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http://ir.librarynmu.com/handle/123456789/830
2024-03-28T22:09:56ZTreatment tactics for gastric erosive-ulcerative bleeding on the background of liver cirrhosis
http://ir.librarynmu.com/handle/123456789/10209
Название: Treatment tactics for gastric erosive-ulcerative bleeding on the background of liver cirrhosis
Авторы: Колосович, Ігор Володимирович; Халіл, Узун
Краткий осмотр (реферат): Analysing the polymorphism of etiological factors that contribute to the development of erosive-ulcerative
gastric lesions in patients with liver cirrhosis (acid-peptic factors, transformation of venous blood flow, immune
complexes, etc.), it should be noted that portal hypertension is the most important cause of these lesions. Bleeding from erosive-ulcerative gastric lesions is a direct cause of death, occupying the first place in the structure of mortality and far exceeding ulcer perforations in this regard. Mortality in the first massive acute gastric bleeding reaches 50 %, after the second — 70 %, in hepatic coma — 80 % or more.
OBJECTIVE — to improve the treatment outcomes for patients with erosive and ulcerative bleeding in the stomach due to liver cirrhosis.
MATERIALS AND METHODS. The treatment outcomes of 192 patients with the hepatic form of portal hypertension
(liver cirrhosis) who were hospitalised in the therapeutic and surgical departments, which are the clinical bases
of the Department of Surgery No. 2 at Bogomolets National Medical University, were studied for the period from
2005 to 2023. During upper endoscopy, degenerative changes in the gastric mucosa were detected in 94 (48.9 %) patients. Specifically, gastric erosions were observed in 31 (33.0 %) patients, gastric ulcers in 34 (36.2 %), and portal gastropathy in 29 (30.8 %) patients. A total of 88 (46.6 %) patients with liver cirrhosis and acute gastric bleeding were admitted to the surgical department as an emergency. According to the Child-Pugh scale, the vast majority of patients were at the stage of sub- and decompensation (71 patients, or 89.1 %). In 41 (45.2 %) patients, gastric cancer was attributed to gastric erosive and ulcerative lesions: erosive gastritis — in 20 (48.8 %) patients and gastric ulcer — in 21 (51.2 %) patients.
RESULTS. Enhancing the protective properties of the mucous-bicarbonate barrier of the gastric mucosa as part of pathogenetic conservative treatment schemes can reduce the influence of this mechanism on the development of hemorrhagic complications in 89.4 % of patients. The risk of bleeding in this group of patients with liver cirrhosis is 15.1 %, which requires the search for new methods of conservative treatment. In 79.6 % of cases, primary endoscopic hemostasis of bleeding erosive-ulcerative gastric lesions was effective when combined with drug therapy. For 53.1 % of patients, it proved to be the final treatment. This enabled a reduction in overall mortality to 22.4 % from 50 % (p < 0.05) and, if necessary, a delay in surgical intervention. Out of the total number of patients, 19 (38.8 %) patients required surgical intervention, with 73.7 % of them undergoing urgent surgery and 26.3 % undergoing delayed surgery. When considering operative methods for peptic ulcers complicated by hemorrhage, preference should be given to organ- and function-preserving interventions. They yield more favourable immediate outcomes for this extremely challenging group of patients (postoperative mortality was reduced to 26.3 % vs. 50.0 % (p < 0.05).
