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1.
Khirurgiia (Mosk) ; (1): 67-73, 2023.
Artigo em Russo | MEDLINE | ID: mdl-36583496

RESUMO

The authors consider the influence of carbohydrate metabolism disorders on postoperative period. Data on the influence of diabetes mellitus on morbidity are summarized. Mechanisms and significance of stress-induced hyperglycemia are described. The authors also discuss modern approaches to the treatment of hyperglycemic conditions in perioperative period.


Assuntos
Diabetes Mellitus , Hiperglicemia , Humanos , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Perioperatório/efeitos adversos , Período Pós-Operatório
2.
Khirurgiia (Mosk) ; (9): 14-20, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36073578

RESUMO

OBJECTIVE: To compare and statistically evaluate the severity of pain syndrome and quality of life depending on the method of fixation of the parietal peritoneum during laparoscopic hernia repair (suture fixation or the use of tack fixation). METHODS: A randomized clinical trial was conducted from May to June 2021 at the Lomonosov Moscow State University Medical Center. It was planned to observe patients for a year. In the first group, the fixation of the parietal peritoneum was performed using suture fixation, in the second group, the peritoneal flap was fixed using a fixation device. In the course of statistical data processing, it was planned to study the dependence of the duration of the operation, the severity of the pain syndrome in the early postoperative period, the frequency of complications, the quality of life of patients in the postoperative period on the chosen method of the fixation of the parietal peritoneum. RESULTS: At the initial stage of the study, 8 patients with inguinal hernias were selected in the first group during randomization, and 6 patients were selected in the second group. Each patient of the second group in the early postoperative period had a more pronounced local pain, protective muscle tension in the projection of fixation of the parietal peritoneum with tacks, which was accompanied by negative psychoemotional reactions, an increase in the dose of analgesic drugs. Due to the revealed features of the early postoperative period in patients of second group, it was considered unethical and inappropriate to continue the study within the protocol. CONCLUSION: The results obtained do not allow us to draw statistically supported conclusions. The solution of the problem of the peritoneal flap fixation method is possible in two ways: abandoning stapler fixation in favor of suture or conducting additional clinical studies with an analysis of the impact of the choice of peritoneal fixation technique not only on acute and chronic postoperative pain, but on quality of life in the early and delayed postoperative periods.


Assuntos
Herniorrafia , Laparoscopia , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Peritônio/cirurgia , Qualidade de Vida , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (6): 127-132, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35658144

RESUMO

A review of the current national and foreign literature is devoted to epidemiology, risk factors, causes, diagnosis and modern treatment approaches for fecal incontinence (FI). Incidence of FI in early and delayed period after childbirth is 30% or more. At the same time, up to 87% of postpartum injuries of anal sphincter remain undiagnosed. Importantly, routine caesarean section does not reduce the risk of incontinence. In addition to typical complaints of spontaneous gas and stool, diagnosis of FI after childbirth includes transrectal ultrasound, MRI, anorectal manometry and pudendal nerve terminal motor latency testing. Survey of proctologists from different regions of Russia revealed a high demand from medical community for educational programs devoted to diagnosis, treatment and rehabilitation of patients with postpartum perineal injuries.


Assuntos
Incontinência Fecal , Canal Anal , Cesárea , Incontinência Fecal/diagnóstico , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Manometria/efeitos adversos , Períneo , Período Pós-Parto , Gravidez
4.
Khirurgiia (Mosk) ; (1): 34-41, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395510

RESUMO

OBJECTIVE: To compare early and long-term results of various mesh prosthesis fixation methods in laparoscopic inguinal hernia repair. MATERIAL AND METHODS: It is a prospective clinical non-randomized trial. The study included 212 patients. Conventional stapler fixation (112 patients), self-gripping mesh implants (48 patients) and n-butyl cyanoacrylate adhesive fixation (52 patients) were compared. We estimated surgery time, pain syndrome severity in early and long-term postoperative period, postoperative morbidity and recurrence rate were evaluated. RESULTS: Early postoperative morbidity, activation of patients and hospital-stay were similar in all groups. Pain syndrome within 6 postoperative hours in the first group exceeded the same parameter in the second group by 1.23 times (95% CI 1.15-1.31, p<0.05) and by 1.19 times in the third group (95% CI 1.12-1.26, p<0.05). Within 12 hours, pain syndrome in the first group was 1.27 times more severe compared to the third group (95% CI 1.20-1.34, p<0.05). Pain syndrome in long-term period was similar in all groups. In the first group, one recurrence was detected (0.9%). CONCLUSION: There were no significant between-group differences. However, we found the correlation of postoperative pain syndrome with mesh implant fixation technique.


Assuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Implantação de Prótese , Telas Cirúrgicas , Cianoacrilatos/administração & dosagem , Cianoacrilatos/efeitos adversos , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/métodos , Fatores de Tempo , Adesivos Teciduais/administração & dosagem , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (2): 62-67, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105257

RESUMO

Ventral hernia is still one of the most common reason for scheduled and emergency surgery. The review is designed to reveal relationships between metabolism in extracellular matrix of connective tissue and pathogenesis of ventral hernias. These data will be valuable to develop a personalized approach to the treatment of these patients.


Assuntos
Tecido Conjuntivo , Matriz Extracelular , Hérnia Ventral , Tecido Conjuntivo/metabolismo , Matriz Extracelular/metabolismo , Humanos , Telas Cirúrgicas
6.
Khirurgiia (Mosk) ; (6): 35-40, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31317939

RESUMO

AIM: To evaluate safety of early closure of ileostomy in patients with rectal cancer after primary surgery. MATERIAL AND METHODS: The trial included patients from several medical centers without signs of anastomotic leakage. CT-proctography or rectoscopy were performed in 8 days after primary surgery to confirm integrity of the anastomoses. Exclusion criteria were factors affecting normal tissue regeneration (diabetes mellitus, steroid drugs prescription, etc.). Patients with intact anastomoses and no exclusion criteria were randomized into 2 groups: group 1 (n=31) with early closure of ileostomy (in 8-13 days after surgery) and group 2 (n=34) with delayed closure (after 12 weeks). All data were analyzed. RESULTS: Postoperative morbidity was similar in both groups (6.45% vs. 5.88%, p=0.08). However, less duration of reconstructive surgery was noted in group 1 (50 (27-126) min vs. 71 min (31-134). This value was 1.42 times less in the main group (95% CI 1.30-1.52; p=0.02). CONCLUSION: Early closure of ileostomy in patients after surgery for rectal cancer is feasible and does not result increased postoperative morbidity. This approach may be considered as an alternative to delayed closure. However, further researches devoted to analysis of ileostomy-associated complications and quality of life are necessary.


Assuntos
Ileostomia/métodos , Íleo/cirurgia , Neoplasias Retais/cirurgia , Anastomose Cirúrgica , Humanos , Protectomia , Reoperação , Fatores de Tempo
7.
Khirurgiia (Mosk) ; (2): 26-31, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30855587

RESUMO

AIM: To assess mechanisms of recurrent gastroesophageal reflux disease and the ability to perform adequate surgical correction after previous surgery. MATERIAL AND METHODS: The authors from various surgical centers have operated 2678 patients with gastroesophageal reflux disease and hiatal hernia for the period 1993-2018. 127 (4.74%) patients underwent redo surgery for recurrent disease, 46 of them were previously operated in other clinics. RESULTS: Median follow-up after redo surgery was 63 months (12-139). Satisfactory functional result was achieved in 76.4% of patients.


Assuntos
Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Humanos , Laparoscopia , Recidiva , Reoperação
8.
Khirurgiia (Mosk) ; (4): 36-40, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28418366

