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Article exists only in Russian.
Abstract: Aim: was to investigate the application of decompression interventions conducted under ultrasound control in patients with acute cholecystitis in elderly including methods of obliteration of gallbladder with «MM-ge». Materials and methods. For the period from July 2008 to September 2011 in City Hospital №68 mini-invasive methods have been appliec in 173 elderly and senile age patients with clinical and echographic picture of acute destructive cholecystitis. There were performed 219 minimally invasive procedures. In this study we performed obliteration of the gall bladder through the implantation of a porous crosslinked polyvinyl alcohol («MM-gel»), intended for use in medicine. Results. On the base of experience we developed tactics of treatment of elderly and senile patients with acute cholecystitis with the use of mini-invasive ultrasound-guided interventions. Study showed that it is optimum to make gallbladder puncture under ultrasound guidance for sanitation and decompression. In case of failure percutaneous ultrasound-cholecystostomies were performed. Obliteration of gallbladder cavity with implantation of «MM-gel» were successfully performed in 5 cases. Conclusions. During the research, efficiency and safety of minimally invasive treatment of acute cholecystitis in elderly and senile patients were proved, there was no negative impact on quality of life. Obliteration of the gallbladder cavity with plastic «MM-gel» can be the method of choice for surgical treatment of these patients and requires further development and study of long-term results. References 1. Vasiliev V.V.,Perunov A.B. Acute colecystitis: modern technologies of treatment. Consilium Medicum. 2001; 6: 279-284 [In Russ]. 2. Gallinger Yu.I., Karpenko V.I.,Mizikov V.N. Laparoscopic cholecystectomy in patients with high operational-anestesialogical risk. Annals of Surgical Hepatology. 2002;1: 97 [In Russ]. 3. Ermolov A.S., Gulyaev A. A., Acute cholecystitis : modern methods of treatment. Treating physician. 2005; 2: 16-18 [In Russ]. 4. Ermolov. S. Ivanov, P. A., Turco A.P.. The main causes of mortality in acute cholecystitis in a hospital in 5. Kapralov S.V., Ismailov U.Z., Shapkin J.G. The role and place diapevticheskih decompression operations in the surgery of acute cholecystitis in patients with high-risk surgery and anesthesia. Modern problems of science and education. 2010;2: 47-52 [In Russ]. 6. Privalov V. A., Shramchenko V.A., Gubnitsky A .V. Surgical tactics in acute cholecystitis in elderly patients and old age. Surgery. 1998; 7: 28 - 30 [In Russ]. 7. Altmeir G., Die akute Cholecystitis. G. Altmeir. Chirurg. 2001; 3(52): 450-453. 8. Zatevakhin 1.1., Tsitsiashvili M.S., Dzarasova G.J. Acute cholecystitis : diagnosis and treatment. Journal of 9. 9. Pantsirev J.M., Nozdrachev V.I., Lagunchik B.P. Decompression of the gallbladder in acute cholecystitis in elderly patients and old age. Surgery. 1990; 2: 17-20 [In Russ]. 10. Tagiyeva M.M. Diagnosis and treatment of acute cholecystitis. Surgery. 1998; 1:15-19 [In Russ]. 11. Fedorov V.D., Danilov M.V., Glabay V.P. Emergency surgery of cholelithiasis. In book Cholecystitis and its complications. Cholecystitis and its complications. 12. Shulutko A.M. ,Lukomski G.I.,Surin Y.V. Predicting the risk of surgery in acute cholecystitis. Surgery. 1989; 1: 29-32 [In Russ]. 13. Kuznetsov N.A., Ignatenko S.N., Brontveyn A.T., Rodoman G.V. Modern technologies of treatment of acute cholecystitis . Actual problems of practical medicine : Sat. researcher. Tr./ 14. Zhidkov S.A. Clinical management of acute cholecystitis in patients over 60 years. Medical News. 2005; 7: 68-70 [In Russ]. 15. Zatevakhin I.I. , Magomedov E.G. Therapeutic tactics in acute cholecystitis. Russian Journal of Medicine. 