The main reasons for the development of complications of 'open' surgeries for severe acute pancreatitis are the destruction of the wall of the main pancreatic duct, parapancreatitis, the intervention of a hollow organ or a vessel of trunk in a purulent lesion. As a rule, mentioned changes appear due to the long-team course of severe acute pancreatitis.
Возникновение острого билиарного панкреатита обусловлено микролитиазом, миграцией или вклинением камня в большой дуоденальный сосочек и, как следствие, развитием панкреатической гипертензии и аутолиза ткани поджелудочной железы. Цель исследования-разработка рациональной хирургической тактики ведения больных острым билиарным панкреатитом и его осложнениями. За 10 лет наблюдали 378 больных острым билиарным панкреатитом, из них у 304 (80%) степень тяжести болезни была легкой, у 74 (20%)-средней и тяжелой. Практически все больные с легким течением острого билиарного панкреатита оперированы в течение 3-7 сут после разрешения атаки. У больных с тяжелой степенью билиарного панкреатита отмечены общие и местные осложнения, требовавшие дифференцированной лечебной тактики. Выводы. 1. Вклинение камня в большой дуоденальный сосочек предполагает экстренную эндоскопическую папиллотомию. 2. Холедохолитиаз, холангит и механическая желтуха при остром билиарном панкреатите является показанием эндоскопической папиллотомии. 3. Холецистэктомию при билиарном панкреатите тяжелого течения следует выполнять после разрешения воспалительных изменений желчного пузыря и поджелудочной железы. Ключевые слова: желчнокаменная болезнь, микролитиаз, острый билиарный панкреатит, эндоскопическая папиллосфинктеротомия, панкреатические скопления, инфицированный панкреонекроз.
In this reviewing article there are discussed such topics as modern classification of acute pancreatitis, indications for surgical treatment of severe and, first of all, infected pancreatic necrosis, modern tendencies in this problem and controversial issues of it. The analysis of two different methods of surgeries («closed» and «open») for drainage of retroperitoneal space depending on the scale of necrotic lesion has been carried out. The perspective use of the natural transluminal endoscopic surgery (ENOTES) in the treatment of acute pancreatitis, complicated by abdominal compartment syndrome, is shown. The frequency of intraoperative and early complications after «closed» and «open» surgical interventions for severe acute pancreatitis has been reviewed; also recognition of the complications, the prevention of their occurrence and the choice of surgical or conservative methods of treating the complications.
Thyroid carcinoma with thymus-like differentiation (Carcinoma Showing Thymus-Like Differentiation, CASTLE) is an extremely rare disease. It arises from the thymus tissue ectopic into the tissue of the thyroid gland, usually in patients 40–50 years old. In this work, we present an observation of the development of CASTLE in a patient at a young age. A 21-year-old woman was admitted to our clinic with a volumetric education in the projection of the left lobe of the thyroid gland. Ultrasound revealed a 5-centimeter thyroid tumor. Surgery was performed in the scope of thyroidectomy, selective cervical dissection (level VI). Morphological and immunohistochemical studies showed that cancer has a thymus-like differentiation (CASTLE). After 32 months, she recurred to the lymph nodes of the neck (level IV on the left). She underwent repeated surgery, after which she was observed without signs of relapse for 120 months. The rarity of the pathology leads to difficulties in establishing a diagnosis at the preoperative stage and in choosing the optimal treatment tactics during treatment and further follow-up.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.