22 research outputs found
Therapeutico-surgical options in hydatid cyst of the left hepatic lobe
Catedra 2 Chirurgie, Clinica Chirurgie 2 USMF „Nicolae Testemițanu”Se prezintă cazul clinic de chist hidatic hepatic gigant depășit și neglijat de către pacientă, pentru mai mult de 15 ani. Acesta a fost depistat la timp, în anul
2000, însă, din cauza neglijenței pacientei, a fost operat tardiv.There is presented a clinical case of giant hepatic hydatid cyst outdated and neglected by the patient, for over 15 years. It was detected on time, in 2000, but
due to patient’s negligence, the operation was delayed
Insuficiența hepatică postoperatorie - cauză semnificativă a mortalității la pacienți cu chisturi hidatice gigante complicate
Background. Giant hydatid cysts usually lead to diffuse irreversible damage to the liver, aggravating
the results of surgical treatment and their presence is accompanied by high mortality. Objective of the
study. Analysis of factors that predispose to the development of liver failure in patients with
complicated echinococcosis Material and Methods. 347 patients with hepatic hedadidosis were
operated on in the clinic between 2000 and 2020. The diagnostic algorithm included: USG, Doppler,
EFGDS, CT, MRI in cholangiography regime, serological and biochemical analyzes. Results. In 33
(9.5%) cases, giant hydatid cysts located in more than 4 segments of the liver were detected. Of which,
in the preoperative period, liver cirrhosis was detected in 4 (12.1%) patients, the early stage of portal
hypertension was detected in 7 (21.2%), mechanical jaundice in 9 (27.3%), reactive hepatitis in 10 (
30.3%) patients, hydatid cachexia in 3 (9.09%). Postoperative liver failure developed in 9 (27.3%)
patients who underwent urgent surgery. Mortality rate - 7 (18.1%). Conclusion. Predisposing factors
for the development of postoperative liver failure are as follows - large destructive lesions of the liver
parenchyma, small volume of the remaining parenchyma, decreased blood supply, cachexia, old age,
the presence of concomitant pathologies.
Introducere. Chisturile hidatice hepatice gigante, de regulă, determină leziuni difuze ireversibile ale
ficatului, agravând astfel rezultatele tratamentului chirurgical și sunt insoțite de o mortalitate
înaltă. Scopul lucrării. Analiza factorilor predisponibili evoluției insuficienței hepatice la pacienții cu
chisturi hidatice gigantice complicate. Material și Metode. Studiul este axat asupra 347 pacienți cu
hidadidoză hepatică operați în perioada aa.2000 – 2020. Algoritmul diagnostic a inclus: USG,
dopplerografie, FEGDS, CT, IMRCP în regim colangiografic, analize serologice și biochimice.
Rezultate. În 33 (9.5%) cazuri au fost depistate chisturi hidatice hepatice gigante, ce au inclus mai mult
de 4 segmente ale ficatului. În acest grup, preoperator s-a atestat ciroză hepatică la 4 (12.1%) pacienți,
manifestări clinice ale hipertensiunii portale - la 7 (21.2%) pacienți, icter mecanic- în 9 (27.3%) cazuri,
hepatită reactivă la 10 (30.3%) pacienți, cașexie hidatică la 3 (9.09%) bolnavi. Insuficiența hepatică
postoperatorie a evoluat la 9 (27.3%) pacienți operați după indicații vitale. Mortalitatea generală în acest
lot a constituit 7(18.1%) cazuri. Concluzii. Factorii predisponibili ai insuficienței hepatice
postoperatorii în chisturile hepatice gigante sunt polimorfi, primordial fiind reprezentați de leziunile
destructive voluminoase ale parenchimului hepatic cu funcționalitate redusă a parenchimului hepatic
restant, hipoperfuzie arterială și portală
The reevaluation of the role of duodenal dysmotility in the etiopathogenesis of vesicular cholelithiasis
Department of Surgery No 2, Laboratory of Liver Surgery, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Gallstone disease and chronic calculous cholecystitis are the most prevalent gastro-enterological diseases requiring a surgical treatment.
