ENDOPROSTHESIS REPLACEMENT OF FOOD PIPE

CH.M. JAFAROV, B.I. SADIKHOV, R.KH. BAGHIROV, KH.G. HUSEYNOVA

Azerbaycan Medical University, Baku, AZERBAJAN

After gastro-colo operations executed in chronical impassability of food pipe (cancer, chemical, post-burn and peptic stenosis), stenosis is emerged in anastomosis area, in connection with partial weakness of sutures in some patients. Complete dysphacia is emerged in some group of patients, whose surgery treatment of chronical impassability is impossible. Patients get thin, lean, and charged to death. Compulsory gastro-stoma (35 patients) has been put to this patients before in purpose of providence of food receive. Gastrostomy operation is non-appropriate in point of esthetical view and majority of patients prefer death to gastrostomy. In modern life, it is possible to provide food receive by injection endoprothesis to stenosed segment of food pipe in some group of patients. Endoprosthesis replacement of food pipe has been executed in 37 patients (cancer of food pipe and esophagocardial channel-35, stenosis of gastro-esophago anastomosis-2). Endoprosthesis replacement operation was conducted in following sequence with intra-vein anesthesia (phentanile 50mg/kg+propophol 2mg/kg): video endoscopy is injected to lower part of duodenum and after location of distal edge to intestine endoscopy is taken out and proximal edge is taken out of mouth cavity. Endoprothesis is located to stenosed part of food pipe by passing through proximal edge. Correct location of endoprothesis in pathological focus is checked by re-endoscopy and by opening endoprothesis gradually, by pushing pathological tissues, restoration of passability of lumen is checked. In the next day, patients receive watery and half-watery foods from mouth. After endoprosthesis replacement of food pipe, patients live in period of 6-14 months. Endoprosthesis replacement of food pipe different from gastrostomy is executed easily, esthetical prevail, provides food receive, life of patients is prolonged, living quality is improved.

RESULTS OF SURGICAL TREATMENT OF CANCER OF THE THORACIC PART OF ESOPHAGUS

F.G JAMALOV, A.F.CHERNOUSOV, I.T.AKHUNDOV, T.P.JAMALOVA, V.A.FATTAKHPUR

Azerbaijan Medical University, Baku,AZERBAIJAN

RSSC named after acad. B.V. Petrovsky, RAMS, Moscow,RUSSIA

98 patients with the cancer of thoracic part of esophagus were performed reconstructive operations in the department of esophageal and gastric surgery of RSSC named after acad. B.V. Petrovsky, RAMS (Moscow) and the surgical department RCH named after acad. M.A. Mir-Gasimov (Baku) in 2002-2010. Patients were at the age of 42 - 70 years, average age of patients – 54.3 ± 0,8 years. 39.9% of patients were over 60 years. The male to female ratio was 2:1. In the majority of cases (63.0%) esophageal tumor was located in the middle or lower third of the thoracic part and in 21 patients (21.4%) lesion extended to the distal 2 / 3. The length or diameter of esophageal tumors ranged between 1.0 - 12.0 cm. The average tumor size was 5,1 ± 0,2 cm. Primary foci with the length of 5.0 cm or more were found in 59.1% of patients.

According to the TNM-classification of the Union for International Cancer Control (UICC) 1997. 52.8% of patients with esophageal tumors had 3rd and 4^th stages of the disease, with the latter (with celiac metastases) occurred in 27.0% of them. The overall regional frequency of dissemination of esophageal cancer was 44.7%.

All patients were performed subtotal resection (extirpation of thoracic part) of the esophagus with simultaneous plastic posterior mediastinal plasty with a gastric tube. Interventions in the esophagus were made from 2 accesses - abdomino-cervical (84 - 85.7%) or from 3 - with the addition of the right-lateral thoracotomy in the V intercostal space (in 15 - 14.3% of patients).

Duration of postoperative period in operated patients ranged from 8 to 44 days and constituted at average, 22,6 ± 0,9 days. The average postoperative hospital stay of patients with complications was 26,5 ± 1,4 days, without complications - 17,5 ± 0,8 days, that is, 9 days shorter (p <0.01).

There was one fatal termination due to stroke, in a 73 years old patient.

The given direct results of operations show possibility and relevance of the validity and performance of advanced radical interventions, provided technical respectability of the tumor, which is especially important in the group of patients with “late” esophageal cancer. Such criteria as age of a patients, size of primary tumor, its local spread were not contraindications to radical surgery.

RESULTS OF TREATMENT COMBINED POSTBURN CICATRICIAL ESOPHAGEAL AND PHARYNGEAL STENOSIS

SH.SH.JURAYEV, E.U.SHAYKHIYEV, T.A.BAYTILEUOV, T.A.MAMETOVA, E.R.RAKHIMOV

National Scientific Center of Surgery named after A.N. Syzganov, Almaty, KAZAKHSTAN

Introduction. The literature does not fully covers problems of treatment of patients with associated post-burn cicatricial pharyngeal and esophageal stenosis.

The aim of the investigation was to improve the treatment results of combined postburn cicatricial pharyngeal and esophageal stenosis.

Materials and methods. From 1980 to 2009 shunting esophagocoloplasty for postburn cicatricial pharyngeal and esophageal stenosis was performed in 25 patients. Of them 14 (56%) were men, 11 (44%) were women aged between 16 to 47 years. In 15 (60%) patients with burns of the upper segments of gastrointestinal tract occurred because of accidental use, in 4 (16%) patients – deliberately, for the purpose of suicide, the remaining 6 (24%) – under the influence of alcohol intoxication. In 13 (52%) patients acid poisoning took place. Cases of alkali poisoning were observed in 7 (28%) patients, burn by an unknown chemical agent in 5 (20%) cases. The vast majority of admitted patients were underweight.

In view of pronounced metabolic disorders reconstructive rehabilitation interventions were performed in all patients after 4 - 5 months after the first stage of treatment.

Results and discussion. Colotransplantate necrosis in the presented group of patients was not observed. No cases of insolvency of colo-colar, colo-gastric anastomosis were observed. The failure of the anastomosis on the neck was found in 3 (12%) cases. Anastomotic stenosis on the neck was observed in 7 (28%) patients. Anastomotic patency was restored by bougienage. One patient failed to restore patency of faringocoloanastomosis because of complete obliteration of anastomosis. The patient was performed reconstruction of anastomosis. No cases ob fatal outcomes were observed during the study.

Conclusion. Thus, in case of combined postburn cicatricial esophageal and pharyngeal stenoses, shunting esophagocoloplasty, which allows to return more than 90% of patients to normal active life. The feature of the pharyngo-coloanastomosys is its often cicatricial stenosing, thus elimination of gastrostomy during reconstructive restorative treatment is not reasonable.

Date: 2014-12-28; view: 1058