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III. ХИРУРГИЯ
МРНТИ 76.29.50
IMPROVING THE ORGANIZATION OF
ABOUT THE АUTHORS
Kaniyev Sh.A. - MD, senior researcher at the A.N. Syzganov's NSSC, Secretary Almaty surgeon's society, member of surgeon's society of the Republic of Kazakhstan, member of the hepatobiliary surgeon's association of the CIS countries. Baimakhanov Zh.B. - PhD, chief researcher of the A.N. Syzganov's NSSC, member of IHPBA, ILTS, APASL, Association of surgeons of Kazakhstan. Doskhanov M.O. - MD, Head of hepatopancreato-biliary surgery and liver transplantation department, senior researcher at the A.N. Syzganov's NSSC. Serikuly E. - MD, surgeon, Junior researcher at the A.N. Syzganov's NSSC. Skakbaev A.S. - MD, surgeon, Junior researcher at the A.N. Syzganov's NSSC. Askeyev B.T. - MD, surgeon, Junior researcher at the A.N. Syzganov's NSSC. Mussina A.S.-MD, surgeon, Junior researcher at the A.N. Syzganov's NSSC. Sadykov Ch.T - MD, doctor of ultrasonic diagnostics at the A.N. Syzganov's NSSC Barlybai R.A. - MD, doctor of ultrasonic diagnostics at the A.N. Syzganov's NSSC Medeubekov U.Sh. - Professor, Deputy Chairman of the Board for scientific, clinical and innovative activities
Kausova G.K. - professor, Kazakhstan's Medical University «KSPH» Seisembaev M. A. - Head of educational and methodological council, chief researcher, state prize winner, PhD, Professor. Baimakhanov B.B. - professor, transplant-surgeon, chairman of Board of JSC «National Scientific Center of Surgery named after A.N. Syzganov» (.info@ baimakhanov.kz, 87017223381).
Keywords
liver echinococcosis, pericystectomy, parasitic liver disease, liver hydatid disease
DIAGNOSTIC METHODS AND SURGICAL TREATMENT OF PATIENTS WITH LIVER ECHINOCOCCOSIS
Kaniyev Sh.A.1,2, Baimakhanov Zh.B.1, Doskhanov M.O.1, Serikuly E.1, Skakbayev A.S.1, Askeev B.T.1, Musina A.C.1, Sadykov Ch.T.1, Barlybay R.A.1, Medeubekov U.Sh.1, Kausova G.K.2, Seisenbayev M.A.1, Baimakhanov B.B.1
1National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan 2Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan
Abstract
Background. Untreated hydatid disease could pose a threat to human life. Despite the success in the diagnosis and treatment of liver echinococcosis, an issue of diagnosis and optimal treatment remains open. Methods. From January 2017 to July 2019, 111 patients with primary liver echinococcosis were treated at the Syzganov National Scientific Center as part of a scientific and technical project on the topic "Development of scientifically based optimal surgical and medicinal methods for the treatment of liver echinococcosis". Results. Treatment of patients with liver cystic echinococcosis involves an individual approach (table 2) with consideration in each case of a possible combination of different treatment options.
