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I. ДИАГНОСТИКА И ЛЕЧЕНИЕ
EFFECTIVENESS OF USING LESS INVASIVE TECHNOLOGIES IN SURGICAL TREATMENT OF ACUTE GALLSTONE DISEASE TOGETHER WITH DYSFUNCTION OF THE THYROID GLAND
МРНТИ 76.29.34
Aliyev Y., Mehdizada S.
Scientific Centre of Surgery named after M. A. Topchubashov, Baku, Azerbaijan Abstract
Thus, continuous increase in the number of patients suffering from gallstone disease and thyroid dysfunction and their combination, absence of a single idea with respect to diagnosis and surgical treatment in such contingent patients determines the relevance of the problem selected for the research. Research materials and methods. 25 patients with goitrous forms together with gallstone disease was inpatient treatment in scientific centre of surgery named after M. A. Topchubashov. They are from 17 up to 63, 19 women (76%) and 6 (24%) men. Among those with different goitrous forms, those who were able to work were prevailed. All 25 patients, who constitute the material of this scientific study, were divided into two groups. The main group consisted of 17 (68%) patients that they were operated (joint cholecystectomy with thyroidectomy) using laparoscopic techniques and instruments (laser). 8 (32%) of patients constitute the control group that traditional surgical intervention was used in gallbladder and gallbladder pathways here jointly with thyroidectomy. All 25 patients with gallstone disease, with various goitrous forms, have undergone surgical treatment. Results. It should be noted that in the last decade significant changes were observed in the structure of the thyroid gland dysfunction. Thus, if patients who previously suffered from thyroid gland with nodular and multiple goitrous were the majority and recently, the significant increase of chronic thyroiditis and cancer disease of thyroid gland was recorded. While using less invasive techniques in the implementation of interventions postoperative complications were encountered in 1 (one) of 17 patients, 1 (5.9%) (seroma), whereas while using conventional methods, complications were occurred in 4 patients (50%) of 8 patients (seroma, irritation and subcutaneous bleeding). When analysing their characteristics it became apparent that while using less invasive technology, complications after thyroidectomy have been observed 2.5 times less than traditional operations; hemocoagulation complications were not found in any patient.
Калканбездщ дисфункциясымен 6ipre жт ет-тас ауруын хирургиялык емдеудеп азинвазивт технологияларды колдануыньщ ттмдшт
ABOUT THEАUTHORS
Aliyev Yusif - Professor of the Department of Biliary Surgery. The MA Scientific Center of Surgery Topchibasheva
Sevda Mehdizadeh - graduate student of the MA Topchibashev Scientific Center of Surgery
Keywords
gallbladder, cholelithiasis, thyroiditis
Алиев Ю., Мехдизада С.
М. А. Топчубашов атында?ы Рылыми хирургия орталь™, Баку к,., Эзiрбайжан Ацдатпа
Сонымен, ет-тас ауруына, калканша бездщ дисфункциясына жэне сондай аралас ауруларына шалдыккан па-циенттер саныныц Yнемi улгаюы, сондай контингент ауруларды диагностикалаужэне хирургиялык емдеу туралы бiрьщFай кезкарасыныи жоктыы тацдалган проблеманы зерттеу Yшiн езектюн белплейд. Материалдар мен зерттеу эд 'ютер/. вт-тас ауруымен леспе зоб тYрлерi бар 25 пациент М. А. Топчубашов атындагы гылыми хирургия орталы^ынын стационарлык ем алып жатты. Олар 17жастан 63 жаска дейiнгi 19 эйел (76%) жэне 6 (24%) ерлер курады. Зоб ауруыныи тYрлi нысандарына шалдыккан адамдар арасында басымдысы жумыс iстей алатын-дары болды. Осы гылыми зерттеудiц материалы болып табылатын барлык 25 пациент ею топка бел'тд'г Непзп топ 17 (68%) пациенттен куралган, оларта лапароскопиялык эдстер мен куралдарды (лазер) колдануымен (б'1р'1ккен тиреоидэктомиямен холецистэктомия) отасы жасалды. 