RESUMEN
The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.
Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos , Insuficiencia Multiorgánica , Pancreatectomía , Pancreatitis Aguda Necrotizante , Complicaciones Posoperatorias/mortalidad , Adulto , Factores de Edad , Anciano , Investigación sobre la Eficacia Comparativa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/mortalidad , Pancreatitis Aguda Necrotizante/fisiopatología , Pancreatitis Aguda Necrotizante/cirugía , Planificación de Atención al Paciente , Pronóstico , Ajuste de Riesgo , Factores de Riesgo , Federación de Rusia/epidemiología , Índice de Severidad de la Enfermedad , Factores Sexuales , Análisis de Supervivencia , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
Intraoperative assessment of vascularization of isoperistaltic tubular gastric transplant using angiotensiometry and Doppler flowmetry was performed at 136 patients undergone extirpation of esophagus with esophagogastroplasty. The main criteria of gastric transplant convenience for anastomosis with esophagus were: clear intramural pulse on all circle of gastric transplant by flowmetry data; intramural arterial pressure according to angiotensiometry data have to be not less 80 mm Hg, and the ratio of venous to arterial pressure has not to be more 50%. At inadequate criteria the surgery must be finished with cervical esophago- and gastrostoma.
Asunto(s)
Esofagoplastia/métodos , Gastroplastia/métodos , Cuidados Intraoperatorios , Peristaltismo/fisiología , Estómago/irrigación sanguínea , Estómago/trasplante , Neoplasias Esofágicas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Neoplasias Gástricas/cirugíaRESUMEN
Immediate and long-term results of surgical treatment of cancer of the esophagus and esophageal-gastric passage in 103 patients were analyzed. Ninety-nine extirpations of the esophagus with simultaneous isoperistaltic tubic esophagogastroplasty (95) and coloplasty (4), 4 Luis surgeries were performed. Hospital lethality was 4.9%, rate of postoperative complications - 47.6%. 5-year survival after surgery was 32.4+/-5,8%: in cancer of cervical or upper-thoracic part of the esophagus - 0, middle-thoracic part - 24.6+/-7.2%, lower-thoracic part - 56.5+/-11.9%, esophageal-gastric passage - 35.6+/-16.1%. Problems of surgical techniques, indications for transhiatal and transthoracic approaches to the esophagus, schemes of combined treatment are discussed.