Biliary (BO) and duodenal obstruction (DO) are a common complication in patients with pancreatic head adenocarcinoma. In the surgical clinic of the Botkin Hospital (Moscow) for the period from 2013 to 2017 21 patients with BO and DO due to adenocarcinoma of the pancreatic head were treated with double stenting with nitinol self-expandable stents (8 males, 13 females; mean age 68 ± 2.3 years). The level of obstruction of the gastrointestinal tract according to Mutignani: Type I - 6, Type II - 12, Type III - 3. A total of 43 stents were implanted into 21 patients (2 patients had 2 biliary stents implanted). The technical success of biliary stenting was 100%. The average serum bilirubin level before biliary stenting was 314.2 ± 96.3 mmol / l and decreased to 32.6 ± 11.8 mmol / l 7 days after stenting (p>0.05). The efficiency of the biliary stent was 46 ± 4.5 weeks. The technical success of duodenal stenting was 91.3%. Clinical success was achieved in 20 (95.2%) patients (GOOSS score prior to stenting, 0.4 ± 0.13; GOOSS score after stenting, 2.3 ± 0.5). The efficiency of the duodenal stent was 34 ± 6.1 weeks. The survival time in 17 patients was 5-21 months (median - 10.1 ± 3.8 months).
The study is based on the analysis of the results of surgical treatment of 298 patients with various diseases of the thyroid gland, who were examined and treated in the department of endocrine surgery of the City Clinical Hospital named after S. P. Botkin from 2012 to 2016. 147 (49.3%) patients of the I group were operated on using extrafascial technique with intersection of the prelaryngeal muscles and visualization of the recurrent laryngeal nerve. 151 (51.7%) patients of group II underwent extrafascial surgical interventions from reduced migratory approaches using modern, including original, methodological approaches. For the prevention of paresis of the larynx in the allocation of recurrent laryngeal nerves, microsurgical instruments and magnifying devices were used. For the prevention of postoperative hypoparathyroidism, in addition to carefully accounting for anatomical and topographic-anatomical features, a «stress-test» and a method of double visual-instrumental recording of the parathyroid gland-induced fluorescence were used. In the first group of patients with surgical treatment, the following complications were recorded: in 2 (1.4%) patients developed permanent, in 8 (5.4%) transient postoperative hypoparathyroidism, and in 3 (2.0%) - temporary unilateral laryngeal paresis. The overall incidence of operative complications was 8.8% (13 patients). In the postoperative period, the following complications were recorded in group II: 2 (1.3%) patients developed transient hypocalcemia, and 1 (0.7%) patient had unilateral laryngeal paresis. The overall incidence of operative complications was 1.99% (3 patients). Analysis of the cosmetic result of the intervention, assessed on the POSAS scale, showed that cosmetic effect was better in group II (p 0.05). Thus, modern surgical interventions in patients with thyroid diseases, including new methodological approaches, have improved the results of surgical treatment with a decrease of the number of complications and achieving a better cosmetic effect of the surgical intervention.
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.