СИМПТОМАТИКА И ЦИСТОСКОПИЧЕСКАЯ КАРТИНА У ЖЕНЩИН С СИНДРОМОМ БОЛЕЗНЕННОГО МОЧЕВОГО ПУЗЫРЯ

Introduction. The relevance of the problem is in high incidence of bladder pain syndrome (BPS) and a significant effect on the quality of life of patients.The objective of the research is to study the relationship between clinical manifestations and the cystoscopic pattern in women with BPS.Materials and methods. The results of a survey of 61 women with BPS aged 39 to 68 years are presented. The severity of clinical symptoms was assessed using a PUF questionnaire, a visual analogue pain scale and diaries of urination. All patients underwent cystoscopy after a preliminary hydrodistension of the bladder. Depending on the severity of the clinical manifestations of BPS all patients were divided into 3 groups.Results. Patients with more severe symptoms of BPS experienced more pronounced changes in the bladder during cystoscopy. Thus, the Gunner lesions were detected only in patients of the 3rd group with the most severe clinical symptoms and in none of the patients of the 1st (mild degree) and the 2 nd group (moderate degree). At the same time, none of the patients of the 3rd group had cystoscopy with normal cystoscopic pattern.Conclusions. The results of the study showed a correlation between the clinical manifestations of BPS in women and the changes in the bladder detected in cystoscopy after bladder hydrodistension.Введение. Актуальность проблемы обусловлена высокой частотой синдрома болезненного мочевого пузыря (СБМП) и существенным его влиянием на качество жизни больных.Цель исследования – изучить связь между клиническими проявлениями и цистоскопической картиной у женщин с СБМП.Материал и методы. Представлены результаты обследования 61 женщины с СБМП в возрасте от 39 до 68 лет. Выраженность клинической симптоматики оценивали с помощью опросника PUF, визуальной аналоговой шкалы боли и дневников мочеиспускания. Всем пациентам выполняли цистоскопию после предварительной гидродистензии мочевого пузыря.Результаты исследования. Выявлена зависимость между интенсивностью основных симптомов СБМП и выраженностью изменений в мочевом пузыре по данным цистоскопии. Гуннеровские поражения мочевого пузыря были выявлены только у больных с наиболее выраженной клинической симптоматикой (3-я группа) и ни у одного из больных с легкой (1-я группа) и умеренной (2-я группа) симптоматикой. При этом ни у одного больного 3-й группы при цистоскопии не было нормальной цистоскопической картины.Выводы. Результаты проведенного исследования показали наличие связи между клиническими проявлениями СБМП у женщин и изменениями в стенке мочевого пузыря, выявляемыми при цистоскопии

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА И РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ СИНДРОМОМ КОМПРЕССИИ ЧРЕВНОГО СТВОЛА И В СОЧЕТАНИИ С РЕФЛЮКС-ЭЗОФАГИТОМ

