peptic ulcer disease.
Summary. Differential diagnosis of cystic lesions of the pancreas remains one of the most problematic sections of abdominal surgery. Endoscopic ultrasonography is gaining more and more importance in the diagnosis and determination of treatment tactics of cystic lesions. The goal is to determine the place of endoscopic ultrasonography in the diagnosis of patients with cystic lesions of the pancreas. Materials and methods. Analyzed literary sources that were devoted to the use of endoscopic ultrasonography for the diagnosis of cystic lesions of the pancreas. Results and their discussion. Endoscopic ultrasonography, thanks to its high resolution and the absence of interposition of air-containing organs, allows you to visualize both the characteristic features of the structure of the cystic tumor itself and the ductal system of the pancreas, as well as to evaluate the thickness of the cyst wall, the presence of intracystic membranes and a solid component, the nature of the contents, the number of cystic cavities in the lesions. Conclusions. Endoscopic ultrasonography is a clarifying method of diagnosis, which should be used in all patients at the stages of examination, planning treatment tactics and choosing a surgical intervention method.
Background. The variety of cystic tumors of the pancreas from benign to malignant, the availability of a large number of modern diagnostic methods, increasingly directs surgeons to systematize already existing experience and to search for new algorithms for the treatment of patients from the standpoint of evidence-based medicine. The purpose of the work is to analyze literary sources related to the results of diagnosis and surgical interventions for patients with various forms of cystic tumors of the pancreas, with the aim of determining the strategy of their surgical treatment. Materials and Methods. The data of full-text publications obtained as a result of a literature search in the Scopus and PubMed databases for the period from 2009 to 2022, which were devoted to the issues of surgical treatment of various morphological forms of cystic tumors of the pancreas, were analyzed and systematized. The search was conducted using the following keywords: «cystic tumor», «mucinous cystadenoma», «cystadenocarcinoma», «pseudocyst of the pancreas», «diagnostics», «surgical treatment». Results. For the diagnosis of cystic tumors of the pancreas, the entire range of known methods of perioperative research is used. The extent of surgical intervention for benign cysts is determined by such factors as the size of the neoplasm, its relationship with the parenchyma of the pancreas, the main pancreatic duct, and the vessels of the organ. Mucinous cystic tumors are an indication for surgical treatment. If the size of the serous cystadenoma is less than 3–4 cm, surgical intervention can be postponed, such patients are subject to dynamic observation. The choice of method of resection of the pancreas depends on the location of the tumor and may include distal pancreatectomy with or without splenectomy, median pancreatectomy, or Whipple pancreatoduodenal resection. When the neoplasm is located proximally, classical pancreatoduodenal resection is performed, and its localization in the body or tail of the gland requires distal resection of the organ. Laparoscopic technology can be an alternative for such damage to the gland by a small or medium-sized tumor. Issues of lymph node dissection and adjuvant chemotherapy currently remain debatable. Conclusions. Thus, the analysis of foreign literature on diagnosis and surgical treatment of cystic tumors of the pancreas showed that the use of modern instrumental examination methods affects the results of treatment of patients with this pathology. Fine-needle aspiration of cyst fluid is a safe, highly accurate diagnostic manipulation when cytological diagnosis of a cystic lesion of the pancreas is required. Multispiral computed tomography with bolus contrast enhancement remains the «gold standard», but the use of magnetic resonance imaging, endoscopic ultrasonography, and positron emission tomography are increasingly used to assess the operability, staging, and resect ability of cystic tumors. Knowledge and interpretation of imaging data are crucial for developing personalized patient treatment algorithms and improving treatment outcomes and patient quality of life.
Summary. The relative technical simplicity of performing a transcutaneous puncture of the pancreatic cyst cavity under the control of modern medical imaging devices, as well as the simultaneous possibility of performing a minimally invasive medical and diagnostic manipulation regardless of the severity of the patient’s condition, attracts the attention of many researchers. The goal. The improvement of the results of treatment of cystic formations of the pancreas in patients with chronic pancreatitis with the help of minimally invasive interventions. Materials and methods. The retrospective results of treatment of 42 patients aged 18 to 72 years (average (36.7±8.4) years) with cystic formations of the pancreas in chronic pancreatitis for the period from 2015 to 2022, who were in the department of surgery of the liver and biliary tract of State University «Institute of General and Emergency Surgery named after V. T. Zaitsev National Academy of Sciences of Ukraine» are summarized. Results and their discussion. In the presence of small cystic lesions of the pancreas, not connected to the main pancreatic duct, the most appropriate method of intervention was their repeated therapeutic transcutaneous punctures under the control of ultrasonography. In patients with large cystic masses greater than 7 cm in diameter that are not connected to the main pancreatic duct, the operation of choice was long-term transcutaneous «pig tail» drainage under ultrasound guidance. Open surgical interventions (making of cystoenteroanastomoses) were performed as a second stage for patients in whom cystic formations connected with the main pancreatic duct. Conclusions. Treatment of patients with cystic lesions of the pancreas in chronic pancreatitis should be staged, and begin with transcutaneous fine-needle aspiration puncture of the cystic cavity. The effectiveness of treatment of cystic lesions in chronic pancreatitis can be increased due to the correct choice of indications for puncture, drainage or open traditional surgical interventions.
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