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1.
Khirurgiia (Mosk) ; (9): 57-65, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-39268737

RESUMEN

Currently, severe combined abdominal trauma ranks third among all causes of mortality In Russia, second only to cardiovascular and oncologic diseases. In the period from 2019 to 2020 in our country, a slight decrease in traumatism is noted due to a decrease in the number of traffic accidents as the main cause of combined and multiple trauma. The number of abdominal injuries from the total number of injuries In Russian regions ranges from 1.5 to 36.5% and is accompanied by a high level of disability (25-80% in combined trauma and 5-8% in isolated trauma). Despite modern medical advances, lethality in combined trauma of abdominal organs varies from 10.7 to 69.7%, with closed abdominal trauma accounting for up to 6% of fatal outcomes. OBJECTIVE: Improving treatment outcomes in patients with closed abdominal trauma through comprehensive diagnosis of SCN and optimization of enteral therapy in patients with closed abdominal trauma. MATERIAL AND METHODS: The study included 40 patients (29 (72.5%) men and 11 (27.5%) women), who underwent examination and treatment at the State Budgetary Institution "Research Institute of SP. Im. N.V. Sklifosovsky Research Institute of St. Petersburg State Medical Center with the diagnosis: Closed abdominal trauma. The age of the patients varied from 25 to 81 years (Mean age was 49.6±13.1). To evaluate the effectiveness of intensive therapy, the patients were divided into 2 groups: the comparison group (n=26) included patients who were treated with complex conservative therapy. Patients of the main group (n=14) conservative therapy was supplemented with the use of ER to restore the functional activity of the intestine under the control of ultrasound and assessment of the degree of intra-abdominal hypertension, as well as with Intestamine to stimulate the intestinal trauma. RESULTS: In the course of the study it was found that, as a result of complex enteral therapy in the patients of the main group, starting from the 7th day of stay in the ORIT, positive dynamics was observed, consisting in a statistically significant decrease in the levels of lactate, ALT, AST, LDH, and CRP. By the 14th day there was also a statistically significant decrease in leukocyte and PCT levels. The lethality in the main group amounted to 7.2%, n=1. At the same time, in patients of the comparison group only by the 7th day there was a decrease in concentration of CRP (p=0.065), by the 10th day - ALT (<0.001) and by the 14th day there was a decrease in leukocytes level (p=0.038). Lethality in this group amounted to 23.1%, n=6. CONCLUSION: Timely initiation of pathogenetic enteral therapy contributes to faster normalization of clinical and laboratory parameters, protection of intestinal barrier function, prevention of complications associated with bacterial translocation and bacterial overgrowth syndrome, increase in immunoresistance of the organism.


Asunto(s)
Traumatismos Abdominales , Heridas no Penetrantes , Humanos , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/terapia , Masculino , Femenino , Persona de Mediana Edad , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatología , Federación de Rusia/epidemiología , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/terapia , Traumatismo Múltiple/mortalidad , Adulto , Nutrición Enteral/métodos , Nutrición Enteral/estadística & datos numéricos , Síndrome , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/terapia
2.
Khirurgiia (Mosk) ; (5): 47-52, 2023.
Artículo en Ruso | MEDLINE | ID: mdl-37186650

RESUMEN

OBJECTIVE: To study the relationship between serum creatine phosphokinase and outcomes of injury in victims with electrical burns. MATERIAL AND METHODS: Among 40 patients with electrical injury, 7 (18%) ones underwent upper limb amputation. There were 37 (92.5%) men and 3 (7.5%) women aged 37 (28; 47) years. We analyzed total serum creatine phosphokinase and MB fraction on the first day in patients with and without amputations. RESULTS: Total serum creatine phosphokinase exceeded the upper reference value in 11 out of 33 patients without amputation and in all 7 patients with limb amputation (p=0.001). Patients with limb amputation had significantly higher total serum creatine phosphokinase and MB fraction (p<0.001 and p=0.030, respectively). Logistic regression equation showed that high total serum creatine phosphokinase significantly influenced amputation rate (p<0.001), as evidenced by odds ratio (42.7, 95% CI 3.5-514.8). ROC analysis revealed the cut-off value of total serum creatine phosphokinase (950 IU/L). Sensitivity was 100% (63; 100), specificity - 94% (86; 94), positive predictive value - 78% (49; 78), negative predictive value - 100% (92; 100). CONCLUSION: Total serum creatine phosphokinase depends only on severity of electrical and flame burns. Serum creatine phosphokinase is a predictor of upper limb amputation in patients with electrical injury. Total serum creatine phosphokinase ≥ 950 IU/L is significant for upper limb amputation (in CK-MB fraction within the reference values).


