SURGICAL TACTICS IN COMBINED LUNG AND LIVER ECHINOCOCCOSIS
Keywords:
liver echinococcosis, pulmonary echinococcosis, laparoscopic echinococcectomy, minilaparotomic echinococcectomy, laparotomic echinococcectomyAbstract
Relevance. Surgical intervention remains the main method of treatment of echinococcosis of both pulmonary and hepatic localization. Alternative conservative therapy is not highly effective. The aim of this study was to evaluate minimally invasive surgical interventions in the treatment of echinococcal cysts of the liver and lungs.
Material and methods. This work includes the results of surgical treatment of 112 patients with combined echinococcosis of the lungs and liver, operated in general surgery of the Samarkand Medical University.
The clinical material was divide into three groups: in the first group (control), 36 (32.14%) patients underwent surgery on the lungs and liver through separate wide accesses. At the same time, 34 (94.44%) patients - operations performed in stages with an interval of 4-6 weeks, 2 (5.56%) - echinococcectomy from the lungs and liver performed simultaneously with separated accesses; In the second group, 29 (25.89%) patients underwent removal of echinococcal cysts from the right lung and liver at the same time through thoracophrenolaparotomy; In the third group, in 47 (41.97%) patients, the removal of cysts from the lungs and liver carried out in stages. At the same time, in 35 (74.47%) cases, at certain stages of echinococcectomy, mini-approaches developed by us were use in combination with video assistance, and in 12 (25.53%) cases, all thoracic and abdominal approaches performed using only mini-incisions. In 7 patients, surgical interventions on the lungs and liver were performed through separate mini-accesses at the same time, and in 5 patients, cysts were removed from the lungs and liver in stages with an interval of four weeks.
The use of minimally invasive approaches and simultaneous operations contributed to the reduction of early postoperative complications from 13.89% (control group) to 9.21% (main group), i.e. 2 times.
Conclusion: this study shows that the use of endovisual technology allows operations through minimally invasive accesses both in the lungs and adjacent localizations of liver cysts and does not lead to an increase in the number of postoperative complications compared with operations performed by traditional thoracotomy and laparotomy approaches.
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