FEATURES OF MULTISTAGE SURGICAL TREATMENT OF MULTIPLE ABDOMINAL ECHINOCOCCOSIS

M.I. MALANKA, A.V.DYADKOV, E.A.CHUKHRYAEV, A.V.POPOV

Stavropol State Medical Academy, Stavropol, RUSSIA

According to different authors, the occurrence rate of multiple echinococcosis varies from 5.9 to 30%, with 90% of multiple lesions accounted for the abdominal cavity and its organs. The principle of multi-stage surgical treatment of multiple abdominal echinococcosis is applied if it is not possible to remove all the cysts simultaneously.

Materials and methods. A group of 152 patients treated at the clinic for multiple abdominal in 1991-2010 years was analyzed. In 23 of 75 patients operated for primary multiple echinococcosis, and 25 of 77 operated for secondary-multiple lesion, a multistage surgical treatment method was used as a residual.

Results and conclusion. Planned surgical treatment was held in two stages in 18, in three stages - in 11, in four stages - in 6, in five stages - in 6, in six stages - in 4, and more - in 3 patients of the common group with residual cysts in the abdominal cavity. Totally, there were performed 170 staged operations. In secondary multiple abdominal echinococcosis, the number of staged operations was significantly greater (57.7%) than in primary-multiple (42.3%) lesion (p <0,05). This is due to the greater prevalence of the parasitic process in the abdominal cavity with a secondary-multiple lesion. Within the first year after the first operation, staged operations were performed in 12 (25.0%) patients of the common group with multiple cysts of the abdominal cavity, within the second year - 22 (45.8%), third year - 11 (22.9%) and later - 3 (6.3%) patients. Thus, over 70% of patients completed staged treatment of multiple abdominal echinococcosis within two years after the diagnosis of multiple feature of pathology and the first non-radical operation. For the staged treatment of multiple abdominal echinococcosis a special complexity of the technique of surgical interventions is characteristic because of the expressed commissural process in the abdominal cavity. First of all, easily accessible cysts, complicated cysts shall be removed in the first operation, and cysts located far from the zone of surgical access, due to technical difficulties of the elimination of their residual cavities are left in place as residual and are removed by stages after 3-4 months from more convenient surgical access and under more favorable conditions for patients.

RESULTS OF LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS

M.M. MAMAKEEV, E.A. TILEKOV, R.K.JORTUCHIYEV, J.A.CHINGISHEVA

National Surgical Center, Bishkek, KYRGYZSTAN

We analyzed the experience of 3567 laparoscopic cholecystectomies (LCE), performed in NSC of the MH of the RK in the period from 1996 to 2010.

The age of patients was 13-79 years, of which 3060 were women (85.8%), 507 (14.2%) were men. Acute cholecystitis (AC) was diagnosed in 2775 (77.8%). 767 (21.5%) patients were operated for acute calculous cholecystitis, 2386 (66.9%) - acute phlegmonous cholecystitis, 414 (11.6%) - acute gangrenous cholecystitis. Destructive forms of AC were in 2800 patients, that is 78.5%.

On the admission based on the clinical picture and ultrasound data, indications for urgent surgery are given or conservative treatment is carried out within 12-24 hours (at night, in the absence of express destructive changes in the gallbladder wall (GB) during ultrasound, refusal of a patient from surgery). In case of rapid relief of symptoms urgently LCE is carried out after 48-72 hours.

The total number of complications constituted 175 (4.9%), them 25 (0.7%) were life-threatening. Complications during the operation occurred in 93 (2.6%) patients, of them: injuries of the portal vein in 2 (0.06%), injury of the hepaticocholedoch - in 11 (0.3%), failure of the cystic duct stump in 5 (0 , 1%); bleeding from the cystic artery in 26 (0.7%); from additional cystic artery - in 17 (0.6%); from the bed GB - in 23 (0.6%); outflow of bile from the bed of GBin 9 (0.2%). Transition to laparotomy was performed in 172 (4.8%) patients. In the postoperative period complications were observed in 82 (2.3%) patients, of them: subhepatic abscess in 32 (0.9%); subhepatic infiltrate in 20 (0.6%), pneumonia - in 6 (0.1%) ; adhesive deformation of the duodenum with symptoms of CDI in 14 (0.4%). Relaparotomy was performed in 10 (0.3%) patients.

The introduction of laparoscopy lead to the increase of surgical activity in AC from 54.5% to 88.6%, with the increase of the special weight of LCE from 11.5% to 94.5%. Duration of hospital stay of patients with acute cholecystitis are directly dependent on the duration of disease before surgery and at average 2 times lower than in the open CE. Thus, the LCE is the operation of choice for acute cholecystitis.

Date: 2014-12-28; view: 1216