RESUMO
The problem of an acute pancreatitis was one of "key" ones in investigations of A. A. Shalimov and his school. While the knowledge concerning the disease pathogenesis improved, diagnostic and treatment algorhythm elaborated, modern medicinal preparations and surgical treatment introducted, including miniinvasive technologies, so also approaches to treatment of patients, suffering an acute pancreatitis, have changed.
Assuntos
Pâncreas , Pancreatite Necrosante Aguda , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Necrose , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/terapiaRESUMO
Experience of treatment was analyzed of 862 patients with cancer of periampullar zone organs, to whom radical tumoral excision was performed in 1972-2005 yrs. Performance of radical operative intervention have permitted to achieve satisfactory late results in patients with tumor of duodenal major papilla and distal part of common biliary duct. Last years better immediate results of operative treatment were achieved due to postoperative mortality lowering.
Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Duodenais/cirurgia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/mortalidade , Neoplasias do Ducto Colédoco/mortalidade , Intervalo Livre de Doença , Neoplasias Duodenais/mortalidade , Feminino , Humanos , Masculino , Neoplasias Pancreáticas/mortalidadeRESUMO
Basing on morphologic-anatomical peculiarities of extrahepatic biliary ducts (EBD) analysis the classification of their tumors was elaborated. The EBD portions borders were determined: the proximal, with predominant affection of right and left biliary duct, their branching; the central; the therminal; affection of common biliary duct ampulla and large duodenal papilla. Basing on the classification proposed, surgical tactics of the EBD tumors treatment was elaborated.
Assuntos
Neoplasias dos Ductos Biliares/classificação , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/diagnóstico por imagem , Adulto , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Extra-Hepáticos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , UltrassonografiaRESUMO
Experience of surgical treatment of 271 patients the extrahepatic biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect signs of extrahepatic biliary ducts tumor were revealed in 84% of observations. Depending on the tumor localization the trustworthiness of the endoscopic retrograde pancreatocholangiography method had constituted from 79.8 to 96.4%. Correct diagnosis was established before the operation in 94.3% of patients. Radical operation was done in 93 (34.3%) of patients, including 22 with proximal localization of tumor, 13--with central one, 10--distal, 48--terminal. Palliative operation was performed in 178 patients, in 76 of them biliodigestive anastomosis was done. Total postoperative mortality was 14.8%.
Assuntos
Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Extra-Hepáticos/patologia , Ductos Biliares Extra-Hepáticos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Ten-year experience of operative treatment of cholelithic disease using mini-access cholecystectomy (MACH) in 920 patients was summarized. There were operated on 167 patients for an acute cholecystitis, chronic calculous cholecystitis--716, gall bladder polyposis--36, gall bladder cancer--1. In 48 patients the MACH was matched with choledochus drainage, in 9--choledocholithotomy was performed, in 1--choledochoduodenostomy. In 6 observations the MACH were done simultaneously inguinal herniotomy, in 10--umbilical herniotomy, in 7--uterine extirpation, in 13--operation for ovarial cyst. The bile leakage from gall bladder bed occurred in 3 observations, the operative wound suppuration--in 4. Duration of stationary treatment was 4.1 days at average.
Assuntos
Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos RetrospectivosRESUMO
Experience of surgical treatment of 721 patient with necrotic pancreatitis was summarized. Indications and tactics of treatment of patients with an acute pancreatitis (AP), methods of their conservative and operative treatment were substantiated. Classification of an AP was elaborated.
Assuntos
Pancreatite Necrosante Aguda/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico , Índice de Gravidade de DoençaRESUMO
Complex hemodynamical investigations were done in 32 patients in 1985-1999 yr. period before the operation, in 6-8 and 12-24 mo after performance of the partial portosystemic shunting operation (in 8 patients mesentericocaval anastomosis was formed, in 10--central splenorenal anastomosis, in 12--splenorenal anastomosis side to side and in 2--lowermesentericorenal anastomosis). The performance of shunting operation had promoted the lowering of the blood flow volumetric velocity and of the pressure in v. cava as well, its diameter reduction, the lowering of general hepatic blood flow. The lowering of blood flow in the v. cava system after the shunting operation performance caused the arterial hepatic blood flow enhancement occurrence.
Assuntos
Encefalopatia Hepática/etiologia , Cirrose Hepática , Fígado/irrigação sanguínea , Fígado/fisiopatologia , Derivação Portossistêmica Cirúrgica/métodos , Anastomose Cirúrgica , Hemodinâmica/fisiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Cirrose Hepática/cirurgia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos RetrospectivosRESUMO
The methods of formation and the surgical instruments for the biliodigestive compression anastomoses (BDA) doing were elaborated in the clinic. For the 1997-2000 years period 137 patients were operated on for the biliary ducts impassibility, in 36 of whom the compression BDA was formated. In 69% patients the rejection was noted on 7-10th day after the operation. The result of treatment was studied in 6 month-4 years term and estimated as good in 32 (94.12%) patients.
