Целью исследования явилась оптимизация технических условий выполнения селективной проксимальной ваготомии у больных с перфоративными пилородуоденальными язвами путем применения метода химической денервации.В качестве метода исследования применялся диффузионный способ, сопряженный с исследованием протеолиза верхних отделов пищеварительного тракта по методу В.А. Горшкова (1988).Представлены результаты лечения 88 (контрольная группа) и 82 (основная группа) больных с перфоративными пилородуоденальными язвами за период 1990-2002 гг., которым в сочетании с ушиванием перфоративного отверстия выполнялась селективная проксимальная ваготомия методом скелетирования малой кривизны желудка и методом химической денервации. Проанализированы результаты лечения в ближайшем послеоперационном периоде и в отдаленные сроки до пяти лет.Установлено стойкое снижение кислотно-протеолитической активности (протеолиз -(419,0 23,2) г/м 2 24 -1 , концентрация соляной кислоты -(18,4 2,14) ммоль/л) тела желудка в обеих группах больных, выявлен низкий процент рецидива язвенной болезни двенадцатиперстной кишки, который недостоверно выше в основной группе (4,3 и 7,3% соответственно).Простота и доступность метода химической денервации и его эффективность позволяют рекомендовать его для широкого применения.Ключевые слова: дуоденальная язва, селективная проксимальная ваготомия, химическая денервация.The aim of the study was to optimize the technical conditions of the selective proximal vagotomy in patients with perforating pyloroduodenal ulcers by the chemical denervation method.The diffusion method was applied, which includes the study of the proteolys of the top parts of a digestive tract by the Gorshkovs' method (Gorshkov V.A., 1988).The results of treatment of 88 (the control group) and 82 (the basic group) patients with perforating pyloroduodenal ulcers (PPDU) for the period 1990-2002 are presented. The patients were subjected to the combination of suture plication and selective proximal vagotomy (SPV) by the method of skeleting of small curvature of stomach and the method of the chemical denervation. The results of treatment in the nearest postoperative period and in the long terms up to five years are analyzed.The stable decrease of the acidic and proteolytical activity (APA) (proteolys (419,0 23,2) g/m 2 24 -1 , concentration of the hydrochloric acid (18,4 2,4) mmol/l) of the stomach body in the both groups of patients was established, accompanied by the low percentage of relapse of a duodenal ulcer, which was uncertainly higher in the basic group (4,3 and 7,3% respectively).Simplicity and availability of the chemical denervation method and its efficiency allow it to be recommended for the wide application.
Introduction: Surgical operations remain the main and most effective option for the treatment of liver echinococcosis. With the development and mastering of the method, laparoscopic operations are being used more and more widely. New technologies aimed at improving treatment outcomes are being developed and implemented in laparoscopic surgical methods. The purpose of the study is to present and evaluate the results of treatment of operated patients with liver echinococcosis using new technologies. Materials and methods: The results of treatment of 19 patients (9/47.4 % men, 10/52.6 % women) with liver echinococcosis, who were treated with organ-sparing laparoscopic resection techniques using new technologies in the surgical department No. M.A. Podgorbunsky. Results: There was no statistically significant advantage in dissection rate among the methods used (p = 0.74). In the group of patients with the applied hemostatic matrix Floseal, the time of hemostasis was significantly less than in the group without using the method (p = 0.001). In the group of patients with the improved laparoscopic Pringle maneuver, the blood loss was significantly less than in the group without using the technique (p = 0.00008). Findings: A new patented improved method of temporary hemostasis in laparoscopic resection interventions on the liver in the study proved its effectiveness. The use of the Floseal hemostatic matrix made it possible to reduce the time of hemostasis, and, accordingly, reduce the duration of the operation and reduce intraoperative blood loss in general. The laparoscopic method of surgical intervention using the above technologies is effective and safe in the treatment of medium-sized echinococcal liver cysts.
