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1.
Khirurgiia (Mosk) ; (12): 100-105, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825349

RESUMO

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.

2.
Khirurgiia (Mosk) ; (4): 15-23, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120442

RESUMO

AIM: To analyze incidence, diagnosis and treatment of complicated appendicitis in pregnant women and to determine the optimal surgical approach. MATERIAL AND METHODS: Retrospective cohort analysis included 338 pregnant women who underwent appendectomy in 2012-2016. Complicated appendicitis (abscess, local or common peritonitis and their combinations) was diagnosed in 22 cases. The main perioperative variables (duration of the disease, time of surgery, length of hospital-stay, incidence of wound complications, etc.), clinical and laboratory symptoms, results of ultrasound diagnosis and pregnancy outcomes were analyzed. Statistical analysis was carried out in Stata 14.2. Fisher's exact test, Mann-Whitney-Wilcoxon's U-test and multivariate regression analysis were used to compare data. RESULTS: The incidence of complicated appendicitis in pregnant women was 6.51%. There are no clinical symptoms which would be significantly more common in complicated appendicitis during pregnancy. Complicated course prolongs surgery and hospital-stay, however duration of postoperative analgesia depends on surgical technique as a rule. There were 27% of laparoscopic interventions that is lower compared with women with uncomplicated appendicitis. The percentage of conversions was higher too. CONCLUSION: Clinical diagnosis of complicated appendicitis during pregnancy even by using of ultrasound is not satisfactory and requires the involvement of other objective methods, such as MRI. Laparoscopic intervention is not contraindicated in pregnant women with complicated appendicitis and determine better treatment outcomes than open surgery.


Assuntos
Apendicite/diagnóstico , Apendicite/cirurgia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/cirurgia , Apendicectomia/métodos , Apendicectomia/estatística & dados numéricos , Apendicite/complicações , Feminino , Humanos , Incidência , Laparoscopia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
3.
Khirurgiia (Mosk) ; (1): 70-77, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30789612

RESUMO

Acute appendicitis is the most frequent surgical disease complicating pregnancy. Accurate diagnosis is difficult due to atypical and misleading clinical manifestations. Surgeons frequently do not know about advantages and disadvantages of different diagnostic methods applied during pregnancy. Treatment of acute appendicitis in pregnant women remains the real challenge for surgeons. There are enough researches indicating on benefits and risks of both open and laparoscopic operations. The main risk is due to fetal loss after laparoscopic procedure. Safety of diagnostic techniques and laparoscopic procedures, surgical tactics and independent risk factors of pregnancy loss are touched in the article.


Assuntos
Apendicite/diagnóstico , Apendicite/cirurgia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/cirurgia , Doença Aguda , Apendicectomia/efeitos adversos , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Humanos , Laparoscopia/efeitos adversos , Gravidez , Fatores de Risco
4.
Khirurgiia (Mosk) ; (12): 13-20, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30560840

RESUMO

AIM: To analyze an efficacy of FT-protocol in patients with acute cholecystitis. MATERIAL AND METHODS: Prospective randomized study included 102 patients (45 of main group (FT) and 57 of control groups). Patients did not differ by TG13 severity index. The protocol included information, antibiotic prophylaxis, restriction of drainage, intraperitoneal anesthesia with long-term anesthetics, low pressure pneumoperitoneum, antiemetics in the presence of risk factors, early activation and feeding of the patient. Pain was assessed by VAS immediately after surgery, and 2, 6 and 12-24 hours postoperatively. RESULTS: Surgery time was similar in both groups. Need for anesthesia and pain severity were significantly lower in the FT group. A total absence of pain (VAS 0-1) on the 1st postoperative day was noted in 8 (17.7%) of the FT group and 2 (3.5%) patients of the control group (p=0.038). Shoulder pain developed in 4 (8.9%) cases of the main and 22 (38.6%) cases of the control group (p=0.001). Postoperative nausea developed in 13% of the FT group vs 40.5% in the control group (p=0.05). Hospital-stay was 1.29±0.7 days and 2.7±1.6 (p<0.0001), respectively. The time of the first stool was similar. Twenty-four (53.5%) patients of the FT group and 8,9% of the control group were discharged on 1st postoperative day. There were 2 (IIIA) complications in the main group and 3 - in the control group (IIIA, IIIB and IV). There were no mortality and readmissions. CONCLUSION: FT protocol in AC reduce postoperative pain, dyspepsia, shoulder pain and in-hospital stay with equal number of postoperative complications.


