THE CHOICE OF RATIONAL METHOD OF SURGERY FOR ACUTE APPENDICITIS IN PREGNANT WOMEN

I.Y. KHATKOV, S.M. CHUDNIKH, E.S. ALIYEV

Moscow State Medical-Stomatological University, Moscow, RUSSIA

The progress of new endovideosurgical technologies is accompanied with noticeable tendency for revision of conventional approaches to diagnosis and tactics of operative management of acute appendicitis (AA) in pregnant women. In the recent years the more informative and less traumatic mini-invasive methods became more popular in diagnosis and treatment of AA in pregnant women.

Aim of the study: to comparatively evaluate the efficacy of conventional open and laparoscopic appendectomies in pregnant women.

Material and methods: 39 pregnant women 16 – 40 years old underwent surgery due to AA. 10 women were in I trimester, 21 in II trimester, and 8 in III trimester of pregnancy. Patients were divided into 2 groups. I group included 13 (33.3%) pregnant women who underwent diagnostic laparoscopy and laparoscopic appendectomy (LA) together with routine methods of diagnosis. II (control) group included 26 (66.7%) patients with conventional diagnosis and treatment of AA. LA was mostly conducted via 3 trocars. Intraabdominal pressure controlled by insufflator had to do with the duration of gestation. In most of the patients the gas was insufflated by Veress needle to reach 10-12 mmHg intraabdominal pressure. In case of long duration of gestation (III trimester) the open technique by Hasson was applied. In 12 of 13 patients LA was executed by method of ligation and invagination, covering the stump of appendix with peritoneum by purse-string suture. In one patient with early gestation the ligation method with coagulation of the appendix mucosa was executed.

Results: The informativeness of diagnostic laparoscopy was 100%. There was no conversion. There was no complication during and after LA. The comparative evaluation of two techniques of appendectomy applied to pregnant women proves the advantage of laparoscopic method as less traumatic in comparison with laparotomy.

Conclusion: As a mini-invasive method of surgical management of AA in pregnant women LA provides the better course of gestation in postoperative period. Thus, LA is an effective and quite safe alternative to the conventional open operation.

IMMUNOLOGICAL ASPECTS OF THE CONDITION OF PATIENTS WITH ACUTE SURGICAL PATHOLOGY OF SMALL AND LARGE INTESTINE

N.A. KHODJIMUKHAMEDOVA

Republican scientific center for urgent medical care, Tashkent, UZBEKISTAN

Materials and methods. In RSCEMC there were conducted immunological studies in 50 patients. The age of patients ranged between 15 - 96 years. Taking of blood samples for research works was carried out on the first day (at the time of admission) and on the 5-6^th days after surgery. They included the determination of the number of leukocytes and general lymphocytes, selection of lymphocytes from peripheral blood on Ficoll-verografin density gradient (1.077 g/l), lymphocyte phenotyping, using monoclonal antibodies produced by “SORBENT” RF (CD3, CD4, CD8, CD16, CD20, CD25, CD95), entering the panel of CD-markers for the determination of T-lymphocytes, T helper and T suppressor and natural killer cells, B lymphocytes and their functional status, respectively.

Results and discussion. Studies have shown that the severity of the state of quantitative indicators of immune status in patients with urgent abdominal disorders differed by great diversity, associated with both nosological and age characteristics. The results show that in patients before the operation there was observed statistically significant reduction of CD3, CD4, FAN (P <0,01), and increase in CD16, CD20, SD95 (P <0,001). The obtained data allows to consider that in intoxication secondary immune deficiency which manifests itself in the suppression of T-cell immunity with a reduction in the immunoregulatory CD4 + cells develops, while the number of CD8 + cells does not change, which leads to IRI disorder with decrease. There takes place a disorder in the relationship on natural protective factors. As a result of surgical procedures there was determined significant normalization as compared with initial data, the number of leukocytes, and percentage of lymphocytes and natural killer cells (P <0,05) with a trend towards an increase in the absolute number of total lymphocytes (P> 0,05). Significant (at P <0,001) reduction in the percentage of natural killer cells (CD16 + cells) by 58% as compared to the control group, determined the trend of normalization of the relations of the natural protective factors (FAN and CD16 + cells) after surgery. After surgery, patients still had por condition of the immune status, which is characteristic for secondary immunodeficiency. This, in turn, shows the need for maintenance of immunotherapy according to individual clinical and immunological parameters. Conducted clinical and immunological comparison showed that the level of depression of cellular immunity and the severity of the disbalance of immunoregulatory subpopulations of T lymphocytes directly correlat with the clinical condition.

COMPLEX TREATMENT OF LIVER METASTASISES IN COLON CANCER WITH APPLICATION OF THE TRANSCUTANEOUS RADIO TERMOABLATION WITH INTERSTITIAL CHEMOTHERAPY

O.I. KIT, V.E. KOLESNIKOV, F.N. GRECHKIN,

N.V. SOLDATKINA

Rostov Scientific and Research Oncology Institute, Rostov-on-Don, RUSSIA

Introduction. Stable increase in the number of patients with unresectable metastases of colon cancer into liver makes the search of effective treatment methods actual. Aim of the study – improvement of the results of treatment of patients with unresectable metastases of colon cancer into liver by the application of a comprehensive treatment, including radio frequency thermoablation with interstitial chemotherapy on autoplasma.

Materials and methods. Information about 35 patients aged between 32 - 72 years, earlier treated for colon cancer (T3-4N0-2M0) by comprehensive method with revealed unresectable metastases with a diameter of 16 to 60 mm into liver. 15 patients (main group) were performed percutaneous radiofrequency thermoablation by the standard procedure under ultrasound control, after the completion of which through the infusion pump in a electrosurgical device in the bed of metastasis subjected to thermal destruction of metastasis was injected incubated autoplasma 5- fluorouracil (13.5 mg/kg), at the same time there was injected oxaliplatin (85mg/m2) by intravenous stream method. Further the patients received multicourse chemotherapy by FOLFOX diagram. The control group - 20 patients who received only multicourse chemotherapy by FOLFOX diagram.

Results. In the study group complications were revealed in 1 patient (liver abscess). In 3 (20%) patients of the main group with initial sizes of metastases less than 30 mm, after treatment in repeated ultrasonographies of the destruction zone were not visualized, and SCT identified homogenous formations in the area of ​​destruction, do not accumulate the contrast. With sizes of metastases less than 30 mm, total destruction was achieved in 100%, with size 30 - 50mm – in 90%, with sizes over 50mm – in 75%. Of the 36 metastases complete necrosis was detected in 94.4%. Within 12 months of observations in the study group, progression of the disease was revealed only in 1 (6.7%) patient, in the control group - in 8 (40%) patients. Period before progression in the main and control groups constituted 7 and 3 months respectively.

Conclusions. 1) Application of the complex treatment, including RFTA with interstitial chemotherapy on autoplasma with isolated unresectable metastatic lesion of liver by colon cancer allows to increase recurrence-free period and reduce frequency of progression of the disease 2) The most effective is the method of RFTA with interstitial chemotherapy with sizes of liver metastasis up to 30 mm.

Date: 2014-12-28; view: 684