Особенности диагностики и тактики лечения сочетанного эхинококкоза органов грудной клетки и брюшной полости

Abstract

Combined echinococcosis of the chest and abdominal cavity is one of the cause of morbidity and disability in the Republic of Kazakhstan (RK). Currently, a threatening situation has arisen in the countries of Central Asia due to the epidemiology of dangerous zoonosis - echinococcosis. There is a tendency for an increasing in the invasion of people by this helminth in Kazakhstan. In 2017, according to statistics, 217 cases of echinococcosis per 100,000 people was detected. Echinococcosis is one of the serious reasons for the increase in the number of surgeries. The purpose of this article is to analyze the clinical cases of combined echinococcosis of the chest and abdominal cavity received at the Department of Thoracic Surgery of the National Scientific Center for Surgery named after A.N. Syzganova since 1997 to 2009. Material and methods. We conducted a study of the surgical activity of the department, the distribution of patients with combined echinococcosis by factors of social status, contact with animals and place of residence, the nature of the combined lesion of echinococcosis of the organs of the chest and abdominal cavity, who received surgical treatment. Results and discussion. According to a study of 413 patients, were identified 534 cysts: single cysts: right (30 (5.6%)) and left (21 (4.0%)) lungs, both lungs (9 (1.7%)), subphrenic surface of the liver (40 (7.4%)); multiple cysts: right (84 (15.7%)) and left (51 (9.5%)) lung, both lungs (96 (17.9%)), liver (132 (24.7%)), liver and abdominal cavity (53 (9.9%)), mediastinum (14 (2.6%)), diaphragm and retroperitoneal space (4 (0.7%)). Simultaneous echinococcectomy of 2-3 organs was performed in 261 (63.3%) patients, phased echinococcectomy of several organs with an interval of 2 weeks to 6 months was performed in 152 (36.7%) patients. Postoperative complications were revealed in 35 (8.5%) patients who were associated with combined lesions of various organs, initially complicated forms of lesions, and late referral to a doctor after long unsuccessful treatment at the place of residence. In 17 (4%) patients with an empty echinococcal cyst, a postoperative pneumonia was observed, which was resolved conservatively. Complications in the form of exudative pleurisy were observed in 12 (2.9%) patients; pleural cavity punctures were performed for all. In 6 (1.4%) patients there was suppuration of the laparotomic postoperative wound. Conclusion. The endemicity of the zone, the high contagiousness of the par-asite, the wide age range of patients, the combined defeat with parasite of many organs and different cavities - all this indicates the relevance of this topic and require further discussion and improvement of diagnostic and therapeutic tactics. The necessary for a multidisciplinary approach, namely the inclusion of oncologists and TB specialists together with surgeons in the diagnostic algorithm, is fundamental to improving diagnostic results. The tactics of treatment of combined echinococcal lesions, in contrast to isolated ones, is based on the determining the sequence and stages depending on the location, size and presence of complications. Keywords. Thoracic surgery, combined echinococcosis, analysis.