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 immediate results of surgical treatment of diseases of the liver and biliary tract. Methods: We have experience in diagnosing and treating 142 patients with postoperative bile leakage who were treated at the Clinic for Surgical Diseases No. 1 from 2008 to 2022. There were 62 men (43.7%), 80 women (56.3%). The age of the patients ranged from 24 to 78 years. In 75 (52.8%) cases, bile leakage developed after planned (n = 39) and urgent surgical (n = 36) interventions on the liver for focal diseases (n = 68) and traumatic liver injuries (n = 7). In 65 (45.8%) cases, bile leakage occurred after operations on the biliary system for cholelithiasis and its complications performed by traditional (n = 34) and videolaparoscopic methods (n = 31) in planned (n = 14) and emergency (n = 17) okay. In 2 more patients with residual choledocholithiasis, bile leakage developed after percutaneous transhepatic cholangiostomy. A special group consisted of 2 (1.4%) patients with postbulbar duodenal ulcer, operated on an emergency basis for a bleeding penetrating ulcer, in whom bile leakage was observed after gastric resection. Results: Endoscopic and combined videolaparoscopic interventions for the treatment of postoperative bile leakage were effectively used in 54 cases. In 17 cases, endoscopic papillosphincterotomy (EPST) was used to prevent bile leakage and correct biliary hypertension. At the same time, in 6 cases, biendoscopic interventions were performed in the form of relaparoscopy with re-clipping of the cystic duct and EPST (n = 4) and relaparoscopy with sanitation and drainage of the subhepatic space and endoscopic transduodenal prosthesis (n = 2). In 17 cases, laparoscopic debridement and drainage of the subhepatic space with coagulation of the liver stump (n = 5) were performed, and only in 4 cases they resorted to puncture and drainage of the biloma under ultrasound control. In 6 cases, with bile leakage, caused by damage to the hepaticocholedochus, they resorted to the formation of hepaticojejunoanastomosis on an isolated loop according to Roux. In 6 more cases, to prevent bile leakage, relaparotomy was performed with stitching of the cystobiliary fistula (n = 4) and liver stump (n = 2), sanitation and drainage of the abdominal cavity. Complications and lethal outcomes were not observed. Conclusions: With mild severity of bile leakage, the absence of peritonitis and biliary hypertension, conservative therapy is advisable. With moderate and severe severity of bile leakage and the presence of biliary hypertension, it is necessary, according to indications, endoscopic or surgical methods of correction.
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: Improving the results of surgical treatment of intra-abdominal abscesses after surgery on the liver and biliary tract. Methods: Over the past 18 years, 54 cases of intra-abdominal abscesses have been registered after surgery on the liver and biliary tract. The age of the patients ranged from 19 to 76 years. Among the patients, there were 39 (72.2%) women and 15 (27.8%) men. Postoperative subphrenic abscesses were observed in 38 (70.4%) patients. At the same time, in 26 (68.4%) abscesses were located in the subhepatic space, in 5 (13.1%) in the suprahepatic space, and in 7 (18.5%) -intrahepatic location of abscesses. In 12 (22.2%) cases, there were multiple interintestinal abscesses, and in 4 (7.4%) cases, abscesses of the pelvic cavity. Results: Intra-abdominal abscesses in 31 (57.4%) cases occurred after various types of liver echinococcectomy (n = 17), subtotal pericystectomy (n = 5) and atypical liver resection (n = 3). In 6 (19.3%) cases, intra-abdominal abscesses developed after fenestration of liver cysts (n = 2) and opening and drainage of liver abscesses (n = 4). After surgical interventions on the biliary tract, due to suppuration of the outflowing bile or blood, intra-abdominal abscesses occurred in 23 (42.6%) cases. At the same time, in 15 (65.2%) cases, patients underwent traditional open cholecystectomy, in 7 (30.4%) cases -laparoscopic cholecystectomy with endoscopic papillosphinketrotomy and lithoextraction (n = 5). Only in 1 (4.4%) observation, the cause of intra-abdominal subhepatic abscess was a partial failure of the choledochoduodenoanastomosis. In the treatment of intra-abdominal abscesses, minimally invasive technology was used in 24 (44.4%) cases, and traditional relaparotomy was used in 30 (55.6%) cases. Laparoscopic opening and drainage of abscesses was used in 6 (25.0%) of the main group, with options for installing the first trocar in the postoperative scar (n = 2), open laparoscopy according to Hassen (n = 3) and installing a trocar through a laparotomic incision (n = 1). In 18 (75.0%) cases, abscesses were opened and drained under ultrasound control. In the postoperative period, complications of a different nature were observed in 6 (25.0%) patients of the main group with 2 (8.3%) deaths. The cause of death was acute myocardial infarction (n = 2). In the control group after traditional relaparotomy (n = 30), complications occurred in 14 (46.7%) with 10 (33.3%) deaths. Conclusions: Minimally invasive interventions are an option for surgical treatment of intra-abdominal abscesses after surgery on the liver and biliary tract.
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