A clinical case of successful radical multi-stage surgical treatment of a patient with bilobar parasitic lesion of the liver with echinococcosis complicated by infection of one of the cysts is presented. The patient was admitted to the clinic with volumetric lesions in both lobes of the liver. At the stage of differential diagnosis, on the basis of process verification by puncture biopsy under ultrasound control, the ethiology of mass lesions was reliably established. At the primary stationary stage, infection of one of the echinococcal cysts was diagnosed, for which the cyst was drained under ultrasound control. After that, the patient was discharged to the outpatient care for compensation, correction of the general level of health and nutritional status. At the next stage of the inpatient examination, the patient was determined to have an insufficient level of functional reserves of the liver to perform a radical operation. For this reason, laparoscopic ligation of the right branch of the portal vein was performed in order to develop vicarious hypertrophy of the contralateral lobe. After 30 days, the increased level of functional reserves of the liver made it possible to plan radical surgical treatment with an acceptable risk for the patient. The operation was performed in the amount of right-sided extended hemihepatectomy with marginal resection of the 3rd segment of the liver. The symptoms of liver failure in the postoperative period according to the ISGLS scale were regarded as Grade A. The patient was discharged from the hospital in a satisfactory condition on day 10 after the operation. In the postoperative period, courses of therapy with albendazole were prescribed according to the standard scheme. The patient is under observation for more than a year after treatment. The condition is satisfactory. No recurrence of the disease was noted.
Introduction. Echinococcosis of the liver with subtotal organ damage remains an urgent surgical problem. The development of surgical technologies does not stand still. In the modern scientific community, more and more publications appear that speak of good treatment results with the staged application of various surgical technologies and their combination in various options. The purpose of the study is to present and evaluate the results of treatment of operated patients with liver echinococcosis using a new diagnostic and treatment protocol for surgical treatment. Materials and methods. The results of treatment of 10 patients [4 men (40%), 6 women (60%)] with widespread parasitic lesions of the liver, who underwent 26 surgical interventions for liver echinococcosis in the surgical department No. 2 on the basis of the M.A. Podgorbunsky” in the period from 2017 to 2022. The difference in the number of operations performed and actual patients is explained by the use of a staged method of surgical treatment. Criteria for inclusion in the study group: the absence of an initial sufficient safe level of liver functional reserves to perform a one-stage extensive liver resection based on the results of a comprehensive assessment of clinical, laboratory and instrumental tests in conjunction with the use of a statistical prognostic model. Results. All patients (10/100%) from the study group underwent laparoscopic vascular isolation of the portal blood flow of the right lobe of the liver in order to create vicarious hypertrophy of the contralateral lobe and increase the reserve capacity of the liver. After objective confirmation of the effectiveness of the above surgical stage of treatment, assessment of the perioperative risk using a statistical model, all underwent extensive liver resections as the next stage. In the postoperative period, 8/80% of patients had post-resection hepatic insufficiency of class A (n = 4) and B (n = 4) according to the ISGLS classification. In two patients, the clinical picture and the absence of liver dysfunctions (synthetic, secretory, detoxification) made it possible to judge the absence of liver failure in the postoperative period. Against the background of conservative therapy, the phenomena of liver failure regressed. All patients were discharged in a satisfactory condition. Findings. Staged laparoscopic vascular isolation of portal blood flow is effective and safe. The use of a modern diagnostic algorithm for perioperative examination in combination with staged surgical techniques makes it possible to achieve good treatment results in a specialized surgical center/
The article presents a review of literature data in order to study current problems in the diagnosis and surgical treatment of liver echinococcosis. At the present stage of technological progress, it is possible to study the genetic, anatomical and pathophysiological aspects of echinococcosis. The article highlights the advantages and disadvantages of surgical operations performed in patients with echinococcal liver damage. Methods and results of surgical treatment in various clinics are considered. The main surgical directions in the treatment of parasitic liver damage have been determined. These are more radical anatomical and extensive liver resections and minimally invasive, including laparoscopic and robotic techniques. Each of the methods used has its own niche of application and its own limitations. An opinion is expressed about the prospects for the development of minimally invasive methods of surgical treatment. The authors note the actual absence of a unified standardized tactics of surgical treatment at the moment. It is noted that the literature contains only fragmentary data on the possibility of combining minimally invasive and classical methods of surgical treatment. Despite the introduction of new methods of treatment, the percentage of complications and mortality are still high. Thus, the lack of uniform diagnostic standards and principles for determining surgical tactics testifies to the urgency of the problem of treating parasitic liver damage and determines the search for new solutions in order to improve the results of surgical treatment of this pathology.
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