АВТОРЛАР ТУРАЛЫ
Каниев Ш.А. - MD, «А.Н. Сызанов ат. Члтты% рылыми хирургия орталы&ы!» АК ара рытыми &3MeTxepi, Алматы %. хирургтары %орамынын хатшысы, Каза%стан Республикасы хирургтары %орамыныщ щшеа, ТМД елдерi гепатобилиарлы% хирургтары %ауы!мдастышныщ щшеа. Баймаханов Ж.Б. - PhD, жалпыхирургия белiмшесiн, мецгеруш&, «А.Н. Сызановат. Члтты% рылыми хирургия орталыырыы» АК бас рытыми %ыlзметкерi, IHPBA, ILTS, APASL, Каза%стан хирург-тары %ауымдастырыньщ щшеа. Досханов М.О. - MD, гепатопанкреатобилиарлыщ хирургия жэне бауыр трансплантациясы белiмшесiнщ мецгерушю, «А.Н. Сызанов ат. ¥лтты%рылыми хирургия орталы&ыр» АК ара рытыми %>вметкер1. Серикулы Е. - Md, хирургдэр!гер, «А.Н. Сызанов ат. ¥лтты% рыылыми хирургия орталыры» АК кш рылыми %>1зметкер1. Скакбаев А.С. - MD, хирургдэр!гер, «А.Н. Сызранов ат. Члтты% рылыми хирургия орталыры» АК кш рылыми %>1зметкер1. АскеевБ.Т. - MD, резидент-хирург, «А.Н. Сызранов ат. Члтты% рылыми хирургия орталыры» АК кш рылыми %>1зметкер1. Мусина А.С. - MD, резидент -хирург, «А.Н. Сызранов ат. Члтты% рылыми хирургия орталыры» АК кш рылыми %>1зметкер1. Садыков Ч.Т. - MD, ульт^адыбысты/%диагностика дэрiгерi, «А.Н. Сызанов ат. Члтты/% рылыми хирургия орталыры!» АК рылыми %>1зметкер1. Барлыбай Р.А. - MD, ультрадыбысты%диагностика дэрiгерi, «А.Н. Сызанов ат. Члтты% рылыми хирургия орталыры» АК рылыми %>1зметкер1. Медеубеков У.Ш. - профессор, Бас%арма терарасыныщ рылыми-клиникалыщ жэне инновациялы% %ы1змет женндег орынбасары. Каусова Г. К. - профессор, «КДСЖМ» Каза%станды% медицина университет.i Сейсембаев М.А. - О%у-эдстемелк Кецес секторыныщ ментеруш!а, бас рылыми %ы!зметкер, мемлекеттк премия лауреаты, м.р.д., профессор. Баймаханов Б.Б. - профессор, трансплантолог, «А.Н. Сызранов ат. ¥лтты%рыылымихирургия орталыры!» АК бас%арма терарасы, (info@baimakhanov.kz).
Туйш сездер
бауыр эхинококкозы, перици-стэктомия, паразиттк бауыр ауруы, гидатидт бауыр ауруы
Бауыр эхинококкозымен ауыратын наукастарды диагностикалау жэне хирургиялык емдеу эдютерш уйымдастыруды жетшд1ру
Каниев Ш.А.1,2, Баймаханов Ж.Б.1, Досханов М.О.1, Серикулы Е.1, Скакбаев А.С.1, Аскеев Б.Т.1, Мусина А.С.1, Садыков Ч.Т.1, Барлыбай ^A.1, Медеубеков У.Ш.1, Каусова Г.К.2, Сейсембаев М.А.1, Баймаханов Б.Б.1
А.Н. Сь^анов атындагы Улттык, гылыми хирургия орталыгы, Алматы, Казахстан «КДСЖМ» Казак,стандык, медицина университету Алматы, Казахстан
Ацдатпа
Kipicne. Емдеуаз калпан бауыр эхинококкозы, адам eMipiHe Kayin TeH^pyi MYMm. Бауыр эхинококкозын диагностикалау мен емдеудеп желспктерге карамастан, диагноз кою жэне eмдeyдiц оцтайлы эдiстepi жайлы сурак ашык ^йнде калып отыр. Эд'ютерi. А. Н. Сызпанов атындапы YFXO-да 2017 жылпы кацтардан бастап 2019 жылпы шлдеге дeйiн «бауыр эхинококкозын емдеудц пылыми непзделген оцтайлы хирургиялык жэне дэpi-дэpмeктiк эдстерн эзipлey» такырыбында пылыми-техникалыкжобаны ске асыру шецбернде бауырдыц эхинококкозы диа-гнозымен 111 пациент eмдeлдi. Нэтижелер '1. Бауырдыц эхинококкозы бар пaциeнттepдi емдеу эр накты жапдайда терапияныц эpтYpлi нускаларыныц ыктимал комбинациясын карастыра отырып, жеке тэсmi (2-кесте) камтиды
