ЦЕЛЬ. Проанализировать доступные за последние 5 лет исследования с последующей систематизацией основных групп факторов, приводящих к несостоятельности толстокишечных анастомозов после резекционных и реконструктивно-восстановительных операций. Анализ литературы проведен в медицинских базах PubMed, Medline, Cochrane Library, Web of Science. учитывая представленную большую выборку пациентов и количество оцениваемых факторов со статически значимой достоверностью, в литературный обзор вошли 22 рандомизированных исследования и метаанализа. Проанализированы и представлены контролируемые и неконтролируемые факторы, приводящие к несостоятельности толстокишечных анастомозов после реконструктивно-восстановительных и резекционных операций на разных этапах лечения данной категории пациентов. Частота развития несостоятельности межкишечных анастомозов, по данным изученной литературы, довольно высока. Оценка доказанных факторов и их нивелирование в дооперационном периоде позволит в большинстве случаев снизить риски и, как следствие, частоту несостоятельностей кишечных анастомозов, что значительно улучшит результаты лечения колопроктологических пациентов.
Relevance. The most severe component of acute destructive pancreatitis (ADP) is enzymatic parapancreatitis (EPP). Pathogenetic treatment methods are limited.The objective was to evaluate the effectiveness of different treatment methods.Material and methods. Group 1 included 86 patients with ADP, enzymatic peritonitis (EP), EPP; 44 patients with EPP of them were performed LD of the retroperitoneal tissue. Group 2 included 120 patients with EPP without EP, 48 – with PPD (percutaneous drainage of parapancreatic tissue).Results. Mortality rate in patients with hemorrhagic EPP with LD was 16 %, without LD – 37 %, in patients with serous EPP with LD – 15 %, without LD –15 %. Mortality rate in patients with EPP without EP and with PPD was 6.2 %, without PPD – 8.3 %Conclusion. LD and PPD should have been applied on the basis of the variant of EPP.
The article presents a review and analysis of modern conceptions about the course of acute destructive pancreatitis, according to national and international recommendations. The problematic and perspective questions of treatment of this pathology are highlighted. The key directions of treatment of acute destructive pancreatitis are determined, according to the authors, requiring additional development.
Primary hyperparathyroidism (PH) is one of the most common diseases of the endocrine system that requires surgical treatment. The most common cause of PH is parathyroid adenoma, which occurs in 8590% of cases, in 510% multiple adenomas or hyperplasia of several or all parathyroid glands. Surgical treatment is the only radical and effective method of treating PH, however, the variability of the anatomy of the parathyroid glands, the possibility of their ectopic location, as well as the close connection with the thyroid gland, in some cases, complicate the intraoperative verification of the parathyroid adenoma. All this can lead to inadequate volumes with parathyroidectomy. In this article, the presented clinical case demonstrates how the complexity of intraoperative verification of the parathyroid glands during parathyroidectomy led to intra-abdominal life-threatening complications acute duodenal ulcer with subsequent perforation and acute cholecystitis against the background of persistent hypercalcemia and perioperative stress. Also, on the example of this case, surgical tactics are demonstrated, taking into account the pathogenesis of abdominal complications.
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