RÉSUMÉ
OBJECTIVE: To study the possibilities of minimally invasive methods for removing intra-abdominal calculi after laparoscopic cholecystectomy. MATERIAL AND METHODS: There were 5 patients with abdominal abscesses associated with infected calculi after previous laparoscopic cholecystectomy at the Sklifosovsky Research Institute for Emergency Care between 2020 and 2023. Mean age of patients was 55±12 years. There were 3 (60%) women and 2 (40%) men. All patients underwent minimally invasive treatment. RESULTS: Four patients (80%) underwent percutaneous drainage of abscess with subsequent replacement by larger drains and removal of calculi with endoscopic assistance. Event-free period after cholecystectomy was 44±32 months. One patient developed subhepatic abscess in 72 months after laparoscopic cholecystectomy. This patient underwent transluminal removal of calculus through the duodenal wall. There was 1 calculus in 3 (60%) patients, 2 calculi in 1 (20%) patient and 3 calculi in 1 (20%) patient. CONCLUSION: The above-mentioned cases demonstrate successful minimally invasive interventions for symptomatic abdominal calculi after laparoscopic cholecystectomy. Minimally invasive treatment can reduce surgical aggression and accelerate rehabilitation.
Sujet(s)
Abcès abdominal , Cholécystectomie laparoscopique , Interventions chirurgicales mini-invasives , Humains , Mâle , Cholécystectomie laparoscopique/effets indésirables , Cholécystectomie laparoscopique/méthodes , Femelle , Adulte d'âge moyen , Interventions chirurgicales mini-invasives/méthodes , Interventions chirurgicales mini-invasives/effets indésirables , Abcès abdominal/étiologie , Abcès abdominal/chirurgie , Complications postopératoires/étiologie , Complications postopératoires/prévention et contrôle , Complications postopératoires/diagnostic , Complications postopératoires/thérapie , Drainage/méthodes , Sujet âgé , Adulte , Résultat thérapeutique , Calculs biliaires/chirurgieRÉSUMÉ
Malignant lesions of tracheal bifurcation usually lead to respiratory failure and risk of mortality. Airway stenting is the only minimally invasive method for these patients. The authors present a patient with T4N3M0 left-sided lung cancer (inoperable stage IIIc) complicated by respiratory failure due to tracheal bifurcation obstruction. Bilateral stenting by self-expanding stents with perforated coatings was effective for airway recanalization and provided subsequent chemotherapy.
Sujet(s)
Obstruction des voies aériennes , Maladies des bronches , Insuffisance respiratoire , Sténose trachéale , Humains , Sténose pathologique/complications , Sténose trachéale/diagnostic , Sténose trachéale/étiologie , Sténose trachéale/chirurgie , Maladies des bronches/complications , Obstruction des voies aériennes/complications , Endoprothèses/effets indésirablesRÉSUMÉ
OBJECTIVE: To improve the outcomes in patients with malignant obstructive jaundice using intraluminal stenting. MATERIAL AND METHODS: The present study included 62 patients with clinical symptoms of malignant obstructive jaundice. In the main group, we performed biliary stenting with self-expanding multi-perforated stents (Hanarostent Multi-hole Biliary). Microscopic perforations of these stents prevent migration and reduce the risk of blocking the cystic and main pancreatic ducts. In the control group, stenting was performed with fully and partially covered self-expanding stents. RESULTS: Lower incidence of obstructive cholecystitis and acute pancreatitis in the main group was associated with multiperforated stents reducing the risk of blocking the main pancreatic and cystic ducts. CONCLUSION: In our study, multiperforated stents excluded migration and reduced the incidence of complications (acute cholecystitis from 11.5 to 3.8%, acute pancreatitis from 15.3 to 7.7%).
Sujet(s)
Ictère rétentionnel , Pancréatite , Humains , Maladie aigüe , Sténose pathologique , Ictère rétentionnel/diagnostic , Ictère rétentionnel/étiologie , Ictère rétentionnel/chirurgie , Pancréatite/complications , Pancréatite/diagnostic , Endoprothèses/effets indésirablesRÉSUMÉ
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.
Sujet(s)
Traumatismes de l'abdomen , Plaies non pénétrantes , Mâle , Humains , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Études prospectives , Études rétrospectives , Alanine transaminase , Plaies non pénétrantes/diagnostic , Plaies non pénétrantes/thérapie , Traumatismes de l'abdomen/diagnostic , Traumatismes de l'abdomen/thérapieRÉSUMÉ
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.
