Epiphrenic esophageal diverticulum: clinical experience

Catedra Chirurgie FECMF, USMF „Nicolae Testemiţanu”, Spitalul Clinic Republican, Secţia Chirurgia Toracică, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Diverticulul epifrenic se întâlneşte rar şi, de regulă, este asociat cu diverse tulburări de motilitate ale esofagului. Acuzele mai frecvente sunt disfagia, eructaţiile, durerile toracice şi manifestările pulmonare ale aspiraţiei. Examenul radiologic cu contrast şi cel endoscopic sunt prioritare la stabilirea diagnosticului, iar manometria esofagiană relevă tulburările de motilitate. Tactica chirurgicală optimală nu este încă materializată, subiect de dezbateri fiind morbiditatea perioperatorie şi mortalitatea postoperatorie înalte. Studiul dat relatează experienţa acumulată în tratamentul chirurgical al diverticulilor epifrenici. Material şi metode: Cercetarea include 25 bolnavi cu diverticul epifrenic internaţi în perioada 1970-2015. Evaluarea preoperatorie a inclus examenul radiologic baritat, examenul endoscopic şi testele funcţionale. Douăzeci de bolnavi au fost supuşi tratamentului chirurgical tradiţional, în 3 cazuri diverticulectomia a fost realizată prin tehnica minim invazivă, iar 2 bolnavi au beneficiat de tratament conservativ. Rezultate: Vârsta pacienţilor a fost cuprinsă între 20 şi 82 ani. Dimensiunile medii ale diverticulului au constituit 4,6 cm cu limitele absolute între 1,5 şi 12 cm. Durata media a bolii a constituit 22 luni. Acuzele predominante au constituit disfagia (88%) şi eructaţiile (71%). Mortalitatea postoperatorie a constituit 3,19%. Durata medie de spitalizare a fost de 17,2 zile. În 19 cazuri (76%) au fost înregistrate rezultate favorabile, iar în 3 cazuri au fost semnalate simptome reziduale. Concluzii: Diverticulectomia tradiţională transtoracică asigură o morbiditate postoperatorie redusă şi rezultate favorabile la distanţă. În cazurile necomplicate diverticulectomia poate fi realizată prin intermediul chirurgiei minim invazive.Introduction: Epiphrenic diverticulum is rare and usually is associated with various esophagus motility disorders. Frequent complaints are dysphagia, eructation, chest pain and pulmonary manifestations of aspiration. When revealing motility disorders, priority is given to contrast radiography and endoscopic examinations. The optimal surgical tactics has not been applied yet but it is being debated on the subject of perioperative morbidity and high postoperative mortality. This study recounts the experience in surgical treatment of epiphrenic diverticulum. Material and methods: Study involves 25 patients with epiphrenic diverticulum hospitalized during 1970-2015. Preoperative evaluation included barium radiographical, endoscopic examination and functional tests. Twenty patients underwent traditional surgery, in 3 cases diverticulectomy was performed by minimally invasive technique, 2 patients received conservative treatment. Results: Patients age ranges from 20 to 82 years. The average size of the diverticulum was of 4.6 cm with absolute limits between 1.5 and 12 cm. The average duration of disease was 22 months. Complaints of dysphagia (88%) and eructation (71%) prevailed. Postoperative mortality was 3.19%. The average duration of hospitalization was 17.2 days. In 19 cases (76%) there have been recorded favorable results and in 3 cases have been reported residual symptoms. Conclusions: Traditional transthoracic diverticulectomy ensures reduced postoperative morbidity and good long-term results. In uncomplicated cases diverticulectomy can be performed by applying minimally invasive surgery

Анестезия плечевого сплетения

Trauma of the upper limbs is the third most common cause of disability among the general world population and the leading cause among young people between the ages of 20 and 40. This “Silent Epidemic of the Modern World” has resulted in an increase in the number of surgical interventions, many complexes, in trauma and orthopedic clinics. It is important for surgeons to make the best choice of the method of anesthesia, which depends on many factors, the nature of injury, the age of the patient, and the maintenance period after surgery, and the anesthesia must be simple and effective with the minimum of risk for the patient. Though general anesthesia is increasingly common, the local anesthesia has a well-defined place, and can significantly reduce the cost of outpatient surgery.Травма верхних конечностей часто ведёт к инвалидности, которая находится на третьем месте в общей патологии, а у молодых лиц 20-40 лет на первом месте. Её ещё называют «скрытой эпидемией современного мира». Это привело к увеличению числа хирургических вмешательств в клиниках травматологии и ортопедии. Большинство таких операций характеризуются сложностью выполнения. Здесь особую роль играют методы анестезии, которые зависят от многих факторов: характера травмы, возраста пациента, ведения послеоперационного периода. В то же время анестезия должна быть простой, эффективной и с меньшим риском для пациента. Несмотря на то, что методы общей анестезии продолжают разрабатываться, местная анестезия тоже имеет своё определённое место. Некоторые преимущества локальной анестезии, в сравнении с общей, приводят к существенному снижению стоимости амбулаторной хирургии