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19МЕДИЦИНСКИЕ НАУКИ
ACUTE CHOLECYSTITIS IN ELDERLY AND SENILE PATIENTS
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Babajanov A.S. , Saydullaev Z.Ya. , Vohidov J.J.
1Babajanov Akhmadjon Sulatanbaevich - PhD, Associate Professor;
2Saydullaev Zayniddin Yakhshiboevich - Assistant; 3Vohidov Jahongir Jamshedovich - Student, DEPARTMENT OF SURGICAL DISEASES, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the article presents a scientific review of gallstone disease in the elderly. The etiology, pathogenesis, modern methods of minimally invasive methods of surgical treatment of gallstone disease are described in detail. Keywords: cholelithiasis, acute cholecystitis, cholecystectomy.
The study of the results of world demographic indicators indicates a change in the age composition of humanity in the direction of its aging. The age group over 65 years old increased from 4% to 15% during the past twentieth century [3, 12]. A significant increase in patients with acute cholecystitis (ACh) is also associated with the general tendency of aging in developed countries [12, 14]. The peak incidence of GC falls on 50-70 years, when the operation involves a significant risk [3, 14, 15]. The relative amount of destructive forms of TC in patients older than 60 years continues to be according to the literature from 40.5 to 92.8% [13, 17]. Thanks to the research of many clinicians and morphologists, it was found that age-related changes in the gallbladder (Gb) are expressed in an increase in its size and progressive fibrosis of all layers of its wall. The greatest changes are noted in a muscular coat and arteries Gb. At the age of 40, atrophy of the muscular layer of the skin begins [3, 8, 19]. These changes are especially pronounced in patients with concomitant diseases of the cardiovascular system - atherosclerosis and hypertension, in which sclerosis of the arteries of the left ventricle is detected, up to their stenosis [5, 14, 18]. Violation of the blood supply to the wall of the RR, due to its overstretching, aggravated by the presence of sclerosis and vascular fibrosis.
The leading role in the development of acute destructive cholecystitis belongs to biliary hypertension [3, 6, 20], the main cause of obstruction of the cystic duct are stones - 97.5% of cases [13]. The role of microbial flora in the development of GO is secondary, since favorable conditions for the growth and reproduction of E. coli creates a cessation of the outflow of bile from the ACh [5, 9]. Many authors have put forward an autoimmune theory of the occurrence of OX [2, 18]. Thus, in patients with elderly and senile age, severe and irreversible processes in the wall of the Gb occur in the early hours after the onset of an acute attack [3, 8]. The inflammatory process often affects all layers of the wall, diffuse, and when the destructive forms are accompanied by the formation of microabscesses, swelling and swelling of all structures of the wall Gb 2, 9, 13].
Many authors emphasize the complexity of the clinical diagnosis of ACh in elderly and senile patients. In a number of works, the abrasion and atypia of the clinical picture of ACh and its frequent inconsistency with the pathological changes in the liver [5, 8] are noted. However, other surgeons believe that there are no differences in the clinical manifestations and the course of occlusion in patients of different age groups [4, 7]. There is also an opinion that, despite the similar symptoms, in patients of the older age group, the clinical course of ACh is characterized by more frequent destruction of the wall of the Gb [1, 8]. The main clinical manifestations of ACh (high temperature, sharp pain, peritoneal irritation, leukocytosis) in patients of the older age group are most often either absent or slightly expressed [14]. This is due to the fact that in the process of aging in the body changes occur
in the immune, endocrine, vascular and nervous systems [12, 17]. Many authors have noted different degrees of occurrence and unclear manifestations of symptoms of ACh. The most significant symptoms include: 1) pain in the right hypochondrium (77-100%); 2) Ortner symptom (67.4-77.7%). Irradiation of pain, dyspeptic symptoms, symptoms of Murphy, Musse and others are much less common (2.1-23.4%) [3, 6, 18]. Also unreliable in diagnostic and prognostic terms in elderly patients is the temperature response [13]. Many authors have noted a slight reaction and the absence of a pattern of changes in peripheral blood depending on the form of ACh (3, 18). These difficulties in the diagnosis of OC in this category of patients lead to late hospitalization, which largely determines the high percentage of postoperative complications and high mortality [12]. The restraining factor, according to the majority of domestic and foreign authors, is an increase in the degree of operational risk in patients of elderly and old age due to concomitant diseases [16]. The severity of the condition of patients with elderly and senile age is caused by complications of the underlying disease and associated diseases [14, 15]. In this category of patients, the "mutual complication syndrome" manifests itself when, as a result of an attack of GO and subsequent intoxication, decompensation of concomitant diseases occurs, which in turn leads the patient to an inoperable condition [11, 17]. is an increase in the degree of operational risk in patients of elderly and senile age due to concomitant diseases [16]. The severity of the condition of patients with elderly and senile age is caused by complications of the underlying disease and associated diseases [14, 15]. In this category of patients, the "mutual complication syndrome" manifests itself when, as a result of an attack of GO and subsequent intoxication, decompensation of concomitant diseases occurs, which in turn leads the patient to an inoperable condition [11, 17]. is an increase in the degree of operational risk in patients of elderly and senile age due to concomitant diseases [16]. The severity of the condition of patients with elderly and senile age is caused by complications of the underlying disease and associated diseases [14, 15]. In this category of patients, the "mutual complication syndrome" manifests itself when, as a result of an attack of GO and subsequent intoxication, decompensation of concomitant diseases occurs, which in turn leads the patient to an inoperable condition [11, 17].
