Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.
The guide will allow doctors of surgical profile to get information about the meaning of eponymous terms that they face in practice and in the study of special medical literature. The book contains 2008 eponymous symptoms, symptomocomplexes, syndromes and diseases related to the main sections of surgery. The book consists of two parts, the first part of which refers to the semiotics of surgical diseases and presents their symptoms and signs. The second part of the manual includes nosological units, which are divided into 8 chapters – sections of clinical surgery – and systematized in alphabetical order. Their explanation, the historical reference, data on epidemiology of diseases, their etiology and pathogenesis and a clinical picture are given. From the standpoint of modern evidence-based medicine provides information on the diagnosis, treatment and prevention of major surgical diseases. At the end of the book is a subject index, referring to which the reader can easily find the term of interest.
The guide is addressed to a wide range of doctors of surgical profile. It will be useful to researchers, teachers of higher medical school.
Проведен ретроспективный анализ протоколов умерших и серийных морфологических срезов внутренних органов при остром некротизирующем панкреатите. Дополнены положения об основных этиологических факторах, характере локализации деструктивно-некротического проц
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