Sujet(s)
Tumeurs des canaux biliaires , Cholestase , Ictère rétentionnel , Tumeur de Klatskin , Humains , Ictère rétentionnel/diagnostic , Ictère rétentionnel/étiologie , Ictère rétentionnel/chirurgie , Tumeur de Klatskin/complications , Tumeur de Klatskin/diagnostic , Tumeur de Klatskin/chirurgie , Tumeurs des canaux biliaires/complications , Tumeurs des canaux biliaires/diagnostic , Tumeurs des canaux biliaires/chirurgie , Études rétrospectives , Endoscopie/effets indésirables , Endoprothèses/effets indésirables , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Cholestase/étiologieRÉSUMÉ
OBJECTIVE: To improve the outcomes after orthotopic liver transplantation (OLT) followed by early biliary complications via endoscopic bilioduodenal stenting. MATERIAL AND METHODS: The study enrolled 41 patients with early biliary complications within 90 days after OLT. All patients underwent endoscopic treatment between 2001 and 2021. There were 34 (82.9%) men and 7 (17.1%) women aged 48.5±12.5 years. Strictures and failure of biliary anastomosis occurred in 33 (80.5%) and 8 (19.5%) patients, respectively. RESULTS: After endoscopic treatment, serum bilirubin normalized in 3.3±0.86 days in patients with strictures (23.7 (16.4; 34.5) mmol/l, p<0.001). Diameter of lobar ducts as a criterion of biliary hypertension was normalized after 4 (2.5; 5.5) days (p<0.001). Bile leakage after stenting with a covered self-expanding stent regressed in all 7 patients after 3 (2; 5) days. In 1 patient, bile output through the drainage stopped in 8 days after bilioduodenal stenting with a plastic stent. CONCLUSION: Endoscopic bilioduodenal stenting is always effective and minimally invasive treatment after liver transplantation followed by early biliary complications (failure or stricture of anastomosis). This approach minimizes postoperative complications (9.8%) that do not require surgical intervention (Clavien-Dindo grade I).
Sujet(s)
Maladie des voies biliaires , Transplantation hépatique , Mâle , Humains , Femelle , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Résultat thérapeutique , Transplantation hépatique/effets indésirables , Sténose pathologique/diagnostic , Sténose pathologique/étiologie , Sténose pathologique/chirurgie , Maladie des voies biliaires/diagnostic , Maladie des voies biliaires/étiologie , Maladie des voies biliaires/chirurgie , Endoprothèses/effets indésirables , Complications postopératoires/diagnostic , Complications postopératoires/étiologie , Complications postopératoires/prévention et contrôle , Études rétrospectivesRÉSUMÉ
Adenoma of the major duodenal papilla can cause bile flow blockade and obstructive jaundice. We present successful endoscopic radiofrequency ablation for adenoma of the major duodenal papilla with intraductal growth in the common bile duct.
Sujet(s)
Adénomes , Ampoule hépatopancréatique , Tumeurs du cholédoque , Ablation par radiofréquence , Humains , Ampoule hépatopancréatique/chirurgie , Tumeurs du cholédoque/diagnostic , Tumeurs du cholédoque/chirurgie , Conduit cholédoque/chirurgie , Adénomes/diagnostic , Adénomes/chirurgie , Résultat thérapeutiqueRÉSUMÉ
The authors present ultrasonography-assisted endoscopic diagnosis of chemical burn of the esophagus. This method early predicted decompensated cicatricial stenosis of the esophagus that was valuable to determine treatment strategy. Preventive mini-invasive endoscopic percutaneous gastrostomy provided adequate enteral nutrition in a patient with decompensated esophageal stenosis before reconstructive surgery.