This disease occupies a special place in the pathology of the hepato-bilio-pancreatic area, which is important for the etiological diagnosis as well as for the
resonance and the complex impact on the function of the adjacent organs. Besides, gallstone disease can result in serious outcomes, such as acute gallstone
pancreatitis and gallbladder cancer. This article analyzes the clinico- morphological characteristics of gallbladder stones. At the same time, the role of
duodenal dysmotility in the ethiopathogenesis of cholestasis was reevaluated through the contemplation of the contemporary concepts of lithogenesis.
Conclusions: The pathogenesis of gallstone disease is suggested to be multifactorial and probably develops from complex interactions between many
genetic and environmental factors and the state of adjacent organs. Based on its anatomical and physiological features, the duodenum is a completely
unique crossroads where the digestive pathways of the stomach, liver and pancreas meet. The sealing functionality of these organs allows them to be
cataloged as an integral system, and the duodenum due to its specific role exerts ”the pituitary function” of the gastrointestinal tract. Therefore, any
disruption of the duodenum activity may not be etiopathogenetically reflected on the hepatobiliary-pancreatic disease, and biliary cholelithiasis is no
exception in this regard. The achievement in the study of the pathophysiology of bile stones formation and the pathogenesis of gallstone disease can help
to improve the complex medico-surgical treatment of this category of patients
Risk factors in the development of acute appendicitis complications
Department of Surgery No 2, Laboratory of Liver Surgery, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: To study the risk factors of the development of acute appendicitis (AA) complications in adults in order to improve the results of surgical
treatment.
Material and methods: The research included 449 patients with AA treated surgically during the years 2015-2017 divided into 2 groups: 117 patients
who were admitted with complicated appendicitis (intra- and extraabdominal complications) and 332 patients with non-complicated AA were randomly
selected from the same period. The rate and characteristic of the complications evolved during the pre- and postoperative period in these two groups
were specified and analyzed.
Results: In the acute complicated appendicitis group (CAA), there was a predominance of women with a ratio of 1.60 versus 1.26 in the uncomplicated acute
appendicitis group (NAA). The proportion of people aged> 60 years was significantly higher in the case of CAA-23.1% (n=27), while in uncomplicated
AA it was only 3.9% (n=13). In the case of AA complications, there was an emphasis on late addressing, the debut-addressing term being higher compared
to uncomplicated AA. The low socio-economic status has a significant negative impact on the evolution of AA and its complications, as well as on the
results of appendectomy. Thus, uninsured patients (n=59, 49.6%) formed almost half of CAA group. Associated comorbidities were established in 76 or
16.9% of cases, respectively in CAA-21.4% vs 15.4% in NAA group. In summary we note that the presence of associated uncorrected comorbidities has
an obvious negative impact on the development of AA.
Conclusions: Our findings suggest that clinical assessment is most important for identifying individuals at risk of developing complications of AA and
the above-mentioned risk factors are useful for emergency surgical decisions
Postoperative hepatic insufficiency as a cause of mortality in patients with giant complicated hydatic cysts
Department of Surgery no. 2, State University of Medicine and Pharmacy „Nicolae Testemitanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction
Giant hydatid cysts usually lead to diffuse irreversible damage to
the liver, aggravating the results of surgical treatment and their
presence is accompanied by high mortality.
Purpose
analysis of factors that predispose to the development of liver
failure in patients with complicated echinococcosis
Material and methods
347 patients with hepatic hedadidosis were operated on in the
clinic between 2000 and 2020.
The diagnostic algorithm included: USG, Doppler, EFGDS, CT,
MRT in cholangiography, serological and biochemical analyzes.
Results
In 33 (9.5%) cases, giant hydatid cysts located in more than 4
segments of the liver were detected.
