Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery最新文献

{"title":"Obstructive jaundice: routing, diagnostics, treatment tactics","authors":"S. Bagnenko, A. Korolkov, D. Popov, S. A. Shatalov, L. A. Logvin","doi":"10.16931//1995-5464.2023-4-24-31","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-24-31","url":null,"abstract":"Aim. To analyze three-level system of medical care for different categories of patients with obstructive jaundice on the example of Pavlov University.Materials and methods. The paper presents a retrospective analysis of treating patients with obstructive jaundice. The analysis covered the period from January 2015 to April 2023 and involved an etiology of obstructive jaundice, range of performed surgical interventions, postoperative complication rate, and mortality.Results. The study involved 2494 patients, including 1569 (62.9%) with cholelithiasis. The total mortality accounted for 7.2%, the incidence of postoperative complications – 13.9%. A choice of decompression procedure in patients with malignant tumors depended on the block level. Interventions included percutaneous transhepatic drainage, cholecystostomy, stenting of common bile duct. Hybrid surgery was performed in patients with calculous cholecystitis and choledocholithiasis. A number and size of concrements, a diameter of common bile duct influenced the choice of interventions and their volume. Two-stage tactics for stricture of biliodigestive anastomosis included percutaneous transhepatic drainage and reconstructive surgery. Endoscopic intervention was performed for choledocholithiasis. Procedures for stricture of biliary anastomoses after orthotopic liver transplantation involved endoscopic papillosphincterotomy, balloon dilatation of stricture and stenting of bile duct. Management of obstructive jaundice against the background of gestation included endoscopic papillosphincterotomy, lithoextraction, and, if necessary, treating the pregnancy termination threat.Conclusion. The routing of patients with obstructive jaundice to the 2nd and 3rd level of healthcare units is found necessary to be differentiated, depending on the etiology and severity of their condition. Obstructive jaundice in pregnant women requires the patient to be referred to the hospital of the 3rd level. Creation of a shared dispatch service responsible for a certain territory can reduce a number of routing stages.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"47 11-12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern principles of hepatocellular carcinoma treatment","authors":"Х Айвазян, З ИкрамовР., Ю Степанова, Б ВараваА., Минздрава России, Большая Серпуховская, Российская Федерация, Сеченова Минздрава России, Большая Сухаревская пл, A. VishnevskyV., Stepanova Yu, Kovalenko Yu, Zharikov Yu, Pakhomova A. Yu","doi":"10.16931/1995-5464.2020215-26","DOIUrl":"https://doi.org/10.16931/1995-5464.2020215-26","url":null,"abstract":"Aim. To improve the treatment outcomes, quality and life expectancy, prognosis in patients with hepatocellular carcinoma based on an analysis of treatment outcomes.Materials and methods. The analysis of the long-term results of treatment of 114 patients with hepatocellular carcinoma for 2015–2020 was carried out. Two groups of patients were distinguished: 41 (35.9%) patients were included in group I (a potentially resectable tumor with R0 surgery), and 63 (55.2%) patients were included in group II (advanced tumor does not suggest R0 resection).Results. Actuarial survival for patients with R0 surgery (48) was: 1 year – 85%, 3 years – 65%, 5 years – 55%; in patients with unresectable tumor after transarterial chemoembolization: 1 year – 65%, 3 years – 29%, 5 years – 11%; after local destruction methods – 0.5 years – 75%, 1 year – 36%, 1.5 years – 22%.Conclusions. The results of treatment of patients with hepatocellular carcinoma confirm the feasibility and effectiveness of a rational multidisciplinary approach. It allows you to achieve satisfactory results in multidisciplinary hospitals. The results are consistent with the data of large surgical centers.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"52 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141209290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic criteria for a “soft” pancreas and their influence on the occurrence of pancreatic fistula after pancreatoduodenal","authors":"Yu. S. Galchina, G. G. Kаrmаzаnovsky, D. V. Kalinin, E. Kondratyev, D. S. Gorin, G. Galkin, A. Kriger","doi":"10.16931/1995-5464.20202113-123","DOIUrl":"https://doi.org/10.16931/1995-5464.20202113-123","url":null,"abstract":"Purpose. Identification of the possibilities of contrast enhancement computed tomography in evaluated the number of the acinar structures in the pancreatic parenchyma at the preoperative stage to predict the development pancreatic fistula.Material and methods. In 2016–2019, 196 pancreatoduodenectomy were performed. 