RESUMO
An acute postresection hepatic insufficiency (PHI) constitutes a necessary moment before the hepatic resection planning, permits in some situations to conduct prophylactic measures and to avoid this severe complication. Possibility of PHI occurrence was prognosticated for results of surgical treatment improvement in patients, suffering focal hepatic affection, using introduction of certain preoperative preparation and surgical tactics. The main task of the investigation was to determine the diagnostic and prognostic value of the investigation methods and elaboration of prognostic algorithm of an acute PHI occurrence.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Equinococose Hepática/diagnóstico , Insuficiência Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias/diagnóstico , Complicações Pós-Operatórias/patologia , Doença Aguda , Adulto , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Equinococose Hepática/mortalidade , Equinococose Hepática/patologia , Equinococose Hepática/cirurgia , Feminino , Hepatectomia/métodos , Insuficiência Hepática/etiologia , Insuficiência Hepática/mortalidade , Insuficiência Hepática/patologia , Humanos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/patologia , Neoplasias/cirurgia , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Basing on analysis of own material (84 patients) and data of literature there was established, that vascular invasion by pancreatic tumors constitutes the main obstacle for conduction of the patients' radical treatment. Early diagnosis permits radical resectability of the patients, what constitutes the only one effective method of treatment. In vascular invasion by tumor a surgeon experience and professional preparation determines possibility of the extended operation performance with intervention on affected main vessel, enhancing the treatment radicalism.
Assuntos
Adenocarcinoma/diagnóstico , Carcinoma Papilar/diagnóstico , Neovascularização Patológica/diagnóstico , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Carcinoma Papilar/irrigação sanguínea , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/patologia , Neovascularização Patológica/cirurgia , Pâncreas/irrigação sanguínea , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Neoplasias Pancreáticas/irrigação sanguínea , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/patologia , Artéria Esplênica/cirurgia , UltrassonografiaRESUMO
Basing on own material analysis (386 observations) and the literature date there was established, that hepatic resection occupies the first place in treatment of the organ focal affection, together--nontumoral and a tumoral one. The treatment of all kinds of focal hepatic affection must be expanded in a specialized clinic in the Ukraine. The main task of the investigation was to determine a permissible volume of hepatic resection, depending on functional state of the organ parenchyma, improvement of existing and elaboration of a new methods of operative intervention, directed on the complications prophylaxis and the hepatic function preservation.
Assuntos
Carcinoma Hepatocelular/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Insuficiência Hepática/etiologia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias , Sarcoma/cirurgia , Adulto , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/secundário , Colangiocarcinoma/mortalidade , Colangiocarcinoma/secundário , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/secundário , Neoplasias Colorretais/cirurgia , Feminino , Insuficiência Hepática/mortalidade , Insuficiência Hepática/patologia , Humanos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/secundário , Neoplasias Pancreáticas/cirurgia , Sarcoma/mortalidade , Sarcoma/secundário , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/secundário , Neoplasias Gástricas/cirurgia , Análise de Sobrevida , UcrâniaRESUMO
Remote results of surgical treatment of patients, suffering locally spread forms of pancreatic malignancies (PM), using different approaches, were analyzed. In retrospective investigation were included 84 patients with PM and invasion of the main vessels. In the group Ð patients palliative operations were performed, including in a subgroup Ðа cryoablation of PM, in a subgroup Ðb palliative pancreatic resection with leaving the tumor on the main vessels intact; and in patients of group ÐÐ the tumor was resected radically, including in a sub* group ÐÐаpancreatic resection or total pancreatectomy with resection of the main vessels, and in subgroup ÐÐb pancreatic resection or total pancreatectomy with cryoablation of tumor, which was left on the main vessel. The oneyear, threeyears and fiveyears survival indices have constituted in a subgroup Ðа, accordingly 74, 17 and 0% (survival median 16 mo); in a subgroup Ðb 70, 20 and 0% (survival median 20 mo); in a subgroup ÐÐа 83, 49 and 21% (survival median 29 mo); in a subgroup ÐÐb 73, 41 and 18% (survival median 26 mo). Difference between the general survival indices in subgroups Ðа and ÐÐа, Ðb and ÐÐа is statistically significant. Application of aggressive surgical tactics have permitted to improve the general survival indices of the patients.
Assuntos
Carcinoma Ductal Pancreático/cirurgia , Criocirurgia/métodos , Cuidados Paliativos/métodos , Pâncreas/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Idoso , Carcinoma Ductal Pancreático/irrigação sanguínea , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/irrigação sanguínea , Pâncreas/patologia , Pancreatectomia/classificação , Neoplasias Pancreáticas/irrigação sanguínea , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
In 2015 yr еndoscopic transpapillary interventions (ÐТI), performed for diseases of the hepatopancreatoduodenal zone organs, were done in 697 patients. In 315 (45.2%) of them ÐТI were diagnostic, in 382 (54.8%) performed with treatment objective. Ðеdicinal support for the ÐТI conduction in 631 (90.5%) patients have included conduction of superficial sedation and local anesthesia of pharynx. Ðnesthesiological support was applied in 66 (9.5%) patients, including total intravenous anesthesia in 11 (16.6%), еndotracheal narcosis in 55 (83.4%). Using of general anesthesia in comparison to superficial sedation creates more favorable conditions for the ÐТI performance, what have permitted to reduce their duration and complications rate twice.
Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Coledocolitíase/cirurgia , Relaxantes Musculares Centrais/uso terapêutico , Pancreatite/cirurgia , Adulto , Anestesia por Condução/métodos , Anestesia Endotraqueal/métodos , Anestesia Intravenosa/métodos , Anestesia Local/métodos , Coledocolitíase/patologia , Duodeno/patologia , Duodeno/cirurgia , Endoscopia do Sistema Digestório , Feminino , Humanos , Fígado/patologia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatite/patologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Combined method of laparoscopically and retroperitoneoscopically assisted necrsequestrectomy, consisting of staged application of miniinvasive methods with simultaneous laparoscopic and retroperitoneoscopic control of necrsequestrectomy, was elaborated with the objective to improve surgical treatment of an acute pancreatitits. The procedure has significant advantages over open operative intervention in purulent complications of necrotic purulent pancreatitis: reduction of the local and systemic operative treatment severity, minimization of microbial metabolites coming into the blood, total visual control of intervention, reduction of the vascular injuries risk, аdequate surgical sanation with saving of viable pancreatic parenchyma, absence of conditions for the purulent complications occurrence while the operative wound healing is going on, preservation of possibility for an adequate draining, using drains of a large diameter.
Assuntos
Laparoscopia/métodos , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/cirurgia , Espaço Retroperitoneal/cirurgia , Supuração/cirurgia , Idoso , Antibacterianos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Drenagem/instrumentação , Drenagem/métodos , Feminino , Humanos , Laparoscopia/instrumentação , Pâncreas/microbiologia , Pâncreas/patologia , Pancreatectomia/instrumentação , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/patologia , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/patologia , Supuração/tratamento farmacológico , Supuração/microbiologia , Supuração/patologia , Resultado do TratamentoRESUMO
Influence of therapeutic plasmapheresis on bowel barrier function and evacuation was investigated in 83 patients with severe acute necrotizing pancreatitis. Except standard therapy patient obtained therapeutic plasmapheresis using "Haemonetics" PCS 2 system. Complex treatment of patients with acute necrotizing pancreatitis and dynamic ileus using plasmapheresis increases contractive and propulsive function of stomach and duodenum and prolongs period of activity of these organs on 32%. Intestinal barrier function associates with restoration of bowel evacuation. Addition of plasmapheresis to standard therapy of necrotizing pancreatitis can be effective prevention of dynamic ileus.
Assuntos
Motilidade Gastrointestinal/fisiologia , Obstrução Intestinal/prevenção & controle , Intestinos/fisiopatologia , Pancreatite Necrosante Aguda/terapia , Plasmaferese/métodos , Estômago/fisiopatologia , Mucosa Gástrica/metabolismo , Humanos , Mucosa Intestinal/metabolismo , Obstrução Intestinal/sangue , Obstrução Intestinal/fisiopatologia , Pancreatite Necrosante Aguda/sangue , Pancreatite Necrosante Aguda/fisiopatologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
There was investigated a hepatic bile in 50 persons, aged 35-58 years old, including 20--practically healthy persons (I group), 20 patients, suffering chronic fibrose-degenerative pancreatitis (CHFDP) without jaundice syndrome (II group) and 10 patients, suffering CHFDP with jaundice syndrome (III group). There were determined the contents of the bile acids, the lipids and electrolytic contents of bile. A trustworthy difference in the bile contents was registered in patients, suffering CHFDP with the jaundice syndrome and without it, comparing with such in healthy persons. This have had permitted to add the complex of medicinal preoperative preparation of these patients substantially, and to apply the electrolytes content of a bile to apply as an additional diagnostic marker.
Assuntos
Ácidos e Sais Biliares/análise , Bile/química , Icterícia/diagnóstico , Lipídeos/análise , Pancreatite Crônica/diagnóstico , Adulto , Estudos de Casos e Controles , Humanos , Icterícia/complicações , Icterícia/tratamento farmacológico , Pessoa de Meia-Idade , Pancreatite Crônica/complicações , Pancreatite Crônica/tratamento farmacológicoRESUMO
The dependence of a hypercoagulation state occurrence from value of the adipose-cutaneous flap mass, excised while performing abdominoplasty, was established, using the logistic regression method, in patients, suffering the anterior abdominal wall cosmetic defects and obesity. The possibility the hypercoagulation state occurrence raises nonlinearly together with such of the excised flap mass (% EFM), it exceeds 50% (high risk of hypercoagulation occurrence), when the EFM value constitutes 5.1% of the body mass.
