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15МОРФОЛОГИЯ
5
Морфология
УДК: 616.366-002.8-45.2
RESULTS OF MORPHOLOGICAL EXAMINATION OF THE
GALLBLADDER
AKHMEDOV FARKHOD KHAKIMOVICH
Independent doctoral student of department of anatomy and clinical anatomy of the Bukhara medical Institute.
ORCID ID 0000-0001-8618-0791 KHAMDAMOVA MUHKHAYOHON TUKHTASINOVNA DSc, docent of department of obstetrics and gynecology 2 of the Bukhara medical Institute. ORCID ID 0000-0003-3128-6120
ABSTRACT
Giving a key place in the preoperative diagnosis to ultrasound examination, which gives not only the possibility of determining the main etiological factors of acute cholecystitis, but also the objectivity of the degree of severity of inflammatory changes in the gallbladder wall and paravesical space. Failure to recognize such a danger at the diagnostic stage leads to an incorrect choice of the operation method, and performing laparoscopic cholecystectomy "at any cost" causes serious errors, followed by complications.
Keywords: ultrasound examination, gallbladder, cholecystitis, "a symptom of a continuous acoustic shadow".
РЕЗУЛЬТАТЫ МОРФОЛОГИЧЕСКОГО ИЗУЧЕНИЯ ЖЕЛЧНОГО
ПУЗЫРЯ
АХМЕДОВ ФАРХОД ХАКИМОВИЧ
Соискатель кафедры анатомии и клинической анатомии, Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, город Бухара Республика Узбекистан.
МОРфОЛОТИЖ
ОИСЮ Ю 0000-0001-8618-0791 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА
ЮБо, доцент кафедры акушерство и гинекологии, Бухарский
Государственный медицинский институт имени Абу Али Ибн
Сино, город Бухара Республика Узбекистан.
ОИСЮ Ю 0000-0003-3128-6120 АННОТАЦИЯ
Отдавая ключевое место в дооперационной диагностике ультразвуковому исследованию, которое дает не только возможность определения основных этиологических факторов острого холецистита, но и объективности степени выраженности воспалительных изменений стенки желчного пузыря и паравезикального пространства. Нераспознование на диагностическом этапе такой опасности приводит к неправильному выбору способа операции, а выполнение лапароскопической холецист-эктомии «любой ценой» обуславливает серьезные ошибки, за которыми следуют осложнения.
Ключевые слова: ультразвуковой исследование, желчный пузырь, холецистит, «<симптом сплошной акустической тени».
УТ ПУФАГИНИ МОРФОЛОГИК ТЕКШИРИШ НАТИЖАЛАРИ
АХМЕДОВ ФАРХОД ХАКИМОВИЧ
Анатомия ва клиник анатомия кафедраси мустацил изланувчиси, Бухоро давлат тиббиёт институти, Бухоро шацри, Узбекистон Республикаси. ORCID Ю 0000-0001-8618-0791 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА ЮБс, акушерлик ва гинекология кафедраси доценти, Бухоро давлат тиббиёт институти, Бухоро шацри, Узбекистон Республикаси. ORCIЮ Ю 0000-0003-3128-6120
АННОТАЦИЯ
Уткир холециститнинг асосий этиологик омилларини анинлаш имкониятини эмас, балки ут пуфаги девори ва паравезикал бушлицдаги яллигланиш узгаришининг огирлик даражасини объектив аницлаш имкониятини берувчи ултратовуш текширувига операциядан олдинги ташхисда асосий урин бериш муцим ацамиятга эга. Диагностика босцичида бундай хавфни тан олмаслик операция усулини нотугри танлашга олиб келади, лапа-роскопик холецистектомия амалиёти жиддий хато ва ортидан асоратларга сабаб булади.
Калит сузлар: ультратовуш текширув, ут пуфаги, холецистит, акустик соя симптоми.
With the introduction of the latest technology — endoscopic surgery, the diagnosis and surgical treatment of cholelithiasis and its complications are currently being paid special attention - [1, 2, 3, 6]. This is due to a significant increase in the number of patients with calculous cholecystitis, a relatively high postoperative mortality. In the structure of patients with acute abdomen, acute cholecystitis occupies the second place after acute appendicitis, acquiring the significance of a socio-economic problem - [4, 7, 8].
The increase in the incidence of cholelithiasis is primarily associated with an increase in the average life expectancy, an increase in the number of elderly and senile patients and an increase in the welfare of the population - [1, 5, 6]. Due to the growing number of patients with cholecystitis, the number of operations has increased dramatically in recent years, not only in large surgical clinics, but also in regional hospitals. From the point of view of physical, emotional, psychological and social functioning of patients, laparoscopic cholecystectomy is superior to traditional. In laparoscopic cholecystectomies, the costs are compensated
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by reducing the time of patients' stay in hospitals and rehabilitation, reducing the volume of medications and reducing the access to disability and mortality - [4, 8].