RESUMO

AIM: To define the indications for pancreatoduodenectomy using 3D CT-imaging, to calculate the volume of damaged and intact tissues and to determine type of surgery depending on severity of disease in case of ductal pancreatic adenocarcinoma. MATERIAL AND METHODS: Retrospective analysis of CT-scans of 30 patients with ductal pancreatic adenocarcinoma was performed. In groups 1 and 2 by 15 patients total pancreatectomy and pancreatoduodenectomy were made respectively. All patients underwent contrast-enhanced CT examination (Brilliance iCT, Phillips) followed post-processing on Brilliance Workspace Portal platform. All data were assessed by two reviewers. RESULTS: In group 1 CT volume of the tumor was 24±19 cm3 (32% of total pancreas), in group 2 - 9.8±6 cm3 (16% of total pancreas). CT-volume of celiacomesenteric arteries and portal system was 25.8±10 mm/59.5±18.9 mm and 23.3±6/49.9±14.7 mm in groups 1 and 2 respectively. Greater volume of tumor was significantly associated with increased portal system (p<0.03). Sensitivity, specificity and accuracy of determining of tumor location were increased up to 94%, 50% and 80% respectively in group 1. There were no cases of wrong localization in group 2. Data of both reviewers were similar. CONCLUSION: Total pancreatectomy is advisable for pancreatic adenocarcinoma if its volume is over 31.8% of total pancreas according to 3D CT-scans. 3D-modeling improves preoperative assessment of resectability, accuracy of determining of tumor localization and identifying vascular invasion.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/cirurgia , Imageamento Tridimensional , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Tomografia Computadorizada por Raios X , Carcinoma Ductal Pancreático/patologia , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Humanos , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/cirurgia , Invasividade Neoplásica/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia , Sistema Porta/diagnóstico por imagem , Sistema Porta/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Estudos Retrospectivos , Carga Tumoral
9.
Khirurgiia (Mosk) ; (2): 4-9, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28303867

RESUMO

AIM: To present treatment of 52 149 patients with ulcerative gastroduodenal bleeding (UGDB) who were treated in different regions of Central Federal District (CFD) for the period 2011-2014. It is noted that UGDB incidence per 100 thousands is increased proportionally from 32.9 to 77.8 according to population less than 20 and over 100 thousands, respectively. In hospitals of small and medium settlements the number of UGDB patients without surgery reaches 81.6 and 81.1%, the number of operated patients - 18.4 and 18.9% respectively. In hospitals of large settlements this ratio is 90.1 and 90.6%, the number of operated patients - 9.9 and 9.4%, respectively. In areas of Central Federal District the mortality rate in patients without surgery is 3.9-8.2%, in operated patients - 17.4-36.9%. RESULTS: Structured analysis of the organization of surgical care in Central Federal District revealed the relationship between outcomes and efficient use of endoscopic diagnostics and haemostasis. In municipal hospitals of Central District endoscopic technologies are insufficiently used for final elimination of ulcerative bleeding.


Assuntos
Hemostasia Cirúrgica , Hospitais , Úlcera Péptica Hemorrágica , Endoscopia Gastrointestinal/métodos , Necessidades e Demandas de Serviços de Saúde , Hemostasia Cirúrgica/métodos , Hemostasia Cirúrgica/mortalidade , Hemostasia Cirúrgica/estatística & dados numéricos , Hospitais/classificação , Hospitais/estatística & dados numéricos , Humanos , Mortalidade , Úlcera Péptica Hemorrágica/epidemiologia , Úlcera Péptica Hemorrágica/cirurgia , Federação Russa/epidemiologia
10.
Khirurgiia (Mosk) ; (1): 42-47, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28209953

RESUMO

AIM: To develop the method for extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC. MATERIAL AND METHODS: The study included 37 patients with morphologically confirmed RCC pT1a-Т3bN0M0-1G1-3 with intraparenchymal and central location of the tumor in cases of single kidney, comorbidity of contralateral kidney and kidney on the side of lesion. RESULTS: Mean surgery time was 413.97±89.14 minutes. Mean time of warm ischemia was 8.39±4.75 minutes, cold ischemia - 151.41±41.29 minutes. Intraoperative and postoperative complications were detected in 3 (8.1%) and 18 (48.6%) patients respectively. CONCLUSION: Extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC is a relatively safe organ-sparing treatment. It provides resection of large tumors with any location under prolonged cold ischemia without ureter intersection.


Assuntos
Carcinoma de Células Renais , Isquemia Fria/métodos , Neoplasias Renais , Nefrectomia , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Feminino , Taxa de Filtração Glomerular , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Federação Russa
11.
Inflamm Res ; 65(10): 785-94, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27312112

