Antegrade interventional approach for minimally invasive procedures is technically feasible, has the same effectiveness as the retrograde endoscopic method and also all advantages of minimally invasive techniques.
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия; 2 ГБУЗ «Городская клиническая больница им. братьев Бахрушиных» ДЗ Москвы, Москва, Россия В последние годы отмечается неуклонный рост числа заболеваний, сопровождающихся развитием синдрома механи-ческой желтухи и требующих экстренного хирургического вмешательства. С целью разрешения механической желтухи выполняются операции наружного желчеотведения, при которых частота развития осложнений составляет 2,4-32,7%, а летальность -0,4-13,8%. Благодаря совершенствованию методик антеградных вмешательств, инструментального обе-спечения, детальному изучению топографо-анатомических особенностей строения печени и сосудистой системы печени повышается безопасность выполнения оперативной техники -антеградные чрескожные чреспеченочные вмешательства. Цель исследования -определить оптимальную оперативную технику декомпрессии билиарного тракта у больных с забо-леваниями гепатопанкреатобилиарной зоны, осложненными синдромом механической желтухи, основываясь на топо-графо-анатомических особенностях строения печени, желчевыводящих путей и сосудистой системы. Материалы и методы. Проведен ретроспективный анализ лечения 150 больных с механической желтухой в возрасте от 29 до 83 лет (средний возраст 74,3±5,4 года). С целью купирования механической желтухи больным выполнена чрескож-ная чреспеченочная наружная холангиостомия. Оптимальным при холангиостомии является использование двух мето-дов визуализации желчных протоков: на первом этапе ультразвуковая визуализация с оценкой топографо-анатомических особенностей гепатопанкреатобилиарной зоны, позволяющая выполнить канюляцию желчных протоков с последующим рентгенологическим контролем. В случае недостаточности данных для оценки топографо-анатомических особенностей, полученных в результате ультразвукового исследования (УЗИ), больным показано выполнение спиральной компьютер-ной томографии (СКТ). В нашем исследовании мы выполняли канюляции протоковой системы через левую долю печени, пунктируя второй сегментарный проток по левой парастернальной линии, отступив от края реберной дуги на 3-6 см, через правую долю выполняли канюляцию шестого сегментарного протока точкой доступа по задней подмышечной линии в восьмом-одиннадцатом межреберье. При анализе лечения 150 больных с синдромом механической желтухи оцени-вались следующие параметры: объем интраоперационной кровопотери, продолжительность пребывания в стационаре, частота развития осложнений и летальность в зависимости от выбора точки пункции билиарного тракта, основываясь на топогрофо-анатомических особенностях. Результаты. Объем интраоперационной кровопотери при пункции правых отделов протоковой системы составил 32±9 мл, при пункции левых -18±5 мл (р=0,029). Кровотечение из пункционного канала в послеоперационном периоде из правой доли отмечено у 4 больных, левой -у 2, желчеистечение с правым доступом -у 4, с левым -у 5; нагноение места стояния дренажа -у 15 (10%); гематомы паренхимы печени -у 2 (1,3%); пневмоторакс -у...
Massive lymphorrhea can cause severe dysfunction of organs and systems and result in death due to loss of vital metabolites from the bodyAim. To demonstrate low efficacy of conservative therapy and late lymph duct ligation in continuous massive postoperative lymphorrhea.Results. We treated a patient with previous subtotal gastric resection with single-plane pancreatic resection, D2 lymph node dissection, peritoneal draining due to poorly differentiated carcinoma in the lower third of stomach and total hysterectomy who developed external lymphorrhea through peritoneal drainage tubes 3 days after surgery. A fat-rich diet, endolymphatic sodium etamsylate administration, and lymphatic duct ligation were not successful in terminating the lymph leakage. Despite the intensive care including extracorporeal detoxification, the multi-organ failure progressed and on day 28 after the surgery the patient was pronounced dead.Conclusion. Damage to lymph ducts and lymph nodes can be complicated by massive lymphorrhea. If the source of lymphorrhea can be identified, an urgent surgical intervention is warranted to stop the lymph leakage, as well as the restoration of homeostasis to replenish the lost metabolites and prevent death of the patient.
Analysis of clinical specimens showed that in 13 (12.5%) of the observations to intubate the colon was not possible. The main reason is the poor preparation of the colon to the study, which failed to improve even with the aid of a water jet pump.
In this article provides an overview of publications by foreign authors of the novel coronavirus (SARS-CoV-2) and introduce a modified treatment method for COVID-19-associated pneumonia. X-ray therapy was used to treat pneumonia during the first half of the 20th century. Fifteen studies report that approximately 700 cases of bacterial (lobar and bronchopneumonia), sulfanilamide non-responsive, interstitial, and atypical pneumonia were effectively treated by low doses of X-rays, leading to disease resolution, based on clinical symptoms, objective disease biomarkers, and mortality incidence. The capacity of the X-ray treatment to reduce mortality was similar to serum therapy and sulfonamide treatment during the same time period. The mechanism by which the X-ray treatment acts upon pneumonia involves the induction of an anti-inflammatory phenotype that leads to a rapid reversal of clinical symptoms. The capacity of low doses of X-rays to suppress inflammatory responses is a significant new concept for treatment COVID-19 pneumonitis. Low dose whole lung irradiation may be a potential solution in the present time. International research organization and the International Geriatric Radiotherapy Group (http://www.igrg.org) proposed a simple and practical protocol for Low dose whole lung irradiation to allow participation of all countries in the world regardless of their resources and made available to the whole world community for treatment COVID-19 pneumonitis.
Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.
Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.
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