LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS AT ELDERLY AND OLD AGE

F.S. KURBANOV, S.F. ABBASOV

Peoples’ Friendship University, Moscow, RUSSIA

To assess the capabilities of laparoscopic cholecystectomy in patients with cholelithiasis of older age groups, results of 43 patients at the age of 60 - 84 years (average age 69,7 ± 0,9 years), operated in 2007-2010 were assessed. The evaluation was conducted based on such clinical parameters as average age, complications of the underlying disease and severity of comorbidities. The first group consisted of 24 patients with cholelithiasis, who underwent laparoscopic cholecystectomy. Cholecystectomy of conventional access was performed in 19 patients (2^nd group). Groups significantly differed by mean age (66,0 ± 0,6 years in patients of the 1^st group and 74,5 ± 0,8 years in patients of the 2^nd group). Gallbladder empyema was found 1 patient of the 1^st group (4.1%). 11 patients of the 2nd group (57.9%) had uncomplicated cholelithiasis (choledocholithiasis mechanical jaundice stricture of the terminal choledochal portion). In the 1^st group of patients, comorbidities, severity of which was referred to the Class II of ASA classification, were found in 75.0% of patients, to the Class III - in 25.0% of patients. The second group 2 included only 3 patients with Class II ASA, the remaining comorbidities correspond to the III-IV Classes (84.2%). Patients of the 1^st group had no transitions to laparotomy and intraoperative complications. In the 2nd group, mucoclasis of the mucosa of the gallbladder was performed in two patients, drainage of common bile duct in 3 patients, application of choledochoduodenostomosis in 2 patients. Intraoperative complication (bleeding of the gallbladder bed) was observed in 1 patients of the 2nd group (5.3%). The 1^st group had not postoperative complications. 2 patients of the 2^nd group had complications in the postoperative period, including biliary leakage along the drainage from the abdominal cavity.

Careful selection of patients for laparoscopic treatment would allow achievement of good effect in the majority of elderly patients that entered to the surgical hospital.

NEW APPROACHES TO THE PATHOGENETIC TREATMENT OF COMPLICATIONS OF FIBROSIS AND LIVER CIRRHOSIS

M.A. KURYSHEVA

City Clinical Hospital No. 30, Nizhny Novgorod, RUSSIA

The aim of the work - to study the frequency of urgent complications in patients with liver cirrhosis (LC) and their correlation with the processes of fibrosis in the liver for the optimization ofpathogenetic therapy.

Materials and methods. 500 patients with LC (57.2% men and 42.8% women), treated in a multisectoral hospital from 2000 to 2010 were observed. The age of patients - 19-78 years. Etiology of LC: viral - 21.4%, alcoholic - 52%, NAJP - 8%, PBC - 3.2% mixed genesis - 15.4%. The occurrence of the LCof the Class A according to Child-Pugh constituted 12.8%, Class B - 44.6%, of the Class C - 42.6%. Patients got standard LC therapy. Changes of clinical-laboratory-instrumental parameters were assessed in dynamics,assessment of the progression of liver fibrosis according to calculated indices was assessed: the Bonaciniscale, APRIindexes, Forns, Fibroindex, PGA, elastometries, ultrasonic indices in comparison with the results of liver biopsy.

Results.Within 10 years mortality in patients constituted 13.4% with the development of complications of LC. It was determined that the major urgent complications in patients were: 1) bleeding from varices of the esophagus and the stomach –occurrence rate - 22.6%,mortality- 44.2%, 2) progression of liver failure with the development of coma –occurrence rate - 11.4%, mortality - 66.7%, and 3) hepatorenal syndrome –occurrence rate - 8.2%, mortality - 17.5%. The correlation between severity of liver fibrosis (assessment by the results of biopsy, elastometry and according to the data of noninvasivedesign and ultrasound indexes) and occurrence of complications of urgent LC was determined. Positive influence on the processes of liver fibrosis, and forecasts of patients for etiologic treatment of hepatitis, pathogenetic therapy with application ofpentoxifylline, glucocorticoids, ademetionin, silymarin, UDCA, sartans, ACE inhibitors, which can be used for the treatment of liver fibrosis and reduction of the risk of urgent complications in cases ofLC.

Conclusions: In the real clinical practice, it is preferred to evaluate the severity of liver fibrosis, by using not only a liver biopsy and elastometry, but alsodesignindices (Bonaciniscale, APRIindexes, Forns, Fibroindex, PGA, ultrasound indexes) in order to reduce the risk of complications of urgent and reduce mortality of patients. The use of antifibrotic agent, and etiologic treatment of hepatitisesreduces the risk of urgent complications duringLC, improves the forecast of patients

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Date: 2014-12-28; view: 1003