QUALITY OF A LIFE OF CHILDREN HEALTH STATUS WITH CHRONIC VIRAL HEPATITIS

N.V. SAVVINA, T.G. DMITRIEVA, L.G. MARINOVA

Institute of postgraduate medical education, North-East Federal University, Yakutsk, RUSSIA

Introduction: Viral hepatitis is traditionally one of the most actual problems of health care organization. Viral hepatitis in childhood, it is now not only medical but also social problem. Due to the discovery of a universal criterion for the assessment of the basic functions of a person (physical, psychological, social and spiritual), called Quality of life, an opportunity to assess subjective indicators of health and general welfare of the population, the study of which is a new topical area of ​​interdisciplinary research in the national health care.

Materials and methods: Assessment of quality of life of children with chronic viral hepatitis carried out with general international questionnaire Pediatric Quality of Life Inventory - PedsQLtm4.0 (Varni et al., USA, 2001). We use the Russian version of the general PedsQL questionnaire for children 8-18 years. The total amount of marks after procedure of recoding was settled accounts on a 100-marks scale. The statistical analysis of research results was conducted by the program Microsoft Excel XP and program SPSS version 13.0 for Windows.

Results and discussion: In children with chronic viral hepatitis are statistically significant decreased physical functioning, depending on the availability of collateral and the severity of concomitant diseases on the responses of children (<0,05) and parents. Depending on the disability of another disease, suffer from social functioning on the responses of children (<0,05) and parents (<0,01). Boys 8-12 years revealed the same reduction in social functioning on the responses of parents (<0,01). Role functioning suffer in both age groups, depending on the sex, more boys on the responses of parents (<0,05). The responses of parents, presence of disability for hepatitis decrease the quality of life on all scales (total score <0.002). A comparison of life quality parameters of children with chronic viral hepatitis with healthy children is estimated. Quality of life in children with chronic viral hepatitis compared with healthy children aged 8-12 years from the responses of children as a whole decreased by 20,9 %, more suffering role functioning. At the age of 13-17 years is worse as a whole at 5,8 %, while the study showed that the emotional background is better to 10,4 %.

Conclusions: Thus, as demonstrated by a case study, quality of life in children with chronic viral hepatitis in general worse than in healthy children. There are more issues concerning school life (role functioning), which is associated with frequent omissions on medical grounds. Children with disabilities decreased quality of life anymore.

RESULTS OF SURGICAL MANAGEMENT OF BILE DUCT INJURIES
OCCURRED DURING LAPAROSCOPIC CHOLECYSTECTOMY

M. A. SEISEMBAYEV, B.A. NARZHANOV, D. S. TOKSANBAYEV, O.T. IBEKENOV,

N. U. AUELOV, A.S. ISBAMBETOV

National Scientific Center of Surgery n.a. A.N. Syzganov, Almaty, KAZAKHSTAN

Objective: To improve results of surgical management of bile duct injuries occurred during surgical interference.

Materials and methods: We have an experience of treatment of twenty one (21) patients suffering from iatrogenic injuries of bile ducts occurred during laparoscopic cholecystectomy were undergoing treatment in the department of the liver, bile ducts and pancreatic diseases surgery of NSCS. Nine (9) patients were transferred from other clinics in 5 to 12 days after bile ducts injury, with peritonitis.

Results: Types of bile ducts injuries are the following: 9 patients with parietal wound, 7 patients with complete bile duct transection, 3 patients with bile duct clipping, and 2 patients with coagulation necrosis. Parietal wounds were treated as follows: 3 patients had a primary suture of the common bile duct, with a drain; 3 patients had hepaticojejunostomy. Patients with complete intersections and bile peritonitis were cured as follows: four (4) patients had hepaticojejunostomy, and for three (3) patients, the external bile drainage was performed followed by hepaticojejunostomy. For cases of complete clipping, 2 patients had hepaticojejunostomy, for 6 patients suffering from obstructive jaundice various hepaticojejunostomy was performed after they have stabilized.

Afterhistory is available for 12 patients: 7 patients described themselves in a good status of health, condition of 2 patients is satisfactory. Obstruction of bile ducts developed in three (3) patients in 6-18 months after the original choledochoplasty repair, and thus repeated reparative operation was required.

