diafragmis posttravmuli Tiaqrebis diagnostikisa da mkurnalobis Sesaxeb

 

g. gvaxaria, b. nakaiZe, z. gagua, s. danduriSvili,

 

iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universitetis  qirurgiis kaTedra (kaTedris gamge prof. b. mosiZe)

 

 

 

     muclisa da gulmkerdis Rrus travmuli dazianebebis dros diafragmis gagleja warmoadgens SedarebiT iSviaT paTologias. Heerard-isa da Tanaavtorebis (1979) monacemebiT aRniSnuli travma Seadgens yvela mZime Torakoabdominaluri dazianebebis 2-4,5%-s. ZiriTadad ziandeba diafragmis marcxena gumbaTi (98%)

  diafragmis travmuli dazianebis pirvel etapze muclis Rrus organoebis gadanacvleba plevris RruSi xSirad mimdinareobs naklebad gamoxatuli simptomatikiT. avadmyofebi xvdebian qirurgiul stacionarSi mogvianebiT, rodesac saxezea iseTi garTulebebi, rogoricaa CaWedva, nekrozi, sisxldena.

  Cvens mier warmodgenilia diafragmis posttravmuli Tiaqris sami SemTxveva. samive avadmyofi moTavsda qirurgiul stacionarSi daavadebis garTulebis stadiaSi. anamnezSi mkurnalobdnen sxvadasxva stacionarSi politravmis gamo. (neknebis mravlobiTi motexiloba, gulmkerdisa da muclis Rrus daxuruli travma, qala-tvinis travma, lulovani Zvlebis motexiloba). mas Semdeg avadmyofebma mimarTes gaurkveveli CivilebiT sxvadasxva stacionars, sadac diagnozi ver iqna dasmuli. Cvens klinikaSi diagnozis dasma ar warmoadgenda sirTules, vinaidan gamoxatuli iyo iseTi tipiuri simptomokompleqsi, rogoricaa Zalze Zlieri tkivili gulmkerdis marcxena naxevarSi, auskultaciurad aqve gamoxatuli nawlavTa yuryuri da Sxefis xma, rentgenografiulad kuWisa da nawlavebis gadanacvleba plevris RruSi.

  samive SemTxvevaSi operacia warmoebuli iqna Torakoabdominaluri midgomiT. CaWedili aRmoCnda kuWi, elenTa, wvrili nawlavis maryuJebi. erT SemTxvevaSi warmoebuli iqna gastreqtomia kuWis 360 gradusiT RerZis garSemo Semogrexis Semdgom totaluri nekrozis gamo formirebuli iqna ezofago-duodeno anastomozi. meore SemTxvevaSi warmoebuli iqna 180 gradusiT Semogrexili kuWis gasworeba da spleneqtomia, mesame SemTxvevaSi SemovifargleT rotirebuli kuWis gasworebiT. yvela operacia dasrulda organoebis CamotaniT muclis RruSi, diafragmorafiiT, gulmkerdisa da muclis Rrus drenirebiT. postoperaciuli garTulebebi ar aRiniSneboda. oTxi wlis Semdeg avadmyofebi Tavs kargad grZnoben, Civilebs ar warmoadgenen.

  daskvna: saWiroa gamaxvildes gansakuTrebuli yuradReba politravmebis dros, raTa droulad iqnes gamovlenili diafragmis travmuli dazianeba.

  diafragmis posttravmuli  CaWedili Tiaqrebis operaciuli koreqcia mizanSewonilia warmoebuli iqnas Torakoabdominaluri midgomiT.