Relevance. Clarifying the sequence and mutual connection of the median arcuate ligamentum syndrome (MALS) and reflux esophagitis (RE) makes it possible to determine the indications and success of the operation. The objective of the study was to compare the results of the examination and operations in patients with the MALS in combination with RE. Material and methods. 198 patients with MALS were examined and operated. Among them, 85 patients was just with MALS, and decompression of celiac trunk was performed for them. 84 patients had MALS and RE, simultaneously decompression of celiac trunk and Nissen fundoplication were performed for that group of patients. 29 patients had MALS and RE, only decompression of celiac trunk was performed for that group. A comparative analysis of the results of examination and surgical treatment of 85 patients with the MALS and 84 in combination with RE was carried out. The average age of the patients is about 30 years, the female gender prevailed. The feeling of heaviness and abdominal pain due to eating and physical activity, neurovegetative disorders was almost in all patients. Daily or weekly heartburn, regurgitation, vomiting and dysphagia as well as edema, erythema and erosion of the esophageal mucosa were observed mainly in patients with MALS in combination with ER. Results. Significant compression stenosis of the celiac trunk was detected in all patients. After the decompression of the celiac trunk in patients with MALS as well as decompression of the celiac trunk and Nissen fundoplication in patients with MALS in combination with ER, most of them received good clinical results and normalization of anatomical and hemodynamic parameters in celiac trunk. Conclusion. In the combined version of the MALS and RE and the corresponding indications it is expedient to perform decompression of celiac trunk and Nissen fundoplication simultaneously.Введение. Выяснение последовательности и взаимной связи синдрома компрессии чревного ствола и рефлюкс- эзофагита дает возможность определить показания и успех операции. Цель исследования – сравнить результаты обследования и операций у больных синдромом компрессии чревного ствола и в сочетании с рефлюкс-эзофагитом. Материал и методы. Были обследованы и оперированы 198 больных с синдромом компрессии чревного ствола (СКЧС). Из них у 85 был только СКЧС, им произведена декомпрессия чревного ствола (ДЧС). У 84 был СКЧС и рефлюкс-эзофагит (РЭ), им выполнена одновременна ДЧС и фундопликация по Ниссену. У 29 был СКЧС и РЭ, им сделана только ДЧС. У всех больных оценены исходы операций. Проведен сравнительный анализ данных обследования и хирургического лечения 85 больных СКЧС и 84 в сочетании с РЭ. Средний возраст больных – около 30 лет, превалировали лица женского пола. Ощущение тяжести и боль в животе в связи с приемом пищи и физической нагрузкой, нейровегетативные расстройства были почти у всех больных. Ежедневная или еженедельная изжога, срыгивание, рвота и дисфагия, а также отек, эритема и эрозии слизистой пищевода наблюдались в основном у больных СКЧС с РЭ. Результаты исследования. У всех больных выявлен значимый компрессионный стеноз чревного ствола. После ДЧС у больных СКЧС, а также ДЧС и фундопликации по Ниссену у больных СКЧС с РЭ у большей части из них были получены хорошие клинические результаты, нормализация анатомических и гемодинамических показателей в ЧС. Заключение. При сочетанном варианте СКЧС и РЭ и соответствующих показаниях целесообразно выполнение одновременно ДЧС и ФП по Ниссену

THE SIGNIFICANCE OF RESPIRATORY AND ORTHOSTATIC TESTS IN DUPLEX SCANNING IN DIAGNOSTICS OF CELIAC ARTERY COMPRESSION SYNDROME

The preoperative transabdominal ultrasonics duplex scanning (UDS) of celiac artery was made in quiet breathing, in inspiration, in expiration, using vertical position in 180 patients. As well as the intra-abdominal UDS was made before the decompression of the celiac artery using the pulmonary ventilation during narcosis and relaxation. Peak systolic blood velocity, degree of stenosis, arterial pressure gradient in the celiac artery and volume blood velocity were hemodynamically significant in quiet breathing, in expiration and intraoperatively, reliably lower in inspiration in vertical position. It is important to use respiratory and orthostatic tests in diagnostics of compressive stenosis of the celiac artery. The data, which were obtained in quiet breathing using vertical position, should be taken into account in order to distinguish the compressive stenosis from atherosclerotic stenosis or other origin

Repeated operations in patients with unsatisfactory results of celiac artery compression syndrome treatment