Assuntos
Parede Abdominal/cirurgia , Obesidade/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/normas , Trombofilia/prevenção & controle , Adulto , Idoso , Índice de Massa Corporal , Feminino , Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/efeitos adversos , Análise de Regressão , Risco , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Trombofilia/complicaçõesRESUMO
The priority of surgical approach for focal hepatic affection is doubtless. Hepatic resection (HR) is the main method, securing notable lengthening of life and sometimes--radical reconvalescence of patients, suffering hepatic tumors. At the same time HR is a very high risk operation in sense of danger of the complications occurrence. The hepatic insufficiency occurrence or exacerbation constitutes one of the dangerous and frequent complications. The problem of an acute hepatic insufficiency is actual, because the necessity exists to perform HR in patients with insufficient postresectional residual parenchyma volume, the lowered regeneration capacity in presence of cirrhosis, chronic hepatitis, dystrophic changes, etc. That's why the only method for prophylaxis of this complication occurrence is its prognosis estimation. The hepatic functional reserve and residual parenchyma volume determination constitute the base of postoperative hepatic insufficiency prognosis.
Assuntos
Hepatectomia , Insuficiência Hepática/diagnóstico , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Hepatectomia/efeitos adversos , Insuficiência Hepática/etiologia , Insuficiência Hepática/patologia , Humanos , Fígado/metabolismo , Fígado/patologia , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Regeneração Hepática , Tamanho do Órgão , PrognósticoRESUMO
Estimation of the severity state in patient, suffering an acute pancreatitis, while admitting him into a hospital, constitutes a significant part of diagnosis and complex treatment. Application of a highly accurate scales and markers, which are used to prognosticate the disease course severity and to determine the inflammation grade, may influence the results of complex treatment of the patients. In the investigation a high diagnostic accuracy in prognosis of an acute pancreatitis course severity was noted for APACHE II scale (24 hours) and Ranson scale (48 hours). There was established, that determination of a C-reactive protein content has less diagnostic accuracy, but it may be applied as a less complex and more rapid test for prognostication of an acute pancreatitis course severity after admitting the patient to hospital.
Assuntos
Proteína C-Reativa/análise , Pancreatite Necrosante Aguda/diagnóstico , Índice de Gravidade de Doença , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/sangue , Pancreatite Necrosante Aguda/etiologia , Prognóstico , Sensibilidade e Especificidade , Adulto JovemRESUMO
The impact on a lipids metabolism of a certain volume of fat tissue extraction from organism was investigated. With that objective there was determined the lipids content in a blood serum before and on a 14th day after abdominoplasty. In 73 patients (the main group) surgical interventions were performed on the organs of abdominal cavity, small pelvis and anterior abdominal wall with a simultant abdominoplasty, in 59 patients (a comparison group) abdominoplasty was not performed. The lipids metabolism desorders was observed in both groups of patients. The results of operations, conducted with a simultant extraction of a fat tissue were characteristic for positive dynamics of the lipids spectre in the blood. A normalizing impact on the blood serum lipids was caused by a triglyceride depot volume reduction, which promotes a catabolism processes strengthening in atherogenic lipoproteins and stabilizes a nonesterified fat acids concentration on optimal level. The data obtained witness, that abdominoplasty conduction secures antiatherogenic affect in patients, suffering obesity.
Assuntos
Gordura Abdominal/metabolismo , Parede Abdominal/cirurgia , Aterosclerose/prevenção & controle , Metabolismo dos Lipídeos , Obesidade/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Gordura Abdominal/cirurgia , Parede Abdominal/patologia , Aterosclerose/sangue , Aterosclerose/epidemiologia , Estudos de Casos e Controles , Humanos , Lipídeos/sangue , Obesidade/sangue , Obesidade/epidemiologia , Obesidade/metabolismo , Resultado do TratamentoRESUMO
The modern tendencies of surgery development include not only the operative procedures improvement but guaranteeing also a maximally high level achievement in the patients quality of life in the early, as well as during remote, postoperative period. The quality of life analysis was done in 132 patients, operated on for the anterior abdominal wall defects, obesity and other surgical diseases, using special questionnaire SF-36. The patients have aged 23-65 years old, in all of them the excessive body mass or obesity of abdominal type was noted.
Assuntos
Músculos Abdominais/cirurgia , Parede Abdominal/anormalidades , Parede Abdominal/cirurgia , Obesidade/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Procedimentos de Cirurgia Plástica/métodos , Adulto JovemRESUMO
The conduction of pathogenetically substantiated treatment--enterosorption together with procedures of electrostimulation--in patients, suffering obturation jaundice of nontumoral genesis, secures favorable course of postoperative period, the hepatorenal insufficiency prophylaxis, and postcholecystectomy syndrome occurrence as well.
Assuntos
Bile/química , Terapia por Estimulação Elétrica/métodos , Enteroadsorção/métodos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Icterícia Obstrutiva/cirurgia , Masculino , Micelas , Microscopia de Polarização , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
62 patients with acute pancreatitis (AP) were examined in order to determine hemocoagulation disorders. The obtained results showed that the patients developed the consumptive coagulopathy with high levels of D-dimer, activation and exhaustion of antithrombin III (AT III). The development of hemocoagulation disturbances in patients with severe AP was confirmed through decrease of activity of AT III up to 68% and high level of D-dimer>693 ng/ml.