PANCREATOGASTROSTOMY IN PROXIMAL PANCREATICODUODENECTOMY

N.LOMIDZE, I. TSERETELI., Z. MANIJASHVILI

Tbilisi State Medical University. Ltd Academician N. Kipshidze Central University Clinic

Tbilisi, GEORGIA

During the Last twenty years we have witnessed the vivid development of surgical judgment and attitude towards the pancreas disease. With the introduction of new technologies in diagnosis (CT,endoscopic US ,MRT,PAT) and experience gained in pancreoduodenal resection, the rate of post-operational complications are reduced to 5%, in comparison with 60-70 years of the 20th century, when the rate of mortality was 20-25% and more. In the literature exists many pancreatodigestive methods of reconstruction after pancreatoduodenal resection. Pancreatogastroanastomosis lately is gaining more and more popularity. Many surgeons consider the results from pancreatogastroanastomosis to be hoping.

In surgical department of University clinic after Academician N.Kipshidze from 2004 has been performed by us different variants of pancreatoduodenal resection, and from 2010 has been made proximal resection of the pancreas for the tumors of the bileopancreatic zone of different nature, with the formation of sutureless pancreatogastroanastomosis in three patients at the stage of reconstruction. After standard (Whipple) pancreatoduodenalresection at the reconstructive step, the key moment, often defining the outcome of the operation, has been the mobilization and treatment of pancreatic body till 4 centimeters. On the posterior wall of the respected stomach is made a hole with the diameter smaller then the diameter of pancreatic body. Around the hole at the posterior wall of the stomach, from the side of serous layer is made serous-muscular kisset suture. From the interior side of the stomach's wall was made the same mucosa-submucosal kisset suture with the monofilamentous thread 3.0 on the nontraumatic needle. After inserting of the stump of pancreas in the hole of the posterior side of the stomach, kisset suture was tied up. In order to interfere the pressure on the lumen of the gland, a tube of the corresponding diameter could be inserted in the lumen and after fastening kisset suture could be removed. Other steps of the reconstruction are standard. While the formation of the suturless pancreatogastro anastomosis, there is no necessity to make sutures between pancreatic stamp and stomach, because two kisset sutures on the posterior wall of the stomach induce reliable hermetics without disturbance of the trofica of the gland and problemless drainage of pancreatic secretion in the stomach. While formation of pancreogastroanastomosis their inconsistency was not seen. The advantage of pancreogastroanastomosis is a good blood circulation of stomach, low intralumenal pressure, prophylaxis of the acute pouring of base secretion of pancreas in the stomach.

Chronic diffuse diseases of liver and cytolyTIC SYNDROME ACCORDING TO prophylactic survey OF THE POPULATION OF MOLDOVA

I. LUPASCO

State University of Medicine and Pharmacy "N. Testemitanu" Chisinau, MOLDOVA

Introduction: In the 80-90s the mortality rate in our country was 70-80/100000 population. After the collapse of the Soviet Union this data began to grow progressively, reaching 101.8/100000 population in 2006.

The aim: To examine the morbidity nature among residents of Moldova, living in different regions.

Materials and methods: A routine inspection of 1451 people living in different areas of Moldova has been carried out with the help of clinical, laboratory and instrumental methods. For this purpose was developed and put into practice a special questionnaire, containing more than 1000 characters. In order to assess the cytolytic syndrome we studied the transaminase (ALT, AST) and histidaze activity.

Results: In 1451 people from various regions of the Republic of Moldova, chronic diffuse liver diseases (CDLD) were detected in 41.01% (595). Among patients with CDLD predominated patients with hepatopathy - 51.60% and chronic hepatitis (CH) - 26.72%, rarely diagnosed steatosis - 18.32% and liver cirrhosis (LC) - 3.36%. Determination of ALT and AST levels in patients with CDLD showed their maximum activity in CH, while histidaze – in LC, in comparison with those of other groups and control values. It was established the influence of the male gender on the increased ALT activity in patients with LC, CH and hepatopathy in comparison with those of women. Age older than 40 years with CH led to more meaningful than in the group of patients younger than 40 years increased levels of ALT and AST.

Discussion: The data obtained shows that the majority of patients with CH do not know about the disease, do not address for medical help and do not receive adequate therapy, which leads to disease progression and poor prognosis. The results presented above have revealed a number of risk factors among surveyed persons with CDLD, such as the male gender and older age.

Conclusions: Among the healthy population the number of patients with CDLD is much higher than data from official reports submitted to the Ministry of Health of the Republic of Moldova. There is a strong necessity of alertness in terms of identification or early diagnosis of CDLD, not only for hepatologists, but, above all, for primary care physicians in outpatient clinics.

Date: 2014-12-28; view: 942