Pericardial effusion is the most common pericardial pathology. This disease has been described even during the days of Hippocrates. The first method of drainage of pericardium was described by Larrey in 1810. Since then, the number of interventions in the pericardium has increased significantly and diversified. Novadays minimally invasive interventions have become increasingly important.The aim of our study. To estimate the application results of pericardioscopy during the diagnosis and treatment of pericardial deseases. Materials and methods. The application results of pericardioscopy during surgical treatment of 1958 patients with various diseases were analyzed and estimated.Results. In contradistinction to traditional methods, the pericardioscopy helps to reduce operational trauma, the risk of complications and relapses without reducing the quality of treatment.Conclusions. Using pericardioscopy can significantly reduce the time of diagnostic, treatment and rehabilitation, as well as increase their effectiveness.
Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings; 2009.
У 10% пацієнтів при гастроезофагеальній рефлексній хворобі (ГЕРХ) відсутні типові прояви захворювання, а основні симптоми виявляють у дихальній, серцево–судинній системах, ЛОР–органах.
Мета. Покращення діагностичного алгоритму при виявленні позастравохідних проявів ГЕРХ; встановлення ефективності лапароскопічної фундоплікації у хворих за різних видів гастроезофагеального рефлюксу (ГЕР).
Матеріали і методи. З використанням опитувальників якості життя (ЯЖ) SF–36 та GERD–HRQL оцінювали віддалені результати консервативної терапії та хірургічного лікування пацієнтів за наявності респіраторних та ЛОР проявів ГЕРХ.
Результати. Більш суттєве покращення фізичного та психологічного компонентів ЯЖ відзначене у хворих, яким виконували лапароскопічну фундоплікацію. За опитувальником GERD–HRQL, ЯЖ хворих пысля хірургічного лікування покращилась через 6 міс – з (16,4 ± 5,3) до (6,2 ± 0,6) бала (р < 0,001), через 12 міс – до (6,4 ± 0,8) бала (р < 0,001); після консервативної терапії через 6 міс – з (15,9 ± 6,6) до (9,2 ± 1,9) бала (р < 0,001), через 12 міс – до (11,4 ± 1,5) бала (р < 0,05).
Висновки. Лапароскопічна фундоплікація порівняно з консервативною терапією більш ефективний метод лікування пацієнтів за наявності позастравохідних проявів ГЕРХ.
Summary. The most formidable early postoperative complications of Lewis esophagogastroplasty (EGP) is the failure of esophagogastroanastomosis (EGA), and in the late period — stricture of EGA, in some patients there are functional disorders. The aim of the study. Assess the treatment of complications of EGP using minimally invasive methods. Materials and methods: The results of 150 operations for cancer of the middle and upper thoracic esophagus with the imposition of high EGA were analyzed (65 used cervical EGP). X-ray endoscopic techniques are used to treat patients with complications. The functional results of EGP using esophageal manometry and pHZ monitoring were also evaluated.
Results and discussion. When applying EGA on the neck was significantly higher incidence of failure of the anastomotic sutures, which was associated with impaired blood supply with increasing length of the graft. Surgical tactics in case of failure of the EGA on the neck was to open and drain the deep space of the neck, conducting a transnasal tube for feeding into the stomach — there were no fatalities. Surgical tactics in case of failure of intrapleural EGA, which took place in 4 cases, consisted of drainage of the empyema cavity and conducting a transnasal tube for nutrition in the initial parts of the small intestine under X-ray video surveillance. In the treatment of failure of intrathoracic anastomoses there was 1 fatal case. At strictures of EGA which took place at 24 patients, performed balloon dilatations under X-ray video control. In 2 patients with the phenomena of pylorospasm performed balloon dilatation of the pyloric pulp under X-ray video control. In general, patients who underwent EGP showed good and satisfactory functional results, but in some patients there were functional disorders that were transient in nature.
Conclusions:
The use of clinically developed methods of esophagogastroplasty can reduce the number of failures and strictures of anastomoses.
At insufficiency and strictures of an esophagogastroanastomosis, and also at a hypertonia of pyloric pulp X-ray endoscopic methods are highly effective and low-traumatic.
Summary. Aim. To study the characteristics of gastroesophageal reflux using pH-impedance monitoring.
Materials and methods. pH-impedance monitoring was carried out in 38 patients with GERD symptoms without endoscopic signs and 22 patients with endoscopic signs of reflux esophagitis and reflux gastritis.
Results. All studied parameters confirmed the physiological nature of GER in 38 patients of group I and 9 patients of group II; the presence of pathological GER and impaired gastroesophageal antireflux barrier function in 13 patients of group II.
Conclusions. The conducted pH-impedance monitoring made it possible to determine not only acidic GER and superrefluxes, but also weakly acidic and weakly alkaline ones, most accurately obtain quantitative and qualitative characteristics of GER, as well as establish a violation of the chemical and volumetric clearance of the esophagus. The data obtained can be used when choosing the method of antireflux surgery in patients with GERD.
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