SUBMITTED TO HEMIMEPATECTOMY

A.A. MUZAFFARZADE, E.A. ISKANDAROV

Scientific Center of Surgery named after M.A.Topchubashov, Baku, AZERBAIJAN

Purpose: Liver resections in jaundiced patients are associated with significant rates of mortality and morbidity, resulting mainly from the development of postoperative complications such as sepsis, bleeding, and liver failure. For effective bleeding control, occlusion of hepatic blood inflow (the Pringle maneuver) is a valuable procedure. However, this procedure may result in ischemia-reperfusion injury of hepatocytes. The main aim of this study was to determine the influence of ischemic preconditioning (IPC) on postoperative results on rats with liver cirrhosis.

Methods: Cirrhosis was induced in Wistar rats by occlusion of the hepatic duct. The animals were divided into four groups: control group (liver resection only), total ischemia group, cirrhotic control group (liver resection in cirrhotic rats), and IPC group (cirrhotic rats with ischemia, previously submitted to IPC). The IPC procedure consisted of partial hepatic ischemia for 10 minutes, followed by 5 minutes of reperfusion and ischemia for 15 minutes, followed by 5 minutes of reperfusion. In the case of the IPC group, the animals were submitted to liver ischemia for 60 minutes after the preconditioning procedure, followed by 1 hours of reperfusion. Blood samples were collected for measurement of serum aminotransferases (ALT and AST), alkaline phosphates and total bilirubin. Nonparametric statistical analysis was used and a value of p<0.05 was considered statistically significant.

Results: The results of our study indicate that liver cirrhosis leads to alterations in hepatic parenchyma and to elevation of transferaze activity. Reperfusion injury is deeper in biliary cirrhosis group than in intact group animals. Hemihepatectomy during total ischemia led to destructive and dystrophic changes in sinusoids. Morphological changes in cirrhotic liver significantly deeper in non-cirrhotic rats. There were significant differences between the cirrhotic rats group without preconditioning and IPC groups in alanine aminotransferase and aspartate aminotransferase levels.

Conclusion: Ischemic preconditioning protects the liver from hepatic injury induced by the ischemia/ reperfusion process. In IPC group the reparative and recovery process in the liver parenchyma were better than in another groups. IPC is the usefully technique and have a wide perspective in clinical use too.

SOME PROPERTIES OF THE CORRECTION OF HOMEOSTATIC DISORDERS OF ACUTE CALCULOUS CHOLECYSTITIS

R.F.NAGHIYEV

City clinical hospital No. 6 named after A.D. Melikov, Baku, AZERBAIJAN

It is known that one of the reasons of death of patients having associated diseases or complicated forms of the disease during the surgical treatment of acute calculous cholecystitis is the complex of volemic and hemocirculatory disorders forming during the pathology. It shall be noted that in most cases investigators miss structural and functional state of liver, playing a decisive role in one of the most important reasons of revealed disorders, that is, in the maintenance of water-salt balance, synthesis of protein component of plasma, detoxication of metabolic products, the accumulation of circulating blood and regulation of hemodynamics, synthesis of the components of the coagulation system of blood and generally in the homeostasis of the organism. Therefore, the main purpose of the work is to recommend adequate treatment measures by determination of mutual relation of volemic and mehocirculatory changes during acute calculous cholecystitis in the pathogenic relation with structural and functional disorder of liver cells. The following examination methods were used for the achievement of the set purpose: to study water migration in liquid sectors of the organism by examination groups; examination of enzymatic and chemical properties of blood; comparative study of general, biochemical and coagulation systems of blood; examination of osmolarity of blood and urine; analysis of peripheral and central indications in dynamics. The shown examinations were carried out in 80 patients with acute calculous cholecystitis divided into two groups. The first group included 30 patients with acute gangrenous and phlegmanous cholecystitis, severe infiltrate or abscess around the sac, perforation of gallbladder, peritoneal diseases of various degrees. The second group included 50 patients operated in planned manner after the remission of the inflammatory process. Correction of changes in 20 of the patients was carried out by the adopted method, and in 30 of them - given the replacement of liquid between sectors. As a result of conducted examinations it was found out, that in patients with severe acute cholecystitis a complex of disorders conditioning water-salt balance and metabolism of the liver that leads to respective worsening of main indicators of central hemodynamics. In the patients of the second group the offered treatment measures play a significant role in the prevention of the disorders.

