Slovakia
online
Volume 97 / No. 12 / 1996
The following articles were presented at 49th Kostlivy's surgery day with the central theme Reoperations in surgery. English resumes are available only for some of them
Risk Diseases of the Stomach
BEZAYOVA T., DURIS I.
The opinions on precanceroses of the stomach have lately changed essentially.
The problem does not involve only terminology and morphology, but also
the functional aspect of this group of diseases which is still not entirely
defined. Regarding the difficulties in following the process of changing
of dysplasias into carcinomas of the stomach, the human pathology chooses
the term risk diseases. (Ref. 78.)
Key words: risk diseases, carcinogenes, gastric carcinomas.
Bratisl Lek Listy 1996; 97: 705-711
The Therapy of Metastasizing Carcinoid
KINOVA S., PAYER Jr. J., DURIS I., HUORKA M.
Carcinoids are tumors producing excessive amounts of serotonin. The
authors briefly characterize the possibilities of diagnosis. The case of
a 43-year-old patient with a multifold carcinoid of the ileum
with metastases in the liver is used for the description of the therapy
strategy. They summarize the current opinions on the therapy of this disease.
(Tab. 1, Fig. 4, Ref. 14.)
Key words: carcinoid, carcinoid syndrome, somatostatin, alpha interferone.
Bratisl Lek Listy 1996; 97: 713-716
APOLIPOPROTEIN B (apoB) IN HYPOTHYROIDISM
ORAVEC S., ORAVEC D.
The concentrations of serum lipids (total cholesterol, triacylglycerols),
apolipoprotein B and thyroid hormones (thyroxine, triiodthyronine) were
observed before and during hormone replacement therapy by thyroid hormones
in 24 hypothyroid patients (18 women and 6 men) until the state of euthyroidism
was reached. The observed parameters regained standard values gradually,
while the concentration of apolipoprotein B recovered to normal as the
last among them.
Therefore the authors recommend to consider apolipoprotein B concentration
in serum as a risk factor of the development of aterosclerosis in
hypothyroid patients, the value of apolipoprotein B concentration can serve
as a guideline in choosing the optimal hormone substitution therapy.
(Tab. 1, Fig. 1, Ref. 5.)
Key words: apolipoprotein B, apoB, hypothyroidism, thyroid gland,
hormone therapy.
Bratisl Lek Listy 1996; 97: 717-719
OHRADKA B., BILIK A., HRBATY B.
Reoperacie pri ochoreniach stitnej zlazy delime na vcasne a neskore.
Reoperacie bezprostredne po operacii su zriedkave. Indikuju sa pri peroperacne
nepoznanej lezii oboch nervus recurrens, tracheomalacii a pri pooperacnom
krvacani v operacnej rane. Drazdenie na kasel, dychavicnost a zvacsovanie
objemu krku su dovodom na operacnu reviziu rany pri krvacani. Reoperacie
s odstupom niekolko dni robime, ak sa malignita strumy v zriedkavych
pripadoch dokaze az pri definitivnom histologickom vyhodnoteni operacne
odstraneneho tkaniva strumy. V tychto pripadoch pri vsetkych typoch
malignych strum, vcitane papilarneho karcinomu. Neskore reoperacie pri
malignych strumach su z dovodov recidivy a metastaz. Reoperacie
pri benignych strumach nemaju zvysene riziko komplikacii, pricinou moze
byt malo radikalna prva operacia, nedostatocna alebo ziadna endokrinologicka
dlhodoba starostlivost. (Lit. 5.)
Klucove slova: struma, reoperacie.
Bratisl Lek Listy 1996; 97: 721-722
HAMZIK J., PIOVARCI D.
Nahrada pazeraka hrubym crevom je vyhodna u pacientov s predpokladom
dlhodobeho prezivania, pretoze zabezpecuje kvalitnu deglutinaciu a dlhoobu
funkcnost. V pripadoch zhubneho ochorenia pazeraka je mortalita aj
morbidita po jeho resekcii a nahrade hrubym crevom vysoka, preto sa
kolon interponuje len vtedy, ak nemozno pouzit zaludok. Z neskorych
komplikacii sa najcastejsie vyskytuje stenoza krcnej ezofagokolickej anastomozy,
ktora sa vo vacsine pripadov lieci konzervativne. Pri nedilatovatelnej
stenoze vsak treba pristupit k reoperacii, ktora prinasa riziko neuspechu
a akceleracie komplikacii. Autori prezentuju uspesnu reoperaciu pre
stenozu krcnej ezofagokolickej anastomozy po nahrade pazeraka hrubym crevom.
