PROMENA STAVOVA U DIJAGNOSTICI I LEČENJU EHINOKOKUSA JETRE U ŠEZDESETOGODIŠNJEM PERIODU: ISKUSTVO TERCIJARNE INSTITUCIJE U ENDEMSKOM PODRUČJU U EVROPI
Sažetak
Srbija je dobro poznat endemski region kada je reč o hidatidnoj bolesti jetre. Premda hirurgija ostaje primarni modalitet lečenja, došlo je do značajnih promena u dijagnostici i lečenju ove bolesti u poslednje vreme. Cilj ovog istraživanja bio je da retrospektivno analizira demografske i kliničke karakteristike pacijenata koji su podvrgnuti hirurškom lečenju hidatidne bolesti jetre u tercijarnoj referentnoj ustanovi (Univerzitetskom kliničkom centru u Nišu) u poslednjih šezdeset godina (1960‒2020). Izvršena je komparativna analiza triju perioda od dvadeset godina: perioda I (1960‒1980), perioda II (1980‒2000) i perioda III (2000‒2020). U poređenju s ukupnim brojem operacija, procenat operacija urađenih zbog hidatidne bolesti jetre bio je značajno manji u poslednjem periodu (1,23‰) nego u prvom i drugom periodu (5,15‰, odnosno 4,86‰). Pokazalo se i da je incidencija veća kod žena (1 : 2,2). Lokalizacija cisti i procenat uočenih komplikacija nisu se menjali s vremenom. Standardne dijagnostičke procedure u novije vreme obuhvataju ultrazvuk (engl. ultrasound ‒ US), kompjuterizovanu tomografiju (engl. computed tomography ‒ CT), enzimski imunosorbentni test (engl. enzyme-linked immunorbent assay ‒ ELISA) i imunohemaglutinaciju (engl. indirect hemagglutination ‒ IHA). Iako se u lečenju hidatidne bolesti jetre sve više primenjuju minimalno invazivne procedure, otvorena operacija ostaje zlatni standard za postizanje potpunog izlečenja, posebno u komplikovanim slučajevima. Ispostavilo se da su u celokupnom posmatranom periodu u najvećem broju slučajeva (61,91%) rađene poštedne hirurške intervencije. Međutim, registrovano je blago povećanje broja radikalnih operacija ‒ sa 25,4% u prvom periodu na 43,15% u drugom i 46% u trećem periodu. Prema mišljenju autora, metodu izbora predstavlja operacija po Papadimitriouu ‒ parcijalna pericistektomija sa omentoplastikom ‒ budući da se njome postiže balans između potrebe za radikalnošću i principa poštednosti tkiva jetre. Minimalno invazivne procedure poput perkutanih drenaža i laparoskopije postepeno su se uvodile u pažljivo odabranim slučajevima u poslednjim dvama analiziranim periodima; primećeno je da se njihov broj povećao sa 3,4% na 8,1%.
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