2005; 4: 17-20 [In Russ]. 16. Kuznetsov N.A., Brontveyn A. T., Aronov L.S. Laparoscopic cholecystectomy in acute cholecystitis. Russian Journal of Medicine. 2003; 3: 19-22 [In Russ]. 17. Korovin A.J., Andreev A.V., Kulish V.A., Meshesha Berhane Reda. Ultrasonography in the diagnosis and evaluation of the effectiveness of percutaneous decompression of the gallbladder in patients with acute cholecystitis. In Sat: New Technologies in Medicine (morphological, experimental, clinical and social aspects). Volgograd: Print. 2005: 182-183 [In Russ]. 18. Chadayev A.P., Lyubsky A.S. Two-stage treatment of acute cholecystitis in elderly patients. Int. researcher. conference.: «Actual issues of diagnosis and treatment of diseases of the hepatobiliary area. Endoscopic Surgery.» Proc. Reports. 19. 20. Gulyaev A.A., Shapovalyants S.G., Burov V.A., Mihaylusov S.V. Obliteration of the lumen of the gallbladder in patients with high operative risk. Surgery. 1998; 9: 42-44 [In Russ]. 21. Emelianov S.I., Fedorov A.V., Fedenko V.V. Technological aspects of endoscopic surgery of the billiary tract. Annals of Surgical Hepatology. 1996; 1: 115-119 [In Russ]. 22. Nikulenkov S. Yu., Belkov A.V., Efimkin A.C. Endoscopic obliteration of the gallbladder in patients with acute cholecystitis with high operativ risk. Endoscopic Surgery. 1998; 1: 34 [In Russ].
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Article exists only in Russian.
Abstract: Aim. Was to estimate the role of transcutaneous interventions under the supervision of radiodiagnostics in the maintenance of all mini-nvasive kinds of operation stages of surgical treatment in patients with pancreatic and duodenal zone tumors Materials and methods. For the period from January 2007 till march 2010, 21 patients, aged 49-75 (10 men, 11 women) - were under aparoscopic pancreaticoduodenectomy (LPDE) Results. The use bile ducts drainage systems before LPDE in 95% cases leads to small hemorrhage (less than 1 liter). The presence of cholangiostomy also leads to early diagnostics of biliodigistive anastamosis (BDA) stenosis, and makes bile peritonitis – impossible. Conclusion. Usage of non-vascular methods of interventional radiology allows to make effective and less traumatic biliar decompression in patients with biliopancreatic and duodenal zone tumors as a stage of LPDE preparations. The presence of decompression cholangiostomy prevents further BDA inconsistency, and makes pacreaticojejunoanastamosis healing faster in case of its' decompression. References 1. Barnett S.A., Collier N.A. Pancreaticoduodenectomy. Does preoperative biliary drainage, method of pancreatic reconstruction or age influence perioperative outcome? A retrospective study of 104 consecutive cases. ANZJ. Surg. 2006; 76 (7): 563-568. 2. Sewnath M. et al. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J. of the Am. Col. of Surg. 2008. Volume 192, Issue 6, Pages. 726-734. 4. Srivastava S. et al. Outcome following pan-creaticoduodenectomy in patients undergoing preoperative biliary drainage. Dig. Surg. 2001; 18 (5): 381-387. 5. Laurent A., Tayar C., Cherqui D. Cholangiocarcinoma: preoperative biliary drainage (Con). HPB (Oxford). 2008; 10 (2): 126-129. 6. Tsai Y.F. et al. Effect of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy. Hepatogastroenterology. 2006; 53 (72): 823-827. 7. Li Z. et al. Pancreaticoduodenectomy with preoperative obstructive jaundice. Drainage or not. Pancreas. 2009; 38 (4): 379-386. 8. Chen D. et al. Effect of preoperative biliary drainage on liver function changes in patients with malignant obstructive jaundice in the low bile duct before and after pancreaticoduo-denectomy. Ai. Zheng. 2008; 27 (1): 78-82. 9. Wang Q. et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst. Rev. 2008; 16 (3): CD005444.