Of which, in the preoperative period, liver cirrhosis was detected
in 4 (12.1%) patients, the early stage of portal hypertension was
detected in 7 (21.2%), mechanical jaundice in 9 (27.3%), reactive
hepatitis in 10 ( 30.3%) patients, hydatid cachexia in 4 (12.1%).
Postoperative liver failure developed in 9 (27.3%) patients who
underwent urgent surgery. Mortality rate - 7 (18.1%).
Conclusions
Predisposing factors for the development of postoperative liver
failure are as follows - large destructive lesions of the liver
parenchyma, small volume of the remaining parenchyma,
decreased blood supply, cachexia, old age, the presence of
concomitant pathologies
Дифференцированное хирургическое лечение перфоративной язвы двенадцатиперстной кишки
USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaWe studied 374 clinical observations of patients admitted urgently with perforated duodenal ulcer, for the period 1994-2015 and operated in the Surgical Clinic of the Municipal Hospital “Holy Trinity”. The frequency of perforated duodenal ulcers during this period was 3.8%. We studied the etiopathogenetical factors, which affect the clinical picture and surgical treatment, such as age, time from onset of the disease to entering the clinic, the symptoms on admission, as well as the type of surgical intervention. Surgery was performed according to the general condition of the patients at admission and status of each patient individually during the operation. The mortality was 3.2% in the studied lot
Было изучено 374 клинических наблюдения пациентов, госпитализированных в срочном порядке с перфоративной язвой двенадцатиперстной кишки, за период 1994–2015 годов, и оперированных в хирургической клинике Муниципальной клинической больницы «Святой Троицы». Частота перфоративной дуоденальной язвы в этот период составляла 3,8%. Были изучены этиопатогенетические факторы, которые влияли на клиническую картину и хирургическое лечение, такие как возраст, время от начала заболевания до поступления в клинику, симптомы при поступлении, а также вид хирургического вмешательства. Хирургические вмешательства производились в зависимости от общего состояния пациентов при поступлении и состояние каждого больного в частности во время операции. В изученном материале смертность составляет 3.2%.
Etiopatogenia colecistitei acute acalculoase: schimbare de mit?
Background. Usual predisposing factors of acute acalculous cholecystitis (AAC) are critical conditions,
prolonged fasting, parenteral nutrition, sepsis. However, we notice an incidence of AAC in several of
our patients in the absence of these factors. This fact determined us to initiate this study. Objective of
the study. To estimate the rate, clinical and evolutive characteristics of AAC in order to identify the
risk factors. Material and Methods. 142 cholecystectomized pts for acute cholecystitis were analyzed.
AAC was defined by: 1) absence of gallstones/biliary sludge at US; 2)intraoperative confirmation of
AAC; 3)diagnosis morphological certification. Demographic, clinical and intraoperative parameters of
the patients divided into 2 groups: I -AAC; II -acute calculous cholecystitis were analyzed. Results. 14
(9.9%) cases met the AAC criteria. The M/F ratio in AAC was 11/3 compared to 49/79 in the group II
(p<0.01). The mean age in the groups was 48±2.3 and 57±1.2 years(p<0.05). Concomitant pathologies
were more frequent in AAC - 78.6% compared to 32% in group II (p<0.001). Preoperative EGD showed
evident duodenogastric reflux in almost all ACC pts (71.4%), which indicates the role of intraduodenal
pressure growth in the ACC etiopathogeny. In 6 (42.9%) pts with AAC, destructive forms with a
fulminant course of inflammation were established during 72 hours. It was attested a direct correlation
between the development of destructive forms and the age of the pts in the AAC group. Conclusion. We
can assume that the disruptions of the gastro-duodenal motility with elements of duodenostasis play a
certain role in the development of non-calculous inflammation of the gallbladder. The rapid evolution
of the inflammatory process in AAC requires early surgical treatment.
