RESULTS OF EXTENSIVE HEPATIC RESECTIONS

N.BAYRAMOV, N.NOVRUZOV, A.SAFIYEVA, A.GADIROVA

Central Hospital of SCC, Baku, AZERBAIJAN

Materials and methods: In our clinic there was performed hepatic resection of 9 patients. Indications for the operation included severe hemangioma in 2 patients, hepatocellular carcinoma in 2 cases, cholangiocelullar carcinoma in 1 patients, hepatocellular adenoma in 1 patients and inflammatory pseudotumor in 1 patient. Metastases of pancreatic cancer and colonic adenocarcinoma into the liver were considered indication in 2 patients.

The operation was performed in 4 patients in the form of right lobe, in 2 patients – expanded right-lobe, in 2 patients left-lobe hemihepatectomy and in 1 case – extended left-lobe hemihepatectomy.

Severity of hepatic disfunction was assessed by Child-Turcotte-Pugh alculation system: Child A was observed in 2, Child C –in 1 case, no serious functional changes were observed in the extratumour parenchyma in the liver of other patients.

Results: The volume of parenchyma preserved after extensive resection was not less than 30% of the initial volume of the liver. Small-for-Size-Syndrome (SFSS) of the liver developed in 1 patient after extensive right-lobe hepatectomy against severe hepatic insufficiency (Child C). this functional physiologic complication was normalized by means of conservative treatment. In another patient extensive right-lobe hemihepatectomy planned for numerous metastases of colonic cancer into the liver was performed in two stages for the prophylactics of Small Hepatic Syndrom. The first stage was limited by Hartman operation for adenocarcinoma of the sigmoid colon and ligation of the right branch of portal vein and injection of 96% ethanol solution into metastatic nodes of the IV segment, 6 weeks later, contralateral left lobe hypertrophy related with right-lobe vascular obstruction allowed performance of extensive right-lobe hepatectomy.

In 1 patient, sizes of the tumor reduces in the IV segment after transarterial chemical embolization (TACE) and left-lobe hemihepatectomy was technically possible.

In the resection of hepatic parenchyma cavitation ultrasound surgical aspirator device and bipolar coagulator were used, blood loss constituted average of 1450 ml. In the post-operative period, no cases of bile leakage and bile fistula were observed. 1 patients had atelectasis, 2 patients subputaneous injury seroma, 1 patient ventral hernia. No patients had fatal outcome within 1 year after the operation.

Conclusion: Surgical treatment may be used in case of non-invasion of a giant solitary mass and absence of extrahepatic invasion. Non-resectable condition can be made resectable, by local destruction and application of the ligation of the portal vein.

STAGED SURGICAL MEASURE IN ACUTE DESTRUCTIVE PANCREATITIS

R.R. BAYRAMUKOV, F.A. KUDJEVA

Stavropol State Medical Academy, Stavropol, RUSSIA

Acute pancreatitis (AP) is a critical challenge of emergency surgery. It takes the third place among the diseases constituting acute surgical pathology of abdominal organs, with occurrence of 9% to 12.5%.

Materials and methods: During the determination in the CDH of subtotal, large-focal sites of destruction of the pancreas with widespread purulent lesions of retroperitoneal fat, of the abdominal cavity, with the stabilization of hemodynamic indicators, usually on the 3-4^th days, after consultation with a surgeon of air medical service, the patients were transferred by a resuscitation ambulance for a staged treatment to specialized center of the regional clinical hospital – total of 160 observations.

Results and conclusion: 52% of admitted patients were operated on in the districts of the region at different times from the start of the disease and further were sent to the clinic because of the ineffectiveness of conservative therapy. In the clinic the patients were performed repeated staged operations after average of 2-4 days from of admission after intensive preoperative preparation.

During the insertion of laparostomy, there were performed programmed sanations of the abdominal cavity after every 24-48 hours till the relief of purulent inflammation in the abdominal cavity. The application of the tactics of programmed sanations in spread septic complications of ADP led to reduction of the frequency of "on request" relaparotomies more than by 3 times, reduced the number of arrosive bleedings by 2.2 times, and the number of perforations of hollow organs by 1.7 times.

In the majority of cases, active surgical tactics allowed stop purulo-necrotic process in the omental bursa by 11-16^th days, in the retroperitoneal fat by the 17-24^th days, in DPP by the 21-28^th days. Use of the surgical tactics of programmed sanations of the omental bursa in treatment of spread purulent complications of ADP with 4-6 days intervals and the abdominal cavity after 24-48 hours in DPP helped to reduce postoperative mortality from 40.3 to 19.7%.

The applied tactics of multi-step surgical treatment of purulo-necrotic forms of pancreatitis allows to carry out adequate control over the course of the inflammatory process in the pancreas and abdominal cavity.

Date: 2014-12-28; view: 860