Совершенствование организации методов диагностики и хирургического лечения больных с эхинококозом печени
ОБ АВТОРАХ
Каниев Ш.А.1,2, Баймаханов Ж.Б.1, Досханов М.О.1, Серикулы Е.1, Скакбаев А.С.1, Аскеев Б.Т.1, Мусина А.С.1, Садыков Ч.Т.1, Барлыбай Р.A.1, Медеубеков У.Ш.1, Каусова Г.К.2, Сейсембаев М.А.1, Баймаханов Б.Б.1
Национальный научный центр хирургии им. А.Н. Сызганова, Алматы, Казахстан Казахстанский медицинский университет «ВШОЗ», Алматы, Казахстан
Аннотация
Введение. Эхинококкоз при отсутствии лечения может представлять угрозу для жизни человека. Несмотря на успехи в диагностике и в лечении эхинококкоза печени, вопрос диагностики и оптимальном объем лечения остаются открытыми. Методы. В ННЦХ им. А.Н. Сызганова с 2017 января по июль 2019 г в рамках реализации научно-технического проекта на тему «Разработка научно-обоснованных оптимальных хирургических и медикаментозных методов лечения эхинококкоза печени» прошли лечения 111 пациент с диагнозом первичный эхинококкоз печени. Результаты. Лечение пациентов с цистным эхинококкозом печени предполагает индивидуальный подход (таблица 2) с рассмотрением в каждом конкретном случае возможную комбинацию различных вариантов терапии
Каниев Ш.А. - MD, старший научный сотрудник ННЦХ им. А.Н. Сызганова, секретарь общество хирургов г. Алматы, член общество хирургов Республики Казахстан, член ассоциации гепатоби-лиарных хирургов стран СНГ. Баймаханов Ж.Б. - PhD, заведующий отделением общей хирургии, главный научный сотрудник ННЦХ им. А.Н. Сызганова, член IHPBA, ILTS, APASL, Ассоциации хирургов Казахстана. Досханов М.О. - MD, Заведующий отделением гепатопанкреатобилиарной хирургии и трансплан-тациеи печени, старший научный сотрудник ННЦХ им. А.Н. Сызганова.
Серикулы Е. - MD, врач хирург, младший научный сотрудник ННЦХ им. А.Н. Сызганова. Скакбаев А.С. - MD, врач хирург, младший научный сотрудник ННЦХ им. А.Н. Сызганова. АскеевБ.Т. - MD, резидент-хирург, младший научный сотрудник ННЦХ им. А.Н. Сызганова. Мусина А.С. - MD, резидент -хирург, младший научный сотрудник ННЦХ им. А.Н. Сызганова. Садыков Ч.Т. - MD, врач ультразвуковой диагностики, научный сотрудник ННЦХ им. А.Н. Сызганова. Барлыбай Р. - MD, врач ультразвуковой диагностики, научный сотрудник ННЦХ им. А.Н. Сызганова. Медеубеков У.Ш. - профессор, заместитель председателя Правления по научно-клинической и инновационной деятельности Каусова Г.К. - профессор, Казахстанский медицинский университет «ВШОЗ» Сейсембаев М.А. - Заведующий сектором Учебно-методического Совета, главный научный сотрудник, лауреат государственной премии, д.м.н, профессор.
Баймаханов Б.Б. - профессор, трансплантолог, председатель правления АО «Национального научного центра хирургии им. А.Н. Сызганова» (info@baimakhanov.kz, 87017223381).