“SMALL STREAM” ANESTHESIA OR EXTENDED EPIDURAL BLOCKAGE DURING VIDEOLAPAROSCOPIC SANATIONS OF ABDOMINAL CAVITY IN PATIENTS WITH INFECTED PANCREATIC NECROSIS

Y.I. NALAPKO ¹, S.V.SATSUTA ¹, S.V.KIRICHENKO ², O.E.DUDNIK ³

Department of anesthesiology, intensive therapy and emergency medical aid¹, Lugansk pancreatic center ²Intensive Care Unit of CCH, Alchevsk city³"SA" Lugansk State Medical University, Lugansk, UKRAINE

Introduction. Anesthesia in extensive surgical interventions requires the introduction of modern anesthesiologic technologies with the use “small stream anesthesia» (G. Krieger, 2010), as well as the improvement of methods of anesthesia and perioperative intensive therapy (Saveliev V.S., Helfand B.R. et al. , 2006).

Purpose. Comparison of the effectiveness of “small stream” anesthesia and extended epidural blockage (EB) during anesthetic management of videolaparascopic sanations (VLS) in patients with acute general peritonitis (AGP).

Materials and methods. A prospective, randomized study was performed in 30 patients with infected pancreatic necrosis, VLS. The average age was 50 years. The risk of anesthesia in all the observations constituted III according to ASA scale and was due to primary disease. In all patients, VLS were performed under general balanced combined intravenous anesthesia with the application of Sevoflurane with mechanical ventilation of lungs. In 16 observations of general anesthesia was combined with an extended EB at Th_8-9 level. “Step by step” induction of an epidural block was used.

Results. In the observations, where extended EB was used, restoration of intestinal peristalsis occurred about 24-30 hours earlier.

Conclusion. Extended EB is an optimal component of an anesthetic management and postoperative intensive therapy in patients with AGP during the performance of abdominal VLS in them.

NEW METHOD FOR SEPARATION OF GASTROESOPHAGEAL VENOUS RESERVOIR IN PATIENTS WITH PORTAL HYPERTENSION

F.G. NAZIROV, A. V. DEVYATOV, A.H. BABAJANOV, U.S.NURITDINOV

Republican Specialized Center of Surgery after academician Vakhidov, Tashkent, UZBEKISTAN

Introduction: In portal hypertension surgery parallel to shunt operations are used surgical interventions, which have a fundamentally different direction - operations of portoazigal separation.

Materials and Methods: Was proposed and implemented an original method for ligature transsection of cardioesophageal venous basin. The technical result of the proposed method consists in elimination of negative effects (operating injuries, long-term functional disorders of evacuation and secretory functions of the stomach), simplification of procedures and is caused by a set of essential features, allowing to carry out a guaranteed interruption of portal esophageal-gastric collector. The method includes the following steps: devascularization of stomach in large and small curvatures with disconnection of subserous portal venous collaterals; implantation of a synthetic corrugated cylinder through a small gastrotomic hole into subcardial area of a stomach for subsequent ligature transsection; pyloroplasty. The total separation of gastroesophageal collector (TSGEC) with the usage of the new method was applied in 28 patients with PH.

Results: The most common complication of previously developed techniques of separation in the immediate postoperative period was inconsistency of seams of a cardiofundal anasthomosis. In contrast, the proposed new version is performed through a small gastrotomic hole, that’s why these complications were not observed. The signs of liver failure and encephalopathy were observed in 5 patients. Radiocontrast study on the 10th day after the operation showed free pass of the prosthesis, violations of the stomach evacuation function were not observed. In terms of one month after the operation at the control endoscopy synthetic cylinder was removed without technical difficulties. In all cases, regression of esophageal varices was marked.

Conclusion: Ligature transsection on a synthetic prosthesis in contrast to previously proposed methods of TSGEC can not only facilitate the technical operation, but also ensures the prevention of early postoperative complications associated with the traumatism of the previous methods. Advanced original technology of TSGEC is the most promising operational tool in urgent surgery and during planned interventions in patients with PH syndrome with repeated surgical interventions, or it may be the alternative method of portosystemic shunting, if it is impossible to fulfill the latter.

Date: 2014-12-28; view: 1038