CONCLUSIONS. Acute gastric bleeding resulting from erosive-ulcerative gastric lesions, which are complications of liver cirrhosis, can significantly impair the health of patients. However, by implementing modern treatment technologies, such as surgical procedures, it is feasible to achieve a 50 % reduction in both overall and postoperative mortality.2023-12-01T00:00:00ZDIAGNOSIS OF DUODENO-GASTRONIC REFLUX IN OPERATED PATIENTS WITH COMPLICATED PYLORODUODENAL ULCER
http://ir.librarynmu.com/handle/123456789/10208
Название: DIAGNOSIS OF DUODENO-GASTRONIC REFLUX IN OPERATED PATIENTS WITH COMPLICATED PYLORODUODENAL ULCER
Авторы: Колосович, Ігор Володимирович
Краткий осмотр (реферат): Operative interventions at the gastroduodenal zone with a violation of the integrity of the pyloric sphincter are accompanied by the development of a whole series of postoperative complications, the main of which are violations of the motorevacuator function of this stomach and duodenum [1]. The lack of a installment income
of food, its insufficient digestion due to the loss of the closing function of the pylorus causes the development of the syndrome of malnutrition [2]. In this case, the presence of pathological reflux of bile, in particular lysolecithin, in the stomach, which is known as duodeno-gastric reflux (DGR), leads to increased stimulation of gastric secretion and the dangerous development of gastric ulcer in 60% of cases [3]. Timely diagnosis of moderate and severe DGR is extremely important in this condition [4]. However, screening methods for diagnosing this disease, especially in the early postoperative period after surgical interventions on the upper parts of the digestive tract, are still unknown today.
The purpose of the study was to improve the development of methods of screening diagnosis of moderate and severe duodeno-gastric reflux in the early postoperative period after surgical interventions on the upper parts of the digestive tract.
Materials and methods of research.
The study of the motor-evacuation function of the gastric outlet was conducted in 143 patients with perforated pyloroduodenal ulcers. The main group consisted of 52 patients who underwent duodenoplasty, that is, in this case, the pylorus was not dissected. The comparison group included 35 patients with subpyloric localization of
the ulcer, who underwent pylorus-corrective gastroduodenoplasty according to their own methodology, and 56 patients - classic gastroduodenoplasty (pylorus-destructive intervention). During the first two to four days of the postoperative period, before the removal of the nasogastric tube and the start of per os fluid intake, the resence of severe DGR was determined using the method developed by us (Ukrainian utility model declaration patent U46697). The essence of the technique is as follows: gastric contents are aspirated through the nasogastric tube installed before the operation. An assessment of the presence of pathological reflux of the contents of the gastrointestinal tract into the stomach is carried out by immersing a strip of developed (illuminated, fixed) X-ray
film in a container with gastric contents for 20 minutes. In the presence of DGR, the film becomes transparent.h is a component of duodenal contents, the gelatin layer of the developed X-ray film dissolves, as a result of which the film becomes transparent.
Results of the research. In all 56 patients who underwent hemipylorectomy, the presence of DGR was established, which was later confirmed using other methods. Despite the course of anti-relapse drug treatment, including the use of gastrokinetics, patients complained of aching pain in the upper half of the abdomen, a feeling of distension in the abdomen, nausea, and the urge to vomit. This required long (up to 6 months) courses of conservative treatment, which allowed to improve the condition of 38 patients (67.9%).
In the rest of the patients who underwent various variants of duodenoplasty, including those with subpyloric localization of the ulcer, there were no signs of severe DGR. When characteristic complaints of DGR appeared, the symptoms quickly disappeared after short-term (within 2 weeks) use of prokinetic drugs.
Conclusions. The proposed screening method for diagnosis of GDR is effective in the early postoperative period after interventions in the gastroduodenal zone.
Thus, hemipylorectomy is accompanied by the development of DGR in all
patients, and in the early postoperative period, severe forms are recorded in the vast
majority. Carrying out long (up to 6 months) courses of conservative treatment, which
made it possible to improve the condition of 38 patients (67.9%) of this group.