All of the above factors determine the difficulties in treating this category of patients, and are largely due to the presence of comorbidities and reduced body reactivity, which leads to complications due to an increased risk of surgery [4]. On the other hand, the timely relief of the inflammatory process in the gastrointestinal tract helps to improve the general condition and creates the most favorable conditions for the treatment of comorbidities [15].
Since the clinical picture of OX in elderly and senile patients is often erased, laboratory data often do not reflect the true picture of inflammation, timeliness of treatment requires timely diagnosis [3, 18, 36, 38]. In order to establish an accurate diagnosis and informed treatment tactics, ultrasound is used (ultrasound) [6, 18]. There are active, expectant and actively-expectant tactics of treatment of GH, which have found their application in different periods of the development of surgery [2, 12, 14, 18]. The main limiting factor in the choice of tactics of treatment of GH, most authors consider an increased risk of surgical intervention in patients of elderly and old age [4, 6, 10]. At the meeting of the Moscow Society of Surgeons on the report of S.F. Bagnenko et al. [3] reviewed the modern tactics of treating patients with acute cholesterol. According to accepted standards, in identifying emergency complications of OX patients, prompt treatment is indicated for emergency indications. In this case, the operation of choice is laparoscopic and minimally invasive CE, in case there are contraindications to the VLH, cholecystectomy from laparotomy access should be performed. The maximum time limit for evaluating the effectiveness of conservative therapy is 48-72 hours. Currently, active wait-and-see tactics are regulated by orders and standards of the Moscow Department of Health. According to this tactic, all patients with chronic pancreatitis with a clinical picture of peritonitis are shown to have an emergency operation in the next 3 hours after admission to the hospital after a short
preoperative preparation. In the absence of peritonitis, conservative therapy is prescribed to patients. In the case of relief of inflammation during the first day, the patients are shown operative treatment in a planned manner (CE) in this hospitalization [4, 9, 11, 17].
In the absence of a positive effect from the ongoing conservative therapy for 12-24 hours, patients should be divided into several groups. Patients with the absence of comorbidities, with a disease duration of not more than 48 hours, with no signs of peripulum infiltration, lesions of the extrahepatic biliary tract, are shown urgent CE. If patients have a high operative-anesthetic risk, with pronounced infiltrative changes in the peripral tissues, a two-stage treatment is indicated: Stage I - microcholecystostomy; Stage II - deferred CE (in the period from 7 days to 3 - 4 weeks after applying a microcholecystostomy) [6, 7]. Patients with extremely high operative and anesthetic risks are shown to apply a "wide" (1-2 cm diameter) cholecystostomy from a small (4-6 cm) access under local anesthesia and removal of calculi using endoscopic techniques [4]. The modern principles of treatment of OX were formulated by DL Pikovsky (1996) [9, 17] in the form of several tasks: 1) to save the life of the patient; 2) if possible, heal the patient radically; 3) to maintain the patient's ability to work. Traditional cholecystectomy is the most effective method of treating hypertension, since it simultaneously eliminates the inflammatory focus and, if necessary, can eliminate biliary hypertension.
Thus, given the high operative-anesthetic risk and severe comorbidities in patients with ocular insufficiency, it is often necessary to resort to two-stage surgical treatment. As the first stage of treatment, minimal interventions are performed aimed at decompression of RR.
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ROLE OF CHEMOTHERAPY IN PROPHYLAXIS OF THE LIVER ECHINOCOCCOSIS RECURRENCE
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Babajanov A.S. , Saydullaev Z.Ya. , Vohidov J.J.
1Babajanov Akhmadjon Sulatanbaevich - PhD, Associate Professor;
2Saydullaev Zayniddin Yakhshiboevich - Assistant; 3Vohidov Jahongir Jamshedovich - Student, DEPARTMENT OF SURGICAL DISEASES, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: in analysis exposed the results of treatment 513 patients, operated in Samarkand State Medical Institution's clinic of surgical department during for the 10 years (2006-2015y.y). The frequency of recurrence of the patients without chemotherapy has formed 9,7%(n=20). Patients after prophylactic chemotherapy recurrences noted only in 3(0,9%) events. The primary operation on cause of the liver echinococcosis without supporting phylactic chemotherapy, held on in condition of the modern high-tech surgical institution, does not guarantee from recidivation of the disease. Keywords: chemotherapy, liver echinococcosis, prophylaxis.
Introduction. Contemporary condition of the liver echinococcosis surgery cannot be recognized as satisfactory, because after primary performed operation a considerable number of reccurent forms resulting in repeated operations is observed [2, 9, 15]. On evidence different authors, frequency recurrence after surgical treatment of echinococcosis in different localization consist about 10% and hesitant within 3-54% [1, 5, 13]. Most of complicated problem represent repeating and multiple recurrence of echinococcosis, in the time which may be lethal outcome
