S.I. HADIYEV., E.A. ABDINOV, K.H. SARIYEVA

Azerbaijan Medical University, Baku, AZERBAIJAN

Draining of abdominal cavity after carried out operation in abdominal surgery preserves its treating, diagnostic and preventive importance during laporoscopic cholecystectomies. Scientific researches are being carried out on application of draining in Laporoscopic cholecystectomies (LXE) and improvement of its efficiency. Draining of abdominal cavity in Laporoscopic cholecystectomies (LXE) carried out for the reason of cholecystitis with acute concrement should ensure stable position of a drain lower part of liver, in view of gall-bladder bed. And this in its turn helps to prevent in time formation of suppurative exudate, excess of necrotic tissue, in case of gall flow abcess under liver, biloma and peritonitis. In cases of complicated form of cholecystitis with acute concrement (phlegmonous cholecystitis, thick joinings around the sack, infiltrate around sack neck, cholecystopancreatitis and etc.), if operation processes technically hard draining of abdominal cavity is more important in postoperative period. In order to prevent such complications drain should be placed in such a way that in postoperative period its dislocation probability be minimum. 415 LXE was invented in the years of 2007 – 2010, so that operation has been carried out within 1-14 days beginning from starting day of disease. While draining abdominal cavity with the purpose of elimination risk of formation of local complications in postoperative period in LXE III trocar is placed in definite direction and under such an ankle in abdominal cavity that upon completion of operation when placing silicone drain pipe through this hole does not form crease, its conductivity is normal, its end is in vinslov hole and lower side holes is in level of sack artery and remainder of its flow and upper holes are in the level of sack bed. Outside end of a drain tied to skin close to section. Drains have been applied in 154 LXE executed by us in relation with complicated forms of cholecystitis with acute concrement and in case of technically hard operation process at the result of inflamed-degenerative changes, so that in this case no nay complication and reoperation in postoperative period have not been observed. So drains ensure valid draining and sanitation in an area of surgical intervention.

METHOD OF PROPHYLAXIS OF EARLY AND LATE POSTOPERATIVE COMPLICATIONS IN BILIARY SURGERY IN EMERGENCY MEDICINE

A.M. HAJIBAEV, H.A. AKILOV, F.A. HAJIBAEV, N.A. HODZHIMUHAMEDOVA

Republican scientific center of emergency medical care; Tashkent, UZBEKISTAN

In RSCEMC a method of formation of biliary-enteric anasthomosis by means of a carcass metal ring was applied in 26 patients. Experimental morphological studies, confirming the possibility of its use in the clinic (patent № FAR 00 305 "A device for anasthomosis of gastrointestinal tract," patent № IAP 04 332 "Method of applying of biliary anasthomosis") were carried out previously. The method consists in formation of anasthomosis, installing of metal carcass, where carcass is installed as a ring in the region of biliary-enteric anasthomosis from outside and is fixed by interrupted sutures. In 6 patients were imposed biliodigestive and bilioenteroanasthomoses with a metal carcass during the operation of pancreaticoduodenal resection. The proposed method of formation of biliary-enteric anasthomosis has been used in 20 more patients after choledochal resection due to PChES and iatrogenic injuries of a common bile duct (12), as well as choledochal cysts (8). In all 26 patients ultrasonography has shown an extension of common bile duct, the width of which varied from 10 to 35 mm. Expansion of intrahepatic bile ducts was found in 9 patients. According to preoperative ultrasound examination volume formations in liver parenchyma were not found. For assessing the condition of bile ducts at various times after the surgery, all patients underwent ultrasound examination of liver, extrahepatic bile ducts, pancreas, and zone of biliodigestive anasthomosis. In no one case sonography has revealed an expansion of extrahepatic bile duct, the diameter of common hepatic duct was 5-7 mm. According to ultrasonography the width of anasthomosis ranged from 10 to12 mm. Moreover, 8 patients in the period from 3 months to 1.5 years after the surgery underwent MCT- in both cases the expansion of bile ducts were not detected.

In conclusion it may be noted that the formation of biliodigestive anasthomoses with aapplication of a ring is an effective measure of prophylaxis of failure and stenosis of biliary-enteric anasthomosis.

Date: 2014-12-28; view: 1046