Pylorus-preserving (duodenoplasty) and pylorus-corrective (modified
duodenoplasty for subpyloric ulcer of the duodenum) interventions do not cause
violations of the motor-evacuator function of the gastroduodenal transition, which
positively affects the results of treatment.2024-03-01T00:00:00ZImprovement of endoscopic methods of treatment of patients with acute biliary pancreatitis
http://ir.librarynmu.com/handle/123456789/9903
Название: Improvement of endoscopic methods of treatment of patients with acute biliary pancreatitis
Авторы: Колосович, Ігор Володимирович; Ганоль, Ігор Васильович
Краткий осмотр (реферат): Modern approaches to the choice of treatment tactics for acute pancreatitis (AP) are quite diverse, but the main trend is the superiority of complex conservative therapy over early surgical intervention [1]. It is quite clear that the decision regarding the treatment plan for AP depends on a number of reasons: the etiology and clinical picture of the disease, methods of diagnosis and forecasting the development of complications, the chosen tactics of patient management [2]. With regard to the tactics of AP of biliary etiology, at the moment a consensus has been reached among surgeons ‒ the treatment of patients should be minimally invasive, aimed at restoring the patency of the pancreatico-biliary duct system, reducing the risk of complications and recurrence of the disease. However, despite the relative safety of endoscopic interventions compared to traditional methods and their important role in many clinical situations, the frequency of postoperative complications can reach 20.6%, and the mortality rate is 3% [3].
The purpose of the study was to improve the results of surgical treatment of patients with acute biliary pancreatitis through the development and implementation of advanced endoscopic techniques aimed at restoring the patency of the pancreatic-biliary duct system.
Materials and methods of research. The study was based on the results of the examination of 100 patients with acute biliary pancreatitis, who were divided into two groups: a comparison group - patients who used traditional methods of examination and treatment (n=48) and the main group - patients who used improved surgical tactics (n=52). Indications for endoscopic operations were: mechanical jaundice, choledocholithiasis, including complicated by acute cholangitis, stenotic papillitis, dilation of the common bile duct (regardless of the presence of calculi in it according to ultrasound). To assess the effectiveness of surgical tactics in the studied groups, a comparative analysis of the applied methods, the frequency of postoperative complications and mortality was carried out.
Results of the research. Endoscopic interventions to restore the passage of bile and pancreatic juice in cases of biliary etiology of AP were performed in 75% (39/52) of the main group, in 77.1% (37/48) of the patients in the comparison group (χ2=0.06, 95% CI -14.66-18.42, p=0.8). Thus, among patients in the comparison group, endoscopic papillosphincterotomy (EPST) was used in 21 (43.8%) patients, balloon dilatation of the sphincter of Oddi in 12 (25%) patients, balloon dilatation and choledochal stenting in 4 (4%) patients. In turn, among the patients of the main group, EPST was performed in 7 (13.5%) patients, including one (1.9%) patient with choledochal stenting, EPST under the control of choledochoscopy according to our own method (Ukraine utility model patent No. 135693 «Method of surgical treatment of biliary pancreatitis») ‒ in 9 (17.3%) patients, installation of a nasobiliary stent and lavage of the pancreatico-biliary duct system according to our own method (Ukraine utility model patent No. 139587 «Method of surgical treatment of acute pancreatitis») – in 23 (44.2%) patients. In the postoperative period, in the comparison group, complications occurred in 21.6% (8/37) of patients, namely, hemorrhagic complications in 10.8% (4/37) cases (in two (5.4%) patients, they occurred immediately after EPST), purulent-septic ‒ in 10.8% (4/37) cases, postoperative mortality was 2.7% (1/37). In the main group, hemorrhagic complications in the postoperative period were observed in one (2.6%) patient and were associated with the progression of the disease, while there were no purulent-septic complications and deaths.
Conclusion. The introduction of improved endoscopic methods of treatment of acute biliary pancreatitis aimed at restoring the patency of the pancreatico-biliary duct system made it possible to reliably reduce the frequency of postoperative complications in patients of the main group by 19% (χ2=6.47, 95% CI 4.24-34.71, p=0.01), a trend towards a decrease in mortality by 2.7% was also observed (χ2=1.05, 95% CI -6.53-13.82, p=0.3).