Purpose of the study. The reasons for the unsatisfactory results of surgical treatment of patients with celiac artery compression syndrome (CACS) and the role of repeated interventions allows to achieve a lasting improvement in most of them. The purpose of the study is to clarify the reasons for the unsatisfactory outcomes of surgical treatment of patients with CACS and the nature and significance of repeated operations.Patients and methods. From 860 patients with CASC who were operated on over the past 25 years 82 patients were selected with unsatisfactory treatment results. Initial conventional abdominal surgery was performed in 26 (31.7%) patients without a positive outcome before decompression of celiac artery (DCA). Primary operations were performed in 82 patients with proven CASC, of which 69 (84.1%) had DCA in open approach, isolated in 43 (52.4%) and combined in 26 (31.7%). Embolization of PDA aneurysm in one (1.2%) patient. In other medical institutions 15 (18.3%) patients were operated, among them 3 (3.7%) patients had DCA in open approach, in 4 (4.9%) laparoscopic DCA, in 6 (7.3%) angioplasty and emergency stenting and two (2.4%) reconstructive operations, all technically and clinically unsuccessful.Results. After DCA in open approach 51 (73.9%) patients of 69 patients had normal celiac artery flow. 4 patients had unresolved stenosis of the celiac artery and 15 relapsed its stenosis, one of them with residual stenosis after DCA twice, which amounted to 0.5% and 1.7%, respectively of 860 patients. Repeated operations were performed in 51 (62.2%) patients out of 82 to restore the celiac artery in 28 (34.2%), among them 4 (4.9%) in combination with interventions on the abdominal organs. Abdominal operations with concomitant diseases of the gastrointestinal tract with normal flow in celiac artery in 21 (25.6%).Scalenotomy in two (2.4%). Of 28 patients, re-revascularization of the celiac artery was successful as a result of open decompression in 7 out of 8, bypass surgery in 9 out of 10 and balloon angioplasty and with stenting in two out of 7. One had an effective primary DCA and the other resected PDA aneurysm. 19 patients out of 25 showed a good result after operations on the abdominal organs.Conclusion. The unsatisfactory results of surgical treatment of patients with CASC are associated with inadequate restoration of celiac artery restenosis and/or concomitant diseases of the abdominal organs. Repeated vascular operations are mainly: decompression of celiac artery in open approach, bypass surgery and balloon angioplasty and stenting, and/or abdominal mainly: cholecystectomy, NissenFP, and Strong surgery are of primary importance in the treatment of patients with CASC

SYMPTOMATIC AND CYSTOSCOPIC PATTERN IN WOMEN WITH THE BLADDER PAIN SYNDROME

Introduction. The relevance of the problem is in high incidence of bladder pain syndrome (BPS) and a significant effect on the quality of life of patients.The objective of the research is to study the relationship between clinical manifestations and the cystoscopic pattern in women with BPS.Materials and methods. The results of a survey of 61 women with BPS aged 39 to 68 years are presented. The severity of clinical symptoms was assessed using a PUF questionnaire, a visual analogue pain scale and diaries of urination. All patients underwent cystoscopy after a preliminary hydrodistension of the bladder. Depending on the severity of the clinical manifestations of BPS all patients were divided into 3 groups.Results. Patients with more severe symptoms of BPS experienced more pronounced changes in the bladder during cystoscopy. Thus, the Gunner lesions were detected only in patients of the 3rd group with the most severe clinical symptoms and in none of the patients of the 1st (mild degree) and the 2 nd group (moderate degree). At the same time, none of the patients of the 3rd group had cystoscopy with normal cystoscopic pattern.Conclusions. The results of the study showed a correlation between the clinical manifestations of BPS in women and the changes in the bladder detected in cystoscopy after bladder hydrodistension

INTRAOPERATIVE ULTRASOUND DUPLEX SCANNING IN THE DIAGNOSIS AND ASSESSMENT OF RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CELIAC COMPRESSION SYNDROME

The authors have performed an analysis of main indicators of celiac duplex scanning in 180 patients with celiac compression syndrome before operation, during decompression and at the postoperative period. All the patients underwent trunk decompression. The indicators of the intraoperative celiac surgical celiac duplex scanning (stenosis degree, linear peak systolic circulation rate) of the celiac trunk shower hemodynamic reliable stenosis and were sufficiently different from preoperative findings. The stenosis degree and linear peak systolic circulation rate were less during intraoperative examination than before the operation. Intraoperative, duplex canning allowed compressive stenosis of the seliac trunk to be differentatied in some patients from intravasal one (atherosclerosis and arteritis), and its adequate decompression to be performed. When performing the celiac trunk decompression it is thought to be necessary to fulfill its intraoperative ultrasound duplex scanning before and after elimination of the compression