Sujet(s)
Brûlures chimiques , Brûlures , Sténose de l'oesophage , Humains , Brûlures chimiques/complications , Brûlures chimiques/diagnostic , Endosonographie , Sténose de l'oesophage/imagerie diagnostique , Sténose de l'oesophage/étiologie , GastrostomieRÉSUMÉ
OBJECTIVE: To develop an effective method for percutaneous endoscopic gastrostomy using gastropexy technology. MATERIAL AND METHODS: We retrospectively analyzed 260 ICU patients with dysphagia associated with neurological disorders between 2010 and 2020. All patients were divided into two groups: the main group (n=50) - percutaneous endoscopic gastrostomy with gastropexy, control group (n=210) - surgery without fixing the anterior wall of the stomach to the abdominal wall. RESULTS. G: Astropexy significantly reduced the incidence of postoperative complications (p=0.045) and severe complications (grade IIIa and higher) (χ2=3.701, p=0.055). Early postoperative complications occurred in 20 (7.7%) patients. Surgery and subsequent treatment were associated with normalization of leukocyte count (p=0.041), C-reactive protein (p=0.024) and serum albumin (p=0.0012). Mortality was similar in both groups. Overall 30-day mortality rate in both groups was 20.8% that was associated with clinical severity of patients. Percutaneous endoscopic gastrostomy was not the direct cause of death in any case. However, complications of endoscopic gastrostomy aggravated the underlying disease in 2.9% of cases. CONCLUSION: Percutaneous endoscopic gastrostomy with gastropexy reduces the incidence of postoperative complications.
Sujet(s)
Troubles de la déglutition , Maladies du système nerveux , Humains , Troubles de la déglutition/diagnostic , Troubles de la déglutition/épidémiologie , Troubles de la déglutition/étiologie , Études rétrospectives , Estomac/chirurgie , Complications postopératoires/diagnostic , Complications postopératoires/épidémiologie , Complications postopératoires/étiologie , Maladies du système nerveux/diagnostic , Maladies du système nerveux/étiologieRÉSUMÉ
Cholelithiasis complicated by cholecystoduodenal fistula and small bowel biliary obstruction is an absolute indication for surgical treatment. Modern possibilities of intraluminal endoscopy (electrohydraulic lithotripsy) made it possible to avoid intra-abdominal access (laparotomy, laparoscopy) and postoperative complications. Finally, rapid rehabilitation was noted.
Sujet(s)
Fistule biliaire , Lithiase biliaire , Cholestase , Occlusion duodénale , Fistule intestinale , Lithotritie , Humains , Occlusion duodénale/diagnostic , Occlusion duodénale/étiologie , Occlusion duodénale/chirurgie , Lithiase biliaire/complications , Lithiase biliaire/diagnostic , Lithiase biliaire/chirurgie , Endoscopie/effets indésirables , Endoscopie gastrointestinale/effets indésirables , Lithotritie/effets indésirables , Fistule intestinale/diagnostic , Fistule intestinale/étiologie , Fistule intestinale/chirurgie , Fistule biliaire/diagnostic , Fistule biliaire/étiologie , Fistule biliaire/chirurgieRÉSUMÉ
OBJECTIVE: To improve the results of treatment of obstructive jaundice by using of oral cholangioscopy. MATERIAL AND METHODS: There were 321 patients with obstructive jaundice between October 2020 and November 2021. Of these, cholangioscopy (SpyGlass video system) was used in 18 patients. Patients were divided into two groups: group 1 (n=9) - malignant biliary strictures; group 2 (n=9) - choledocholithiasis with large calculi (≥1.2 cm). At admission, all patients underwent laboratory and instrumental examination. In the first group, bilioduodenal stenting with plastic stents 7 and 10 Fr in diameter, 7 to 12 cm long or self-expanding nitinol stents 0.8-1.0 cm in diameter, 6 to 10 cm long was carried out. Patients with large calculi underwent targeted laser lithotripsy under endoscopic control until formation of 1-cm fragments. These fragments were removed using a lithoextraction balloon and Dormia basket. RESULTS: Cholangioscopy (SpyGlass system) was performed within 2 days after admission. In group 1, tumor tissue overgrowths were found during cholangioscopy. Five out of 9 (55.6%) patients underwent bilioduodenal stenting for adequate biliary drainage. Of these, 4 (44.5%) patients developed acute edematous pancreatitis on the first postoperative day. This complication regressed after 3-4 days under therapy. Four (44.5%) patients died from cancer-related multiple organ failure. In group 2, cholangioscopy effectively visualized the calculus and ensured its destruction by laser contact lithotripsy. Intraoperative and postoperative complications were not revealed in both groups. CONCLUSION: SpyGlass system is effective and safe for diagnosis and treatment in 100% of patients with extrahepatic biliary strictures and/or large calculi.