Assuntos
Colecistite Aguda/reabilitação , Colecistite Aguda/cirurgia , Protocolos Clínicos , Assistência Perioperatória , Humanos , Assistência Perioperatória/reabilitação , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (9): 15-23, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30307416

RESUMO

AIM: To analyze outcomes of fast track rehabilitation in patients with acute appendicitis. MATERIAL AND METHODS: Prospective, randomized multi-center trial including 86 patients was conducted. There were 38 patients in the main group and 48 in the control group. All patients underwent laparoscopic appendectomy under endotracheal anesthesia. Protocol included informing, no premedication, glucose infusion prior to surgery, antibiotics administration, mesoappendix excision, limited deployment of drainage tubes, intraabdominal prolonged anesthesia, minimal pneumoperitoneum, limited irrigation, minimum power monopolar electrocautery, antiemetics, early activation and eating (2 and 6 hours after surgery). Pain was evaluated by visual-analogue scale. Auscultative peristalsis was considered every 2 hours after surgery. Cortisol level was assessed preoperatively, in 6 and 12-24 hours after surgery in 11 (29%) and 15 (31%) patients of the main and control groups respectively. Discharge criteria: no leukocytosis, fever and pain syndrome requiring anesthesia, no signs of complications and patient's consent. RESULTS: Terms of disease, gender, age and comorbidities were similar in all patients. Duration of surgery under minimal pneumoperitoneum and standard pressure was also similar: 69.2±3.98 and 70.9±3.89 min (p=0.762). Pain syndrome grade and need for analgesics were significantly lower in the main group within entire follow-up. Pain syndrome was absent at the 1st postoperative day in 16 (42%) and 2 (4.1%) patients of both groups, respectively (score 0-1). Phrenic nerve syndrome was observed in 36.8% of the main group and 60.4% of the control group (p=0.05). Incidence of dyspepsia and terms of peristalsis onset were similar. Length of hospital-stay was 1.45 days in the main group and 3.15 days in the control group (p=0.002). In the main group 18 (47%) patients were discharged on the first day after surgery. There were only 4 (8.3%) patients with similar hospital-stay in the control group (p<0.001). There were no repeated hospitalizations. Postoperative cortisol concentration was similar in both groups as well as in complicated and uneventful postoperative period. In the main group postoperative intestinal paresis (Clavien-Dindo grade 2) occurred in 1 patient. In the control group 7 patients had postoperative infiltrate and 1 patient - intestinal paresis (Clavien-Dindo grade 2). Postoperative drainage tube was deployed in 3 out of 7 patients with postoperative infiltrates and 6 of them received antibiotic therapy. Medication was successfully applied in all patients with complications. CONCLUSION: There are some advantages of FTR for AA including reduced pain syndrome, morbidity and less length of hospital-stay. Issue of cortisol concentration requires further trials.


Assuntos
Apendicectomia/reabilitação , Apendicite/reabilitação , Apendicite/cirurgia , Protocolos Clínicos , Assistência Perioperatória , Doença Aguda , Apendicectomia/métodos , Humanos , Laparoscopia , Tempo de Internação , Assistência Perioperatória/normas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
6.
Khirurgiia (Mosk) ; (6): 62-65, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29953102

RESUMO

AIM: To define optimal surgical approach for middle primary and postoperative ventral hernias. MATERIAL AND METHODS: We have presented the first results of endoscopic retro-muscular alloplasty in 8 patients with umbilical hernia and postoperative ventral hernia combined with rectus abdominis muscles diastase. RESULTS: One patient had seroma above mesh implant that was evacuated under ultrasonic control. Absent hernial protrusion and reduced diastase were noted in all patients. There were no symptoms of recurrence, purulent-septic complications and venous thromboembolic complications. Mortality was absent. CONCLUSION: Further experience and analysis of long-term results are necessary to determine the role of this technique in anterior abdominal wall hernias management.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia , Hérnia Incisional/cirurgia , Complicações Pós-Operatórias , Seroma , Cirurgia Assistida por Computador/métodos , Parede Abdominal/cirurgia , Drenagem/métodos , Feminino , Hérnia Ventral/etiologia , Herniorrafia/efeitos adversos , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Seroma/etiologia , Seroma/cirurgia , Telas Cirúrgicas , Resultado do Tratamento , Ultrassonografia/métodos
7.
Khirurgiia (Mosk) ; (3): 24-30, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29560955

RESUMO

AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.


