No abstract

No abstract

Кафедра факультетской хирургии №2 (зав.-проф. И.Е. Хатьков) Московского государственного медико-стоматологического университета им. А.И. Евдокимова, Москва, Россия РЕЗЮМЕ Проведенный анализ данных литературы показал несомненное преимущество МИЭ по сравнению с подобными операциями из традиционных доступов. Несмотря на отчетливую тенденцию к увеличению доли операций на пищеводе из МИД, остаются дискутабельными вопросы о выборе операционного доступа, техники операций и формирования анастомозов. Дальнейшие исследования, направленные на решение указанных проблем, позволят улучшить результаты МИЭ. Ключевые слова: минимально инвазивная эзофагэктомия, хирургия пищевода.

The post-traumatic diaphragmatic hernia is a rare type of trauma which most commonly occurs after the blunt trauma of the thorax and abdomen. In the acute period of trauma, the symptoms of the emergency diseases and nonspecific signs of the diaphragmatic rupture are the reasons of frequent diagnostic mistakes. A missed diaphragmatic rupture grows in time and leads to migration of organs from the abdominal cavity to the thoracic one due to pressure gradient. The symptoms of diaphragmatic hernia are not expressed and the duration of the asymptomatic period of the disease may vary from some years to 10 years and longer. The increasing restructuring of the abdominal wall leads to reduced abdominal cavity, which makes the standard reconstructive surgery difficult, the intraabdominal pressure grows and relapse occurs in the postoperative period. In these cases, surgeons perform complex techniques which enlarge the abdominal cavity with local tissues or an artificial graft. However, there are no clear recommendations about the extent of the abdominal wall reconstruction so that the abdominal cavity size would be adequate for organs. The authors suggested a simple method to calculate it and used it in practice. In the article, we report the clinical case of a 53-year-old woman with a giant post-traumatic diaphragmatic hernia after motor vehicle accident 48 years ago and offer an original method of treatment. The first operation including hernia resolution and repair of diaphragmatic rupture was complicated by relapse on the second day after operation due to the high intra-abdominal pressure. During the second reconstructive surgery (4 months later), the authors performed their own method of abdominal cavity enlargement and got a good result in the shortand long-term postoperative period.

Aim. Assessment of the prevalence and prognostic value of gastroenterological manifestations in patients with COVID-19. Materials and methods. A single-center retrospective cohort study was carried out. Only cases with laboratory confirmed detection of SARS-CoV-2 virus RNA using polymerase chain reaction in oro-/nasopharyngeal smear samples were subject to analysis. Patients with documented (according to anamnestic data and/or according to examination data during hospitalization) organic pathology of the gastrointestinal tract (GIT) and/or hepatobiliary system, malignant neoplasms of any localization, as well as pregnant patients were excluded from the general register of retrospective data. The final cohort was divided into two groups depending on the presence of gastrointestinal symptoms: COVID-19 with gastrointestinal symptoms (cases) and COVID-19 without gastrointestinal symptoms (control). Results. The final sample consisted of 3764 patients, including 2108 (56%) women and 1656 (44%) men. The average age of the subjects included in the analysis was 58.0 years (95% confidence interval CI 48.663.0). In the study cohort, gastroenterological manifestations (alone or in combination) were recorded in 885 (23.51%) patients. Calculation of the odds ratio (OR) of unfavorable and lethal outcomes between the analyzed groups showed that the presence of gastroenterological symptoms significantly increases the chances of lethal outcome in a cohort of elderly and senile patients (OR 1.6817, 95% CI 1.03352.7364; p=0.0364), determines a higher risk of hospitalization or transfer to the intensive care unit (OR 1.2959, 95% CI 1.05471.5922; p=0.0136), development of acute respiratory distress syndrome (OR 1.5952, 95% CI 1.31641.9329; p0.0001), as well as the need for mechanical ventilation (OR 1.2849, 95% CI 1.0771.5329; p=0.0054). Conclusion. The present study has demonstrated that gastroenterological symptoms are detected in about one in four patients infected with the SARS-CoV-2 virus and multiply the risk of adverse and life-threatening complications of COVID-19.