Asunto(s)
Quemaduras por Electricidad , Creatina Quinasa , Masculino , Humanos , Femenino , Quemaduras por Electricidad/diagnóstico , Quemaduras por Electricidad/etiología , Quemaduras por Electricidad/cirugía , Valor Predictivo de las Pruebas , Amputación Quirúrgica/efectos adversos , Extremidad Superior/cirugía
3.
Khirurgiia (Mosk) ; (4): 55-60, 2023.
Artículo en Ruso | MEDLINE | ID: mdl-37850895

RESUMEN

OBJECTIVE: To improve treatment outcomes in patients with Klatskin tumor and obstructive jaundice by using of endoscopic bilioduodenal stenting. MATERIAL AND METHODS: There were 1904 transpapillary interventions between August 2017 and February 2022. Endoscopic bilioduodenal stenting was performed in 250 patients including 25 (10%) ones with Klatskin tumor. RESULTS: Bilioduodenal plastic and self-expanding stents were installed in 19 (76%) and 6 (24%) patients, respectively. In Klatskin tumor type I, 11 patients (44%) underwent bilioduodenal stenting of common hepatic duct with plastic stent; 5 (20%) patients with Klatskin tumor type II received self-expanding stents. In case of tumor type IIIA, 3 (12%) patients underwent stenting of the right lobar duct with plastic stent. Four (16%) patients with Klatskin tumor type III B underwent stenting of the left lobar duct. Two 2 (8%) patients with Klatskin tumor type IV underwent bilateral bilioduodenal stenting with plastic and bifurcation self-expanding stents. Peroral cholangioscopy using the SpyGlass DS system was performed in 4 (16%) patients. No intraoperative complications were identified. One (4%) patient developed gastrointestinal bleeding in 2 postoperative days after retrograde intervention that did not require surgery. Moreover, 1 (4%) patient with distal dislocation of plastic bilioduodenal stent required redo bilioduodenal stenting. Three (12%) patients died from multiple organ failure despite adequate biliary decompression, and 22 (88%) patients were discharged in 8±5 days after retrograde intervention. CONCLUSION: Bilioduodenal stenting as minimally invasive and physiological method was highly effective for obstructive jaundice in patients with Klatskin tumor. Peroral cholangioscopy using the SpyGlass system provides effective and safe direct visualization of the biliary tract, as well as biopsy for morphological verification and prescription of chemotherapy in patients with intraductal growth of tumor.


Asunto(s)
Neoplasias de los Conductos Biliares , Colestasis , Ictericia Obstructiva , Tumor de Klatskin , Humanos , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Tumor de Klatskin/complicaciones , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/cirugía , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/cirugía , Estudios Retrospectivos , Endoscopía/efectos adversos , Stents/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colestasis/etiología
4.
Khirurgiia (Mosk) ; (11): 63-71, 2023.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-38010019

RESUMEN

OBJECTIVE: To improve the outcomes in ICU patients with blunt abdominal trauma via enteral therapy by saline enteral solution. MATERIAL AND METHODS: A retrospective and prospective study included 24 patients (18 (75%) men and 6 (25%) women) with blunt abdominal trauma who underwent examination and treatment at the Sklifosovsky Research Institute for Emergency Care. Age of patients ranged from 38 to 81 years (mean 50.1±13.6). RESULTS: Enteral therapy was followed by normalization of serum lactate, alanine aminotransferase and aspartate aminotransferase after 3 days. There were significant differences in decrease of lactate dehydrogenase, alanine aminotransferase and C-reactive protein. In the control group, these parameters decreased only by the 10th day. CONCLUSION: Inclusion of saline enteral solution into the complex therapy contributes to earlier recovery of gastrointestinal function and prevents compartment syndrome. These aspects reduced the number of patients with multiple organ failure.


