MINI-INVASIVE METHOD OF ECHINOCOCCECTOMY FROM THE LIVER

R.T. MAJIDOV, A.I. GAJAKAEVA

Clinic of General Surgery of SEI of HPE, Dagestan State Medical Academy

Makhachkala, RUSSIA

Introduction. In recent years, methods of mini invasive surgery: endovideoscopic echinococcectomy, puncture and drainage of echinococcus cysts under echosonographic control, under the CT control and radiographictelevision set have been increasingly used in the treatment of echinococcosis. However, the issues of liver echinococcectomy from mini access are not sufficiently covered in the literature, although the method is a more preferable for liver echinococcectomy.

The aim of the study. Compliance with the principles of aparasitisity of echinococcectomy.

Materials and methods. For the last 10 years, the Republican hepato-endoscopy center has accepted 840 patients with hepatic localization of echinococcosis. Of them, 32 patients were performed liver echinococcectomy from a mini access with the use of a Mini-Assistant set. In 19 cases there was observed the 1^st degree complexity of surgical intervention, that is, marginal localization of cysts, superficial single cysts, in 6 - 2^nd degree: more than half of the cyst projected over the surface of the liver, the area of ​​contact with parenchyma not more than 5-7 cm; introduction depth not more than 5 cm; multiple echinococcosis (but no more than 2 cysts); cysts in the phase of late post-mortem changes and early empyema of cyst, no complications of echinococcosis, or the cysts are united with the adjacent organs without the formation of fistulas. In 8 cases there was observed 3-4^th degree of surgical intervention: the localization of the cyst in 2 and 8 segments of the liver; deep location of the cyst, complicated cysts.

Results. The effectiveness of echinococcectomy from mini access was studied by us through comparison of the result of treatment by this method with conventional and endoscopic variants of operations. Duration of echinococcectomy of liver with mini access constitutes average of 53 minutes, from laparotomic access - 72 min, and laparoscopic access - 69 min, intraoperative complications were not observed. The comparative analysis showed that the liver echinococcectomy from mini access in case of localization of cysts in 7 and 8^th segments has a number of advantages, as a broad laparotomy does not ensures the increase of the angle and decrease of the axis of operational effect. During the laparoscopic echinococcectomy, there remains the danger of contamination of the abdominal cavity with parasites.

Conclusion. Thus, the liver echinococcectomy is more preferable from mini access, especially during single cysts of the liver. With such access, it is possible to comply with the principles of aparasitisity.

PROPHYLAXIS OF FAILURE OF PANCREATOJEJUNAL ANASTOMOSIS DURING PDR

R.T. MAJIDOV, A.I. GAJAKAEVA, A.G.GASANOV

Clinic of General Surgery of SEI of HPE, Dagestan State Medical Academy

Makhachkala, RUSSIA

Introduction. Increase in the number of patients with tumors of the pancreatic head and periampular zone is observed. In connection with this, the number of radical surgeries during the disease also increases. The main reason of unfavorable outcome of radical surgery - is failure of pancreatojejunal anastomosis.

The aim of the investigation. To increase the effectiveness of different options of biliary tract reconstruction after the removal of tumors of the pancreatic head.

Materials and methods. To protect pancreatojejunal anastomosis when performing PRD, several methods are used in the clinics: naeopancreatic drainage; drainage of pancreatic duct of the remaining stump through the lumen of the gallbladder and stump of the common bile duct in the form of microcholecystostomy; purse-string suture on the stump of the pancreas stepping back from the edge of the intersection of gland by 1.5 cm.

Results. At the clinic, PDR for periampular tumors was performed in 43 patients. Of them, cancer of the pancreatic head was observed in 27 patients, of the terminal part of choledoch –in 7 and of Vater’s ampulla - 9. The above methods of protection of pancreatojejunal anastomosis were used in 29 patients. Of them, 3 cases of external diversion of pancreatic juice was performed in the variant drainage of the remaining pancreatic duct through the lumen of the gallbladder and common bile duct stump in the form of microcholecystostomy. In the control group (14 persons) failure of pancreatojejunal anastomosis occurred in 3 (21.4%) patients, 1 (7.1%) patient died. In two other cases there developed pancreatic fistula, closed after conservative therapy. In the main group of patients (29 people) no cases of pancreatojejunal anastomosis failure were observed. One patient died of necrosis of the left lobe of the liver (3.8%). Complication was diagnosed late, and the reason of necrosis of the left lobe of the liver remained unclear. The overall postoperative mortality after PDR constituted 4.7%.

Conclusion. Thus, different methods of protection of pancreatojejunal anastomosis are significant in a radical improvement of the results of surgical treatment of patients with periampular tumors, of them nasopancreatic drainage, drainage of the remaining pancreatic duct through the biliary tract and the method of strengthening of the stump by a purse-string suture are most effective method.

Date: 2014-12-28; view: 817