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MEASURES TO IMPROVE THE RESULTS OF SURGICAL
TREATMENT OF HEPATIC ECHINOCOCCOSIS AND PREVENTION OF
RECURRENCE
Radjabov Jasur Pardabayevich
Atoyeva Mokhigul Otabekovna
Usmonov Amirbek Usmonovich
Samarkand State Medical University, Republic of Uzbekistan
,
Samarkand
Bukhara State Medical Institute, Republic of Uzbekistan, Bukhara
https://doi.org/10.5281/zenodo.12719903
Introduction.
According to the World Health Organization, "more than 1
million people are affected by echinococcosis in the world, while among various
organs and tissues in 44-84% of cases the process is localized in the liver". Due
to the absence of a downward trend in the number of patients and the existence
of endemic regions where the incidence rate varies from 1.2 to 9.0 per 100,000
population, this parasitic disease continues to be a serious medical and social
problem [1-5].
Material and methods.
The clinical study consisted of 371 patients with
EP. Out of 371 patients in 2005-2008, 145 (39.1%) were operated on, who made
up the 1st subgroup of the comparison group. The 2nd subgroup of the
comparison group included 111 (29.9%) patients operated on in 2009-2012, in
whom 80-100% glycerin at room temperature was used to treat the residual
cavity. The main group included 115 (31.0%) patients operated on in 2013-
2017, in whom the residual cavity with uncomplicated echinococcosis was
treated with hot glycerin heated to 600C, and with complicated - with hot
glycerin in combination with low–frequency ultrasound
Results and discussion.
The absolute majority of the performed
echinococcectomies (99.8%) were of an organ-preserving nature, and only 1
(0.2%) patient had to resort to resection of the left lobe of the liver. In suitable
situations, the opportunity to perform an ideal echinococcatomy was not missed
– 2 (0.3%) parasitic cysts were removed by peeling the entire chitinous shell. In
our observations, 412 (77.6%) residual cavities were treated according to the
type of closed echinococcectomy and only 116 (21.8%) fibrous capsules were
sutured with a semi-closed drainage method. Chemotherapy with albendazole
was started no later than 1 month after surgical treatment. In the comparison
group, postoperative chemotherapy was performed in 112 (43.8%) patients
according to the traditional scheme. Against the background of treatment, an
increase in the average concentration of AST and ALT after the first course of
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chemotherapy was noted, respectively, to 0.55 ±0.05 and 0.88±0.08 mmol/l.
Parenchymal jaundice was observed in 3 (2.7%) patients, dyspeptic symptoms
were observed in 41 (36.6%) patients and reversible allopecia developed in 2
(1.8%) patients, while in 16 (14.3%) cases it was necessary to cancel preventive
treatment. At the same time, it should be emphasized that an increase in
transaminases was typical for patients suffering from or previously suffering
from liver diseases. Of 112 patients, 54 (48.2%) had concomitant chronic diffuse
liver pathology. Taking into account this fact, the dose of albendazole was
adjusted in the main group, taking into account the initial functional state of the
liver. In cirrhosis of the liver, as well as in cases with an initial (before surgery)
increase in liver enzymes, albendazole was used at a dose of 5 mg / kg / day. In
turn, with the development of changes in blood biochemical parameters or
clinical manifestations of a toxic effect against the background of a standard
dose of albendazole, patients also changed the treatment regimen to 5 mg / kg /
day. In the main group, chronic diffuse liver diseases were detected in 51.3% of
cases. Initially, reduced doses of albendazole were used in 11 (9.6%) patients,
and a reduction in the traditional dose against the background of biochemical
changes was required in another 21 (18.3%) patients. In general, 32 (27.8%)
patients of the main group received chemotherapy according to the proposed
scheme. Dose adjustment in patients with adverse events contributed to the
normalization of biochemical parameters and reduced the risk of toxic
manifestations during chemotherapy. Studies have shown that the probability of
adverse reactions against the background of chemotherapy with albendazole
according to clinical and laboratory parameters was 52.7% (59 patients in the
comparison group), due to the toxic effect of the drug and the presence of
concomitant chronic diffuse liver pathology, while treatment was noted in
14.3%, in turn, the possibility of dose adjustment allowed to reduce This value is
up to 18.3% (21 patients in the main group) and, accordingly, provide a full
course of antiparasitic therapy (criterion χ2 = 26.703; p<0.001). Monitoring of
hepatic amintransferases also showed a significant difference between these
indicators in the comparison groups. Thus, the ALT level in the comparison
group was 0.88±0.08 mmol/l versus 0.51±0.04 mmol/l in the main group
(p<0.001), the AST indicators did not differ significantly, while among patients
with concomitant chronic liver pathology, the ALT value was 1.14±0.11 versus
0.62±0.05 mmol/l (p<0.001) and AST – 0.72±0.07 versus 0.52±0.04 mmol/l
(p<0.05). Of the 236 patients examined in the long term, recurrence of
echinococcosis was noted in 21 (8.9%) patients, while in the group of patients
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operated in 2005-2008, this indicator reached 16.3%, which It was due to the
lack of preventive chemotherapy. Thus, the developed method of preventive
chemotherapy allowed to improve the quality of care by reducing the frequency
of immediate postoperative complications from 12.5% (32 patients in the
comparison group) to 4.3% (5 patients in the main group) (criterion χ2 = 4.954;
Df=1; p=0.027) and recurrence of the disease from 11.9% (19 patients in the
comparison group) up to 2.6% (in 2 patients in the main group) (criterion χ2 =
4.692; Df=1; p=0.031)
Conclusions.
Experimental studies on 32 sheep showed that in areas of the liver
remote from the primary echinococcal cyst, the presence of microscopically
identifiable germinal micro-cysts was revealed, which can lead to the
development of a relapse of the disease after the removal of large cysts.
Stimulation of the proliferative-productive cellular reaction around the germ
cyst of the parasite with a depressing effect when using albendazole at a dose of
20 mg / kg occurs within 2 weeks, whereas at a dose of 10-15 and 5-7 mg / kg,
the effect occurred by 3-4 weeks of follow-up, which allows you to adjust the
recommended dose of albendazole (10-12 mg / kg) in cases of possible the risk
of developing toxic reactions (diffuse liver diseases), taking into account the
prolongation of the course of treatment.
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