 

 

 

 

eqinokokozis qirurgiuli mkurnalobis gamocdileba

 

 

g. gvaxaria, b. nakaiZe, v. gonjilaSvili, s. danduriSvili, z. gagua

 

iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universitetis  qirurgiis kaTedra (kaTedris gamge prof. b. mosiZe)

 

 

 

 

   eqinokokozi warmoadgens sakmaod gavrcelebul daavadebas, rac ganpirobebulia sanitarul-ganmanaTlebluri samsaxurebis muSaobisa da cxovrebis dabali doniT, agreTve mosaxleobaSi profilaqtikuri RonisZiebebis ararsebobiT.

   am paTologiiT q. anabas (alJiri) ibn roSes sax. sauniversiteto klinikaSi da Tbilisis saxelmwifo universitetis klinikuri saavadmyofos bazaze Cvens mier naoperaciebia 79 avadmyofi. 37 SemTxvevaSi eqinokokuri kista lokalizebul iyo RviZlSi, 31 SemTxvevaSi – filtvebSi, 11 SemTxvevaSi – sxva organoebSi. daavadebis diagnoscirebisaTvis vawarmoebdiT  muclisa da gulmkerdis Rrus mimoxilviT rentgenografiul gamokvlevebs, eqoskopias da zogierT rTul SemTxvevaSi viyenebdiT kompiuterul-tomografiul gamokvlevas.

  Cvens klinikaSi SemuSavebulia RviZlis eqinokokuri kistebis operaciuli mkurnalobis originaluri meTodi, romelic mdgomareobs SemdgomSi: eqinokokis kistis qitinis garsis mocilebis  Semdeg  fibrozuli kafsula muSavdeba natriumis qloridis 33%-iani xsnariT, ris Semdegac xdeba kistis Rrus drenireba da gakerva. im SemTxvevaSi, roca fibrozul garsSi ixsneba RviZlSida sanaRvle sadinari, damatebiTad vawarmoebT ganmtvirTavi  qolecistostomis formirebas, romelic uqmdeba daaxloebiT me-11-12 dRes fistulis daxurvisa da kistis Rrus Semcirebis paralelurad. analogiuri operaciebi iqna warmoebuli filtvis eqinokokozis dros, bronqealuri fistulis gakerviT, fibrozuli kafsulisa da plevris Rrus drenirebiT.

   11 SemTxveva warmodgenili iyo 4 SemTxveviT  ileopsoas kunTSi lokalizaciiT, 2 SemTxveviT – elenTaSi, 1 SemTxveviT sarZeve jirkvalSi lokalizaciiT, 4 SemTxvevaSi eqinokokuri kistebi generalizirebuli iyo mTel muclis RruSi.

  eqinokokuri kistebis operaciuli mkurnalobis Cvens mier aRwerili meTodika warmoadgens teqnikurad SedarebiT martiv, damzogvel operacias, romelic saboloo SedegebiT ar Camouvardeba literaturaSi aRweril ufro rTul radikalur meTodebs.

 

dargis wamyvani specialistis recenzia

 

 

 

   iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universitetis qirurgiis kaTedrisa da klinikuri saavadmyofos mier warmodgenili naSromebi `eqinokokozis qirurgiuli mkurnalobis gamocdileba~ da `diafragmis posttravmuli Tiaqrebis diagnostikisa da mkurnalobis Sesaxeb~ warmoadgens saintereso, originalur masalas, ilustrirebulia kargad, gadmocemulia kompaqturad. imis gaTvaliswinebiT, rom diafragmis posttravmuli CaWedili Tiaqrebi warmoadgens SedarebiT iSviaT nozologias, aRniSnuli gamocdilebis gaziareba, Cemis azriT, sakmaod sasargebloa. `eqinokokozis mkurnalobis gamocdileba~-Si sakmaod sainteresod aris aRwerili fibrozuli kafsulis damuSavebisa da daxurvis meTodika, yuradsaRebia RviZlSida sanaRvle sadinaris fistulis arsebobisas ganmtvirTavi qolecistostomis formirebis gamocdileba.

  vTvli, rom orive statiis publikacia dasaSvebia 5-12 ivliss q. baTumSi mimdinare konferenciis `medicina klasikur sauniversiteto ganaTlebaSi~- SromaTa krebulSi.   

