Novosti
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This journal is indexed in Scopus |
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Year 2014 Vol. 22 No 1
EXCHANGE OF EXPERIENCE
S.Y. IVANUSA, A.V. KOCHETKOV, A.V. KHOKHLOV, S.A. POVZUN, M.G. KOBIASHVILI, D.Y. BOYARINOV, O.V. SHUSHAKOVA, I.A. SAMUSENKO, V.L. BELEVICH
DIAGNOSIS AND TREATMENT OF THE COMPLICATED FORMS OF REFLUX-ESOPHAGITIS
FSOEE HPE “Military Medical Academy named after S.M. Kirov” 1, MD RF, St. Petersburg,
FSBE “All-Russian Center of Emergency and Radiation Medicine name after A.M. Nikiforov”, MES of Russia2, St. Petersburg,
SBME “SRI of Emergency Care named after I.I. Dzhanelidze” MH of RF3, St. Petersburg,
SBEE HPE “North-West State Medical University named after I.I. Mechnikov MH RF4, St. Petersburg,
The Russian Federation
Objectives. To improve the diagnostic algorithm and surgical treatment results of the complicated forms of reflux-induced inflammatory diseases of the esophagus.
Methods. The investigation of the results of examination and treatment of 182 patients has been performed on 103 (56,6%) of them with uncomplicated course of the disease, 20 (10,9%) with erosive-ulcerous esophageal bleeding, 18 (9,8%) – peptic strictures of esophagus, 41 (22,7%) – Barrett’s esophagus. The treatment tactics in 113 patients was based on using the examination algorithm including the up-to-date methods of diagnosis: daily pH-metry, reogastrography, endoscopy in narrow band imaging (NBI) regimen, I-scan, zoom-endoscopy, histological and immunohistochemical testing of mucosal bioptats. 67 patients were examined by means of the standard diagnostic test.
Results. Application of the suggested algorithm of diagnosing in the patients suffering from esophagitis with identifying pathogenetic mechanisms of its development provides the differentiated approach to treatment. In case of the complicated forms of peptic esophagitis the two-staged treatment was used with the elimination of complications endoscopically in the first turn and with the following resuscitation of cardia closing function by endovideosurgical method. The indication to restore cardia closing function was considered the signs of absolute cardiac insufficiency. Morphological features of altering of the mucosa depending on the type of reflux and possible causes of the insufficient of esophageal epithelium regeneration at the peptic esophagitis have been determined. The study of the treatment results in various terms revealed the excellent and good results in 92% of cases in the recent period of observation and in 89% of cases – in the distant one.
Conclusions. The conducted research showed that treatment of the complicated forms of reflux-esophagitis based on using the complete examination algorithm of patients with the detection of pathogenetic mechanisms of the disease development allowed improving the short- and long-term results.
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19044, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6, FGKOU VPO «Voenno-meditsinskaia akademiia im. S.M. Kirova» MO RF, kafedra obshchei khirurgii,
e-mail: boyarinov@yandex.ru,
Boyarinov Dmitry Yur’evich
Ivanusa S.J., MD, professor, Honoured Medical Doctor of Russia, a head of the chair of general surgery of FSEE VPO "Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Kochetkov A.V., MD, professor, Honoured Medical Doctor of the Russia, a chief specialist in Surgery of FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations", professor of the chair of general surgery of FSEE VPO "Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Khokhlov A.V., MD, professor of the chair of general surgery of FSEE VPO "Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Povzun S.A., MD, professor, a head of department of pathomorphology and clinical expertise of SBEPH "Scientific Research Institute of Emergency Care named after I.I. Janelidze".
Kobiashvili M.G., MD, professor, a head of the department of endoscopic research of "FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations", professor of the chair of endoscopy of SBEE HPE "North-West State Medical University named after I.I. Mechnikov " MPH of Russian Federation.
Boyarinov D., PhD, a lecturer of the chair of general surgery of FSEE VPO" Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Shushakova O.V., an endoscopist of the department of endoscopic research of "FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations.
Samusenko I.A., PhD, a physician-pathologist of pathology department
of "FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations, the Russian Federation.
Belevich V.L., PhD, a senior lecturer of the chair of general surgery of FSEE VPO" Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
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