Sujet(s)
Voies biliaires , Calculs , Cholestase , Maladies de l'appareil digestif , Ictère rétentionnel , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Cholangiopancréatographie rétrograde endoscopique/méthodes , Sténose pathologique , Endoscopie digestive/effets indésirables , Endoscopie digestive/méthodes , Humains , Ictère rétentionnel/diagnostic , Ictère rétentionnel/étiologie , Ictère rétentionnel/chirurgie , Matières plastiquesRÉSUMÉ
OBJECTIVE: To improve treatment outcomes in patients with acute pancreatitis through a differentiated approach to transluminal drainage. MATERIAL AND METHODS: There were 1074 patients with acute pancreatitis between January 2018 and December 2021 at the Sklifosovsky Research Institute for Emergency Care. EUS was used as a final diagnostic method to determine localization, dimensions, shape and contours of fluid collections. We also assessed content, presence or absence of a capsule and connection with pancreatic ductal system, possibility of intraluminal drainage under EUS control. A plastic stent with rounded ends was installed if homogeneous hypo- and anechoic cavity with clear even contours was detected. The same measure was applied in case of aspiration of serous or serous-hemorrhagic fluid. The indication for installation of covered self-expanding endoprosthesis was inhomogeneous anechoic fluid collection with hyperechoic inclusions (sequesters) and cloudy purulent content. Patients with necrotic forms underwent insertion of a cystonasal drainage tube 7Fr for sanitation of the cavity with 0.05% aqueous chlorhexidine solution. Endoscopic sequestrectomy was performed every 24-48 hours. Stent was removed in 6 (for encapsulated peripancreatic fluid collections) or 1 month (for other types of fluid collections) after discharge. RESULTS: According to the EUS data, endoscopic TLD was performed in 63 (46%) out of 136 patients with fluid collections. Among 63 patients with TLD, connection with pancreatic ductal system was found in 5 (7.9%) patients. These ones underwent pancreaticoduodenal stenting. Twenty-two patients underwent elective sequestrectomy after stenting of necrotic types of fluid collections with fully covered self-expanding stents. Additional percutaneous drainage was required in 11 (45.8%) of 24 patients. Complicated postoperative period was observed in 4 (6.3%) patients with acute necrotic fluid collections (bleeding from the area of pancreatogenic destruction). Four (6.3%) patients died. Autopsy revealed resolution of purulent-inflammatory process in all patients. CONCLUSION: Intraluminal surgery is possible not only for homogeneous delimited fluid collections, but also for advanced lesions including infected destructions. This approach allows us to consider endoscopic intraluminal drainage as the final minimally invasive method of surgical treatment of pancreatic necrosis. Its effectiveness is up to 45.8%.
Sujet(s)
Drainage , Pancréatite aigüe nécrotique , Maladie aigüe , Drainage/méthodes , Endoscopie/méthodes , Endoscopie gastrointestinale , Endosonographie/méthodes , Humains , Nécrose/chirurgie , Pancréatite aigüe nécrotique/étiologie , Endoprothèses , Résultat thérapeutiqueRÉSUMÉ
OBJECTIVE: To improve the outcomes after pancreas transplantation complicated by pancreatitis using percutaneous drainage and endoscopic stenting of the main pancreatic duct. MATERIAL AND METHODS: There were 64 transplantations of the pancreatoduodenal complex between January 1, 2012 and December 31, 2021 at the Sklifosovsky Research Institute for Emergency Care. In 11 (17.2%) cases, early postoperative period was complicated by acute pancreatitis and parapancreatic fluid accumulations. Of these, 7 patients underwent ultrasound-guided percutaneous drainage of focal destructions. This procedure was effective and did not require additional treatment. In 4 patients, debridement and drainage were ineffective and required additional endoscopic stenting of the main pancreatic duct. RESULTS: All patients underwent percutaneous drainage of peripancreatic fluid collections and subsequent fistulography. All patients had inhomogeneous cavities with irregular shape and volume of 19.6±1.8 cm3. In 3 (75%) out of 4 patients, there was a passage of contrast agent into the main pancreatic duct of the graft and donor duodenal stump. We did not find contrast enhancement of ductal system in 1 (25%) patient since filling of the cavity with a contrast agent was not tight. Sensitivity of this method for detecting pancreatic ductal defects was 75%. Indications for stenting of the main pancreatic duct were established in 22.5±9.6 days after transplantation. Drainage and debridement were ineffective in 2 (50%) patients. In other 2 (50%) patients, peripancreatic fluid collections enlarged. All patients underwent endoscopic stenting of the main pancreatic duct. CONCLUSION: Endoscopic stenting of the main pancreatic duct of the donor pancreas combined with percutaneous drainage of peripancreatic fluid accumulations is a highly effective and minimally invasive approach for fluid collections after transplantation of the pancreatoduodenal complex. This method also minimizes the incidence of postoperative complications. Thanks to this method, we avoided redo open surgeries in all cases.