Ключевые слова
эхинококкоз печени, пери-цистэктомия, паразитарная болезнь печени, гидатидная болезнь печени
Introduction
One of the important problems in abdominal surgery in Kazakhstan is cystic echinococcosis of the liver, caused in humans by the tapeworm Echinococcus granulosus. Untreated hydatid disease could pose a threat to human life. Taking into account the relatively young age of patients and the high frequency of disability during repeated operations, the problem of treatment of liver echinococ-cosis in endemic regions of Kazakhstan is becoming more urgent every year. Despite advances in the diagnosis and treatment of liver echinococcosis, the question of diagnosis and optimal treatment remains open [1,2].
Material and methods
From January 2017 to July 2019, 111 patients with primary liver echinococcosis were treated at the Syz-ganov National Scientific Center as part of a scientific
and technical project on the topic "Development of scientifically based optimal surgical and medicinal methods for the treatment of liver echinococcosis".
Patients after screening were divided into 4 groups:
Group 1: pericystectomy (with capsule removal) with antiparasitic drug administration-30 patients;
Group 2: pericystectomy without antiparasitic therapy - 27 patients;
Group 3: echinococcectomy without capsule removal and antiparasitic drug administration - 27 patients;
4th group (incomparable group): conservative therapy without surgical intervention of echinococ-cal cysts up to 5 cm - 20 patients.
Indications for planned hospitalization were: 1) established diagnosis (the presence of clinical, laboratory or instrumental signs of the disease); 2) pronounced clinical signs of the disease, including
WHO classification Tactics
CE1 Cyst <5,0 cm only with Albendazole Cyst > 5,0 cm PAIR+ Albendazole
CE2 Surgical treatment + Albendazole
СЕ3а Cyst <5,0 cm only with Albendazole Cyst > 5,0 cm PAIR+ Albendazole
CE3b Surgical treatment + Albendazole
CE4 and CE5 Watch and Wait
Table 1.
WHO-IWGE Classification of Ultrasound images of cystic Echinococcosis Cysts. (WHO-IWGE 2003) [3].
against the background of chemotherapy (albendazole) in the presence of echinococcal (hydatid) cysts larger than 5.0 cm in diameter; 3) the presence of focal and/or cystic parasitic liver damage larger than 5 cm based on the stage shown in Table 1 which reflects the treatment tactics depending on the stage according to the WHO classification.
Preoperative data
All patients underwent serology and imaging assessment of liver hydatid cyst by abdominal ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI). Liver hydatid cysts were classified according to the WHO international classification of ultrasound images in cystic echi-nococcosis [3]. Chest CT and X-rays were systematically performed to identify associated pulmonary hydatid cyst.
Results
Treatment of patients with cystic echinococco-sis of the liver involves an individual approach (Table 2) with consideration in each case of a possible combination of different treatment options [4-5].
Patients whose cyst size is less than 5 cm, stages CE1-CE3 received conservative therapy on an outpatient level, starting therapy with Albenda-zole was 10-15 mg/kg / day in 2 doses with no side effects [6-7]. The effectiveness of antiparasitic treatment was evaluated according to the following criteria: positive dynamics on ultrasound (reduction in the size of cysts, transition to CE4-CE5), CT and MRI control - a decrease in the volume of the lesion, signs of calcification.
There are three main methods of surgical treatment of liver echinococcosis (depending on the completeness of removal of the fibrous capsule): 1. Removal of elements of an echinococcal cyst with the remaining fibrous casula of the parasite (echinococcectomy);
2. Removal of an echinococcal cyst together with a fibrous parasite capsule (pericystectomy);
3. Removal of an echinococcal cyst by resection of the liver.
The main objectives of surgical intervention were radicalism, reducing the frequency of postoperative complications, relapses, and the duration of hospital stay. The choice of surgical interventions depends on the determination of clear indications for the use of a particular method, depending on the location, size and number, relapse of the disease and complications [8-10].
Discussion
After antiparasitic treatment, all patients are recommended to perform a liver ultrasound to determine the effect of drug therapy. A decrease in the size of echinococcal cysts, the appearance of a detached chitinous layer, an increase in the echogenicity of the cyst contents and calcinates in the capsule is considered a positive response to treatment. This research method can be performed for the purpose of dynamic control in 3-6-12 months.
