RESUMO
Hepatico-jejunoanastomosis (HJA) was formed in accordance to the high-frequency electric welding method: in 14 patients for the main bile outflow disorders, in 8 of them as a consequence of the periampullar zone malignances, in 6 stricture of a common hepatic duct, HJA earlier formatted, purulent cholangitis, iatrogenic damage of biliary ducts. In all the patients the welded averting one-layered termino-lateral or latero-lateral HJA were formatted. The welded anastomoses have appeared hermetic, sufficiently hard, immediately after the formation and further.
Assuntos
Anastomose Cirúrgica/métodos , Neoplasias dos Ductos Biliares/cirurgia , Colangite/cirurgia , Colestase Extra-Hepática/cirurgia , Eletrocoagulação/métodos , Ducto Hepático Comum/cirurgia , Anastomose Cirúrgica/instrumentação , Neoplasias dos Ductos Biliares/patologia , Colangite/patologia , Colestase Extra-Hepática/patologia , Eletrocoagulação/instrumentação , Ducto Hepático Comum/patologia , Humanos , Jejuno/cirurgia , Fígado/cirurgia , Resultado do TratamentoRESUMO
In experiment on rabbits a comparative analysis of various methods of a biliary peritonitis simulation was conducted. In 6 animals a biliary peritonitis was simulated, using perforation of a gallbladder, local serous-fibrinous peritonitis have occurred in 50% of them. In 7 animals biliary peritonitis was simulated, applying intraabdominal injection of medical sterile bile in a 5-40 ml volume. Diffuse peritonitis with exudates and stratification of fibrin was absent. Most effective method have appeared that, when intraabdominal injection of bile was done together with E. coli culture in the rate of 0.33 microbal bodies McF (1.0 x 10(8) CFU/ml) on 1 kg of the animal body mass. Diffuse biliary peritonitis have occurred in all 23 animals, including serous-fibrinous one--in 17 (76%), and purulent-fibrinous--in 6 (24%).
Assuntos
Bile/química , Modelos Animais de Doenças , Infecções por Escherichia coli/patologia , Peritonite/patologia , Animais , Contagem de Colônia Microbiana , Escherichia coli/crescimento & desenvolvimento , Escherichia coli/patogenicidade , Infecções por Escherichia coli/microbiologia , Exsudatos e Transudatos/metabolismo , Fibrina/metabolismo , Humanos , Peritonite/microbiologia , Coelhos , Índice de Gravidade de DoençaRESUMO
In experiment on 20 rabbits a diffuse biliary peritonitis was simulated, using intraabdominal injection of a laboratory culture of E. coli suspension and a medicinal bile. In 24 h on background of peritonitis on excluded loop of a small bowel in accordance to method of Roux, using a high frequency electric welding with the help of apparatus Patonmed EKB3-300 a one-layered everting cholecystoenteroanastomosis and enteroenteroanastomosis was formated. In a 6 mo postoperatively a connection line was not revealed from outside or from inside, the signs of stenosis were absent. In environment of a diffuse biliary peritonitis a welding technologies have permitted to form a hermetic and competent biliodigestive and interintestinal anastomoses, the processes of a welding suture regeneration postoperatively have a typical course. Using a high frequency-electric welding it is possible to perform a one-staged reconstructive interventions in environment of a pronounced inflammation of tissues due to subsequent precise conjunction of mucosal sheets of connected organs, preventing the anastomotic stricture formation.
Assuntos
Anastomose em-Y de Roux/métodos , Ductos Biliares/cirurgia , Bile/química , Eletrocoagulação/métodos , Intestino Delgado/cirurgia , Peritonite/cirurgia , Anastomose em-Y de Roux/instrumentação , Animais , Ductos Biliares/microbiologia , Ductos Biliares/patologia , Modelos Animais de Doenças , Eletrocoagulação/instrumentação , Escherichia coli/patogenicidade , Escherichia coli/fisiologia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/cirurgia , Humanos , Intestino Delgado/microbiologia , Intestino Delgado/patologia , Peritonite/microbiologia , Peritonite/patologia , Coelhos , Técnicas de Sutura/instrumentação , SuturasRESUMO
Comparative analysis of results of the laser diode (the wave length 940 nm) and elec- trocoagulation application while performing laparoscopic cholecystectomy was con- ducted. For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, provide for reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment duration postoperatively from (5.2 ± 1.2) to (4.9 ± 0.6) days.
Assuntos
Colecistectomia Laparoscópica/instrumentação , Colecistite Aguda/cirurgia , Eletrocoagulação/métodos , Vesícula Biliar/cirurgia , Fotocoagulação a Laser/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/métodos , Colecistite Aguda/patologia , Eletrocoagulação/instrumentação , Feminino , Vesícula Biliar/patologia , Humanos , Fotocoagulação a Laser/instrumentação , Lasers , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Abstract Own experience of treatment of patients for biliary calculous disease, coexistent with other abdominal and retroperitoneal organs diseases, was analyzed. The rate of postcholecystectomy syndrome (PCHES) occurrence in such patients was determined, the impact of simultant operative interventions using laparoscopic and laparotomic accesses on the rate of the PCHES occurrence was established. The elaborated diagnostic-treatment algorithm with application of measures, directed on the PCHES prophylaxis, was elaborated. There was established, that performance of simultant operations in accordance to strict indications secures a trustworthy reduction of the PCHES occurrence rate.
