Diagnosis and tactics of surgical treatment of recurrent liverechinococcosis
Introduction. For the last years there is tendency of increasing the prevalence of echinococcosis not only among people involved in animal husbandry, but also among urban population, which is associated with increased in recent years, migration of rural population to urban areas, with low level or without medical examination of population, unresolved sanitary-epidemiological and socio-economic problems. Aim. Improvement of diagnostics and surgical treatment of recurrent liver echinococcosis. Materials. The work analyzes results of a comprehensive diagnosis and surgical treatment of 140 patients with recurrent liver echinococcosis (RLE) in clinic of surgical diseases № 1 ATSMU, CCH EH Dushanbe from 2005 to 2014. Results. Use of serological enzyme immunoassay reactions (SEIR) at patients with RLE showed high diagnostic value in 48 (34%) cases. In 94 (67%) cases were carried out various versions of echinococcectomy with strict adherence to aparasitic and antiparasitic principles. To eliminate residual cavities at 94 patients underwent various ways of closing. Thus in 34 (36%) cases produced kapitonaj, intussusception of fibrous capsule in 27 cases (29%), aplatatsiya - in 19 (20%) and - at 14 (15%) patients used combined methods. Frequency of late complications of various variants of echinococcectomy was significantly more (n = 21) than in patients who had radical intervention (n = 10). In analyzing the structure of late complications in patients with RLE attracted attention increased frequency of residual cavities (n = 16), postoperative hernias (n = 9) and adhesive disease (n = 6). Full recovery of patients rarely observed with palliative interventions, and disability was more than after radical surgical interventions. Conclusion. Diagnosis of recurrent liver echinococcosis should be comprehensive, including serological methods of CT and MRI, allowing in 99% of observations to diagnose diseases. Recurrent liver echinococcosis characterised with multiple lesions and domination of dead and complicated cysts with diameter up to 7.0 cm. Feature of surgical treatment of recurrent liver echinococcosis is mainly use of open echinococcectomy and techniques aimed at eliminating residual cavities and fibrous capsule, as the cause of disease recurrence.