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Diagnosticul şi tratamentul megacoledocului


Author: Hotineanu Adrian
Degree:doctor habilitat of medicine
Speciality: 14.00.27 - Surgery
Year:2010
Scientific consultant: Gheorghe Ghidirim
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council: DH 50-14.00.27-27.03.08
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 1 September, 2010
Approved by NCAA on the 6 October, 2010

Abstract

Adobe PDF document – 1.05 Mb / in romanian

Summary

Hotineanu Adrian. The diagnostic an the treatment of the megacholedochus. Thesis of doctor habilitat in medicine, Chisinau, 2009. Structure of the thesis: introduction, VI chapters, conclusions, bibliography consisting of 529 sources, supplements, 248 pages of fundamental text, 150 figures, and 78 tables. Results of this research were published in 43 scientific papers. Key words: megacholedochus, duodenpacreatectomy, supraduodenal excision of CBD, hepaticojejunostomy. Area of Research: General Surgery. Goal of Research: Demonstration of the etiopathogenic factors of megacholedochus which would permit the creation of the diagnostic algorithm associated with those curative in the relation with ectasia of main biliary ducts. Research Objectives: 1.To study etiopathogenesis of main biliary ducts escasia and to formulate the definition of megalocholedochus in the report with causes of main biliary ducts dilatation.2.To determine etiopathogenic forms of megalocholedochus and in the ratio with them to develop classification of main biliary ducts estasia.3.To create diagnostical algorithm of megalocholedochus basing on dynamics of clinical and paraclinical parameters of patients with main biliary ducts ectasia. 4. To research anatomo-morphological changers of hepatobiliarypancreatic region in all groups of patients with megalocholeochus. 5. After determining of etiopathogenic aspects and selection of necessary group to perform the surgical treatment of choice. 6. To analyze the early and long-term results of proposed treatment. Methodology: Prospective and retrospective, Studiul a fost prospectiv şi retrospectiv, descriptive of prevalence. Scientific novelty. For the first time was established the definition of megalocholedochus. Was developed the classification of megalocholedochus on dependency of etiopathogenic factors. On dependency of the form of megalocholedochus has been determined diagnostical algorithm. Was established the treatment of choice for each group. Theoretical significance. For the first time was created the classification of megalocholedochus, which permitted evaluation of diagnostical algorithm and optimal treatment on dependency of etiologic factors. Scientific value and clinical applicability. 1.Proposed diagnostical algorithm at the patients with megalocholedochus permits to select the patients for performing the treatment of choice. Clinical manifestation and methods of investigation: USG, ERCP, MRI, CT, EGEG, hepatobilioscintigraphy, manometry, permits to determine the conformity at one group of patients with megalocholedochus. 2 Surgical treatment of choice of megalocholedochus is dictated by etiologic factor, which require complex management of this pathology. 3.Applying a new surgical management leads to recovery and sociofamily and full professional rehabilitation of these patients. Implementation of scientific data. The proposed method is currently introduced in clinical practice at surgical clinics Nr.2 State Medical University ”Ntestemiţanu”, MSPI Republican Clinical Hospital.