RESUMO

BACKGROUND: Endometrial hyperplasia (EH) is one of the most common gynecologic diseases in the world. Different statistical categories implicate an imbalance of estrogens and progestogens in the etiology of this disease. We propose that inflammation also plays a key role in the progression of endometrial hyperplasia. OBJECTIVE: The aim of this study is to evaluate the role of inflammation in the transformation and progression of endometrial hyperplasia, using local inflammatory cytokines and nonspecific protease levels, CD 45(+) expression, and histological examination. DESIGN: The study included 107 patients (ages 29-49 years) with different forms of endometrial hyperplasia. The enrolled patients were randomized into one of the four groups: normal endometrium (n = 18) as the control group, simple hyperplasia (n = 41), complex hyperplasia without atypia (n = 36), complex atypical hyperplasia or endometrioid adenocarcinoma (n = 12). METHODS: The following were evaluated for patients with different forms of EH: steroid hormone levels in blood serum and uterine flushings, immunohistochemical estrogen and progesterone receptor expression patterns in the endometrial tissue, CD 45(+) (common leukocyte antigen) expression, the levels of the cytokines IL-1ß, IL-6, and TNF-α, and nonspecific proteases and their inhibitors. RESULTS: The level of estradiol in blood serum and especially in uterine flushings was elevated dramatically in simple EH as compared to that of controls, but there was no significant difference between estradiol levels among the different forms of EH. The estimation of CD 45(+), the levels of the cytokines IL-1ß, IL-6, and TNF-α, and the activity of proteases (elastase-like and trypsin-like activities) and their inhibitors showed that levels of nonspecific inflammatory markers increase with EH progression. CONCLUSIONS: We suggest that the initial responsibility for the development of simple endometrial hyperplasia belongs to systemic hyperestrogenemia and, in particular, local hyperestrogenia, but that the role of inflammatory processes increases in complex and atypical EH. Development of inflammatory changes in endometrial hyperplasia may be considered as a factor in the promotion and progression of pathology, as well as an attributed risk factor for malignancy in endometrial hyperplasia. In this study, we have established a role for CD 45(+) expression cells, non-specific proteases, and the inflammatory cytokines IL-1ß, IL-6, and TNF-α in endometrial hyperplasia-related inflammation.


Assuntos
Hiperplasia Endometrial/metabolismo , Inflamação/metabolismo , Adulto , Progressão da Doença , Hiperplasia Endometrial/patologia , Endométrio/metabolismo , Endométrio/patologia , Estradiol/metabolismo , Feminino , Humanos , Inflamação/patologia , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Antígenos Comuns de Leucócito/metabolismo , Pessoa de Meia-Idade , Peptídeo Hidrolases/metabolismo , Progesterona/metabolismo , Prolactina/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
12.
Khirurgiia (Mosk) ; (10): 27-40, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27804932

RESUMO

AIM: To optimize diagnostics and treatment of cystic liver tumors. MATERIAL AND METHODS: The analysis included outcomes of 46 patients with liver cystic tumors. RESULTS AND DISCUSSION: The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium. CONCLUSION: There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.


Assuntos
Cistadenocarcinoma Mucinoso , Cistadenoma Mucinoso , Hepatectomia , Neoplasias Hepáticas , Fígado , Recidiva Local de Neoplasia/prevenção & controle , Adulto , Biomarcadores Tumorais/sangue , Cistadenocarcinoma Mucinoso/sangue , Cistadenocarcinoma Mucinoso/diagnóstico , Cistadenocarcinoma Mucinoso/patologia , Cistadenocarcinoma Mucinoso/cirurgia , Cistadenoma Mucinoso/sangue , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/patologia , Cistadenoma Mucinoso/cirurgia , Diagnóstico Diferencial , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Processos e Resultados em Cuidados de Saúde , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler/métodos
13.
Khirurgiia (Mosk) ; (12): 86-95, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26978768

RESUMO

AIM: To create multidisciplinary diagnostic and curative approach to patients with intestinal fistulae. MATERIAL AND METHODS: Additional nutritive support was applied in all patients preoperatively. 35 patients with intestinal fistulae were operated. Unformed and formed intestinal fistulae were observed in 10 and 25 patients respectively. Radical one-stage surgery was performed in 30 cases, two-stage - in 3 patients. Unformed fistulae opened into granulating wound were not eliminated in 2 patients. RESULTS: Postoperative complications were observed in 10 patients. 2 of them required re-intervention. There were no deaths.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fístula Intestinal/cirurgia , Intestino Delgado/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Khirurgiia (Mosk) ; (2): 8-15, 2014.
Artigo em Russo | MEDLINE | ID: mdl-24736533

