BILE LITHOGENICITY AND BILIARY TRACT MOTILITY AFTER CHOLECYSTECTOMY

E.Y.PLOTNIKOVA, K.A.KRASNOV, O.A.KRASNOV

Kemerovo State Medical Academy, Regional Hepatic Center MHASCHNo 3 named after Podgorbunskiy, Kemerovo, RUSSIA

The aim of the study: To improvetreatment and rehabilitation measures in patients with cholelithiasis after cholecystectomy (CE), identification and correction of biliary insufficiency in them, and treatment of biliary pain syndrome.

Materials and methods: We observed 45 patients after cholecystectomy with a diagnosis of postcholecystectomical syndrome (PCEC) at the age of 21 - 66 years, women, terms after CE from 2 to 17 years. All patients were exposed to clinical studies, fractional minuted probing, biochemical examination of bile, with the identification of lithogenicityindicators, dynamic ultrasonography ofcholedoch, FGDS, based on the indications of RPCG. Differences between parameters were considered statistically different with p ≤ 0,05.

Results: Fractional duodenal probing revealed indirect signs of duodenal hypertension in 14 patients (increase in the volume and tension of A portion) (p ≤ 0,05), insufficiency of Oddi's sphincter in 24 persons, hypertonia of Oddi's sphincter was found in 1 person, and other patients function of Oddi’s sphincter was maintained. Only in 7 patients the volume and tension of C portion was within norm, in the rest, the data were significantly higher (p ≤ 0,05) the control – 136.5±3.24 ml 34.5±0.92 respectively. Patients of PCE group had statistically significant reduction of bile acids (p ≤ 0,05) in all the examined, and reduction of cholesterol and bilirubin (p ≤ 0,05), lithogenicity indexes were changed (p ≤ 0,05) towards the increase of bile lithogenicity. In the dynamic ultrasonography of the choledoch - diameter of the choledochin all patients did not exceed 8 mm. After 3 months of correction with Ursosanpreparation (12 mg / kg ofbody weight) and Duspatalin, tension and volume of C portion significantly decreased to 57.5 ±4.78(p ≤ 0,05).

Conclusion: Thus, the obtained data show the need to prescribe complex treatment of patients with cholelithiasis after cholecystectomy. drugtreatment of Oddi’s sphincter dysfunction should be aimed at restoring the normal tone of smooth muscles of the latter (mebeverin hydrochloride: 200 mg 2 times a day within 1-3 months after cholecystectomy, and then on demand - to relieve the biliary pain syndrome). To eliminate hepatocellular dyscholia, cholepoiesis and normalization ofexocrinousfunction of the liver, we recommend ursodeoxycholic acid drugUrsosan (10-15 mg / kg of body weight) from 6 months to 2 years under the control of bile lithogenicity.

Desirable form of participation: Report and thesises.

HEPATOMEGALY IN THE EXPERIENCE OF A DISTRICT DOCTOR

T.A.PROKHOROVA, E.G. BURDINA, E.V. GRIGORYEVA, O.N.MINUSHKIN

FSBFE “Polyclinic No.2” Moscow, RUSSIA

Introduction. Hepatomegaly does not exist as an independent nosologic form, it is a symptom encountered in many diseases and is a cause of in-depth clinical evaluation. In everyday practice, hepatomegaly is interpreted as clinically defined large liver mass.

Objective: To analyze reasons of hepatomegaly, diagnosed in outpatient conditions.

Materials and methods: The study includes 180 patients (103 men, 77 women in 1.3:1 ratio, average age 52.5 ± 9.5 years), in which during ultrasound (US) of abdomen revealed hepatomegaly of different degree of intensity. Despite the US of abdominal cavity and analysis of clinical and epidemiological anamnesis, all patients were performed general clinical and biochemical blood examination with the determination of activity of enzyme serum (ALT, AST, γ-GT, ALP), bilirubin, lipids, activity of prothrombin complex, markers of hepatitis B, C, TTV, G ELISA and / or PCR (genotype of the virus was determined in patients with HCV), antibodies (antinuclear, to mitochondria, smooth muscular system, liver microsomes, etc.), ECG, ECHO-CG, according to indications of CT of the organs of abdominal cavity were studied.

Results. Causes of hepatomegaly were divided as follows: steatosis and nonalcoholic steatohepatitis - 38,89% (n = 70); viral hepatitises - 15,55% (n = 28), alcoholic liver disease - 12,78% (n = 23), including with the outcome of liver cirrhosis - 1,67% (n = 3), primary biliary cirrhosis - 6,1% (n = 11), primary sclerosing cholangitis - 1,1% (n = 2); drug-induced liver injury - 0,55% (n = 1) against the background of amiodarone intake, hepatic hydatid cyst - 0,55% (n = 1), liver cysts - 8,89% (n = 16), hemangiomas of the liver - 10,0% (n = 18), liver metastases - 2,78% (n = 5); “nutmeg” liver - 1,1% (n = 2) during chronic right ventricular heart insufficiency.