Introducere. Factorii predispozanți tradiționali ai colecistitei acute acalculoase (CAA) sunt consideraţi:
stările critice, repaosul alimentar, nutriţia parenterală, sepsisul. Remarcăm o incidenţă a CAA la mai
mulţi dintre pacienţii noştri în absenţa acestor factori, fapt ce a determinat efectuarea acestui
studiu. Scopul lucrării. A estima rata şi caracteristicile clinico-evolutive ale CAA în scopul identificării
factorilor de risc. Material și Metode. S-au analizat 142 bolnavi colecistectomizați cu colecistită acută.
CAA a fost definită prin: 1) absenţa calculilor/ sladjului biliar la USG; 2) confirmare intraoperatorie a
colecistitei acute fără calculi; 3) certificarea morfologică a diagnosticului. S-au analizat indicii
demografici, clinici, parametrii intraoperatori ai bolnavilor divizaţi în 2 loturi: I-CAA; II-colecistită
acută calculoasă. Rezultate. 14 (9,9%) cazuri au corespuns criteriilor CAA. Raportul B/F în CAA a fost
11/3 și 49/79 în lotul II (p <0,01). Vârsta medie în I și II loturi a fost de 48±2,3 și 57±1,2 ani (p <0,05).
În CAA, patologii concomitente au fost urmărite mai frecvent – 78,6% comparativ cu 32% în lotul II (p
<0,001). FEGDS a evidențiat reflux duodenogastral pronunțat la majoritatea pacienților cu CAA
(71,4%), ce indică rolul creșterii presiunii intraduodenale în etiopatogenia CAA. La 6 (42,9%) bolnavi
cu CAA s-au stabilit forme distructive cu un curs fulminant al inflamației în decurs de 72 ore. S-a atestat
o corelație directă între dezvoltarea formelor distructive și vârsta pacienților în lotul
CAA. Concluzii. Putem presupune că perturbările motilității gastro-duodenale cu elemente de
duodenostază posedă un rol în dezvoltarea inflamației non-calculoase a vezicii biliare. Evoluţia rapidă
a procesului inflamator în CAA necesită tratament chirurgical precoce
Etiopathogeny of acute acalculous cholecystitis: a myth change?
Department of surgery Nr. 2, State Medical and Pharmaceutical University “Nicolae Testemitanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Usual predisposing factors of acute
acalculous cholecystitis (AAC) are critical conditions,
prolonged fasting, parenteral nutrition, sepsis. However,
we notice an incidence of AAC in several of our patients
in the absence of these factors. This fact determined us to
initiate this study.
Purpose. To estimate the rate, clinical and evolutive
characteristics of AAC in order to identify the risk
factors.
Material and methods. 142 cholecystectomized pts for
acute cholecystitis were analyzed. AAC was defined by:
1) absence of gallstones/biliary sludge at US; 2)
intraoperative confirmation of AAC; 3) diagnosis
morphological certification. Demographic, clinical and
intraoperative parameters of the patients divided into 2
groups: I-AAC; II-acute calculous cholecystitis were
analyzed.
Results. 14 (9.9%) cases met the AAC criteria. The M/F
ratio in AAC was 11/3 compared to 49/79 in the group II
(p<0.01). The mean age in the groups was 48±2.3 and
57±1.2 years(p<0.05). Concomitant pathologies were
more frequent in AAC- 78.6% compared to 32% into group II (p<0.001). Preoperative EGD showed evident
duodenogastric reflux in almost all ACC pts (71.4%), which
indicates the role of intraduodenal pressure growth in the ACC
etiopathogeny.
In 6 (42.9%) pts with AAC, destructive forms with a fulminant
course of inflammation were established during 72 hours. It
was attested a direct correlation between the development of
destructive forms and the age of the pts in the AAC group.
Conclusions. We can assume that the disruptions of the
gastro-duodenal motility with elements of duodenostasis
play a certain role in the development of non-calculous
inflammation of the gallbladder. The rapid evolution of the
inflammatory process in AAC requires early surgical
treatment