Assuntos
Colestase/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
While the result estimation of the distal splenorenal anastomosis formation operation, done in 12 patients according to the W. D. Warren method and in another 12 patients--according to the method, modified by K. Inokuchi, it was established that the hepatic portal perfusion loss causes compensational enhancement of blood flow in a. hepatica, including while the standard method application--by 22% and the modified one--by 8%. Doing the splenorenal venous disconnection improves the patients' quality of life due to the incidence rate of portosystemic encephalopathy reduction by 8.3%, and in this circumstances the life span and the hemorrhage recurrency rate do not differ with such while using the standard method.
Assuntos
Cirrose Hepática/cirurgia , Circulação Esplâncnica/fisiologia , Derivação Esplenorrenal Cirúrgica/métodos , Humanos , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Experience of surgical treatment of 370 patients with chronic pancreatitis, complicated by pancreatic pseudocyst occurrence, was analysed. Differentiational approach to operative intervention permitted to reduce the frequency of conduction of resections by 21.5%, replacing them by enhancing the quantity of drainage operations, what permitted to lower the occurrence of postoperative complications and to improve late follow-up result of treatment.
Assuntos
Pseudocisto Pancreático/cirurgia , Adulto , Doença Crônica , Drenagem/métodos , Humanos , Pessoa de Meia-Idade , Pancreatectomia/métodos , Pseudocisto Pancreático/etiologia , Pancreaticoduodenectomia/métodos , Pancreatite/complicaçõesRESUMO
The experience of surgical treatment of 517 patients with complicated forms of chronic pancreatitis (CP) was analyzed. In patients with the fibrotic CP without ductal hypertension, while involvement in the process of neighboring organs, the operations were conducted for the biliary and duodenal impassability elimination. The drainage operations of various types are indicated in fibrotic CP with ductal hypertension. In patients with fibrotic-degenerative CP the resectional methods were applied. Postoperative mortality have constituted 1.9%. Good and fair result of treatment in the late follow-up period was achieved in 75.7% of patients due to application of the proposed differentiative tactics.
Assuntos
Pancreatite/diagnóstico , Pancreatite/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/métodos , Pancreatite/complicações , Pancreatite/mortalidadeAssuntos
Adenocarcinoma/cirurgia , Tumor Carcinoide/cirurgia , Neoplasias Duodenais/cirurgia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adulto , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/mortalidade , Colecistostomia/métodos , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/mortalidade , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/epidemiologiaAssuntos
Ampola Hepatopancreática , Colestase Extra-Hepática , Ducto Hepático Comum , Adolescente , Adulto , Idoso , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colestase Extra-Hepática/diagnóstico , Colestase Extra-Hepática/cirurgia , Constrição Patológica , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , RecidivaAssuntos
Pneumopatias Obstrutivas/cirurgia , Pneumonectomia , Tuberculose Pulmonar/cirurgia , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Pneumopatias Obstrutivas/reabilitação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reabilitação Vocacional , Fatores de Tempo , Tuberculose Pulmonar/reabilitaçãoAssuntos
Diabetes Mellitus Tipo 1/cirurgia , Insulinoma , Transplante das Ilhotas Pancreáticas , Neoplasias Pancreáticas , Animais , Glicemia/análise , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Experimental/cirurgia , Diabetes Mellitus Tipo 1/sangue , Seguimentos , Humanos , Ratos , Fatores de Tempo , Células Tumorais CultivadasAssuntos
Refluxo Duodenogástrico/cirurgia , Gastrite/cirurgia , Adulto , Duodeno/cirurgia , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Estômago/cirurgiaRESUMO
New principle of choice of the surgical treatment method in patients with necrotic pancreatitis was proposed: different operative procedures don't compete one another but are applied in accordance with the disease stage in dynamics. Such tactics permits to choose an optimal surgical approach in every phase of pathologic process course. From 1989 till 1992 the surgical treatment for necrotic pancreatitis was conducted to 54 patients. Pancreatic resection was done to 14 (25.9%) of patients, 4 of whom died. In necrotic focus delimitation or pancreatic tissue sequestration, observed in terms of more than 2 weeks since the disease beginning, necrectomy was conducted in 40 (74.1%) of patients, 4 of whom died.
Assuntos
Pancreatite/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia , Pancreatite/patologia , Fatores de TempoRESUMO
The results of operative treatment of 36 patients with chronic calculous cholecystitis with the use of minor laparotomy approach are presented. Early postoperative rehabilitation of the patients due to reduced trauma of the operative intervention permitted to shorten 2-times the duration of treatment. There were no postoperative complications.