8 (32%) пациент бакылау тобын курайды, онда тиреои-дэктомиямен б'рге дэстYрлiхирургиялык араласу ет калтасында жэне ет шыгужолдарында жасалды. вттас ауруы бар жэне зобтыц тYрлi нысандары бар барлык 25 пациент хирургиялык ем алып шыкты. Нэтижелер '1. Соцгы он жылдары канканбез дисфункциясыныц курылымында айтарлыктай езгерстер орын алгандыгын атап етке жен. Сондай-ак, егерде тYЙiн жэне кептеген зоб ауруымен косалкы канканбез ауруына бурын шалдыккан пациенттер кепшiлiктi курады, ал соцгы кезде канканбез ауруыныц созылмалы тиреоидит жэне онкологиялык ауруларынын айтарлыктай есуi лркелген. Хирургиялык араласуларды ске асыру ^нде инвазивлп азырак эдiстерiн колдану барысында операциядан кейiнгi аскынулар 17 пациентки iшiнен 1 (б'р) пациентте, 1 (5,9%) (серома) кездеседi, онда аскынудыи дэстYрлi эдiстерiн колданган кезде 8 пациенттен 4 (50%) (серома, ттркену, терiасты кан кету). Талдау жэне оларды сипаттау кез1нде тиреоидэктомиядан кейiн инвазивлп азырак технологияларды колданган ^нде дэстYрлi операцияларга караганда, аскынулары 2,5 есе сирек болатынды^ы аныкгалган; ешкандай пациентте гемокоагуляцияныц аскынуы байкдлмаган.
АВТОРЛАР ТУРАЛЫ
Элиев Юсиф - М.А. Топчыбашев arbiHMaFbi Хирургия Fылыми орталь^ыньщ ет кабы хирургия кафедрасыныц про-фессоры Топчыбашева
Севда Мехдетзаде - М.А. Топчыбашев атындаFы Хирургия Fылыми орталы^ыныц аспиранты
Туйш сездер
ет кабы, ет тасы ауруы, созылмалы тиреоидит
Эффективность использования малоинвазивных технологий в хирургическом лечении острой желчнокаменной болезни вместе с дисфункцией щитовидной железы
ОБ АВТОРАХ
Алиев Юсиф - профессор отдела желчной хирургии.Научный центр хирургии имени М.А. Топчибашева
Мехтизаде Севда - аспирант Научного центра хирургии имени М.А. Топчибашева
Ключевые слова
желчный пузырь, желчнокаменная болезнь, хронический тиреоидит
Алиев Ю., Мехдизада С.
Научный центр хирургии им. М. А. Топчубашова, Баку, Азербайджан Аннотация
Таким образом, постоянное увеличение числа пациентов, страдающих желчнокаменной болезнью и дисфункцией щитовидной железы и их сочетанием, отсутствие единого представления о диагностике и хирургическом лечении у таких контингентов больных определяет актуальность выбранной для исследования проблемы. Материалы и методы исследования. 25 пациентов с зобными формами вместе с желчнокаменной болезнью находились на стационарном лечении в научном центре хирургии им. М. А. Топчубашова. Они от 17 до 63 лет, 19 женщин (76%) и 6 (24%) мужчин. Среди людей с различными формами зоба преобладали те, кто был способен работать. Все 25 пациентов, которые составляют материал данного научного исследования, были разделены на две группы. Основная группа состояла из 17 (68%) пациентов, которые были прооперированы (совместная холецистэктомия с тиреоидэктомией) с использованием лапароскопических методов и инструментов (лазер). 8 (32%) пациентов составляют контрольную группу, в которой традиционное хирургическое вмешательство применялось в желчном пузыре и желчных путях совместно с тиреоидэктомией. Все 25 пациентов с желчнокаменной болезнью, с различными формами зоба, прошли хирургическое лечение. Результаты. Следует отметить, что в последнее десятилетие наблюдались значительные изменения в структуре дисфункции щитовидной железы. Таким образом, если пациенты, ранее страдавшие щитовидной железой с узловым и множественным зобом, составляли большинство, то в последнее время зафиксирован значительный рост хронического тиреоидита и онкологических заболеваний щитовидной железы. При использовании менее инвазивных методов при осуществлении вмешательств послеоперационные осложнения встречались у 1 (одного) из 17 пациентов, 1 (5,9%) (серома), тогда как при использовании традиционных методов осложнения возникали у 4 (50%) из 8 пациентов (серома, раздражение и подкожное кровотечение). При анализе их характеристик выяснилось, что при использовании менее инвазивных технологий осложнения после тиреоидэктомии наблюдались в 2,5 раза реже, чем при традиционных операциях; осложнений гемокоагуляции не было обнаружено ни у одного пациента.
