Проведен сравнительный анализ изменений билиарной системы у 565 пациентов, прооперированных в гепатологическом центре г. Томска, с альвеококкозом, эхинококкозом, хроническим описторхозом, осложненными механической желтухой. Определены три уровня окклюзии и соответствующие виды расширения желчных протоков в зависимости от вовлечения в процесс анатомических структур желчевыводящей системы печени. Выявлены и представлены дифференциальноотличительные ультразвуковые критерии билиарной гипертензии при паразитарных поражениях печени, что позволит повысить эффективность ультразвуковой диагностики данной патологии, выбрать адекватный способ хирургической коррекции и улучшить результаты лечения.Ключевые слова: альвеококкоз, эхинококкоз, описторхоз, билиарная гипертензия, расширение желчных протоков, механическая желтуха.The comparative analysis of the changes of biliary system in 565 patients with alveolar Hydatid disease, hydatidosis, chronic opisthorchiasis, complicated by chronic obstructive jaundice operated in the Hepatology Center of Tomsk. Three levels of occlusion and the enlargement of the bile duct, depending on the involvement of anatomical structures of liver gall ways are Identifies. Differential-distinctive ultrasound criteria biliary hypertension with the parasitic liver problems are identified and presented, that will increase the efficiency of ultrasonic diagnosis of this pathology, choose an appropriate method of surgical correction and improve patient outcomes.
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Objective: a comparative analysis of the results of the use of different surgical methods of treatment of patients with formed pancreatic cysts.Material and methods. 108 patients with formed pancreatic cysts were treated and analysis of shortand long-term results of their surgical treatment was performed. Patients were divided into three groups depending on the type of surgical intervention: I – external drainage – 44 (40.7%), II – internal drainage –33 (30.6%), III – resection operations – 31 (28.7%).Results and discussions. Marsupialization of cyst by laparotomy incision was performed in patients of I group (n = 44). 18 (40.9%) complications, 9 (20.5%) lethal cases were after operation. Anastomoses of cysts with the small intestine were mostly performed in II group (n = 33) – 21 (63.6%). 7 (21.2%) complications, 1 (3.0%) lethal case were after operation. Distal resections were performed in patients of III group (n = 31) in 16 (51.6%) cases. Duodenum-preserving resections were introduced for treatment of cyst of pancreas head – 12 (38.7%). When performing this type of operations we proposed nikelid titanium stents for the prevention of anastomosis stenosis and preoperative retrograde stenting of the common bile duct for the prevention of damage. 10 (32.3%) complications and no lethal cases were after operation. Immediate results were worse in patients of I group. 47 (43.5%) patients were analyzed in long-term period. The number of recurrences of the disease (13.3%) and long-term mortality (33.3%) prevailed in the group of patients undergoing internal drainage of cysts. Quality of life, level of mental and physical health, that was assessed using SF-36, were higher in group of patients with reactionary treatment.Conclusion. The best immediate and long-term results were noted after resection operations, that enables to recommend their as the most optimal and radical method for treatment of patients with pancreatic cysts. Introducing of duodenum-preserving resections in case of pancreas head cyst improves the quality of patients life.
The paper includes the statistics of liver abscesses, etiology and related features of the diseases. The most common methods of conservative and surgical treatment of liver abscesses, currently used in surgical clinics of the Russian Federation, are presented. A small historical excursus about the existed methods of treatment is given in the paper. A comparative analysis of the currently used methods, their advantages and disadvantages is carried out. Some possible criteria for a certain method of treatment of liver abscesses are listed as well.
There are studied frequency of abscesses of a liver at chronic opistorchosis; the reasons of cases; features of clinic, diagnostics, treatment. Laboratory, morphological, instrumental and clinical methods were applied. From 1 170 patients operated concerning complications chronic opistorchosis, liver abscesses are taped at 31 (2,6%) with a long and massive invasion. In 90,5% of cases they were cholangiogenes. The clinic was charactericed by a septic condition. At ultrasonography it is taped two types of the image: corresponding stages of infiltration and a parenchyma destruction. Surgical tactics is individual: at 6 patients — transcutaneum drainage, at 12 — drainage by Melnicov, at 13 — a liver resection. Necessarily external drainage of biliar ducts. 4 persons were died. Features: 1) abscesses in most cases are plural; 2) good effect from concervative treatment at the kept passage of bile; 3) propensity to relapse.
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