Сравнительная оценка инструментальных и хирургических методов лечения кардиоспазма и ахалазии кардии

Тад?и?от усуллари: ускунали ва морфологик текширувларнинг маълумотлари та?лил ?илинган. Тад?и?от натижаларига статистик ишлов берилган.

Олинган натижалар ва уларнинг янгилиги: катта клиник материалда кардиодилатация турли усулларининг бевосита ва олис натижалари ?амда асоратларнинг частотаси та?лилдан ўтказилган. Гидробаллонли дилатацияга кўрсатмалар ишлаб чи?илиб, беморларни шу усулда даволашнинг натижалари ўрганилган. Кардиоспазм ва кардия ахалазиясига учраган беморларда ма?аллий ва секрециясига ?арши терапиянинг кардиодилатация билан биргаликда ўтказиш усули ишлаб чи?илиб, татби? этилган. Касалликнинг I типи мавжуд беморларни хирургик даволашнинг ўзига хос усули ишлаб чи?илган. Кардиоспазм ва кардия ахалазиясига учраган беморлар учун мутаносиб даволаш-ташхислаш алгоритми ишлаб чи?илган.

Амалий а?амияти. Ускунали даволаш усулини танлашга дифференциал ёндошиш кардиоспазм ва кардия ахалазиясига учраган беморларни даволашнинг бевосита ва олис натижаларини яхшилашга ёрдам берган. Ма?аллий ва секрециясига ?арши терапиянинг клиник амалиётга жорий этилиши рефлюкс-эзофагитнинг учрашини камайтиришга имкон бериб, бу эса морфологик текширувларда ўз исботини топган. Гастропластика, СПВ ва нотўли? фундопликация билан ?ўшиб ўтказилувчи такомиллаштирилган эзофагокардиомиотомиянинг биз таклиф этган усули I тип касаллигига (кардиоспазмга) чалинган беморларни хирургик даволашдан кейинги рефлюкс-эзофагит ва дисфагия ?айталанишининг келиб чи?ишини бартараф этиш имконини берган.

Татби? этиш даражаси ва и?тисодий самарадорлиги: диссертация ишининг натижалари акад. В.Во?идов номидаги РИХМ ?изилўнгач ва ош?озон хирургияси бўлимининг клиник амалиётига жорий этилган. Даволаш-ташхислаш алгоритмининг жорий этилиши касаллик ?айталанишлари частотасини камайтириш ?исобига даволаш натижаларини яхшилашга ва даволаш ?ийматини пасайтиришга имкон берган.

?ўлланилиш со?аси: тиббиёт, хирургия.

RESUME

Thesis of H.N. Bekchanov on the scientific degree competition of the candidate of medical sciences on specialiti: 14.00.27 - Surgery, subject: “Relative evaluation of instrumental and surgical methods of treatment of cardiospasm and esophageal achalasia”

Key words: cardiospasm, esophageal achalasia, cardiodilatation, dysphagia relaps, surgical treatment, esophagocardiomiotomia, esophagus extirpation.

Subjects of research: 413 patients, who was underwent different methods os instrumental and surgical treatment in esophagus and stomack surgery department, RSCS named after ac. V.Vahidov since 1976 till 2010.

Purpose of work: To work out optimized treatment tactics of patients with cardiospasm and esophageal achalasia by performing of relative analysis of effectiveness of different methods of cardiodilatation and surgical interventions.

Methods of research: Data of instrumental and morphological researches were analyzed. Results of researches were exposed to statistic process.

The results obtained and their novelty: Immediate and remote results and complications rate of different methods of cardiodilatation were analyzed on basis of large clinical material. Indications were worked out, results of treatment of patients by hydrobaloon dilatation method were investigated. Local and antisecretory therapy in complex with cardiodilatation were worked out and implemented at patients with cardiospasm and esophageal achalasia. Original methodic of surgical treatment of patients with the 1st type of disease was worked out. Optimal treatment and diagnostic algorithm for patients with cardiospasm and esophageal achalasia was worked out.

Practical value: Differential approach to choosing of method of instrumental treatment improved immediate and remote results of treatment of patients with cardiospasm and esophageal achalasia. Planting to clinical practice local and antisecretory therapy allowed to diminish reflux-esphagitis rate, what was proved by morphological investigations. Offered updated method of esophagocardiomiotomy with gastroplasty, SPV and partial fundoplication allowed to exclude reflux-esphagitis development and dysphagia relapse after surgical treatment of patients with 1st type of desease (cardiospasm).

Degree of embed and economic effectivity: Results of investigation were realized in clinical practice of esophagus and stomack surgery department, RSCS named after ac. V.Vahidov. Planting of treatment and diagnostic algorithm allowed to improve results of treatment and diminish treatment cost due to reduce disease relapse rate.

Field of application: medicine, surgery.

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