Computed tomography, mainly with contrast enhancement, is one of the leading methods for diagnosing the hydatid form of echinococcosis in almost all organs and systems of the human body. Computed tomography was the most specific (88.2%) and sensitive (82.5%) method for determining liver echinococcosis [11,12].
The results show that despite the fact that surgery time and blood loss were significantly higher in patients after radical surgery compared to non-radical surgery, we noted a significant reduction in the frequency of complications and hospital stay after surgery in patients after radical surgery, which contributes to early recovery of the patient and early discharge from the hospital.
Radical operations are aimed at complete removal of the cyst, therefore, carry significant intra-
Table № 2.
Study design.
operative risks, but a lower frequency of postoperative complications and relapses. When leaving part of the fibrous capsule (echinococcectomy group), the appearance of reactive pleurisy, hyperthermia in the patient was noted, which increased the patient's stay in the hospital in the postoperative period.
Radical surgical treatment of primary echinococcosis of the liver appeared good results in most cases. The growing frequency of liver echinococcosis in surgical practice makes radical operations more rational than non-radical ones, due to the associated low frequency of relapses and a relatively safe postoperative period (fewer hospital stay days).
Conservative therapy without surgery (the patient receives only the antiparasitic drug "Albenda-
zole") is effective in active echinococcosis of the liver up to 5 cm in size, regardless of the number of cysts in the liver.
Conclusion
Based on the data obtained, conservative therapy without surgery is effective for liver echinococcosis up to 5 cm in size. This therapy can be performed at the outpatient stage of treatment.
In the treatment of echinococcosis of the liver larger than 5 cm, radical surgery-pericystectomy, is an economically and socially effective method of surgical treatment (less hospital stay, early recovery).
It is recommended to receive antiparasitic therapy after surgery, regardless of the type of operation.
References
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2. Poluektov V. L., Shutov V. Yu., Nikitin O. V. Surgical treatment of liver echinococcosis / / Annals of surgical Hepatology. 2006, volume 11. No. 2. P. 12.
3. The informal working group of the who. International classification of ultrasound images in cystic echino-coccosis for use in clinical field and epidemiological conditions. ASTA Trop. 2003; 85:253-261.
4. Aliev M. A., Baymakhanov B. B., Fedotovskikh G. V. et al. Morphological detection of echinococcal germ elements in the fibrous capsule of the liver, evaluation of the effectiveness of treatment of the residual liver cavity by a combined method// Annals of surgical Hepatology. - 2007. no. 3. Pp. 3334.
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6. A. S. Tolstokorov, Yu. S. Gergenreter, S. V. Yaitsky.
Echinococcosis of the liver. Educational and Methodological recommendations Saratov 2011 Page 9
7. L. M. Velchev. Journal of IMAB-Annual Proceedings (Scientific papers) 2007, book 1. P. - 125.
8. Garbi ha, Hassin u, Brauner MV, Dupuh K. Ultrasound examination of the hydatic liver. Radiology. 1981; 139:459-463.
9. The informal working group of WHO International classification of ultrasound images in cystic echinococcosis for use in clinical field and epidemiological conditions. ASTA Trop. 2003; 85:253-261.
10. Sergiev V. P., Legonkov Yu. A., Poletaeva O. G., Cystic Echinococcosis (Single-Chamber). Clinic, Diagnosis, Treatment, Prevention. Moscow 2008, page 17
11. Shevchenko Yu. L., Nazirov F. G. Surgery of echinococcosis / / M, 2016
12. Memmet Mihmanli, Ufuk Oguz Idiz, Jemal Kaya, Uygar Demir, Ozgur bostanji, Sinan Omeroglu, Emre Bozkurt, Current state of diagnosis and treatment of liver echinococcosis., World Journal Hepatol, 2016 October 8; 8(28): 1169-1181