Sujet(s)
Transplantation pancréatique , Maladies du pancréas , Pancréatite , Maladie aigüe , Cholangiopancréatographie rétrograde endoscopique , Humains , Transplantation pancréatique/effets indésirablesRÉSUMÉ
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.
Sujet(s)
Pancréatite , Maladie aigüe , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Drainage/effets indésirables , Humains , Pancréas , Conduits pancréatiques/chirurgie , Pancréatite/diagnostic , Pancréatite/étiologie , Pancréatite/chirurgie , Endoprothèses , Résultat thérapeutiqueRÉSUMÉ
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.
Sujet(s)
Pancréatite aigüe nécrotique , Maladie aigüe , Drainage , Endoscopie , Femelle , Humains , Mâle , Adulte d'âge moyen , Nécrose/étiologie , Nécrose/chirurgie , Pancréatite aigüe nécrotique/diagnostic , Pancréatite aigüe nécrotique/chirurgie , Résultat thérapeutiqueRÉSUMÉ
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.
Sujet(s)
Ampoule hépatopancréatique , Tumeurs du cholédoque , Tumeurs du duodénum , Ictère rétentionnel , Ampoule hépatopancréatique/chirurgie , Tumeurs du cholédoque/complications , Tumeurs du cholédoque/diagnostic , Tumeurs du cholédoque/chirurgie , Tumeurs du duodénum/complications , Tumeurs du duodénum/diagnostic , Tumeurs du duodénum/chirurgie , Humains , Ictère rétentionnel/diagnostic , Ictère rétentionnel/étiologie , Ictère rétentionnel/chirurgie , Résultat thérapeutiqueRÉSUMÉ
OBJECTIVE: To report initial experience of endoscopic transluminal drainage of infected pancreatic necrosis. MATERIAL AND METHODS: There were 8 patients with acute severe pancreatitis and large-focal pancreatic necrosis who underwent transluminal drainage of destruction zones for the period from December 2018 to October 2019. RESULTS: Transluminal drainage of pancreatogenic destruction zones in acute severe pancreatitis can be considered as the only surgical approach in 50% of cases that is comparable with literature data.
Sujet(s)
Endoscopie , Pancréatite aigüe nécrotique , Drainage , Endoscopie/méthodes , Humains , Nécrose/étiologie , Nécrose/chirurgie , Pancréas/anatomopathologie , Pancréas/chirurgie , Pancréatite aigüe nécrotique/diagnostic , Pancréatite aigüe nécrotique/chirurgie , Résultat thérapeutiqueRÉSUMÉ
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.
Sujet(s)
Ampoule hépatopancréatique , Tumeurs du cholédoque , Pancréatite , Maladie aigüe , Ampoule hépatopancréatique/chirurgie , Tumeurs du cholédoque/diagnostic , Tumeurs du cholédoque/chirurgie , Duodénoscopie , Femelle , Humains , Mâle , Pancréatite/étiologie , Pancréatite/prévention et contrôle , Réintervention , Résultat thérapeutiqueRÉSUMÉ
A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Further study of this method and its clinical introduction in case of favorable results can significantly reduce the incidence of complications and mortality in patients with perforated gastroduodenal ulcers.
Sujet(s)
Ulcère duodénal/chirurgie , Perforation d'ulcère gastroduodénal/chirurgie , Sujet âgé de 80 ans ou plus , Alliages , Matériaux revêtus, biocompatibles , Duodénoscopie , Gastroscopie , Humains , Laparoscopie/effets indésirables , Polyuréthanes , Implantation de prothèse , Réintervention , Endoprothèses métalliques auto-expansibles , Techniques de suture/effets indésirablesRÉSUMÉ
OBJECTIVE: To evaluate the possibility and safety of modified endoscopic stent in the treatment of benign intestinal fistulas. MATERIAL AND METHODS: Analysis of the experience of Sklifosovsky Research Institute for Emergency Care and recent numerous foreign reports confirms that staged treatment followed by delayed radical surgery is the most perspective approach. Modified endoscopic treatment of intestinal fistulas successfully used in 10 patients is reported in the article. RESULTS: Endoscopic stenting of various parts of gastrointestinal tract is a minimally invasive treatment of this pathology and not followed by complications and mortality. An important advantage is early closure of fistula that reduces duration of treatment and improves further social and labor rehabilitation of patients.