STAGED METHOD OF SURGICAL TREATMENT OF LIVER ECHINOCOCCOSIS

The purpose of the study is to present and evaluate the results of treatment of patients with parasitic liver damage using a modern diagnostic algorithm, various methods and stages of surgical treatment.

Material and methods. The results of treatment of 81 patients (34 men (42%), 47 women (58%)) who underwent 104 surgical interventions for liver echinococcosis in the surgical department No. from 2015 to 2021. The difference in the number of operations performed and actual patients is explained by the use of a staged method of surgical treatment in some cases.

Results. Of the total number of operated patients, one-stage surgical interventions were applied in 64 (79%) cases. In 17 (21%) patients, various staged methods of surgical treatment were applied, which made it possible to exclude some of them from the category of "non-resectable" and perform surgical treatment with good results. An unsatisfactory result of treatment with a fatal outcome was noted in one case from the total array of patients.

Conclusion. The use of a modern diagnostic algorithm, various surgical techniques, including staged minimally invasive and laparoscopic ones, makes it possible to achieve good treatment results in a specialized surgical center.

Prevention of acute post-manipulation pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most informative and often in-demand methods for the detection and treatment of pathology of the biliary tract, its diagnostic value is 79-98%. A significant disadvantage of the method are side effects and various complications (acute pancreatitis, bleeding, retroduodenal perforation, cholangitis, acute cholecystitis, etc.). Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and severe complication of intraluminal endoscopic operations on the large duodenal papilla, its etiology is multifactorial, and the pathophysiology has not yet been fully studied. According to many randomized, controlled studies, the incidence of PEP ranges from 2.7 to 37%. Despite all the possibilities of modern medicine and the introduction of new methods, mortality with the development of PEP remains at a very high level: it reaches 7-15%, and with the development of destructive forms - 40-70%. The problems of prevention of PEP are still the subject of discussions and numerous studies by leading clinics around the world. In this paper, we conducted a review of the literature over the past decade using the sources of major medical libraries Medline, eLibrary, PubMed. The article discusses current modern pathogenetic mechanisms and the main risk factors for the development of PEP, related to both the characteristics of the patient and the procedure being performed, technical options for performing ERCP. The article also presents currently used and recommended by most authors methods of drug prevention of PEP and various technical solutions related to this complication. Thus, the not entirely satisfactory results of the proposed methods of prevention of PEP force the authors to search for safer and more effective solutions to this urgent problem at the present time.