Assuntos
Tratamento Conservador/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Intestinal/cirurgia , Intestino Delgado , Tempo para o Tratamento/normas , Aderências Teciduais/cirurgia , Adulto , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Tempo de Internação , Masculino , Seleção de Pacientes , Projetos de Pesquisa , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico
9.
Biomed Res Int ; 2014: 185265, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24995273

RESUMO

BACKGROUND: The term "paraduodenal pancreatitis" (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly. OBJECTIVE: To assess the results of different types of treatment for PP. METHOD: Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded. RESULTS: Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. CONCLUSIONS: PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.


Assuntos
Duodenopatias/cirurgia , Pâncreas/cirurgia , Pancreaticoduodenectomia , Pancreatite/cirurgia , Adulto , Idoso , Alcoolismo/patologia , Duodenopatias/diagnóstico por imagem , Duodenopatias/patologia , Duodeno/patologia , Endoscopia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pancreatite/diagnóstico por imagem , Pancreatite/patologia , Radiografia
10.
Khirurgiia (Mosk) ; (11): 69-71, 2013.
Artigo em Russo | MEDLINE | ID: mdl-24300617

RESUMO

The advantages of one-day training courses on the example of the short intensive course "manual suture in endoscopic surgery" are represented. The programme consists of the short 8-hours course, including theoretic lectures, practice seminars, virtual trainings and the trainee's self work under the control of the experienced supervisors. The preliminary assessment of the course, performed with the use of questionnaires and testing in small groups, showed it's unarguable efficacy for surgeons.


Assuntos
Competência Clínica , Educação Médica Continuada/métodos , Endoscopia/educação , Humanos , Fatores de Tempo
13.
Khirurgiia (Mosk) ; (5): 32-8, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21606919

RESUMO

Treatment results of 101 patients, operated on with the diagnosis of the chronic appendicitis, were analyzed. Of them, 55 had periodic right iliac pain syndrome, the rest 46 had a history of appendicular abscess or infiltrate. 58 patients were operated on laparoscopically, the rest had traditional open appendectomy. The use of ultrasound and roentgen diagnostics proved to be non-effective. The reliable laparoscopic symptoms of chronic appendicitis were singled out. The laparoscopy provided the correct diagnosis in 93.3% of patients and allowed avoiding the groundless appendectomy in 31.2%. The intraoperative ultrasound is helpful in questionable cases. The diagnostic and treatment algorithm for chronic appendicitis, based on laparoscopic methods, was worked out.


Assuntos
Dor Abdominal , Apendicectomia , Apendicite , Cuidados Intraoperatórios/métodos , Laparoscopia/normas , Complicações Pós-Operatórias/prevenção & controle , Dor Abdominal/etiologia , Dor Abdominal/fisiopatologia , Dor Abdominal/cirurgia , Adolescente , Adulto , Apendicectomia/métodos , Apendicectomia/normas , Apendicite/complicações , Apendicite/patologia , Apendicite/fisiopatologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/patologia , Apêndice/cirurgia , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Cuidados Intraoperatórios/normas , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia
14.
Khirurgiia (Mosk) ; (4): 4-8, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21512453

RESUMO

915 diagnostic laparoscopies for the suspicion on the acute appendicitis were analyzed. Frequency of the acute surgical disease' absence in patients with right iliac pain was defined. The frequency of the chronic appendicitis was defined, basing on the morphologic investigation of the 321 resected appendixes, ectomized on the reason of the acute appendicitis. Literature and personal experience were reviewed to set the frequency of the recurrence secondary chronic appendicitis. Clinical and morphological correlations between chronic noninflammation changes of the appendix and right iliac pain were followed.


Assuntos
Apendicite/epidemiologia , Laparoscopia/métodos , Apendicite/diagnóstico , Diagnóstico Diferencial , Humanos , Morbidade/tendências , Federação Russa/epidemiologia
15.
Khirurgiia (Mosk) ; (9): 9-16, 2010.
Artigo em Russo | MEDLINE | ID: mdl-21164416

