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Purpose: Echinococcus granulosus (EG) is an endemic pathology for a some territories of the Southeren Russia. There is no consensus among specialists regarding the tactics of treatment of patients at various stages and different forms of the invasion.The aim is to optimize the treatment of patients with EG with algorithm ''the diagnosis-surgery-chemotherapy''. Methods & Materials: Surgical treatment of 116 patients with abdominal echinococcosis was performed in the period 1997-2017. The diagnosis was verified with the results of postmortem examination of the cysts.Radical and conditionally radical surgeries were performed in 22.4% and 45.7% patients, respectively. After surgical treatment, the patients underwent courses of anti-relapse therapy, in accordance with generally accepted clinical practice. Before and after surgical treatment, the patients underwent, along with ultrasound examinations, computed and magnetic resonance imaging of organs, as well as enzyme-linked immunosorbent assay (ELISA) of blood serum in order to detect IgG to EG and immune blotting of positive sera. Results: Primary EG was diagnosed in 85.3% cases, residual and recurrent - in 14.7%. Isolated EG of the liver was noted in 108 patients, of the spleen - in 4 cases, combined damage of the liver and lung - in 2, liver and gastrocnemius muscle - in 1.In 1 patient after right-sided hemihepatectomy the results of postmortem examination of the fragment of the right lobe of the liver verified liver alveococcosis. Positive ELISA results before surgery restarted in 77.6%, a month after – in 93.1 %%.Postoperative complications were observed in 17.2%. Relapse of echinococcosis was registered in 1 patient (0.9%). In the treatment of uncomplicated echinococcosis with PAIR technique was used under ultrasound control in an X-ray surgical operating room Conclusion: The use of blood-saving technologies has made it possible to increase the safety of radical operations. A modern diagnostic algorithm should include, in addition to tradicional methods the preoperative computer visualization and virtual modeling techniques to clarify the intrahepatic lesion with vascular structures. Immunological methods allow, before and after surgery avoid an erroneous diagnosis, predict the risks of relapse and the effectiveness of anti-relapse therapy. |