(Tab. 3, obr. 1, lit. 8.)
Klucove slova: nahrada pazeraka hrubym crevom, stenoza krcmej anastomozy,
reoperacia.
Bratisl Lek Listy 1996; 97: 723-725
NEORAL C., KRAL V., AUJESKY R., JEZDINSKA V.
Advanced achalasia with serious additional complications is quite rare.
It should be seen mostly in individuals who were already unsuccessfuly
operated. The way definitively solving both dysphagia and the complications
of advanced achalasia is the resection of oesophagus. Authors are showing
their experience and according to the clinical appearance of the disease
and histological examination of the whole extirpated thoracic oesophagus
they are discussing acceptability of the extirpation of the whole thoracic
oesophagus using regardful technique without thoracotomy. (Tab. 2, Fig.
3, Ref. 8.)
Key words: advanced achalasia, oesophageal resection, dysphagia.
Bratisl Lek Listy 1996; 97: 726-729
KOTHAJ P., MELUS P., POBESKA J., SINKOVIC L., PELIKAN A.
Na subore 398 pacientov operovanych na zaludok na Chirurgickej klinike
Nemocnice F.D. Roosevelta v Banskej Bystrici, z ktorych bolo
27 reoperovanych, a na 7 pacientoch reoperovanych po operacii na inom
pracovisku autori rozoberaju priciny komplikacii a najvhodnejsie sposoby
ich riesenia. Na zaklade skusenosti dospeli k zaverom, ze pri recidive
krvacania zo suturovanych krvacajucich erozii zaludka treba volit resekcny
vykon, pri dehiscencii duodenalneho pahyla treba vzdy dat dren priamo do
duodena, pretoze jednoducha resutura duodena nestaci, pri dehiscencii anastomoz
po resekcii B-I a B-II je najjednoduchsim riesenim resutura anastomozy,
ale pri dehiscencii ezofagogastroanastomozy treba vykonat novu anastomozu.
Pri stenozach treba vykonat novu anastomozu, najlepsie sa na tento ucel
hodi Roux-klucka. (Tab. 3, lit. 9.)
Klucove slova: zaludok, dvanastnik, komplikacie, reoperacie.
Bratisl Lek Listy 1996; 97: 729-732
KOTHAJ P., MARKO L., MELUS P.
V praci autori poukazuju na rozne nazory na volbu operacneho vykonu
pri krvacani z viacpocetnych erozii zaludka. Pouzivane metody su sutura
erozii, sutura erozii s pripojenou vagotomiou, resekcia zaludka, vynimocne
totalna gastrektomia. Na zaklade skusenosti so suborom 316 pacientov s krvacanim
z benignej lezie gastroduodena, z ktorych bolo 59 operovanych
a 55 zastavenych endoskopicky, konstatuju, ze pri solitarnom vrede
su rovnocennymi metodami jednoduchy opich vredu cez gastrotomiu a resekcia
zaludka, pri viacpocetnych eroziach odporucaju volit resekcny vykon. (Lit.
9.)
Klucove slova: gastroduodenalne krvacanie, sutura, resekcia.
Bratisl Lek Listy 1996; 97: 732-733
SVAB J., PESKOVA M., FRIED M., RUZICKA P.
Autori upozornuji na mozne poraneni zlucovodu behem laparoskopicke cholecystektomie.
Uvadeji vlastni zkusenosti s osetrenim 15 nemocnych s timto poskozenim,
s nimz se setkali od roku 1993 do roku 1995. Devetkrat reoperovali
poprve. Jedenkrat slo o insuficienci cystika, jednou o nalozenou
svorku na spolecny zlucovod, sedmkrat o termicke poskozeni zlucovodu
a sestkrat o proteti nebo vyteti nebo vyteti zlucovodu. Pro ne
byla provedena plastika zlucovodu na endoproteze 7krat, o vysokou
hilovou anastomozu na vyrazenou klicku jejuna podle Rouxe 6krat, jednou
podvaz cystika otevrenou cestou a jednou sneseni svorky s zlucovodu.
