CURRENT STATUS OF SURGICAL TREATMENT OF INFECTED PANCREATONECROSIS

S.V. NOVIKOV

Regional Clinical Hospital, Stavropol, RUSSIA

The aim of the study: Clinical evaluation of the significance of staged relaparotomies - planned and “on reuest” - in the treatment of complications of infected pancreatonecrosis.

Methods of investigation: results of treatment in 136 patients with infected pancreatonecrosis with the use of programmed relaparotomies and “on request” relaparotomies. All the patients were for the first time operated in different hospitals of the Stavropol region. After the stabilization of the conditions, consultations on the “Sanavation” line by specialist of our clinic, patients accompanied by a resuscitation specialist were transferred to the department of contaminated surgery of the clinic for further treatment.

Results: After the complete and appropriate preparation, 105 (77.2%) patients were performed planned relaparotomy in order to clarify the nature of disease and complications of acute pancreatitis, sanation of omental bursa, abdominal cavity and parapancreatic tissue. In 13 (9.5%) patients were performed puncture and drainage of pancreatic abscesses and subdiaphragmatic space under ultrasound, CT or MPT-control, and 18 (13.3%) were performed laparoscopic revision and sanation of omental bags. 47 (34.5%) patients with acute pancreatitis was diagnosed for widespread purulent peritonitis, and therefore after the sanation of omental bursa and abdominal, intervention was completed with omentobursostomy and laparostomy. Programmed sanations of the abdominal cavity were repeated after 24-48 hours, before the closing of laparostomy they were combined with sequestrectomy and sanitation of omental bursa. Closing of laparostomy was not always combined with the closure of omentobursostomy, therefore during the functioning omentobursostome its programmed sanations were conducted at 4-6-day intervals. In case of acute complications of pancreatonecrosis (arrosive bleedings, perforations of a hollow organ) “on request” relaparotomies were performed. Total of 244 programmed relaparotomies and sanitations of the abdominal cavity, average of 5.2 sanations per patient, and 139 programmed sanations of the omental bursa, average of 2.9 sanation per patient were performed. Mortality constituted 16.6%.

Conclusions: The use of programmed relaparotomies, and programmed pancreatosequestrectomies and sanitations of omental bursa in patients with complications of infected pancreatic necrosis in combination with modern basic therapy reduces the occurrence of deaths, especially in patients with disseminated purulent peritonitis.

SURGICAL TREATMENT OF INTERNAL BILE FISTULAS IN DISTRICT HOSPITAL

A.A. NURMUHAMETOV, F.R. BASHIROV, I.A. KADYROV, N.I. NURALIYEV, R.V.MUKHAMADIEV, F.Z. KANIPOV

Bolsheustikinsk Central District Hospital, Bolsheustikinsk, RUSSIA

The aim of the study was the improvement of the results of surgical treatment of internal biliary fistulas.

Materials and methods: We observed internal bilious fistulas at 6 patients at the age from 60 to 88 years for the last 10 years. Females were 5, males - 1. The basic group included patients with gall bladder-choledochal (4), gall bladder-duodenal (1), gall bladder-gastric (1) fistulas. Clinical manifestation of acute cholecystitis or cholecystopancreatitis was more often observed at patients of this group. At 5 patients were noted the signs of mechanical jaundice, at 1 - of cholangitis. 3 patients were operated in a planned order, emergency and urgent operations were executed in 3 patients.

Accessible preoperative diagnostics methods (review X-ray examination of the organs of abdominal cavity, intravenous cholangiography, X-ray examination of a stomach and duodenum) turned to be low-informative or impracticable at the given pathology, especially at patients requiring urgent operation. Ultrasonography and fibrogastroscopy were carried out prior to operation alongside with general clinical methods of examination.

Results and discussions: A radical correction of the basic disease remains the primary goal at IBF. Cholecistectomy, the closure of a defect in duodenum and stomach with the double-row central seams with excision of walls of hollow organ were an obligatory stage of operation in 2 patients with biliodigestive fistulas. At 4 patients with biliobiliar fistulas operative intervention on bile ducts was ended with the drainage of choledoch by A.V.Vishnevsky. Minilaparotomic access by M.I.Prutkov's technique was used at 1 patient with gall bladder-duodenal fistula. In the postoperative period bile discharge which was closed independently took place in 1 case. Lethal outcomes were not observed.

Conclusion: Our observations testify that internal bilious fistulas are a severe complication of cholelithiasis and in most cases are combined with obstruction of bile ducts, severe purulent cholangitis and are| distinguished with difficulties in diagnostics and operative treatment in conditions of a central regional hospital.

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF AUTOIMMUNE DISEASES OF LIVER ACCORDING TO THE DATA OF SPECIALIZED CENTER

A.KH.ODINTSOVA ¹, D.I.ABDULGANIEVA ², N.A.CHEREMIN ¹

State autonomous healthcare institution “Republican Clinical Hospital” ¹, Kazan State Medical University²; Kazan, RUSSIA

The aim of the study: To evaluate characteristics of the course of autoimmune hepatic diseases in patients underthe control of the Specialized Republican Center.

Methods: Beginning from 2009 up to the present,a unified questionnaire of autoimmune liver diseases (autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), a chiasm syndrome (CS), primary sclerosing cholangitis (PSC)) of the admitted patientswas prospectively filled.

Results: 60 patientswere included into the database. Of them, 30 with AIH (50%), 11 (18.3%) with PBC, 17 (28.3%) with chiasmsyndrome, 2 (3.8%) with PSC. AIG was more often encountered in women - 25 (83.3%), PBCwas observed in 10 (91%)women, chiasm syndrome in 100% of women, both patients with PSC were male. The peak PBC incidence occurs at the age of 40-60 years (91%), AIG at the age of 20-40 years (77%). Ratio of urban population to rural 3 / 1. The clinical manifestation characterized by weakness (AIHin 60%, PBC in 73%, CS in 71% andPSCin 100%), addition in the debut of a symptom of pruritus was observed in 7 (64%) patients with PBC and 13 (77%) CS.Extrahepaticmanifestations of arthropathy were often observed in patients with AIH (40%) and PBC (64%), osteoporosis –in about half of cases of PBC (55%) and PSC (45%), autoimmune thyroiditis mainly in CS (41%). In 25 cases (83.3%) of AIH, antinuclear AIG (AHA) and smooth muscle (SMA) antibodies were positive. In all cases of PBC,antimitochondrial antibodies (AMA) are defined in diagnostic titers. In 100% of cases with the chiasm syndrome AHA and SMA were positive, and 9 (53%) patients had AMA. Resulting liver cirrhosis was determined in 17 (56.6%) patients with AIH, in 12 (70.6%) patients with chiasm syndrome. In 34 (57%) patientstheliverdiseaseleadtodisability.

Conclusions: In the Republic of Tatarstan, autoimmune liver diseases are often encountered inrather urban than rural (3 / 1) population, mainly women. The disease is often encountered in persons at working age - withAIG 77% of patients aged between 20-40 years, with PBC - 91% of patients aged between 40-60 years. Autoimmune liver diseases in most cases debut with a non-specific symptoms - weakness, skin itch. Keeping ofa such register allows to improve timely selection of patients for inclusion into the transplantation waiting list for liver transplantation.

BREAK OF A HYDATID CYST INTO FREE ABDOMINAL CAVITY,

Date: 2014-12-28; view: 923