Conclusion: Parietal wounds may be treated by way of sealing and draining the bile duct. For cases of complete bile duct transection, primary plastic repair of a bile duct may cause stenosis in the distant future. The operation of choice is hepaticojejunostomy to be performed using high-precision surgical techniques and monofilament suture materials.

SELECTION OF THE SURGICAL APPROACH FOR THE MANAGEMENT OF RESIDUAL CAVITY DURING SURGICAL TREATMENT OF HYDATID DISEASE

M. SEISEMBAYEV, D. TOKSANBAYEV, R. BARLYBAI, E. MOLDABEKOV, Zh. BAIMAKHANOV

National Scientific Center of Surgery n.a. A.N. Syzganov, Almaty, KAZAKHSTAN

Objective: To justify selection of the approach for the management of residual cavity and the optimal surgical treatment of hydatid disease.

Materials and methods: We carried out 283 various surgical interferences for hydatid disease of liver. The original hydatid disease of liver was registered with 236 patients (83.4%), and recurrent with 47 persons (16.6%).

Results: Laparoscopic echinococcectomy of the liver was performed for 19 patients. Endoscopic video-assisted resection of the cystis paries and catchment of the residual cavity was performed for 3 patients. Four surgeries were performed in combination with omentohepatopexy, and 12 – with the total pericystectomy. Cysto-biliary fistulas were not identified.

Traditional echinococcectomy and capitonnage of the residual cavity was performed for 258 patients, total pericystectomy for 25 persons, sub-total pericystectomy for 8 patients, left caval lobectomy for 3 persons, and combined surgical interferences for liver – for 4 patients.

During laparoscopy, specific complications were not identified. Complications in patients who got traditional echinococcectomy amounted to 9.2%, including purulent exudates observed in 16 patients (61.5%).

During the observation period of patients who had recurrent disease, 4 operations (1.6%) were performed in patients who got capitonnage of residual cavity previously (at various times). Patients who got pericystectomy did not have recurrent disease. No fatal cases occurred.

Conclusion: The surgical approach for the management of residual cavity in case of hydatid disease is the resection of fibrous capsule until healthy tissue of the organ is reached (pericystectomy, liver resection). A brief positive experience of minimally invasive laparoscopic echinococcectomy of the liver provides for the future development of that trend in the Clinic.

SELECTION OF THE SURGICAL APPROACH
FOR THE MANAGEMENT OF LIVER HEMANGIOMAS

M.A. SEISEMBAYEV, D.S. TOKSANBAYEV, A.T. CHORMANOV,

N.K. SADYKOV, A.S. ISBAMBETOV

National Scientific Center of Surgery n.a. A.N. Syzganov, Almaty, KAZAKHSTAN

Objective: To improve the results of surgical treatment by way of selecting conservative surgery for the management of liver hemangiomas.

Materials and methods: We possess the experience of 79 operations for the management of liver hemangiomas, including 13 conservative operations (enucleation): laparoscopic operations for 2 patients, and open operations for 11 patients.

The size of hemangiomas varied from 6 to 28 cm. Indications for enucleation were hemangiomas over 5 cm in size, availability of clinical signs and very fast dynamics of a hemangioma. Laparoscopic enucleation was performed if a hemangioma was located in an accessible segment of the liver and less than 10 cm in size. Otherwise, an open operation was performed. Surgical treatment of liver hemangiomas by enucleation was performed using ultrasonic scalpel, clipping of vessels, and Pringle maneuver for the reduction of the size of giant liver hemangiomas and blood loss during enucleation. Vascular bed of the hemangioma was treated with argon beam coagulator. Also, TachoComb hemostatic plate was used during the operation.

Results: The average blood loss, average duration of an operation and frequency of operations were analyzed. The average blood loss was 182±27 ml, the average operation duration was 144±18 min. During the laparoscopic enucleation the average blood loss was 80 ml, and the average duration of the operation was 90 min maximum. In the post-operative period, the outflow of bile under control was identified in 1 patient (7.7%) who had a giant hemangioma. Active surgical interference for the management of postoperative complications was not required. No fatal cases occurred.

Conclusion: Therefore, conservative surgery for the management of liver hemangiomas (enucleation) is the operation of choice on condition that sufficient experience is acquired and all necessary equipment and technologies are available.

Date: 2014-12-28; view: 868