                                 

 

 

 

 

         respublikis mTavari qirurgi                 prof. g. TomaZe

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l i t e r a t u r a

 

 

 

    Njcrby R.L.> :th,jdcrbq D.D.  Uhs;b ;bdjnf. – V. % Vtlbwbyf> 1983.

240 c.> bk.

 

      Rjpkjd B.P.>  Ujhirjd C.P.> Djkrjd D.C.   Gjdht;ltybz ;bdjnf. – V. % Vtlbwbyf> 1988. – 224 c.> bk.

 

   F,frevjd V.V.> Kt,tltd Y.D.> Bjaat ?.C.  Lbfuyjcnbrf b ktxtybt gjdht;ltybq jhufyjd ,h/iyjq gjkjcnb d cjxtnfybb c xthtgyj-vjpujdjq nhfdvjq 

// {bhehubz. – 1985. – # 11. – c 34 - 37.

 

  Lthz,by B.B.> Pfrehlftd D.T. J,obt djghjcs lbfuyjcnbrb b ktxtybz pfrhsns[ gjdht;ltybq ;bdjnf ghb cjxtnfyyjq nhfdvt ## Djty. – vtl. ;ehy. – 1977. - #11. – c 42 – 46.

 

 

 

 

 

 

The Diagnose And Treatment Of Diapragmh Post-Traumatic Hernia

 

Gvakharia G. Nakaidze B. Gagua Z. Dandurishvili S.

 

Iv. Javakhishvili State University  Surgical Department

(Chairman Prof. B.Mosidze)

 

 

 

 

             

 

   During the traumatic inguar of the abdomen and the chest hole, the diapragmh  destruction is a comparativeli rare patologhy. We represent  the three cases of diapragmh post-traumatic hernia, complicated with a stuck. The thoracoabdominal way of the operation was chosen. The stomach, spleen and a small intestine loop were stucked. It was done a gastrectomia, splenectomia, and in the third case-the stomach detorzio. All three operations were finished by the bringing down the organs in the abdomen, diapragmhoraphy and the drenning of the abdomen and chest.     

 

 

  

 

 

l i t e r a t u r a

 

 

 

   Fkmgthjdbx <.B.  {bhehubz  Ý[byjrjrrjpf b fkmdtjrjrrjpf gtxtyb. – Njvcr % Bpl – dj  NUE. 1977. – 165 c.

 

    Fkmgthjdbx <.B. htl. {bhehubz  gtxtyb b ;tkxys[ gentq. - Njvcr % Bpl – dj  NUE. 1997. – 607 c.> bk.

 

  Gtnhjdcrbq <.D.> Vbkjyjd J.<.>  Lttybuby C.K. {bhehubz Ý[byjrjrrjpf. – V. Vtlbwbyf. 1985 – 216 c.

 

 Ifkbvjd F.F. htl. {bhehubz gtxtyb b ;tkxys[ ghjnjrjd. – Rbtd % Pljhjdmt. 1975. – 407 c.

 

 

 

  

 

 

 

The Experience Of  Echinococos Surgical Treatment

 

Gvakharia G. Nakaidze B. Gonjilashvili V. Dandurishvili S. Gagua Z.

 

Iv. Javakhishvili State University Surgical Department

(Chairman Prof. B.Mosidze)

 

 

 

 

 

  We have operated 79 patients with echinococos diagnose at Tbilisi State University clinical hospital and at Anaba  (Algeria) Ibn Rosha Unversity clinic. We  hold the  operation treatment by an original method, which represents the exploition of the phibroze wrapper with a 33% Natrium chloride and drenning of a chistoma hole and sewing. When the gull duct is open in the phibroze wrapper, we do a decompression cholecistostomy. The deseribed method of the operation treatment of the echinococal chistoma is comparatively technologically simple and more saving operation, which with its last results is not worse then the more radical  methods described in  literature.