The actuality of the subject
Despite the achievements in clinical medicine, gallstone disease and gall bladder problem remains one of the most actual problems of so far modern clinical medicine and especially of the surgery [1,3,11,15,17]. In this regard, one of the most important events in medicine in recent decades is the strong development and implementation laparoscopy technologies in extensive clinical practice that radically changing the face of modern surgery (28,12). Currently less invasive interventions are practically used in all areas of abdominal surgery. (11.12) suggests that infections, cholesterol and calcium metabolic disorders, as well as the factors that lead to the development of dyskinesia on sedimentary streams play a major role among the causes of gallstone disease. Taking into consideration the prevalence of females among patients, as well as, pregnancy, obesity, gynaecological disorders accompanying with increase of blood level of cholesterol and calcium, and diseases, it may be assumed that internal secretion glands, specially activity of thyroid gland play great role in the pathogenesis of gallstone disease. As it is known that the frequency of tireopathy is also increasing steadily and currently accounts for about 10% of the total population (7.8) that which is due to iodine deficiency (13,14), pollution of the biosphere (14,15) and radiation effects. Though there is a
great arsenal of methods of examination, diagnosis of the pancreatic gland disease is not an issue that has been solved at all (10,18). There are only rare editions among a large number of cases dedicated to joint operations that it is devoted to simultaneous surgical treatment of patients suffering from gallstone disease and thyroid dysfunction. (2,4,5,8). This is most likely that can be explained by the lack of desire of surgeons to engage in additional surgical interventions with intravenous injection which can alter the adaptation ability of organism to operation trauma. However, undesirable events occur during two-stage operations of patients with gallstone disease and thyroid dysfunction. Thus, at the first stage when performing the surgical operation in thyroid, an increase in the inflammation process in gallbladder pathways and the development of gallstone disease may occur during postoperative period. In reverse sequence, postoperative period may aggravate with the thyrotoxicotic crisis or there is a real danger for transmission of treatment period in cases of malignant injury of thyroid.
Thus, continuous increase in the number of patients suffering from gallstone disease and thyroid dysfunction and their combination, absence of a single idea with respect to diagnosis and surgical treatment in such contingent patients determines the relevance of the problem selected for the research.
ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 1-2019
20
Research materials and methods
25 patients with goitrous forms together with gallstone disease was inpatient treatment in scientific centre of surgery named after M. A. Top-chubashov. They are from 17 up to 63, 19 women (76%) and 6 (24%) men. Among those with different goitrous forms, those who were able to work were prevailed. All 25 patients, who constitute the material of this scientific study, were divided into two groups. The main group consisted of 17 (68%) patients that they were operated (joint cholecys-tectomy with thyroidectomy) using laparoscopic techniques and instruments (laser). 8 (32%) of patients constitute the control group that traditional surgical intervention was used in gallbladder and gallbladder pathways here jointly with thyroidec-tomy. All 25 patients with gallstone disease, with various goitrous forms, have undergone surgical treatment.
Hyperfunction of the thyroid gland may be due to the formation of one or more nodes both in DT3 and in thyroid that in this case active function of thyroid leads to the formation of thyroid hormones. Against the background of the continuous increase in patients with gallstone disease and patients with surgical trauma in the thyroid, increase the number of patients with these diseases is also lawful. It should be noted that the type associated with thyroid pathology is more frequently found among all types of gallstone disease jointly with other pathologies. In this case, if there are appropriate guidelines and conditions for the surgical treatment of the disease, a joint operation is performed. Table 1 shows the gender and age division of patients depending on the type of surgical intervention in bile duct and thyroid of patient with thyroid dysfunction and gall bladder.
