RESUMO
The results of miniinvasive treatment of 319 patients, suffering complicated acute calculous cholecystitis, using laparoscopic technologies, were analyzed in retrospective investigation. The risk factors for unfaithful conduction of laparoscopic intervention on biliary ducts were determined. The chances for possibility of laparoscopic choledocholithoextraction performance on biliary ducts were established, using binary regressive analysis. Reduction of rate of unfaithful laparoscopic interventions, made on common biliary duct, from 18.6 to 5.9% was promoted by application of mathematically elaborated criteria in accordance to the prospective investigation data.
Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistite Aguda/cirurgia , Ducto Colédoco/cirurgia , Vesícula Biliar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/patologia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/patologia , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , UltrassonografiaRESUMO
The peculiarities of performance of endoscopic transpapillary interventions (ETI) during the early period after cholecystectomy were studied up. There were examined 1788 patients, aged from 18 to 90 yrs old, in whom postcholecystectomy syndrome was diagnosed. Emergent interventions were performed in 780 (43.6%) patients (main group). Into the comparison group 1008 (56.4%) patients were included, who were admitted to the hospital in 0.5-552 (Me 36) months after cholecystectomy conduction. The indications to perform the urgent endoscopic intervention were excessive transdrainage biliary output (more than 350 ml a day) from a subhepatic indignation (in 442 patients) and the obturation jaundice presence (in 338). Using ETI the cause of biliary obstruction in the early postoperative period was established in 93.5% of patients. Miniinvasive methods were applied in 82.2% patients of the main group and in 93.4%--of the comparison group.
Assuntos
Colecistectomia/efeitos adversos , Icterícia Obstrutiva/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Síndrome Pós-Colecistectomia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colestase/patologia , Colestase/cirurgia , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/patologia , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Colecistectomia/etiologia , Síndrome Pós-Colecistectomia/patologia , Período Pós-Operatório , Stents , Resultado do TratamentoRESUMO
Of 128 patients, ageing more than 60 years, polynodular toxic goiter was diagnosed in 84, diffuse toxic goiter--in 34, toxic adenoma--in 10. The nodules in thyroid gland (TG) were revealed in 94 patients, cancer--in 3. There were following indications for the operation: the lack of the thyreostatic therapy efficacy, the malignant-like nodules presence, compression of cervical and mediastinal organs. After the euthyreotic state achievement all the patients were operated on using endotracheal narcosis. Subtotal resection of TG was performed in 91 patients, thyroidectomy--in 27, hemithyroidectomy--in 10. The frequency of specific complications (n. recurrence damage, bleeding, hypoparathyroidism, the wound purulent complication) was 4.7%.
