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TREATMENT OF HYDATID HEPATIC CYSTS IN CHILDREN

 

SH.T. SALIMOV, B.Z. ABDUSAMATOV, M.R. ERGASHEV, KH.S. USMANOV

Rep. Scientific and Practical Center of Miniinvasive and Endovisual Surgery in children; Tashkent, UZBEKISTAN

Methods of surgical treatment of hydatidosis can be conventionally divided into traditional (open) and minimally invasive (closed). Minimally invasive operations, in their turn, are subdivided into puncture procedures and laparoscopic operations.

Material and methods: To select the most appropriate surgical treatment of hydatid hepatic cysts we analyzed the results of treatment of 189 patients with hepatic echinococcosis. All were divided into two groups subject to type of surgery: a control group - operated by an “open” method and the main – by laparoscopic method. The control group - 120 patients who were performed “open” echinococcectomy of liver. In this group of patients we performed the following surgical procedures: a semiclosed echinococcectomy with resection of fibrous capsule projecting from the parenchyma with the drainage of residual cavity at - 19 (15.8%), closed echinococcectomy with plasty of the residual cavity by a capitonnage in - 87 (72.5%) , echinococcectomy with omentoplasty of the residual cavity in - 14 (11.7%). The main group consisted of - 69 (36.5%) patients who were performed laparoscopic echinococcectomy with the principles of aparasiticy. The age of patients ranged between 3 -14 years. Single hydatid hepatic cyst was found in only 47 (68.1%) of the 69 patients, multiple (two or more cysts) - in - 22 patients (31.9%).

Results: In control group of patients intra-operative complications were not observed. After the operation, patients activated on the 3-4th days. Leakage of bile through the drainage which stopped on the 10-12th days was observed in - 8 (6.6%) patients, festering of the postoperative wound - in 5 (4%), suppuration of the residual cavity in 1 (0.8%). All patients were discharged on the 13-15th day. Average length of stay of a patient during traditional operations constituted 13,8 ± 0,7 bed-days. In the main group of patients in 3 of 69 performed laparoscopic operations, there was required conversion in connection with the intrahepatic localization of the hepatic cyst. In 66 patients the postoperative period after laparoscopic hepatic echinococcectomy was significantly easier as compared to traditional echinococcectomies. One of the most important criteria of surgical intervention is the number of complications during the operation and immediate postoperative period. The use of laparoscopy allowed to reduce the number of complications in the postoperative period (in groups with laparoscopic and conventional echinococcectomy - 6,0% and 22,8% accordingly. Less traumatism of endovisual surgery, softer course of the postoperative period reduced the duration of stay in hospital (7,6 ± 0,6 bed-days). Consumption of drug and bandaging material significantly reduces. In the traditional hepatic echinococcectomies liver antibiotic (10 ± 1,1 ± 0,6 and 7 days respectively) and post-syndrome therapy related with express pain syndrome due to greater traumatism of the operation etc is conducted longer.



 

NONALCOHOLIC FATTY LIVER DISEASE AND FAMILIAL MEDITERRANEAN FEVER: ARE THEY RELATED?

 

C. SARKIS (1), E. CAGLAR (2), S. UGURLU (3), E. CETINKAYA (4),

N. TEKIN (5), M. ARSLAN (6), S. OZDEMIR (2), M. TUNCER (2).

 

(1) Balikesir University, Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Balikesir, TURKEY.

(2) Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Istanbul, TURKEY.

(3) Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, TURKEY.

(4) Fatih Sultan Mehmet Training and Education Hospital, Department of Internal Medicine, Istanbul, TURKEY.

(5) Bakirkoy Training and Education Hospital, Department of Radiology, Istanbul, TURKEY.

(6) Cumhuriyet University, Faculty of Medicine, Department of Radiology, Sivas, TURKEY.

 

Background / Aims: Familial Mediterranean fever (FMF) is a periodic febrile disease characterized by acute recurrent episodes of serositis. Liver disease is not considered a part of the spectrum of clinical manifestations of FMF. We conducted the present study to describe and characterize the non-alcoholic fatty liver disease (NAFLD) which is possibly associated with FMF.

Methodology: Clinical findings and treatment information of the patients with FMF were obtained from their outpatient files. Weight, height, hip and waist circumference, blood pressure were measured, and blood C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), creatinine, alanine aminotransferase (ALT), insulin levels were measured in all participated subjects, and also their liver ultrasonographies were performed for hepatosteatosis.

Results: 52 age and gender matched patients with FMF, and 30 healthy controls were included in the study (30.17± 9.59 vs. 33.03±7.74, p=0.065; 35 F/17 M vs 18 F/12 M, p=0.505 respectively). The prevalence of metabolic syndrome in the patient group was determined to be significantly higher in patient group compared to healthy group [9/52 (%17.3), 0/30; p=0.016]. FMF patients with and without hepatosteatosis were compared, the prevalence of metabolic syndrome was determined to be 6 (54.5%) vs 3 (7.3%) respectively (p<0.001). While 11 (21.1%) of those with FMF were found to have grade 1-2 hepatosteatosis, only 6 (20%) of healthy subjects were determined to have grade 1 hepatoseatosis (p= 0.901).

Conclusions: When compared to healthy controls, we found the prevalence of NAFLD not to have increased in patients.

 


Date: 2014-12-28; view: 266


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