RESUMO

The rare clinical case of multiple primary gastrointestinal stromal tumors (GIST) in one patient is presented in the article. The analysis of the available material confirmed that there is the problem of early detection of this type of tumors and their differential diagnosis. The minutes of outpatient radiological methods of research should include methods of identifying GIST in various locations. Early diagnosis of the disease allows you to make a radical mini-invasive intervention in the endoscopic or robotic-assisted version. This tactic is characterized by high efficiency in combination with the chemotherapeutic treatment.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Adulto , Idoso , Angiografia/métodos , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
16.
Khirurgiia (Mosk) ; (3): 11-6, 2013.
Artigo em Russo | MEDLINE | ID: mdl-23612331

RESUMO

23 pancreatectomies were made on the reason of various tumors of the pancreas during the period of 2009-2012yy. 15 patients had duct adenocarcinoma, 4 - neuroendocrine neoplasia, 2 - intraductal papillary-mucinous tumor, 1 had metastase of renal-cell carcinoma and 1 was diagnosed with serous cystadenoma. Pancreatectomy was indicated in case of invasion of the whole pancreas or in case of multiple tumor focuses. By adenocarcinoma the pancreatecomy was abstained in case of large vessels (a. mesenterica suoerior, truncus coeliacus and hepatic arteries) invasion or remote metastases presense or impossibility of R0 resection. Metastases and vessel invasion were not considered as contraindication to pancreatectomy in patients with neuroendocrine lesions. 10 (43.5%) patients had postoperative complications; 2 patients died. The survival median was 7 months for the duct adenocarcinoma. Postoperative life duration for patients with other pancreatic tumors was 6-36 months.


Assuntos
Tomada de Decisões , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Estudos Retrospectivos , Federação Russa/epidemiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento
17.
Khirurgiia (Mosk) ; (1): 17-24, 2013.
Artigo em Russo | MEDLINE | ID: mdl-23503345

RESUMO

585 patients were operated on the reason of chronic pancreatitis. 246 patients received various drainig operations: cystojejunostomy with Roux-en-Y anastomosis (n=97), longitudinal pancreatojejunostomy (n=86), external draining of the absceding postnecrotic cysts (n=51), internal draining (n=12). Resections of the pancreas were performed in 327 cases: Frey operation (n=83), Beger operation (n=46), pancreatoduodenal resection (n=61) - of them 55 were suspicious to cancer and 6 had pancreatic dystrophy. Distal resection of the pancreas was performed in 6 cases. 33 patients were operated on pseudoaneurisms, of the 12 patients received endovascular operations. Posoperative complications were registerd in 119 (20.3%) patients. 7 (1.2%) patients died.


Assuntos
Pancreatectomia/normas , Pancreaticoduodenectomia/normas , Pancreaticojejunostomia/normas , Pancreatite Crônica/cirurgia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Anastomose em-Y de Roux , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Khirurgiia (Mosk) ; (8): 44-50, 2012.
Artigo em Russo | MEDLINE | ID: mdl-22968557

RESUMO

The study aims the determination of the CT-scan protocol for the proper assessment of pancreatic tumors respectability. The goal of the CT-scan is a proper visualization of the tumor spread onto the surgically important vessels of the hepatopancreatobiliary zone and remote metastases verification. The diagnostic algorithm of the pancreatic cancer is based on the analysis of the variety of cases and diagnostic means.


Assuntos
Estadiamento de Neoplasias/métodos , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
Khirurgiia (Mosk) ; (11): 4-7, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23258352

RESUMO

11 patients with profuse arrosive intraabdominal bleeding after pancreatic resections were operated on the reason of pancreatic tumor. 9 patients had pancreatoduodenal resections (of the 6 pyloruspreserving), 2 patients had middle pancreatic resections. Bleeding was caused by postoperative pancreonecrosis and suture insufficiency in all cases. The source of bleeding were: vena porta, upper mesenteric and splenic veins, upper mesenteric and common hepatic arteries. 3 patients were relaparotomyzed and the vessel wall was sutured. Nevertheless, they died after bleeding recurrence within 2-3 days. The extirpation of the distal pancreatic stump was performed in 8 patients. Of them 3 patients died of multyorgan failure. The experience permits to consider the distal pancreatic stump the operation of choice by postoperative profuse bleeding.


Assuntos
Necrose , Pâncreas , Pancreatectomia/efeitos adversos , Pancreatopatias/cirurgia , Hemorragia Pós-Operatória , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/fisiopatologia , Necrose/cirurgia , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreatectomia/mortalidade , Pancreatopatias/fisiopatologia , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/cirurgia , Período Pós-Operatório , Reoperação/métodos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
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