Хирургическая тактика у больных эхинококкозом печени

Аннотация

На основании анализа историй болезни 327 пациентов с эхинококкозом печени (ЭП) разработана тактика хирургического лечения с учетом оптимального доступа в зависимости от локализации кисты; определены показания для декомпрессии желчных путей, в том числе и с применением эндоскопической техники. Ключевые слова: эхинококкоз, эхинококкэктомия, ЭРПХГ, папиллосфинктеротомия. 130 БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ | ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ | JOURNAL OF BIOMEDICINE AND PRACTICE №4 | 2021 РАХМАНОВ Косим Ерданович КУРБАНИЯЗОВ Зафар Бабажанович AБДУРАХМАНОВ Диёр Шукуруллаевич Самарқанд Давлат тиббиёт институти. Ўзбекистон ДАВЛАТОВ Салим Сулаимонович Бухоро Давлат тиббиёт институти. Ўзбекистон ЖИГАР ЭХИНОКОККОЗИ БИЛАН КАСАЛЛАНГАН БЕМОРЛАРДА ЖАРРОХЛИК ТАКТИКАСИ АННОТАЦИЯ Жигар эхинококкози (ЖЭ) билан касалланган 327 беморда касаллик анамнезини таҳлил қилиш асосида кистанинг локализациясига боғлиқликка оптимал кириш имкониятини ҳисобга олган ҳолда жарроҳлик даволаш тактикаси ишлаб чиқилди; эндоскопик усуллардан фойдаланган ҳолда, ўт йўлларини декомпрессиялаш кўрсаткичлари аниқланди. Калит сўзлар: эхинококкоз, эхинококектомия, ЭРПХГ, папиллосфинктеротомия. Introduction. Echinococcosis is a dangerous natural focal parasitic disease of domestic animals and humans, occurring sporadically and endemically. Areas that are endemic for echinococcosis include Mountainous areas, echinococcosis is included in the who list of diseases requiring radical eradication. The problem of echinococcosis remains relevant, since the disease is quite common, and treatment issues are becoming debatable. Among the lesions of various organs and tissues with echinococcosis, the frequency of liver damage is 44-84 % [1,2,3,4,5]. Prevalence of echinococcosis inabout all of them the incidence of echinococcosis in the region is 1 per 10,000 inhabitants, in the Republic of Uzbekistan 0.39 per 1000 inhabitants (2017). the Incidence of echinococcosis in the region is 4 times higher than the incidence in the Republic of Uzbekistan [7,8,9,10]. The problem of surgical treatment of liver echinococcosis still remains relevant in many regions of Uzbekistan [8,9,10,11,12,13,14]. 483 patients with echinococcosis were operated on in the 1st clinic of SamSMI from 2005 to 2018, 327 of them were diagnosed with LE. the difficulties of effective surgical treatment are due to the lack of a generally recognized optimal treatment option, depending on the location of the cyst, the condition of the cyst. fibrotic capsule and the lack of a single view on the methods of treatment of the fibrotic bed after removal of the cyst [16,17,18,19,20,21,22]. Improvement of modern diagnostic methods and introduction of new high- tech methods of surgical treatment did not give the expected results [24,25,26,27]. There is no consensus among surgeons about the scope of operations for liver echinococcosis complicated by bile duct damage. Postoperative complications in the form of retention of residual cavities, their suppuration, development of cholangitis, prolonged bile flow, often with the formation of an external biliary fistula, are still frequent and relapse of the disease [26,28,30]. The main reason for the development of these complications is inadequate treatment of the fibrous cyst capsule and its capitonage. to increase the effectiveness of these key stages of surgery, pre-and intraoperative detection of bile ducts opening into the cyst cavity is very important [28,29,30,31]. The aim of the study was to determine a method for improving the immediate results of surgical treatment of liver echinococcosis, and to develop the most rational tactics of surgical treatment. Materials and methods. The work is based on the analysis of medical records of 327 patients. The main group included 152 patients. There are 85 women and 67 men among them. Damage to the right lobe was detected in 102 patients, the left lobe in 14, damage to both lobes in 11 patients, and 24 patients had combined liver and other organ damage. Indications for surgery and the choice of optimal access for them were made considering the location of the cyst and the nature of complications. The choice of access depended on the topical location of the cyst. When cysts were localized in the second and third segments, echinococcectomy was performed from the upper end of the spine. – median access [28], if the first, fourth, fifth, and sixth segments were affected – from the subcostal segment [24], if they were located in the seventh and eighth segments, thoracotomy with 131 БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ | ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ | JOURNAL OF BIOMEDICINE AND PRACTICE №4 | 2021 diaphragmotomy was performed [23]. one patient had a combined access (thoracotomy, laparotomy), considering echinococcal lesion of the left lung and right lobe of the liver. Giant cysts, multiple cysts of both lobes of the liver in 9 cases required transverse laparotomy or total median laparotomy. laparoscopic surgery was performed in five patients