Aim. To evaluate the efficiency of laparoscopic devascularization of the esophagus and stomach with endoscopic ligation of varicose esophageal veins in the prevention of esophageal-gastric bleeding among patients with decompensated liver cirrhosis. Methods. The results of treatment of 73 patients with decompensated liver cirrhosis and high risk of bleeding were analyzed. To prevent recurrent bleeding from esophageal and gastric veins, all patients underwent endoscopic ligation at the first step of treatment. In case of inefficiency of ligation and recurrence of varicose veins of esophagus, laparoscopic devascularization of esophagus and stomach was performed. The efficiency of laparoscopic devascularization with intraoperative endoscopic ligation of varicose esophageal veins and ligation as an independent method of treatment for the prevention of upper gastrointestinal bleeding was estimated by comparison of the frequency of recurrence of esophageal and gastric bleeding and recurrence of esophageal varices according to upper endoscopy in comparison groups. Results. In 6 months, 1 and 2 years after laparoscopic devascularization of the esophagus and stomach in combination with endoscopic ligation, the risk of bleeding is less compared to endoscopic ligation as an isolated treatment method (p=0.05; p=0.052; p=0.06). Laparoscopic devascularization with ligation reduces the risk of recurrence of esophageal varices during the first year after surgery by 20% (χ2=2.61; p=0.106), in 2 years by 23% (χ2=1.75; p=0.091) compared to endoscopic ligation only. Conclusion. Patients with liver cirrhosis with decompensated hepatic failure satisfactorily postpone endovideosurgical interventions; laparoscopic gastric devascularization with the intersection of the main inflows to the esophageal varicose veins is an effective method to prevent esophageal-gastric hemorrhage among patients with decompensated liver cirrhosis after ineffective endoscopic ligation.
Ascites-peritonitis is a severe complication in patients with decompensated cirrhosis. The effectiveness of treatment of ascites of peritonitis depends largely on its early diagnosis. The main component of the treatment of ascites-peritonitis - a complex and targeted antibiotic therapy. Third-generation cephalosporins are recommended as empirical antibiotic therapy. The article presents the results of treatment of ascites peritonitis depending on the method of administration of antibacterial drug - cefbactam. The drug was administered in three ways: intravenous, endolymphatic and combined. The results of pharmacokinetics of the drug depending on the method of administration, as well as the results of the effectiveness of the antibacterial effect in the compared groups of patients. (For citation: Ivanusa SY, Onnitsev IE, Khokhlov AV, et al. Antibacterial therapy in the treatment of ascites peritonitis in liver cirrhosis. Reviews on Clinical Pharmacology and Drug Therapy. 2018;16(2):49-56. doi: 10.17816/RCF16249-56).
Вестник хирургии» • 2017 32 В в е д е н и е . Асцит -один из наиболее распространённых вариантов осложнений цирроза печени (ЦП), встречающийся более чем у 50 % больных [2,12]. В течение первого года от момента появления асцита выживают от 45 до 82 % больных, в течение 5 лет -менее 50 % [1,7,17]. От 10 до 20 % больных ЦП и с асцитом не восприимчивы к назначению бессолевой диеты и мочегонных препаратов [9,11,13]. У многих больных в сроки от 2 до 6 мес после начала лечения асцит становится нечувствительным к мочегонной терапии. Продолжение лечения и дальнейшее устранение асцита с помощью диуретиков достигается дорогой ценой: нарушением Кафедра общей хирургии (нач. -д-р мед. наук, проф. С. Я. Ивануса), ФГБВОУ ВО «Военно-медицинская академия им. С. М. Кирова» МО РФ, Санкт-Петербург ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить результаты и определить эффективность нового метода коррекции диуретикорезистентного асцита у больных циррозом печени с синдромом портальной гипертензии с применением реинфузии экстракорпорально модифицированной асцитической жидкости. МАТЕРИАЛ И МЕТОДЫ. Проведен анализ результатов лечения 83 пациентов, подвергшихся лапароцентезу, эвакуации асцитической жидкости. Сформированы 2 группы пациентов. В 1-й группе из 40 человек выполняли лапароцентез, фракционную эвакуацию асцитической жидкости с возмещением потери белка переливанием 25 % альбумина из расчёта 10 г на 2 л удалённой жидкости. Вторую группу составили 43 пациента, которым выполняли лапароцентез, эвакуацию асцитической жидкости с последующей экстракорпоральной обработкой и реинфузией. РЕЗУЛЬТАТЫ. После реинфузии наблюдалось значительное увеличение суточного диуреза с (620,0 ± 110,0) мл до (2,2 ± 0,4) л, в отличие от 1-й группы пациентов -с (780 ± 80) мл до (1,2 ± 0,5) л, увеличение экскреции натрия с мочой (132 ± 7) ммоль/л, по с равнению с первой группой (120 ± 6) ммоль/л, снижение содержания среднемолекулярных пептидов в плазме крови до (0,254 ± 0,098) ед., по сравнению с первой группой -(0,298 ± 0,045) ед. ЗАКЛЮЧЕНИЕ. Реинфузия модифицированной асцитической жидкости более эффективна, по сравнению с традиционной коррекцией белковых потерь и водно-электролитных нарушений на фоне эвакуации асцитической жидкости. Ключевые слова: цирроз печени, асцит, реинфузия асцитической жидкости Extracorporal modified ascitic fluid reinfusion in treatment of resistant ascites in liver cirrhosisDepartment of general surgery, S. M. Kirov Military Medical Academy, St. Petersburg OBJECTIVE. The aim of the study was to estimate the efficacy of new method of reinfusion of extracorporeal modified ascitic fluid in therapy of diuretic resistance ascites in patients with liver cirrhosis and portal hypertension syndrome. MATERIAL AND METHODS. An analysis of treatment was made in 83 patients, who underwent laparocentesis and ascitic fluid evacuation. The patients were divided into two groups. Laparocentesis and fractional evacuation of ascitic fluid were carried out for the patients of the first group (n = 40). This procedure was followed by intravenous infusion of 25 % albumin (10 g o...
The results a new approach of simultaneous correction of complications of portal hypertension with endovideosurgical method are considered. Surgeries of 4 patients, suffering from portal hypertension, were performed by laparoscopic access and included gastric devascularization with ligation and the transection of the left gastric and short gastric veins; ligation of the splenic artery; resection of the parietal peritoneum, retroperitoneal tissue, and lumbar muscles in the lumbar triangle. Average duration of one surgery was 120±22 minutes. The highest volume of blood loss was 150±35 ml. There were no intraoperative complications. The average time spent in the IC unit was 14±4,2 hours. On the day following the surgery, all patients were able to get out of the bed, walked on their own and were allowed to have liquid food. Each patient had one session of endoscopic ligation with an overlay of 5 to 8 Cook ligatures to eradicate varicose veins of the esophagus. The postoperative period of hospital treatment was 10±2,3 days, treatment responses were favorable in all patients. The total time of inpatient stay was 22±3 days. All patients underwent two sessions of reinfusion of externally modified ascitic fluid. The postoperative spiral computer tomographies and subtraction digital angiographies showed effectiveness of disconnection of vessels in the gastroesophageal system. Blood flow in the splenic artery is not detected, ultrasound shows shrinkage of spleen. The maximum follow-up after the operation was 10 months. There were no episodes of bleeding recurrence and no signs of ascites. All patients are socially adapted and able to work, and do not present any complaints during follow-up examinations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2025 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.