86 patients were retrospectively selected. Patients were divided into 2 groups: group 1 included 16 observations with the development of clinically significant pancreatic fistula, in 2 – 70 cases without complications. According to preoperative contrast enhancement computed tomography, structure of the pancreas, pancreatic parenchyma thickness, pancreatic duct diameter, the density of the pancreas in the native phase, relative parenchyma enhancement ratio, washout coefficient, pancreas stump volume were evaluated. According histological, the number of acinar and fat cells in the section of the removed pancreas was evaluated.Results. “Soft” structure of the pancreas (r = 0.374, p = 0.000), pancreatic parenchyma thickness (r = 0.549, p = 0.000), the density of the pancreas in the native phase of the scan (r = 0.568, p = 0.000), the values relative parenchyma enhancement ratio (r = 0.63, p = 0.000), pancreas stump volume (r = 0.508, p = 0.000) positively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic duct diameter (r = −0.339, p = 0.001) negatively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic fistula risk is 3.09 times higher with the number of acini more than 72.5%, sensitivity 75%, specificity 75.71%. Pancreatic fistula risk is 1.8 times higher with the density of the pancreas in the native phase over 35.5 HU sensitivity 62%, specificity 65%. Pancreatic fistula risk is 2.76 times higher with values parenchyma accumulation coefficient more than 1, sensitivity 75%, specificity 73%.Conclusions. Contrast enhancement computed tomography allows evaluating acinar index in the preoperative period to pick out the high-risk patient group to development of pancreatic fistula.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"133 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141210032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemobilia in percutaneous transhepatic cholangiostomy","authors":"O. I. Okhotnikov, M. Yakovleva, S. N. Grigoriev, V. Pakhomov, O. O. Okhotnikov","doi":"10.16931/1995-5464.2020156-61","DOIUrl":"https://doi.org/10.16931/1995-5464.2020156-61","url":null,"abstract":"Aim. To determine the dependence of the formation of vascular-biliary fistula with the bile ducts bleeding and along the drainage channel on the diameter of the puncture needle and access to the biliary tract.Materials and methods. A retrospective analysis of the results of treatment of 3786 cases of percutaneous transhepatic cholangiostomy using needles 17.5-18 G under Amplatz 0.035’ conductor with a safe J-tip was carried out. In the cholangiostomy in the bile ducts was installed biliary tree drainage shape memory No 8 Fr. In benign lesions of the bile ducts 2066 (54.6%) interventions were performed, 1720 (45.4%) for malignant ones. Central access to the bile ducts was performed in 2442 cases (64.5%), peripheral – in 1344 cases (35.5%).Results. Significant hemobilia was observed in 21 (0.55%) cases: in 8 (0.47%) with a obstructive jaundice of malignant etiology, in 13 (0.63%) – benign etiology. In 3 cases, the cause of hemobilia was arteriobiliary fistula, in 16 – portobiliary, in 2 – biliovenous fistula. Central access was complicated by significant hemobilia in 10 patients, peripheral – in 11.Conclusion. The low frequency of significant hemobilia – 0.55% – when using puncture needles 17.5–18 G for primary access to the bile ducts proves the validity of their use in radiological practice, and also does not allow to consider central access critical for the development of hemorrhagic complications in percutaneous transhepatic biliary drainage.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":" 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141221981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemobilia in percutaneous transhepatic cholangiostomy","authors":"O. I. Okhotnikov, M. Yakovleva, S. N. Grigoriev, V. Pakhomov, O. O. Okhotnikov","doi":"10.16931/1995-5464.2020156-61","DOIUrl":"https://doi.org/10.16931/1995-5464.2020156-61","url":null,"abstract":"Aim. To determine the dependence of the formation of vascular-biliary fistula with the bile ducts bleeding and along the drainage channel on the diameter of the puncture needle and access to the biliary tract.Materials and methods. A retrospective analysis of the results of treatment of 3786 cases of percutaneous transhepatic cholangiostomy using needles 17.5-18 G under Amplatz 0.035’ conductor with a safe J-tip was carried out. In the cholangiostomy in the bile ducts was installed biliary tree drainage shape memory No 8 Fr. In benign lesions of the bile ducts 2066 (54.6%) interventions were performed, 1720 (45.4%) for malignant ones. Central access to the bile ducts was performed in 2442 cases (64.5%), peripheral – in 1344 cases (35.5%).Results. Significant hemobilia was observed in 21 (0.55%) cases: in 8 (0.47%) with a obstructive jaundice of malignant etiology, in 13 (0.63%) – benign etiology. In 3 cases, the cause of hemobilia was arteriobiliary fistula, in 16 – portobiliary, in 2 – biliovenous fistula. Central access was complicated by significant hemobilia in 10 patients, peripheral – in 11.Conclusion. The low frequency of significant hemobilia – 0.55% – when using puncture needles 17.5–18 G for primary access to the bile ducts proves the validity of their use in radiological practice, and also does not allow to consider central access critical for the development of hemorrhagic complications in percutaneous transhepatic biliary drainage.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141221885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}