PROBLEMS AND PROSPECTS OF SURGICAL TACTICS DURING THE RUPTURE OF HYDATID CYSTS OF THE LIVER INTO BILIARY TRACT
A.O.OSMANOV, R.A.KOYCHUYEV, R.T.MAJIDOV
Dagestan State Medical Academy, Makhachkala, RUSSIA
Mechanical jaundice in the result of the rupture of coats and elements of the germ of tenia of echinococcosis of the liver into biliary tree, cholangitis against this background, stenosing papillitis, formation of external biliary fistulas in postoperative period, are one of serious complications of surgical treatment of echinococcosis of the liver. 232 patients with biliary complications of liver echinococcosis were treatedin the clinic of general surgery from 1996 to 2010. In order to improve results of treatment in these patients, we applied endoscopic papillosphincterotomy(EPST) in 22 (2.2%) patients. Sizes of hydatid cysts ranged between 5.7 cm - 11.8 cm, had different location in the segments of the liver. All patients underwent open echinococcectomywith external drainage of residual cavity. Indications for EPST were given on the basis of clinical data, dynamic ultrasound, transdrainagefistulography, CT, retrograde cholangiography. Patients were divided into two groups subject to terms of EPST. The first group consisted of 9 patients who were applied EPST before the operation, and the second group included 13 patients, in which EPST was applied at different times after surgery, where maximum deferred EPST was performed on the 36thday after the operation. The first group included 5 patients with break ofchitinous membrane of the parasite into the biliary tree, 3 patients with cholangitis, and 1 patient with symptoms of stenosingpapillitis and persistent manifestation ofcholangioextasy of thebiliary tree on ultrasound.The second group of patients had a long-termbile outflowthrough external drainage in connection with the formation of cystobiliary fistulas. In the first group of patients, execution of EPST was successful in 5 cases, with the removal of the parasite coats with associated cysts of the common bile duct. In the remaining patients of the first group, as in three cases of cholangitis and stenosis papillitis, performance of EPST improvedthe effect of further operations on the second or third days after EPST, due to the decompression of the bilary tract, biliary tree lavage and decrease of effects of jaundice. In the second group of patients after EPST closure of cystobiliary fistulas and stopping of bile outflow through the external drainage was achieved in 7 patients. In four patients, EPST had nosignificant effect, in three cases there was performed additional endoscopic transdrainagefistulocavascopy with laser coagulation of fistulas, repeated surgical intervention with suturing of cystobiliary fistula was required in one case. After EPST all patients were performedendobiliary lavage with ozonized physiological solution in4 mg / literconcentration. The analyzed group of patients two patients had suppuration of the residual cavity, which was settledon the 16th, the 18thday after the operation. Postoperative complications such as formation of external biliary fistulas, no cases of mortality were observed.
ULTRASOUND DOPPLER SCANNING FOR CHRONIC CHOLECYSTITIS DIAGNOSTICS
G.K. OVEZOVA, G.A. SEYITKULIYEVA, G.M MURADOVA
Turkmenistan State Medical University, Ashkhabad, TURKMENISTAN
Introduction: the ultrasound Doppler scanning (USDS) method is a visual one, and it extends its diagnostic facilities, as the direct assessment of a pathologic process in a certain vessel of the basin researched becomes real one. We think that this method of diagnostics may be applied for chronic cholecystitis (CC) patients.
Materials and methods: methodological aspects of the USDS application have been determined to diagnose the functional state of the abdominal aorta branch vessels when CC exists.
21 CC patients (6 men and 15 women) aged 22 to 77 years have been examined. The main disease was diagnosed on the basis of clinical-laboratory and instrumental data. All the patients examined were divided to 2 groups : I group consisted of chronic calculous cholecystitis (CCC) patients – 11 persons; II group consisted of chronic acalculous cholecystitis (CAC) patients – 10 persons. The control group consisted of 17 persons aged 20 to 67 years old, having no liver and gallbladder diseases. The USDS method was applied by using a device by «Philips». High-permeability Abdominal convex sensor was applied for the abdominal cavity examination (Â:3.0/3.75/5.0/6., PW/F:2/5/3/0/3/75/5/0, 60ãð., 60 mmR). The vessel diameter and systolic-diastolic rate (s/d), the index of pulsation (IP), the vascular system resistance index (IR) of the abdominal aorta branches : arteria gepatika communis (agc), arteria gepatika propria (agp), arteria ñistikus (àñ) were measured in the CG patients and persons by applying Doppler scanning in the mode of coloured and energetic mapping.
Results: in the course of the agp and ac studying the reliable (p>0,01) increase of the bloodstream speed in the CAC patients was received : s/d – 24,3±4,3 ml/min.; IÐ – 3,19±1,75; IR- 0,94±0,04 and 2,07±0,05 ml/min; IÐ – 0,73±0,45; IR- 1,53±0,32, accordingly. The control group rates were as follows : s/d – 4,3±0,31 ml/min.; IÐ – 1,85±0,35; IR- 0,59±0,06 – agc; s/d – 3,0±0,60 ml/min.; IÐ – 1,05±0,01; IR- 0,52±0,05 – agð; s/d – 1,95±0,45 ml/min.; IÐ – 0,80±0,03; IR- 0,44±0,04 – añ. More significant increase of the bloodstream speed in the aortas mentioned above was observed in the CCC patients : s/d – 57,6±5,6 ml/min.; IÐ – 1,72±0,06; IR- 0,87±0,05 - agp and s/d – 6,80±0,48 ml/min.; IÐ – 3,53±0,56; IR- 0,91±0,05 - añ.
Conclusion: the USDS method is a safe, noninvasive and reliable method for assessment of the functional state of the abdominal aorta branches. The data received has some features, and if such features are considered then the haemodynamics of an organ may be assessed more objectively when any type of the CC disease exists.