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Multimodal surgical treatment of patients with columnar epithelial metaplasia of the esophageal mucosa


Author: Fosa Doina
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2022
Scientific adviser: Sergiu Ungureanu
doctor habilitat, associate professor (docent), 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

Status

The thesis was presented on the 9 September, 2022 at the meeting of the Scientific Council and now it is under consideration of the National Council.

Abstract

Adobe PDF document1.91 Mb / in romanian
Adobe PDF document1.77 Mb / in romanian

Thesis

CZU 616.329-072.1-089

Adobe PDF document 16.00 Mb / in romanian
210 pages


Keywords

metaplastic columnar esophagus, complicated reflux disease, Barrett's esophagus, Barrett's metaplasia, esophageal adenocarcinoma, endoluminal surgical treatment

Summary

Doctoral thesis in medical sciences, Chisinau, 2022, consisting in Introduction, 4 chapters, discussions and synthesis of the obtained results, conclusions, recommendations, bibliography of 226 titles, 121 pages of basic content, 23 tables, 49 figures. The obtained results are published in 45 scientific works.

Field of study: 321.13 - surgery.

Purpose of the work: Optimizing the treatment results of patients with columnar epithelial metaplasia of the esophageal mucosa by implementing contemporary methods of diagnosis and minimally invasive multimodal surgical treatment in patients with this pathology.

Objectives of the work: Comparative assessment of the diagnostic value of the clinical-paraclinical data in establishing the diagnosis of columnar epithelial metaplasia of the esophageal mucosa and analysis of the neoplastic progression risk by the means of immunohistopathological examination. Comparative analysis of different methods of minimally invasive treatment (endoluminal and laparoscopic) with the development of the complex algorithm for screening, diagnosis and treatment of these patients.

Scientific novelty and originality: The diagnostic value and accuracy of different clinical-paraclinical diagnostic methods were assessed by comparison, the indications of the surgical interventions for different forms of metaplasia were established, as well as their type necessary for the eradication of the pathological substrate. Various methods of minimally invasive surgical treatment were analyzed and immediate and distant postoperative results were assessed.

Scientific problem solved: The diagnostic-curative algorithm of patients with esophageal mucosa metaplasia was identified and surgical tactics was optimized by approaching and implementing minimally invasive surgical techniques (endoluminal and laparoscopic).

Theoretical significance: The problem of esophageal mucosal metaplasia was complexly analyzed: etiopathogenesis, risks and complications. New diagnostic possibilities (imaging, functional and immunohistochemical) and minimally invasive treatment were identified.

The applicative value of the work: The concept of treatment of esophageal metaplasia was revised and a new diagnostic-curative algorithm was proposed.

Implementation of the scientific results: The scientific results, fundamental principles and practical recommendations are used in the didactic process in the Department of Surgery nr. 4 of the SUMP “Nicolae Testemitanu”, surgical profile departments of the PMSI Republican Clinical Hospital “Timofei Mosneaga”.