Conclusions. The main group of patients with hepatomegaly are persons with nonalcoholic fatty liver disease (steatosis, steatohepatitis) and viral hepatitis. A small number of patients with “nutmeg liver” is explained by early diagnosis of heart pathology. Timely differential diagnosis of hepatomegaly under outpatient conditions allows to determine the tactics of patient management, to prevent further progress of the disease and improve prognosis.

SINGLE-INCISION LAPAROSCOPIC CHOLECYSTECTOMY (SILC)

E.G. RUSTAMOV, G. RUSTAMOV

Tusi Memorial Clinic, Baku, AZERBAIJAN

Background: Findings have shown that single-incision laparoscopic cholecystectomy (SILC) is feasible and reproducible. The authors have pioneered a SILC technique at the Tusi Memorial Clinic of Azerbaijan. Their results for 15 patients are presented.

Methods: From Aprel 2011 to September 2011, 15 patients with symptomatic gallbladder disease underwent SILC through a 1.5- to 2-cm umbilical incision using a single -port technique (Karl Storz). For nearly all the patients, a 30 degrees angled scope was used. The gallbladder was retracted; the SILC procedure was performed using standard technique with 5-mm reticulating or conventional laparoscopic instruments. The cystic duct and artery were well visualized, clipped, and divided. Cholecystectomy was completed with electrocautery, and the specimen was retrieved through the umbilical incision.

Results: In this series, with an average age of 36.8 years (range, 17-61 years) underwent SILC. Their mean BMI was 32.8 kg/m(2) (range, 17-42.5 kg/m(2)), and 2 patients had undergone previous abdominal surgery. The mean operative time was 53.8 min (range, 23-110 min). The mean estimated blood loss was 25.3 ml (range, 5-125 ml), and the patients had’nt an intraoperative cholangiography. There were no conversions of the SILC technique. A SILC technique was feasible for all of the patients. For the remaining patients, either a three-channel port or three individual trocars were required. A SILC technique was used for 5% of the patients to manage acute cholecystitis or gallstone pancreatitis.

Conclusion: The SILC technique with a S-port technique is safe, feasible, and reproducible. The operating times are reasonable and can be lessened with experience. Even complex cases can be managed with this technique. Excellent exposure of the critical view was obtained in all cases. The SILC procedure is becoming the standard of care for most of the authors' elective patients with gallbladder disease. Clinical trials are warranted before the SILC technique is adopted universally.

SURGICAL RADICALITY AND QUALITY OF LIFE IN THE TREATMENT OF PANCREATIC CANCER

M. RYSKA, J. PANTOFLICEK, R. POHNAN, L. BIEBEROVA

Surgery department, 2.Medical School, Charles University and Central Military Hospital, Prague, CZECH REPUBLIC

Aim of study: The aim of the presentation is to present the survival analysis of patients after surgery for pancreatic carcinoma and to assess of QoL.

Method: We analyze 423 patients with pancreatic carcinoma admitted to our surgery department (1998 – 2008), in 271 with head pancreatic carcinoma. 84 patients underwent radical resection (1.gr), 19 palliative resection (2.gr), 129 by-pass procedures (3.gr), and 47 explorations (4.gr). Data were collected prospectively on all patients. QoL assessment was done by SF-36/2.version preoperatively and 3 months after operation in subgroup of patients. Student t test, chi quare statistics, Kaplan – Meyer analysis were used.

Results: Median survival of 1.group reached 18.5 month, 2. group 6.0 mo, 3. group 6.2 mo and 4. group 5.2 with perioperative mortality 4.1 % in 1.group. 5-year survival was in 1. group 8,9 %. 8 % of patients reached more than 5 yrs survival. According to stage of disease there was significant better survival in stage I, II and III to compare to stage IV. By SF – 36/2 - PCS median preoperatively was 45.77 and 3 mo after operation 41.48 (s.), MCS 39.21 and 41.19 (s.) respectively in radical resection. In palliative surgery was PCS 42.69 and 40.13, MCS 38.42 and 39.54 respectively.

Conclusion: Radical resection is only therapeutic method improving the chance for longer survival of patient with pancreatic carcinoma. QoL is the same before radical resection and 3 months after operation. Qol is the very important factor for the decision of therapeutic approach in the advanced pancreatic carcinoma.

Supported by grant of IGA – NR/9998-4.

Date: 2014-12-28; view: 1083