Asunto(s)
Traumatismos Abdominales , Heridas no Penetrantes , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Estudios Prospectivos , Estudios Retrospectivos , Alanina Transaminasa , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/terapia , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/terapia
5.
Khirurgiia (Mosk) ; (6): 18-26, 2022.
Artículo en Ruso | MEDLINE | ID: mdl-35658132

RESUMEN

OBJECTIVE: To evaluate the efficacy of endoscopic retrograde stenting of the pancreatic duct for acute severe pancreatitis. MATERIAL AND METHODS: We analyzed 94 patients with acute severe pancreatitis who underwent surgery (n=87, 92.6%) and endoscopic retrograde pancreatic stenting (n=28, 29.8%). The first group included 15 patients (16%) after pancreatic duct stenting in aseptic phase of acute pancreatitis. The second group enrolled 13 patients (13.8%) who underwent pancreatic duct stenting in the phase of sequestration and infection. The third group consisted of 66 patients (70.2%) after open surgery without pancreatic duct stenting. RESULTS: In the 1st group, we recanalized the necrosis zone up to distal pancreas via stenting. Infection was detected in 14 out of 15 patients. Surgical treatment was performed in 13 patients (13.8%). In the second group, pancreatic duct stenting was carried out in the phase of infected pancreatitis. We applied stenting to block the area of duct destruction or restore outflow in case of distal defect. No infection was observed in 1 out of 13 patients. Pancreatic duct stenting was not performed in 66 patients of the third group. Surgical treatment was performed in 59 patients (62.8%). In general, 11 of 94 patients (11.7%) were free from infection. CONCLUSION: Better postoperative outcomes were observed in patients with damage to pancreatic duct, pancreatic drainage through percutaneous drains installed at the first stage of treatment. Early pancreatic duct stenting did not lead to significant improvement in treatment outcomes.


Asunto(s)
Pancreatitis , Enfermedad Aguda , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Drenaje/efectos adversos , Humanos , Páncreas , Conductos Pancreáticos/cirugía , Pancreatitis/diagnóstico , Pancreatitis/etiología , Pancreatitis/cirugía , Stents , Resultado del Tratamiento
6.
Khirurgiia (Mosk) ; (2): 17-23, 2022.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-35146995

RESUMEN

OBJECTIVE: To evaluate the effectiveness of intraluminal drainage of acute fluid accumulations for infected pancreatic necrosis. MATERIAL AND METHODS: There were 848 patients with acute pancreatitis between January 2018 and December 2020 at the Sklifosovsky Research Institute for Emergency Care. Necrotizing pancreatitis was detected in 232 (27.4%) patients. Among necrotic forms, pancreatic parenchymal necrosis was detected in 56 (24.1%) patients, its combination with peripancreatic necrosis - in 176 (75.9%) patients. All patients underwent transabdominal ultrasound, CT of the abdomen and retroperitoneal space, esophagogastroduodenoscopy, endo-ultrasonography of pancreatobiliary zone. Dimensions and localization of acute necrotic accumulations were established using ultrasound and CT data. Endoscopic transluminal drainage was performed in 22 patients with necrotizing pancreatitis and fluid accumulations attached to the stomach or duodenum. There were 12 men (55%) and 10 women (45%) aged 48.5 [39; 56] (35; 88) years. Effectiveness of endoscopic treatment was assessed considering clinical, endoscopic data and reduction of fluid accumulations confirmed by ultrasound and CT data. RESULTS: Among 22 patients, connection with pancreatic ductal system was detected in 3 patients (13.6%) that required pancreaticoduodenal stenting. Early postoperative period was complicated by bleeding from the area of pancreatogenic destruction in 4 patients (18.1%). Therefore, angiography and endovascular embolization of a. gastroduodenalis were required in 2 (9.1%) cases. In 1 (4.5%) case, we performed endoscopic hemostasis using Hemoblock hemostatic solution (4 ml). Combination of both methods was used in 1 (4.5%) patient. In 11 (50%) patients, endoscopic drainage was the final method of surgical treatment of necrotizing pancreatitis. Four patients (18.1%) died. Multiple organ failure caused mortality in 3 patients (13.6%). One (4.5%) patient died from severe nosocomial pneumonia developed in 32 days after drainage. Spurs not drained into the stomach with US-confirmed suspension and sequestration were observed in 11 (50%) out of 22 patients. These accumulations required additional ultrasound-assisted percutaneous drainage. CONCLUSION: Endoscopic transluminal drainage is a perspective minimally invasive method for necrotizing pancreatitis.


