Aim. To study lymphatic metastasis of proximal gastric cancer to determine the extent of surgical intervention both on the stomach wall and lymphatic pathways. Methods. The data on lymphatic metastasis were analyzed in 185 patients with proximal gastric cancer not extending to the esophagus who underwent gastrosplenectomy with extended lymphodissection D2 in 2 surgical departments of the Republican clinical oncology center (Kazan) in 1982-2014. All patients were morphologically verified prior to surgery. 105 out of 185 patients (56.7%) had metastases to lymph nodes. Results. In proximal gastric cancer (within IV and V angiological segments) lymph node involvement in cancer metastases occurs in all sub-segments of the lymphatic system of the stomach. There is a fairly clear pattern: involvement of lymph nodes in metastases mainly occurs in groups №3a, 3b, and 4d, along the common hepatic artery and its branches, around the celiac trunk, along the splenic artery and in splenic hilum. In case of cancer localization in segment IV metastases were observed in 46.7%, in segment V - in 66.7% and in case of involvement of both segments IV and V - in 53.3% of patients. In gastric cancer located within segments IV and V, starting with the involvement of muscular tunic, lymph nodes of perigastric groups (№3b - in 37.1%, 4d - in 11.4%) are often affected as well as parietal lymph nodes of groups 7-12. Conclusion. In cancer located within gastric segments IV and V gastrosplenectomy with extended lymphodissection D2 should be performed to remove lymph node groups along the splenic artery and in splenic hilum.
Казанский государственный медицинский университет, г. Казань, Россия; Республиканский клинический онкологический диспансер, г. Казань, Россия; Казанская государственная медицинская академия, г. Казань, Россия РефератЦентральная температура тела человека служит важнейшим показателем, мониторируемым в клинической практике анестезиологии и интенсивной терапии. Современные анестетики влияют на процессы регуляции центральной температуры и приводят к её снижению в периоперационном периоде. Непреднамеренная интра-операционная гипотермия сопровождает многие операции, проводимые под общей и регионарной анестезией. Она значительно увеличивает риск кардиальных и инфекционных послеоперационных осложнений, на её фоне возрастают послеоперационная кровопотеря и потребность в гемотрансфузии. Пациенты в условиях гипотер-мии медленнее просыпаются, их пробуждение чаще сопровождается мышечной дрожью. Периоперационная гипотермия приводит к увеличению сроков госпитализации и внутрибольничной летальности. В связи с этим предотвращение непреднамеренной периоперационной гипотермии -важная часть анестезиологического обе-спечения больного во всех областях хирургии. Поддержание нормотермии во время операции служит важной составляющей всех программ ранней послеоперационной активизации больных. Ключевые слова: гипотермия, периоперативное согревание, температура. Human body central temperature is an important monitored value for anesthesiology and intensive care practice. Present anesthetic agents influence on the central temperature regulation and lead to its decrease in the perioperative period. Inadvertent perioperative hypothermia accompanies various surgeries with general and regional anaesthesia. It considerably increases the risk of cardiac and infectious postoperative complications, and against its background blood loss and necessity for blood transfusions also increase. Patients with hypothermia wake up slower and the postoperative shivering may often occur. Perioperative hypothermia increases the length of hospital stay and the nosocomial mortality. In this regard, prevention of inadvertent perioperative hypothermia is an important part of anaesthesia assistance in all fields of surgery. Maintenance of normal temperature during the surgery is an important component of all programs of patient's early postoperative activation. Prevention and management of inadvertent perioparatve hypothermia
The paper presents the development of liver resection methods; it is a brief description of the evolution of improvement and implementation of many scientists’, researchers’ and practical doctors’ ideas, mainly aimed at preventing severe complications, the most common and important of which are bleeding and bile leakage, leading to a series of irreversible consequences and patients death. All described methods originate from each, from simple to complex - from elementary crushing of the liver tissue with two fingers and ligation of tubular structures to compression clips and cryo-scalpel. In the XX century, due to developments in medical technologies and medical physics new contemporary methods of microwave coagulation, using plasma surgical units and radiofrequency generators appeared. Hemo- and cholestasis effects of each method have its own advantages and disadvantages, which are reflected in the presented review. So far, the choice of liver resection method, excluding the most complications of intra- and postoperative periods is a matter of the sole initiative of each hepatic surgeon. The problem of preventing the most frequent complications is related to the surgery method and requires further studies and improvements. The survey does not reflect our own technique developed for liver resection used for 10 years, which is presented for a patent registration and further publication with detailed description of this technique and the results of operations, both immediate and long term.
Gastric stump cancer is a carcinoma which forms no earlier than 5years after surgery for benign disease. The incidence ranges from 2.4 to 5% among patients with stomach cancer. Previous operations lead to the emergence of an adhesive process in the abdominal cavity, changes in the anatomy and topography of the abdominal organs, as well as the development of new ways of lymph outflow. These factors lead to the re-surgery becomes technically more complicated and requires high professional training from the surgeon. Of particular surgical interest is the issue of restoration of the digestive tract, which directly depends on the nature and volume of the previous surgery. In this paper, the authors describe cases of surgical treatment of gastric stump cancer in two patients, who had previously undergone pancreaticoduodenectomy.
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