METHODS OF IMPROVEMENT OF SURGICAL TREATMENT AND DIAGNOSIS OF CICATRIX STRICTURE OF BILE

M.M. ZEYNALOV, P.A. ABBASOV

Scientific Surgical Center named after M. A. Topchubashov, Baku, AZERBAIJAN

We carried out research of inspection and surgical treatment of 230 patients between 16-75 ages having cicatrix stricture of bile in 1980-2010 years. Symptoms of 37,8% of these patients were evaluated as heavy, 62.2% medium-heavy. Symptoms of Cicatrix Stricture of Bile (between 230) jaundice was found at 198 patients, severe syndrome at 180 patients (82.6%), hepatomegaly at 115 patients (50%). We carried out 892diagnostic inspections at these patients. We made echography to all 230 patients, at 210 patients gastroduodenoscopy 80%, skin and liver Cholangiography at 12.1% patients, roentgenography of gastrointestinal at 122 patients 53.4% has been carried out. Appearance of stricture happened at 210 (91.3%) patients after cholecystectomia, at 11 patients (4.7%) after stomach resection, at 9 patients (3.9%) after echinococcectomy and etc. Hepatomegaly, mechanical jaundice happened at 179 patients between 2-10 days. Bile fistula appeared at 57 patients (24.7%). Liver Abscess at 29 patients (12.6%), bile peritonitis at 50 patients (21.7%) appeared. We prepared special improved wired stylet for “stylet bougie and transhepatic drainage” of bile duck bougie. It has been used at 56 patients successfully. Here are the operations carried out at out clinics in accordance with the cicatrix stricture of bile: resection of narrowed bile duct at 32 patients (13.9%), setting up to 28 patients hepotikoduodenoanastamosis (12.1%), Hepaticoyeyunoanastomosis at 82 patients (35.6%). Otherwise, anastomoses were put over the carcass drainages at 110 patients. Saypol-Kurian method preferred during these operations. The research indicated that Hepaticoyeyunoanastomosis put with this bowels buttonhole isolated over the carcass drainages and carried out with Saypol-Kurian method indicated best result.

CLINICAL EXPERIENCE OF CHRONIC HEPATITIS B TREATMENT WITH ENTECAVIR IN RENAL TRANSPLANT RECIPIENTS

M.L. ZUBKIN¹, E.P. SELKOVA¹, T.A. SEMENENKO¹, V.I. CHERVINKO¹, A.V. FROLOV²,

T.P. NEKRASOVA³, A.N. KOLOMOETS¹, F.K. KOKOEVA¹, E.M. BALAKIREV⁴

G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology¹, Moscow City Nephrology Center, City hospital No 52², I.M. Sechenov First Moscow State Medical University³, N.V. Sklifosovsky Research Institute for emergency medical aid⁴, Moscow, RUSSIA

Background: chronic hepatitis B (CHB) significantly impairs clinical outcome of renal transplantation (RT). Due to the high risk of allograft rejection on interferon therapy and the high frequency of lamivudine (LAM) resistance new treatment options for CHB patients after renal transplantation are needed. The study aimed to assess efficacy and safety of entecavir (ETV) in kidney allograft recipients (RT recipients) with CHB.

Patients and Methods: 4 RT recipients with CHB (2 males, 2 females, from 28 to 44 years old) received ETV therapy starting 71.5±36.9 months after RT. Two patients with biochemical remission after previous LAM treatment who were found to acquire the YVDD mutation received 1 mg of ETV daily. One of the patients was HBeAg-negative before the LAM therapy, another patient became HBeAg-negative on LAM treatment. The baseline viral load before ETV therapy was in these 2 patients 1.6´10³ and 3.9´10⁴ cop/ml, respectively; METAVIR fibrosis score was 1 in both patients. Two other naïve HBeAg-positive RT recipients with HCV co-infection received 0.5 mg of ETV per day. Theirs baseline characteristics were: ALT 98 and 149 IU/l, HBV DNA levels 1.6´10⁹ and 1.0´10⁸ cop/ml, respectively and METAVIR fibrosis score was 1 in both patients. The baseline GFR estimated by MDRD calculation was above 60 ml/min for all 4 recipients.

Results: two LAM pre-treated patients with normal aminotransferase (ALT) who had low HBV DNA level at baseline received ETV for 13 and 23 months, respectively. After 6 month of the ETV therapy the HBV DNA level became undetectable. Two naive RT recipients received ETV treatment for 26 and 24 months, respectively. They achieved biochemical remission of CHB after 10 and 15 months of therapy and an undetectable level of HBV DNA after 25 and 23 months of therapy, respectively. In one of them HBeAg seroconversion has occurred. No adverse events were detected on ETV therapy in any patients. The allograft function remained stable in 3 patients and decreased in one RT recipients after an acute rejection due to reduction in dosage of immunosuppressant therapy.

Conclusions: short-term ETV therapy showed high efficacy and safety for CHB patients after RT. Additional long-term evaluation and clinical trials are needed.

Date: 2014-12-28; view: 868