RESUMO

Work of the implanted electric pacemaker (EP) was assessed in 99 patients, aged 62.4±9.6 years, during non-cardiological surgery. Inhibition of the EP stimuli was registered in 9 (9.1%) patients, short episodes of uneffective stimulation with synchronization disturbation--in 2 (2%) patients and change of stimulation regimen was registered in the same number of patients by electocoagulation. Episodes of myopotential inhibition not assotiated with electrocoagulation was registered in 4 cases. The ascertained rhythm disturbances require a thorough preoperative check-up, intraoperative ECG control and short use of monopolar electrocoagulation.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Eletrocoagulação , Eletrodos Implantados/efeitos adversos , Complicações Intraoperatórias , Marca-Passo Artificial/efeitos adversos , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Eletrocoagulação/efeitos adversos , Eletrocoagulação/métodos , Eletrocoagulação/mortalidade , Eletrodos Implantados/estatística & dados numéricos , Análise de Falha de Equipamento , Feminino , Humanos , Cuidados Intraoperatórios/instrumentação , Cuidados Intraoperatórios/normas , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/normas , Marca-Passo Artificial/estatística & dados numéricos , Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/mortalidade
16.
Khirurgiia (Mosk) ; (8): 16-23, 2010.
Artigo em Russo | MEDLINE | ID: mdl-20823815

RESUMO

Two patients with cystic dystrophy of duodenum and chronic inflammation of duodenally ectopic pancreatic tissue were successfully operated on. Both cases clinically demonstrated abdominal pain and duodenal obstruction. Absence of substantial tissue changes in "main" pancreas allowed execution of pancreas-preserving operation. Thus, subtotal duodenectomy was performed in the first patient. The second patient had resection of vertical branch of the duodenum with intestinal fragment replacement. Extensive periorganic fibrosis in both cases substantially complicated verification of anatomic structures and dissection.


Assuntos
Coristoma/cirurgia , Ducto Colédoco/cirurgia , Cistos/cirurgia , Duodenite/cirurgia , Ductos Pancreáticos , Pancreaticoduodenectomia/métodos , Adulto , Cistos/diagnóstico por imagem , Duodenite/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
17.
Khirurgiia (Mosk) ; (1): 4-7, 2009.
Artigo em Russo | MEDLINE | ID: mdl-19156068

RESUMO

The results of open and endoscopic operations in 430 patients with purulent soft tissue diseases are comparatively studied. Hospital stay after the endoscopic treatment averaged 11,6+/-1,1 days. 90,8% of those, who were treated endoscopically, has completely recovered during the hospital stay and didn't require further treatment. 31,6% of patients experienced a suppuration of the postoperative wound, which called forth the conversion to the open operative technique. These patients had an average hospital stay of 15,6+/-2,1 days. The hospital stay of the patients treated traditionally with wide opening of the wound and secondary sutures, averaged 19,3+/-1,8 days. The hospital stay of patients with a complicated disease course was 26,4+/-3,4 days.


Assuntos
Abscesso/cirurgia , Desbridamento/métodos , Drenagem/métodos , Endoscopia/métodos , Infecções dos Tecidos Moles/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Khirurgiia (Mosk) ; (12): 4-7, 2008.
Artigo em Russo | MEDLINE | ID: mdl-19156090

RESUMO

Soft tissues dynamic ultrasound investigation was applied for diagnostics of pyoinflammatory diseases. Ultrasound image correlated with intermuscular liquid formations (abscess, phlegmon) of soft tissues was revealed in 65 observations (100%). On the basis of findings 21 (32.3%) patients underwent surgical treatment of leg and gluteal region phlegmons and abscesses with application of traditional methods. Endoscopic operations on account of pyoinflammatory diseases of soft tissues were carried out in 44 (67.7%) patients. Ultrasound monitoring of traumatic process course was conducted. It is ascertained that total regress of purulent process occurs by the 14th day of postoperative period. Traumatic process regresses more rapid after endoscopic operations in comparison with traditional open methods.


Assuntos
Celulite (Flegmão)/diagnóstico por imagem , Drenagem/métodos , Endoscopia/métodos , Infecções dos Tecidos Moles/diagnóstico por imagem , Nádegas , Celulite (Flegmão)/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/cirurgia , Coxa da Perna , Resultado do Tratamento , Ultrassonografia
20.
Khirurgiia (Mosk) ; (8): 21-6, 2006.
Artigo em Russo | MEDLINE | ID: mdl-17047585

RESUMO

Laparoscopic technologies have been used for the treatment of 184 patients with cancer of colon. Use of electrosurgical and suturing mechanical devices with linear and circular sutures is the essential part of laparoscopic and laparoscopy-assisted operations. Laparoscopic lymphadenectomy at patients with cancer of colon permits to perform required radical surgery that guarantees positive short- and long-term results of treatment.


Assuntos
Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Colonoscopia/métodos , Intestino Grosso/patologia , Intestino Grosso/cirurgia , Laparoscopia/métodos , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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