RESUMEN
The investigation included 35 patients with diseases of blood and spleen pathology (30) and wounds and traumas of the abdomen with injuries of that organ (5), treated by laparoscopic splenectomy through a lateral access. The technique and stages of the operation and advantages of the lateral access are described. The laparoscopic splenectomy was shown to be possible in 90% of cases if patients were selected with special reference to the main disease, size and degree of pathological alterations in the spleen. An adequate approach to selections of patients with injuries of the organ allowed to make operations in more than a third of the patients and casualties. When using the lateral access laparoscopic splenectomy is thought to be more convenient, gives better visualization of the anatomical structures and reduces risk of injury of adjacent organs, thus resulting in less frequency of complications and conversions.
Asunto(s)
Laparoscopía/métodos , Esplenectomía/métodos , Traumatismos Abdominales/cirugía , Anemia Aplásica/cirugía , Anemia Hemolítica/cirugía , Femenino , Humanos , Granulomatosis Linfomatoide/cirugía , Masculino , Selección de Paciente , Postura , Púrpura Trombocitopénica/cirugía , Enfermedades del Bazo/cirugía , Heridas por Arma de Fuego/cirugíaRESUMEN
In this study its authors sum up their practice of emergency treatment of 569 patients with acute surgical pathology, needing an urgent laparoscopy intervention. They present a programme of laparoscopy methods, including a complex of organisation and medical problems and in particular those of the material base development together with the solution of some training methodology and scientific questions. It is emphasized, that the laparoscopy methods have great possibilities in the diagnostics and treatment of acute surgical pathology cases and that an urgent surgical aid should be expedient. Due to the rational application of endovideosurgery methods, the overall lethality was reduced by 1.5 times, negative after-effects--by 4%.
Asunto(s)
Abdomen/cirugía , Endoscopía , Grabación en Video , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/cirugía , Urgencias Médicas , Endoscopía/estadística & datos numéricos , Femenino , Humanos , Laparoscopía , Masculino , Personal Militar , Federación de RusiaRESUMEN
Bioptates of the stomach mucous membrane (SMM) have been investigated in 169 patients suffering from duodenal ulcer (DU). According to the nocturnal gastric secretion test among them there are "hypersecretors" and persons with moderate elevation of acid formation. In conformity with the efficiency of the operative treatment among the patients examined, groups are defined: those with recurrent disease and those recovered after vagotomy. The DU endocrine apparatus undergoes both qualitative and quantitative alterations after vagotomy. When recovery after vagotomy takes place, the number of endocrine cells only slightly exceeds these parameters in the patients with a moderately manifested acid production. These alterations are adaptive. The recurrence of DU in patients with moderately manifested acid production before the operation can be explained by hyperplasia of G-cells. A high degree of hyperplasia of all elements of the endocrine apparatus in the "hypersecretors" can be one of the causes of the DU recurrence. The data about the state of G-, Ec- and EcL-cells before and after vagotomy can be used at prognostication the results of surgical treatment of patients with DU.
Asunto(s)
Células APUD/patología , Úlcera Duodenal/patología , Ácido Gástrico/metabolismo , Mucosa Gástrica/patología , Gastrinas/metabolismo , Liberación de Histamina/fisiología , Serotonina/metabolismo , Vagotomía , Células APUD/metabolismo , Adulto , Anciano , Recuento de Células , Úlcera Duodenal/fisiopatología , Úlcera Duodenal/cirugía , Femenino , Mucosa Gástrica/metabolismo , Gastrinas/fisiología , Humanos , Hiperplasia/etiología , Hiperplasia/fisiopatología , Masculino , Persona de Mediana Edad , Antro Pilórico/patología , Antro Pilórico/cirugía , Recurrencia , Serotonina/fisiología , Vagotomía/efectos adversosRESUMEN
Under analysis are results of vagotomy performed in 95 patients with uncomplicated ulcer of the duodenum after ineffective conservative treatment 10 years after operation. During this time recurrent ulcer developed in 26 patients (27.4%). The disease reappeared more frequently in patients with high level of night gastric secretion before surgery. Results of the operation in 25 patients (26.3%) could be estimated only as satisfactory because of various disorders (dumping-syndrome, diarrhea, gastric dyspepsia). But a usual basis for such an assessment was not a medial degree of some disorders (2 patients) but a combination of light degree disorders (23 patients). One patient was included into the IVth Wisik's group due to severe dyspepsia. Only 43 patients (45.3%) were included in the I and II groups by the Wisik's scheme. Results of vagotomy in patients who had no ulcer complications before operation were compared with the efficiency of vagotomy used totally for all indications and were found to be much worse. The authors make a conclusion that it is not expedient to widen indications to vagotomy at the expense of patients with uncomplicated ulcers.