As seen from Table 1 groups of patients who have performed jointly conventional and joint less invasive operations in bile duct and thyroid were groups that could coordinate the number, sex, and age of patients. Most of these patients were -21 (68%) women. Men were only 4 people, i.e. 32%. The average age of the patients was 47.3 y 6.8 years that which corresponds to the period of endocrine disorders noticeable with body menopause. The nature of inflammation changes of gallbladder and thyroid depending on the type of surgical intervention in the gallbladder pathways and thyroid of operated patients related to gallstone disease and thyroid gland dysfunction is shown in Table 2.
Table 2 shows that most of the patients - 21 (92%) - were operated for chronic inflammation of the gallbladder and various forms of goitrous and 4 patients (8%) were operated for acute phlegmon-ous cholecystitis.
The structure of thyroid gland diseases of operated patients due to gallstone disease and thyroid pathology.
As it seen from indicators of Table 3 that nodular and multiple goitrous, chronic thyroiditis and thyroid gland cancer caused an instruction for surgical intervention in approximately the same number of thyroids patients with gallstone disease. Operations on thyroid were performed later on with diffuse toxic goitrous.
Results
It should be noted that in the last decade significant changes were observed in the structure of the thyroid gland dysfunction. Thus, if patients who previously suffered from thyroid gland with nodular and multiple goitrous were the majority and re-
Type of surgical intervention in the gallbladder and thyroid
Age Control group n-8 Main group n -17
Male Female Male Female
21-30 1 1 2
31-40 - 6 6
41-50 1 3 - 5 9
51-60 2 1 2 5
61-70 1 - 1 1 3
Sum 2 (25%) 6 (75%) 2 (23,5%) 15 (76,5%) 25 (100%)
Table 1.
The gender and age division of patients depending on the type of surgical intervention in bile duct and thyroid of patient with thyroid dysfunction and gall bladder.
Cholecystitis and goitrous forms Type of surgical intervention in gallbladder pathways and thyroid gland. Sum
Control group - 8 Main group - 17
Chronic cholecystitis + various goitrous forms Cholecystectomy + thyroidectomy - 5 Cholecystectomy + thyroidectomy - 16 21 (92%)
Acute Calculix Cholecystitis + nodular goitrous Cholecystectomy + thyroidectomy - 3 Cholecystectomy + thyroidectomy - 1 4 (8%)
8 17 25 (100%)
Table 2.
The nature of inflammation changes of gallbladder and thyroid of operated patients related to gallstone disease and thyroid gland dysfunction
Table 3.
Shows the structure of thyroid gland diseases of operated patients due to gallstone disease and thyroid pathology
Thyroid gland pathology feature Patients number
Absolute %
Nipple and Multiple goitrous 5 20
Chronic thyroiditis 3 12
Cancer of the thyroid gland 2 8
Adenoma of the thyroid gland 14 56
Diffuse toxic goitrous 1 4
Final 25 100
cently, the significant increase of chronic thyroiditis and cancer disease of thyroid gland was recorded. While using less invasive techniques in the implementation of interventions postoperative complications were encountered in 1 (one) of 17 patients, 1 (5.9%) (seroma), whereas while using conventional methods, complications were occurred in 4 patients (50%) of 8 patients (seroma, irritation and subcutaneous bleeding). When analysing their characteristics it became apparent that while using less invasive technology, complications after thyroidectomy have been observed 2.5 times less than traditional operations; hemocoagulation complications were not found in any patient.
Final results
1. Mostly, having nodular and multiple nodular goitrous, chronic thyroiditis of most patients with gallstone disease suffering mainly from chronic cholecystitis indicate joint surgical intervention in thyroid.
2. There is a specific pathogenic correlation hypercholesterinaemia, hypercalcaemia and hypokinesia on gallbladder pathways, as well as changes in the structure of the gallbladder tissue between gallstone disease and thyroid gland disease accompanied by hypothyroid-ism.
3. When encountered gallstone disease and thyroid gland dysfunction, it is advisable to per-
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