Asunto(s)
Pancreatitis Aguda Necrotizante , Enfermedad Aguda , Drenaje , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis/etiología , Necrosis/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/cirugía , Resultado del Tratamiento
7.
Khirurgiia (Mosk) ; (7): 49-56, 2021.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-34270194

RESUMEN

OBJECTIVE: To develop the indications and assess an effectiveness of treatment of patients with ampullary tumors followed by mechanical jaundice. MATERIAL AND METHODS: There were 26 patients with major duodenal papilla neoplasms for the period 2015-2020 at the Sklifosovsky Research Institute for Emergency Care. RESULTS: Twenty patients underwent transpapillary interventions: papillosphincterotomy followed by lithoextraction and bilio-duodenal stenting in 4 (15.3%) patients, bilio-duodenal stenting in 12 (46.1%) patients, nasobiliary drainage in 2 (7.6%) patients, pancreaticoduodenal stenting in 2 (7.6%) patients. Percutaneous transhepatic microcholecystostomy was performed in 6 (23.4%) patients. In all cases, laboratory values decreased in 5-7 days after drainage. Eight (30.7%) patients refused further surgical treatment and were discharged in satisfactory condition. Another 8 (44.5%) patients underwent endoscopic submucosal papillectomy. There were no postoperative complications. Patients were discharged after 5-7 days. Four (22.2%) patients underwent tumor resection via laparotomy. One of these patients required redo laparotomy in postoperative period due to acute perforated duodenal ulcer. Six (33.3%) patients underwent palliative bilio-duodenal stenting. CONCLUSION: Invasion of muscle layer or distal parts of the common bile duct, as well as abnormal vascularization are indications for open surgery or palliative endoscopic treatment. Tumor location within mucous and muscle layers without invasion of distal third of the common bile duct and no abnormal vascularization of tumor justify endoscopic papillectomy. Endoscopic approach can be considered as a final minimally invasive method with minimal risk of postoperative complications in case of benign ampullary tumor.


Asunto(s)
Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Neoplasias Duodenales , Ictericia Obstructiva , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/complicaciones , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/cirugía , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/cirugía , Humanos , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Resultado del Tratamiento
8.
Khirurgiia (Mosk) ; (11): 32-36, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33210505

RESUMEN

OBJECTIVE: To evaluate an efficacy of surgical treatment of patients with benign tumors of the major duodenal papilla. MATERIAL AND METHODS: For the period from January 2015 to January 2020, sixteenth patients with benign tumors of the major duodenal papilla were treated at the Sklifosovsky Research Institute for Emergency Care. There were 7 men (43.7%) and 9 women (56.3%). Tumor dimension ranged from 1.0 to 4.0 cm (mean 2.5 cm). RESULTS AND DISCUSSION: Tumor resection through laparotomy was performed in 4 (25%) patients. Six (37.5%) patients underwent endoscopic submucosal papillectomy. Other 6 (37.5%) patients refused surgical treatment due to regression of symptoms. Postoperative re-laparotomy was performed in 1 patient (10%) with acute perforated duodenal ulcer. There were no complications after endoscopic papillectomy. Control endoscopic examination identified no signs of tumor recurrence in all patients after 3 and 6 months. In our opinion, endoscopic papillectomy is preferable for adenoma of the major duodenal papilla due to reduced surgical trauma. We assume that stenting of the bile ducts and the major pancreatic duct prevented acute pancreatitis and obstructive jaundice. CONCLUSION: Endoscopic papillectomy is an effective minimally invasive treatment of tumors of the major duodenal papilla. Despite a considerable number of complications, most of them can be resolved by conservative treatment or endoscopic procedures. Thus, endoscopic papillectomy may be considered as preferable method in the treatment of patients with benign tumors of the major duodenal papilla.


Asunto(s)
Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Pancreatitis , Enfermedad Aguda , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/cirugía , Duodenoscopía , Femenino , Humanos , Masculino , Pancreatitis/etiología , Pancreatitis/prevención & control , Reoperación , Resultado del Tratamiento
9.
Khirurgiia (Mosk) ; (3): 82-84, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32271742

RESUMEN

Abnormal localization of the appendix in hernial sac occurs in 2-4% of cases. Appendix is often found in inguinal and femoral hernias. Localization of the appendix in diaphragmatic hernia is described as a casuistic case. Case report of successful surgical treatment of a patient with perforated appendicitis in the left diaphragmatic hernia is presented.


