IDENTIFICATION OF SURGICAL TACTICS

A.O.OSMANOV, R.A.KOYCHUYEV, R.T.MAJIDOV

Dagestan State Medical Academy,Makhachkala, RUSSIA

67 patients with perforated hydatid cyst into the abdominal cavity, which constituted 6.8% of all complications of hydatic cyst of the abdominal cavity were treated at the clinic of general surgery of the Dagestan state medical academy from 1996 to 2010. Age of patients ranged between 15 - 65 years. Spontaneous rupture of the cyst was observed in 44 patients, break of the content ofhydatid cyst to the abdomen due to trauma - in 23 patients. Patients were admitted to hospital within the first days after the moment of appearance first symptoms of the disease. The clinical picture was characterized beginning from the development of anaphylactic reactions to express peritoneal signs.Ultrasound investigation, CT, MRT are of diagnostic value for the identification of the perforation of hydatid cysts and help to detect signs of detachment of a chitinous shell from fibrous capsule. In difficult cases, laparoscopy may serve as one of the diapeuticcal methods. Surgical treatment within 6-12 hours from the moment of admission. Primary hydatid disease was observed in 65 (97.01%) patients, recurrent - in 2 (2.9%). Monocysticechinococcosis was detected in 56 (83.5%) patients, and multiple cysts - in 11 (16.4%) patients. Cysts with sizes larger than 10 cm in diameter were found in 23 (34.3%) patients, two large cysts - in 3 (4.4%), and one cyst with diametermore than 10 cm in combination with smaller diameter cysts in 6 (8.9% patients). In 9 cases the final diagnosis of break of germinal elements into the abdominal cavity was set by means of diagnostic laparoscopy, where partial emptying of the liquid contents of the cyst took place in the resultofmicroperforation and closing of perforated holes by surrounding organs or chitin coat.In all cases, surgical intervention consisted of wide laparatomy, open echinococcectomy, thorough sanation of the abdominal cavity. Patientswere divided into two groups subject to the treatment of the abdominal cavity. The main group consisted of 30 patients.Abdominal cavity was irrigated with ozonized physiological solution, which was prepared directly during surgical intervention. In the control group, consisting of 35 patients, sanationof the abdominal cavity was carried out by traditional methods. Long-term results were traced in 65 patients. The effectiveness of treatment and lack of recurrence of thehydatid disease of the abdominal cavity in the main group of patients was proved in 86.3% of cases, and in 66.0% in the control group.

FATE OF RESIDUAL CAVITIES OF LIVER AFTER ECHINOCOCCECTOMY IN CASES OF LARGE PARASITIC CYSTS

A.O.OSMANOV, R.A.KOYCHUYEV, R.T.MAJIDOV

Dagestan State Medical Academy, Makhachkala, RUSSIA

In order to select an optimal surgical treatment of large cysts of the liver we analyzed the results of treatment of 889 patients with echinococcosis of the liver, which were under our observation within the past 13 years. Among the patients observed by us, primary hydatid cyst was encountered in 811 (91.2%) patients, recurrent - in 78 (8.8%). Monocysticechinococcosis was diagnosed in 648 (72.9%) patients, and multiple cysts - in 241 (27.1%) patients. Cysts larger than 15 cm in diameter were in 233 (26.2%) patients, of themsingle liver cysts were observed in 174 (74.6%) patients, two large cysts - in 25 (10.9%), one cyst larger than 15 cm in diameter in combination with smaller diameter cysts in 34 (14.5%) patients. All patients were divided into two groups: main group (127 patients), which was performedechinococcectomyof liver without the reduction of fibrous cavity. The control group (106 patients) - an open echinococcectomyof liver with a reduction of the residual cavity. Of them, partial pericystectomy, invagination, capitonnagewere performed in 76 patients, complete elimination of the residual cavity by capitonnage method - in 30 patients. In the main group of patients the amount of the residual cavity on the 5^thday after the operation constituted 75.6% of the initial (p <0,05), on the 10^thday of 63,4% (p <0,05), on the 15^thday 57,2% (p <0,05). Cystobiliary fistulas were observed in 107 (84.2%) (DI_95% = 0.7%: 0.89%). Suppuration of the residual cavity was observed in 23.7% of patients (DI_95% = 0.16%: 0.35%), which wereperformed sanation of the residual cavity withozonized physiological solution in postoperative period. Complete reduction of residual cavities in the main group was achieved by the 43^rd ± 17 day (p <0,05). Drainagetubeswereremovedinthesameperiod.

In the control group of patients, opening of the sutured cavity in the postoperative period occurred in 32 (30.2%) patients (DI_95% = 0,25:0,46), of them, complete elimination of the residual cavity was performed by capitonnagemethodin 13 patients (DI_95% = 0,6:0,2), external drainage of reduced residual cavity - in 19 patients (DI_95% = 0,11:0,27).

High efficiency of surgical treatment in the main group of patients was constituted by 76.3%, in the control group - in 66.0%. Terms of treatment of patients in the main group of patients constituted 43 ± 17 days (p <0,05), and in the control group - 54 ± 11 days (p <0,05).

Date: 2014-12-28; view: 951