Pri pouziti endoprotezy doporucuji podavat dlouhodobe derivaty kyseliny
deoxycholove. V snizeni poctu osetreni techto poraneni v roce
1995 na klinice vidi snad fakt, ze s technikou vykonu se v rozumnych
hranicich srovnali i nasi chirurgove. (Tab. 2, obr. 3.)
Klicova slova: laparoskopicka cholecystektomie, poskozeni zlucovodu,
plastiky zlucovodu.
Bratisl Lek Listy 1996; 97: 734-736
PECHAN J., MIKULAS J.
V rokoch 1985-1995 na II. chirurgickej klinike LFUK pouzili 37-krat
pri vnutrobrusnych reoperaciach rekonstrukciu podla Rouxa. 8-krat pouzili
Rouxovu exkludovanu slucku pri akutnych septickych komplikaciach, o ktorych
autori podrobnejsie informuju a diskutuju. (Tab. 4, obr. 1, lit.
7.)
Klucove slova: Rouxova Y-slucka, reoperacia.
Bratisl Lek Listy 1996; 97: 736-737
BRUNCAK P., MAZUCH J., PELC J., GEC K.
Autori vo svojej praci referuju o 3 operaciach pacientky s komplikaciami
vredovej choroby gastroduodena. Pri tretej operacii bol odstraneny tumorozny
utvar z oblasti steny duodena. Imunohistologicky sa potvrdil gastrinom.
V diskusii poukazuju na moznosti predoperacnej a peroperacnej
diagnostiky, dokazu, lokalizacie gastrinomov. Odstranenie gastrinomu je
jedinou kauzalnou liecbou ZES a trvale dlhodobe sledovanie v centrach
pre ZES moze zabranit neziaducim komplikaciam. (Lit. 9.)
Klucove slova: Zollingerov-Ellisonov syndrom, predoperacna a peroperacna
diagnostika.
Bratisl Lek Listy 1996; 97: 738-739
BEDRNA J.
In the span of 23 years (1973-1995) 242 patients with Crohn's disease
were operated on at the Department of Surgery in Hradec Kralove. From this
total number there were 146 (60.3 %) men and 96 (39.7 %) women. Eight patients
(3.3 %) died, in 4 cases (1.6 %) carcinoma in Crohn's disease was found.
Reoperations for recurrences were performed in 76 patients (31.4 %), in
46 (60.5 %) of them only 1 operation, in 18 (23.7 %) 2 reoperations and
in 12 patients (15.8 %) 3 or more surgical treatments were necessary. Within
the time interval mentioned above 124 different operations were done. Authors
point out some factors that may affect the Crohn's disease recurrences,
their influence was assessed even in the clinical set. A higher risk
of recurrences and reoperations were found in women, patients younger than
than 20 years, people with a short history prior to primary operation,
in distal parts of intestine (ileum, rectum) localizations, in multiple
gut involvement, after inproper surgical performance, in cases of aggressive
forms of disease and from other reasons (medicamentous post-operative treatment,
immunological factors etc.). (Tab. 11, Fig. 1, Ref. 22.)
Key words: Crohn's disease, recurrences, reoperations.
Bratisl Lek Listy 1996; 97: 740-744
VYSLOUZIL K., KRAL V., KLEMENTA I., EHRMANN J., NICAKOVA R.
Behem tri let bylo na I. chirurgicke klinice FN a LFUP v Olomouci
leceno 29 nemocnych s Crohnovou chorobou. U 18 nemocnych islo
o recidivu onemocneni. Rozbor ukazuje indikace, taktiku a vysledky
chirurgicke lecby u recidiv Crohnovy choroby. (Tab. 7, lit. 9.)
Klicova slova: Crohnova choroba, recidiva, reoperace.
Bratisl Lek Listy 1996; 97: 744-746
MIKULAS J., PECHAN J.
