Тактико-технические аспекты лечения больных эхинококкозом печени

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. Echinococcosis is a dangerous natural focal requiring radical eradication. The problem of parasitic disease of domestic animals and humans, echinococcosis remains relevant, since the disease is occurring sporadically and endemically. Areas that are quite common, and treatment issues are becoming endemic for echinococcosis include Mountainous areas, debatable. Among the lesions of various organs and echinococcosis is included in the who list of diseases tissues with echinococcosis, the frequency of liver 121 JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ №3,2 (том II) 2021 damage is 44-84 % [1,2,3,4,5]. Prevalence of This complex of examinations allowed us to obtain an echinococcosis inabout all of them the incidence of accurate segmental localization of cysts, their size, echinococcosis in the region is 1 per 10,000 inhabitants, number, and signs of a complicated course of the disease, in the Republic of Uzbekistan 0.39 per 1000 inhabitants such as mechanical jaundice, suppuration of the cyst, (2017). the Incidence of echinococcosis in the region is 4 connection of the cyst with the bile ducts, and cyst times higher than the incidence in the Republic of breakthrough into the biliary system. In complex Uzbekistan [7,8,9,10]. The problem of surgical treatment diagnostic cases with the goal of for the differential of liver echinococcosis still remains relevant in many diagnosis of echinococcosis and liver cancer in 3 patients, regions of Uzbekistan [8,9,10,11,12,13,14]. 483 patients an angiographic study was performed. Only the with echinococcosis were operated on in the 1st clinic of information received in full allowed us to solve the Samgmi from 2005 to 2018, 327 of them were diagnosed tactical issues of the upcoming surgical intervention. The with LE. the difficulties of effective surgical treatment comparison group consisted of 175 patients. Of these, are due to the lack of a generally recognized optimal 103 are women, 72 are men. In this group, the right lobe treatment option, depending on the location of the cyst, was affected in 126 patients, the left lobe in 22, both the condition of the cyst. fibrotic capsule and the lack of a lobes in 12 patients, and combined liver and other organ single view on the methods of treatment of the fibrotic damage in 15 cases. The main operative approach in this bed after removal of the cyst [16,17,18,19,20,21,22]. group of patients was the right subcostal one, and ERCP Improvement of modern diagnostic methods and was performed for the purpose of follow-up examination. introduction of new high-tech methods of surgical only in the presence of jaundice. treatment did not give the expected results [24,25,26,27]. Research results. We believe that determining There is no consensus among surgeons about the scope of the most rational surgical approach and timely detection operations for liver echinococcosis complicated by bile of cystobiliary fistulas (CBF) is a key factor in reducing duct damage. Postoperative complications in the form of the likelihood of postoperative complications. One of the retention of residual cavities, their suppuration, most severe complications of EP is the rupture of cyst development of cholangitis, prolonged bile flow, often contents into the bile ducts, which occurs in 6-63% of with the formation of an external biliary fistula, are still cases [2,8,9,10]. According to our study, this frequent and relapse of the disease [26,28,30]. The main complication occurred in 73 people, which was 22.3%. reason for the development of these complications is The clinical picture of getting the contents of an inadequate treatment of the fibrous cyst capsule and its echinococcal cyst into the bile ducts is due to the capitonage. to increase the effectiveness of these key diameter of the CBS and its level a breakthrough in the stages of surgery, pre-and intraoperative detection of bile biliary tract. Depending on the severity of the clinical ducts opening into the cyst cavity is very important picture, we distinguish three degrees of manifestation of [28,29,30,31]. CBF. The first degree was diagnosed in 22 patients The aim of the study was to determine a (6.7%) with severe mechanical jaundice and cholangitis, method for improving the immediate results of surgical which occurred due to the breakthrough of the cyst treatment of liver echinococcosis, and to develop the contents into the large lobar hepatic ducts. All patients in most rational tactics of surgical treatment. this group showed signs of liver failure with severe Materials