Asunto(s)
Apendicitis/cirugía , Apéndice/cirugía , Hernia Diafragmática/complicaciones , Apendicitis/etiología , Humanos
10.
Khirurgiia (Mosk) ; (4): 41-45, 2018.
Artículo en Ruso | MEDLINE | ID: mdl-29697682

RESUMEN

PURPOSE OF THE STUDY: Comparison of the methods of surgical treatment of cholelithiasis. MATERIAL AND METHODS: The work is based on the experience of treating 139 patients with acute cholecystitis complicated by choledocholithiasis from 2008 to 2016, who were on treatment of the department of acute surgical diseases of the liver and pancreas, N.V. Sklifosovsky. RESULTS: The use of percutaneous drainage of the gallbladder in an acute period can reduce complications and reduce the number of urgent video-laparoscopic cholecystectomies to 1%.


Asunto(s)
Coledocolitiasis/complicaciones , Colelitiasis , Drenaje/métodos , Vesícula Biliar , Complicaciones Posoperatorias/prevención & control , Colangiografía/métodos , Colelitiasis/diagnóstico , Colelitiasis/etiología , Colelitiasis/cirugía , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/cirugía , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Gravedad del Paciente , Cuidados Preoperatorios/métodos , Cirugía Asistida por Video/métodos
11.
Khirurgiia (Mosk) ; (3): 42-49, 2017.
Artículo en Ruso | MEDLINE | ID: mdl-28374712

RESUMEN

The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Surgical formation of anastomosis between distal part of the main pancreatic duct and gastro-intestinal tract was carried out when it was impossible to fulfill endoscopic stenting of pancreatic duct either because of its interruption and diastasis between its ends, or in the cases of unsuccessful conservative treatment of external pancreatic fistula caused by drainage of pseudocyst.


Asunto(s)
Complicaciones Intraoperatorias , Páncreas , Enfermedades Pancreáticas/cirugía , Fístula Pancreática , Complicaciones Posoperatorias , Esfinterotomía Endoscópica , Anastomosis Quirúrgica/métodos , Tratamiento Conservador/métodos , Duodeno/cirugía , Endoscopía del Sistema Digestivo/métodos , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Páncreas/diagnóstico por imagen , Páncreas/patología , Páncreas/cirugía , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiología , Fístula Pancreática/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Esfinterotomía Endoscópica/instrumentación , Esfinterotomía Endoscópica/métodos , Stents
12.
Khirurgiia (Mosk) ; (10): 11-15, 2016.
Artículo en Ruso | MEDLINE | ID: mdl-27804929

RESUMEN

AIM: To assess the long-term results and quality of life of patients after different medical and tactical approaches in treatment of severe acute pancreatitis. MATERIAL AND METHODS: Long-term outcomes were studied in 210 patients with severe acute pancreatitis for the period 2003-2013. There were 144 (68.6%) men. RESULTS: The quality of life of patients undergoing both aseptic (GIQLI - 112.9±1.3 points) and infected (GIQLI - 108.8±2.2 points) destructive complications of severe pancreatitis is lower (p=0.00001) compared with healthy population. Reccurence of acute pancreatitis was observed in 27.6% of patients. Diabetes mellitus developed in 40.5% and 23.6% of patients after infected and aseptic complications of severe pancreatitis respectively. Exocrine insufficiency was detected in 32.6% and 38.2% of patients who underwent aseptic and infected complications respectively. Postoperative hernia was observed in 30.8% of patients. Herewith, hernias (p<0.05) are predominantly formed after open operations (73,6%) than minimally invasive procedures (2.6%). Chronic pseudocyst was detected in 13.0% of patients after aseptic complications of severe pancreatitis and in 17.6% after infected complications. CONCLUSION: Quality of life and long-term outcomes are better in patients who were treated using only conservative methods and/or minimally invasive surgical interventions.


Asunto(s)
Diabetes Mellitus , Insuficiencia Pancreática Exocrina , Efectos Adversos a Largo Plazo , Seudoquiste Pancreático , Pancreatitis Aguda Necrotizante , Calidad de Vida , Adulto , Anciano , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etiología , Manejo de la Enfermedad , Insuficiencia Pancreática Exocrina/epidemiología , Insuficiencia Pancreática Exocrina/etiología , Femenino , Humanos , Efectos Adversos a Largo Plazo/epidemiología , Efectos Adversos a Largo Plazo/etiología , Efectos Adversos a Largo Plazo/psicología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Seudoquiste Pancreático/epidemiología , Seudoquiste Pancreático/etiología , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/epidemiología , Pancreatitis Aguda Necrotizante/terapia , Recurrencia , Federación de Rusia/epidemiología
13.
Khirurgiia (Mosk) ; (8): 4-8, 2014.
Artículo en Ruso | MEDLINE | ID: mdl-25327668

RESUMEN

The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.


