The article presents current literature data of domestic and foreign authors on the main problems of endoscopic diagnostics and complex approach to treatment of gallstone disease complicated by pathology of the extrahepatic biliary tract. Efficiency of one-stage and two-stage methods of surgical treatment of cholelithiasis and the possibility of their practical application are considered. Complex approach for minimally invasive bile duct interventions with cholecystoccholedocholitiase, which can be conditionally divided into laparoscopic, mini-access, endoscopic by duodenoscope, cholangioscopy, ultrasound-controlled biliary intervention, is analyzed. Methods of diagnostic testing that can be divided into preoperative and intraoperative, non-invasive and invasive used in patients with cholecystoccholedocholitiase, namely fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, percutaneous-transhepatic cholangiography, diagnostic laparoscopy, intraoperative cholangiography, intraoperative ultrasound, angiography. New concepts of providing surgical care to patients with this pathology are presented, which include one-stage performance of cholecystectomy with priority use of intraoperative antegrade endoscopic papillosphincterotomy, and retrograde litho-extraction under duodenoscope control, in comparison with the two-stage tactics of correction of cholelithiasis with pathology of extrahepatic biliary tract, when the first stage includes its decompression, rehabilitation, and the second — cholecystectomy. Statistical data of complications arising during diagnostic and therapeutic manipulations in patients with cholelithiasis complicated by pathology of the extrahepatic biliary tract are presented. Number of cases of postoperative mortality depending on the severity of complications of cholelithiasis is also considered.
The aim: Is to determine the main causes of adverse outcomes of the patients’ treatment with acute ulcerative gastroduodenal bleeding and to develop preventive measures to improve the quality of the patients’ treatment with this pathology. Materials and methods: A retrospective analysis of the treatment results of 1323 patients with bleeding of ulcerative etiology has been carried out. There are 375 patients with gastric ulcer (28.3%) and 948 patients (71.7%) with duodenal ulcer among them. The patients’ age ranged from 15 to 93 years old. Concomitant pathology was observed in 623 (47.1%) patients, the most common of which were coronary heart disease, chronic non-specific lung diseases and cerebrovascular diseases. Mild severity of blood loss was detected in 404 (30.5%) patients, moderate severity 693 (52.5%), severe 145 (10.9%) and extremely severe 81 (6.1%). Overall mortality was 5.9%, postoperative mortality 6.3%, the mortality in conservative treatment only 6.1%. Results: The main cause of the patients’ mortality with acute ulcerative gastroduodenal bleeding was decompensated hemorrhagic shock which developed at the prehospital stage in 45.3% and as a result of bleeding recurrence during treatment 44.2% of the patients. Inadequate drug therapy increases the risk of bleeding recurrence from 15.8 to 32.7%. The use of proton pump blockers and the combination of bolus and prolonged use of proton pump blockers allow to reduce the risk of bleeding recurrence by half (up to 6.8%). Conclusions: Endoscopic hemostasis in combination with the injection method with diathermocoagulation or thermal coagulation can be considered as full-fledged, and when performing endoscopic monitoring the preference should be given to coagulation methods of diathermo- and hydrodietermocoagulation.
ÂâåäåíèåЗаживление ран в области грудины имеет свои особенности, что наиболее актуально, так как срединная стернотомия является основным оперативным доступом в кардиоторакальной хирургии. Локальные инфекционные осложнения ран в этой зоне возникают у 0,4-6 % больных, проявляясь в виде несостоятельности швов грудины, медиастинита и остеомиелита с формированием свищей, развитием хондрита реберных хрящей и сепсиса [1]. Факторы риска развития гнойных осложнений делят на дооперационные (пол, возраст, сопутствующая патология), интраоперационные (асимметричная стер-нотомия, метод ушивания стернотомного доступа, продолжительность операции, использование внутренней грудной артерии, кровопотеря, использование аппарата искусственного кровообращения) и послеоперационные (нестабильность либо ишемия грудины, рестернотомия, наличие инородных тел, послеоперационные кровотечения и гематомы) [2]. Лечение таких больных требует комплексного подхода, включающего консервативные и оперативные мероприятия. Своевременное дренирование раны и ее очищение с последующим ушиванием являются базисом современной тактики, а анализ индивидуальных особенностей течения раневого процесса
Донецкий национальный медицинский университет, г. Лиман Резюме. Целью и задачами данной работы стали изучение характера течения варикозной болезни вен на фоне артериосклероза ног и оценка эффективности у таких больных лечебных мероприятий. Под наблюдением находились 302 больных (75 мужчин и 227 женщин в возрасте 29-72 лет), 16 % из которых ранее перенесли флеботромбоз, а частота II, III, IV, V и VI классов венозной недостаточности составила 10 %, 14 %, 37 %, 16 % и 23 %. 263 пациентам выполнена эндовенозная лазерная коагуляция, а 39-традиционная флебэктомия или лигирование перфорантов. Артериосклероз бедренных, берцовых, подвздошных и подколенных артерий наблюдается у 23 % от числа больных с варикозом ног, чаще у мужчин и лиц перенесших флеботромбоз, что сопровождалось более высокими цифрами артериального давления и параметрами венозной недостаточнос
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