Настоящий литературный обзор посвящен проблеме спонтанных разрывов печени у беременных. Его целью стало повышение информированности врачей как одного из методов ул учшения ранней диагностики болезни, а также рассмотрения роли хирурга-гепатолога в рамках хирургического лечения редкого акушерского осложнения. Были рассмотрены основные звенья патогенеза разрывов печени, раскрыта проблема высокой материнской и перинатальной смертности. На основании данных литературы была определена наиболее оптимальная акушерская и хирургическая лечебно-диагностическая тактика ведения беременных со спонтанными разрывами печени.
Abstract. The first mention of pancreatic cancer dates back to 1761, when the six-volume work of the famous Italian anatomist G. Morgagni On the location and causes of diseases discovered through dissection was published. However, the history of surgical treatment of malignant tumors of the pancreas dates back to the end of the 19th century. The accumulated experience of operational techniques and the introduction of aseptic rules created objective prerequisites for performing operations in complex anatomical zones during that period of time. On July 16, 1882, the famous German surgeon F. Trendelenburg, firstly, performed a successful resection of the tail of the pancreas for sarcoma, founding the development of surgery in this field. However, the success in this sphere could not be shifted to a tumor of the head of the gland due to the subsequent separation of the duct system from the duodenum. Over the following years, many outstanding surgeons tried to solve this problem, such as: A. Codivilla, W. Halsted, W. Kaush, until in the early 40s A. Whipple proposed a new method of pancreatoduodenal resection, that became the gold standard for head cancer treatment pancreas. Although it was not possible to achieve significant success in the treatment of cancer in the original method of operation, as a result at various stages of time this procedure wasnt used a lot and was almost forgotten. Today, surgery remains the leading method in the complex treatment of patients with pancreatic cancer. Minimally invasive technologies have been actively introduced into pancreatic surgery in the past two decades. The indications for surgery have been expanded, lymphadenectomy standards have been introduced, thereby increasing the chances of a successful cure.
Primary esophageal melanoma is a rare and extremely aggressive malignant neoplasm originating from mucosal melanocytes. The complex histological structure of the tumor, which in 10–25 % of cases may not contain melanin characteristic of these formations, leads to a high frequency of diagnostic errors, reaching 50 %. Immunohistochemical examination is the standard for diagnosing the disease. Primary esophageal melanoma is a tumor with a high potential for hematogenous and lymphogenous metastasis. So, when the tumor spreads to the submucosa, the frequency of locoregional metastasis reaches 54 %. Radical surgery in combination with adjuvant methods of treatment improves the results of treatment in this category of patients. Immunotherapy is a promising method of complex treatment, but requires further study.
Abstract. In 1940, having baggage of three fatal two-stage pancreatoduodenal resections, during the demonstration surgery, the famous American surgeon Allen Whipple performs the first successful one-stage pancreatoduodenal resection for pancreatic head cancer. It is immeasurable surprise and respect that such a volume of intervention was not planned, since the patient was diagnosed with a tumor of the antral part of the stomach before the operation. The complexity of the situation didn`t stop Allen Whipples plans, and the subsequent success, which gave not only 9 years of life of the operated patient, but also to the whole world the original method of operation, became the starting point of a new era of pancreatic surgery Whipples contribution to surgery is not limited to performing one-stage pancreatoduodenal resection. He pioneered the reform of postgraduate medical education in the United States of America, founded the worlds first plastic surgery training program, developed new methods of intra- and perioperative management of patients with colon cancer, criteria for diagnosing insulinoma, which are today called the Whipples triad. The study of the structure of the spleen, as well as its role in the spread of tumor cells, made it possible to determine the indications and contraindications for splenectomy. He also developed and applied porto-caval and splenorenal shunting operations, which reduce pressure in the portal vein system in patients with liver cirrhosis.
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