Asunto(s)
Colecistectomía Laparoscópica , Colecistitis Aguda , Colecistostomía , Colelitiasis/complicaciones , Complicaciones Posoperatorias/prevención & control , Anciano , Anestesia Local/métodos , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Colecistitis Aguda/epidemiología , Colecistitis Aguda/etiología , Colecistitis Aguda/cirugía , Colecistostomía/efectos adversos , Colecistostomía/métodos , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios Retrospectivos , Ajuste de Riesgo , Factores de Riesgo , Federación de Rusia , Resultado del Tratamiento
14.
Khirurgiia (Mosk) ; (4): 9-12, 2011.
Artículo en Ruso | MEDLINE | ID: mdl-21512454

RESUMEN

The combined method of hernioplasty with the use of biologic and sunthetic implants has been worked out. 12 patients have been operated on: the "open" technique was used in 5 patients, the rest 7 have been operated on laparoscopically. The use of dura mater as an implant for hernioplasty allows avoiding tissue tension by muscle sheath plasty. By the combined use of the synthetic implant and dura mater plate, the latter assumes the mechanical load, preventing the hernia recurrence. Besides, the dura mater plate isolates the synthetic implant from the abdominal cavity and subcutaneous fat. No postoperative complications or lethal outcomes were registered.


Asunto(s)
Materiales Biocompatibles , Hernia Ventral/cirugía , Laparoscopía/métodos , Procedimientos de Cirugía Plástica/métodos , Mallas Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Hernia Ventral/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Diseño de Prótesis , Estudios Retrospectivos , Prevención Secundaria , Técnicas de Sutura , Resultado del Tratamiento , Adulto Joven
15.
Eksp Klin Gastroenterol ; (7): 52-6, 2008.
Artículo en Ruso | MEDLINE | ID: mdl-19334445

RESUMEN

The complex of clinico-morphological researches at the preoperative stage is presented, allowing to detail character of complications of a chronic pancreatitis, changes of ductus of a pancreas and nearby organs that provides the individualized approach to a choice of operative intervention.


Asunto(s)
Pancreatitis Crónica/diagnóstico , Pancreatitis Crónica/cirugía , Cuidados Preoperatorios/normas , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Humanos , Pancreatectomía/métodos , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/diagnóstico por imagen , Resultado del Tratamiento , Ultrasonografía
16.
Khirurgiia (Mosk) ; (5): 24-30, 2003.
Artículo en Ruso | MEDLINE | ID: mdl-12792957

RESUMEN

Immediate results of 151 pancreatoduodenal resections (PDR) were analyzed. This surgery was performed for tumors of gastropancreatoduodenal region in 88.1% patients, for chronic complicated pancreatitis--in 11.9%. Pylorus-saving PDR was performed in 82.8% patients, in combination with stomach resection--in 17.2%. Extended and regional pancreatectomy was performed in 20.3% patients with tumors of periampullar zone, extended lymphadenectomy--in 44.4%. Pancreatoenteroanastomosis was created in 82.8% patients, end-loop Wirsungenteroanastomosis by original author's method--in 52.3% of them, traditional Wirsungenteroanastomosis end-to-side--in 30.5%, complete external drainage of pancreas stump was performed in 13.9%, suturing of pancreas stump--in 2.6%, pancreatogastroanastomosis was created in 1 (0.7%) patient. There was no insufficiency of pancreatoduodenoanastomosis performed with original method, while in traditional Wirsungenteroanastomosis it was seen in 4.4% patients. End-loop anastomosis permitted to reduce number of complications after PDR 1.6--3 times. General lethality was 11.3%, in end-loop anastomosis--3.8% that significantly lower than after other methods of treatment of pancreas stump.


Asunto(s)
Duodeno/cirugía , Páncreas/cirugía , Pancreaticoduodenectomía/métodos , Adulto , Anciano , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/mortalidad , Enfermedad Crónica , Femenino , Neoplasias Gastrointestinales/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/mortalidad , Pancreatitis/cirugía , Periodo Posoperatorio , Resultado del Tratamiento
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