The use of laparoscopic techniques can significantly reduce postoperative complications, reduce the patient's stay in the hospital and the duration of temporary disability. However, according to various authors, the total number of complications of laparoscopic cholecystectomy is 3.6-13.3 %. There are few works devoted to the long-term consequences of laparoscopic cholecystectomy.
The purpose of this work was the morphological analysis of gallbladders removed by laparoscopic cholecystectomy. To do this, we conducted a review of micro-preparations, removed gallbladders during laparoscopic cholecystectomy for 2017-2019 (169 cases). The results of this analysis are presented in the table. From the data presented in the table, it follows that the main pathology of the gallbladder, identified morphologically, was chronic cholecystitis without exacerbation — 117 cases (69.2 %). It was characterized by the following morphological signs: atrophy of the gallbladder mucosa, weak or moderate lymphocytic-plasmocytic infiltration with a predominance of lymphocytes. As a rule, focal sclerosis was observed in the submucosa and, sometimes, in the muscle. Signs of exacerbation of varying degrees were observed in 22 patients (13.0 %) with chronic cholecystitis. Morphologically, focal or diffuse weakly expressed infiltration by neutrophil lymphocytes was observed. 16 patients (9.4 %) were operated for acute cholecystitis, which was represented by phlegmonous or phlegmonous-gangrenous forms. Other types of pathology (adenomatosis, gallbladder cancer, polypous hyperplasia, leiomyoma, cholesterol) of removed gallbladders, as follows from the table, were much less common.
In the studied material, in 5 observations against the background of chronic cholecystitis, we found gastric metaplasia of the epithelium of the
mucous membrane, in 1 case — intestinal. Of the total number of observations (169), cases with the presence of metaplasia against the background of chronic cholecystitis amounted to 13.0 %.
Table №1
Results of morphological examination of gallbladders after laparoscopic
cholecystectomy
№ Pathological processes Number of cases %
1 Chronic cholecystitis without exacerbation Chronic 117 69,2
2 cholecystitis with exacerbation 22 13,0
3 Acute cholecystitis 16 9,4
4 Polypous hyperplasia 5 2,9
5 Cholesterol 4 2,4
6 Adenomatosis 3 1,8
7 Leiomyoma 1 0,6
8 Gallbladder cancer 1 0,6
Total 169 100
The presence of metaplasia during the revision of drugs was the subject of careful study, since the very fact of the presence of metaplastic changes indicates the duration of the pathological process. In the histological examination of the gallbladders, in addition to routine hema-toxylin-eosin staining, a CHIC reaction and alcyan blue staining at pH 2.51.0 were used to identify the type of metaplasia. The metaplasia of the pyloric type found by us in 5 cases (2.9 %) was characterized by a folded mucosa, a high surface epithelium containing CHIC-positive substances in the apical half of the cells, and in some cases traces of sulfated and non-sulfated glycosaminoglycans were noted in the epithelial cells. No goblet-shaped cells were found in any of the gallbladders. The glands were most often located in groups, sometimes they were strongly
branched. Their cells were filled with CHIC-positive substances. In 5 preparations, numerous cysts were visible, the contents of which were stained with Schiff's reagent.
In the case of intestinal metaplasia, the mucosa was also folded, but some folds resembled villi. The surface epithelium was of 2 types: in some areas it was similar to the gastric epithelium, in others it was an epithelium with a brush border and goblet-shaped cells. The latter were found both in the surface epithelium and in the crypts. They contained a large amount of neutral mucopolysaccharides and glycosaminoglycans (sulfated and non-sulfated).
The cause of meta-plastic processes in the gallbladder wall may be the reflux of the contents of the 12-duodenum into the gallbladder, with the failure of the Oddi sphincter. The reflex contents can be acidic or alkaline, which, apparently, causes various types of metaplasia (gastric or intestinal). Metaplasia is formed for a long time and is associated with both anatomical features of the structure of the biliary tract and pathological processes (duodenitis, etc.). Hence, it should be assumed that even after laparoscopic cholecystectomy, such patients may have clinical manifestations due to those processes that contributed to the development of metaplasia in the gallbladder wall.
Thus, the detection of metaplasia in the mucosa of the removed gallbladder has an important prognostic value.
References:
1. Kurzantseva O.M. Application of ultrasound and computed tomography in the diagnosis of Klatskin's tumor // Sono Ace Ultrasound. — 2015. — №27 —C. 48—55.
2. Long-term results after laparoscopic cholecystectomy. /B.M.Ure, H.Trogl, W.Spangenberger et al. //B.R.Surg.-2015.-Vol.82, N2. -P.267-270.
3. Metzger J., Muller C. I-year follow-up of laparoscopic cholecystectomy in an unselected patient sample. Objective findings and subgective status. //Helv. Chir. Acta. -2014.- Vol..60, N5.-P.767-772.
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