References:
1. Baron, T. H., DiMaio, C. J., Wang, A. Y., & Morgan, K. A. (2020). American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology, 158(1), 67–75.e1. https://doi.org/10.1053/j.gastro.2019.07.064
2. Kolosovych, I. V., Bezrodnyi, B. H., Hanol, I. V., & Cherepenko, I. V. (2020). Stage approach in surgical treatment of acute pancreatitis. Medicni Perspektivi, 25(2), 124–129. https://doi.org/10.26641/2307-0404.2020.2.206384
3. Cahyadi, O., Tehami, N., de-Madaria, E., & Siau, K. (2022). Post-ERCP Pancreatitis: Prevention, Diagnosis and Management. Medicina (Kaunas, Lithuania), 58(9), 1261. https://doi.org/10.3390/medicina580912612024-01-01T00:00:00ZЗАСТОСУВАННЯ МІНІІНВАЗИВНИХ ЕХО-КОНТРОЛЬОВАНИХ ЧЕРЕЗШКІРНИХ ВТРУЧАНЬ У ХВОРИХ З УСКЛАДНЕНИМ ПЕРЕБІГОМ ГОСТРОГО ПАНКРЕАТИТУ
http://ir.librarynmu.com/handle/123456789/9812
Название: ЗАСТОСУВАННЯ МІНІІНВАЗИВНИХ ЕХО-КОНТРОЛЬОВАНИХ ЧЕРЕЗШКІРНИХ ВТРУЧАНЬ У ХВОРИХ З УСКЛАДНЕНИМ ПЕРЕБІГОМ ГОСТРОГО ПАНКРЕАТИТУ
Авторы: Колосович, Ігор Володимирович; Сидоренко, Роман Анатолійович; Ганоль, Ігор Васильович
Краткий осмотр (реферат): ЗАСТОСУВАННЯ МІНІІНВАЗИВНИХ ЕХО-КОНТРОЛЬОВАНИХ ЧЕРЕЗШКІРНИХ ВТРУЧАНЬ У ХВОРИХ З УСКЛАДНЕНИМ ПЕРЕБІГОМ ГОСТРОГО ПАНКРЕАТИТУ
Колосович І.В., Сидоренко Р.А., Ганоль І.В.
Національний медичний університет імені О.О. Богомольця, м. Київ, Україна
ganoli@ukr.net
Актуальність. Мініінвазивні черезшкірні ехо-контрольовані пункційні дренуючі втручання мають певні обмеження у разі розташування локальних ускладнень гострого панкреатиту за правим та центрально-правим типом у зв’язку з високим ризиком ятрогенних ушкоджень в результаті можливого неконтрольованого просування робочої частини пристрою.
Метою дослідження було покращання результатів хірургічного лікування хворих на гострий панкреатит шляхом впровадження удосконалених методик мініінвазивних черезшкірних ехо-контрольованих втручань при ускладненому перебігу захворювання.
Матеріали та методи. Дослідження базувалось на результатах обстеження 187 хворих на тяжкий гострий панкреатит, які були розділені на дві групи: група порівняння – пацієнти, у яких використовувались традиційні методи обстеження та лікування (n=92) та основна група – пацієнти, яким застосовувалась удосконалена хірургічна тактика (n=95). Для оцінки ефективності хірургічної тактики в досліджуваних групах був проведений порівняльний аналіз застосованих методик, частоти розвитку післяопераційних ускладнень, летальності, тривалості госпіталізації.
Результати. Впровадження удосконалених мініінвазивних черезшкірних ехо-контрольованих оперативних втручань розширило можливості їх використання, у тому числі при локалізації інфікованих локальних ускладнень за правим та центрально-правим типом та вірогідно підвищило їх ефективність на 41,8% (p=0,02). Порівняльний аналіз тривалості стаціонарного лікування в досліджуваних групах виявив вірогідне зниження термінів госпіталізації пацієнтів основної групи на 14,7 діб (р=0,0008), з них у відділенні інтенсивної терапії – на 4,7 діб (р<0,0001).
Висновки. Застосування удосконалених методів діагностики та лікування у хворих основної групи дало змогу вірогідно знизити частоту післяопераційних ускладнень на 28% (p=0,003) та загальної післяопераційної летальності на 27,7% (p=0,005).
Ключові слова: гострий панкреатит, гострі перипанкреатичні скупчення рідини, локальні ускладнення, мініінвазивні втручання, лікування.2023-12-01T00:00:00Z