Autori v praci podavaju prehlad 54 operacii u 40 pacientov
s Crohnovou chorobou na II. chirurgickej klinike LFUK v Bratislave.
44-krat islo o reoperaciu. Analyzuju nalezy a vlastne skusenosti
pri tychto reoperaciach. Zasadne robili setrne resekcie alebo strikturoplastiky.
Usporne resekcie a setrny pristup vychadza z koncepcie, ze operacna
liecba pre Crohnovu chorobu nie je kurativna. Keïze nemozno uplne zabranit
recidivam, treba zachovat najvacsi usek creva, co potvrdzuju vysledky autorov
i skusenosti zahranicnych pracovisk. (Tab. 4, lit. 18.)
Klucove slova: Crohnova choroba, recidivy, reoperacie.
Bratisl Lek Listy 1996; 97: 746-748
SKULTETY J., OHRADKA B., MATIS P., HRBATY B., ZAHOREC B.
Autori vo svojej praci vyhodnotili 10-rocne skusenosti s reoperaciami
po brusnych operaciach na I. chirurgickej klinike FN v Bratislave.
Od roku 1985 do roku 1995 mali 130 reoperacii pre adhezivny ileus. Najcastejsou
pricinou reoperacii bola apendektomia 31-krat (23,8 %), nadory hrubeho
creva 29-krat (22,3 %), operacie na tenkom creve 23-krat (17,7 %) a operacie
v malej panve 11-krat (8,6 %). Najcastejsim chirurgickym vykonom bola
adheziolyza alebo adheziolyza v kombinacii s inou procedurou
115-krat (88,5 %). Do prevencie adhezii po tazsich, prevazne onkologickych
operaciach zaviedli enzymoterapiu s dobrymi vysledkami. (Lit. 9.)
Klucove slova: ileus, reoperacia.
Bratisl Lek Listy 1996; 97: 749-750
HOLECZY P., MALINA J.
Besides of really positives bring laparoscopic procedures also complications,
which sometimes demand reoperation. When in our literature nobody mentioned
this topics the authors bring their own experiences with reoperations after
laparoscopic procedures.
The authors in time from March 1992 to November 1995 performed together
1836 laparoscopic operations. 19 times, it means in 1,03 %, the reoperations
was needed. In the paper the authors discuss the causes of the reoperations,
possibilities and methods of complications solution. They also discuss
possibilities of complications prevention.
The open surgery was performed in lesions of biliary tree, in pancreastitis,
peritonitis and duodenal lesion. This type of surgery was performed also
in hernia repair after technical error.
Laparoscopic reoperations were performed in haemorrhage from the gallblader
bed, in pritonitis and in reccurent inquinal hernia. There is to be said,
that laparoscopic reoperations need experience in this technique.
In euphory from the growing laparoscopic surgery there is the need
to remark also complications and unsuccesses. With gaining experiences
it is possible to perform also reoperations laparoscopically. It is important
to be sufficiently agressive in diagnostic procedures and also in therapy
of complications. It is adviceable to use diagnostic laparoscopy with adequate
solution of situations. Keeping this all in mind, there is possible to
minimise the sequelae of complications and reoperations. There is also
the possibility to prevent the reoperations. (Tab. 2, Ref. 13.)
Key words: laparoscopic surgery, reoperations.
Bratisl Lek Listy 1996; 97: 750-752
KRAL V., HAVLIK R., VOJACEK P.
V publikaci se autori zamysleji nad problematikou spravne indikace
lecebneho vykonu pri poraneni zlucovych cest. Ke klasickemu chirurgickemu
vykonu se dnes radi i "neinvazivni" endoskopicky a perkutanni
transhepaticky pristup. Bez uzke komunikace mezi jednotlivymi obory neni
mozno dosahnout dokonaleho efektu. Autori vychazeji predevsim ze zkusenosti
43 hepatikojejunalnich spojek provedenych v roce 1985-1995. Cast nemocnych
z tohoto souboru, zejmana v poslednich letech, byla podrobena
nekterym "neinvazivnim" postupum. (Tab. 1, obr. 2, lit. 12.)
Klicova slova: poraneni zlucovych cest, ERCP, PTC.
Bratisl Lek Listy 1996; 97: 753-755