Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.81
S. Panasenko, S. O. Guriev, D. M. Lysun, V. A. Kushnir, R. Saliutin
Closed abdominal trauma in polytrauma. Part II: surgical tactics for the damages control
多发伤中的闭合性腹部创伤。第二部分:损害控制的外科策略
{"title":"Closed abdominal trauma in polytrauma. Part II: surgical tactics for the damages control","authors":"S. Panasenko, S. O. Guriev, D. M. Lysun, V. A. Kushnir, R. Saliutin","doi":"10.26779/2522-1396.2022.3-4.81","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.81","url":null,"abstract":"Closed abdominal trauma in polytrauma. Part II: surgical tactics for the damages control","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79347851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.14
V. Grubnik, B. V. Evsikov, D. V. Gerasimov
Objective. Estimation of the clinical results application, concerning various methods of the complex choledocholithiasis treatment. Materials and methods. The investigation was conducted on the base of Odessa Regional Clinical Hospital during 2018 - 2021 yrs. Retrospective analysis of clinical results in treatment of 69 patients with complex choledocholithiasis was accomplished. Results. The tactics of treatment choice in complex choledocholithiasis must be maximally individualized and depend on a patient state and presence of concurrent diseases. In severe state of a patient the treatment must be started with transhepatic drainage of biliary ducts. It permits to eliminate the cholangitis signs, to improve a patient state and to prepare him to more complex operative interventions. Conclusion. In complex choledocholithiasis it is expedient to perform a two-staged interventions with preliminary drainage of biliary ducts for the cholemia level lowering. Tactics of treatment of complex choledocholithiasis must be selected, taking into account the patient state and age, presence of concomitant pathology and the clinic-anatomic peculiarities of the disease course (dimensions of calculi, stenosis, diverticulas of common biliary duct, etc). The extended endoscopic interventions constitute the most secure option.
{"title":"Retrospective analysis of experience of treatment of complex choledocholithiasis","authors":"V. Grubnik, B. V. Evsikov, D. V. Gerasimov","doi":"10.26779/2522-1396.2022.3-4.14","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.14","url":null,"abstract":"Objective. Estimation of the clinical results application, concerning various methods of the complex choledocholithiasis treatment. \u0000Materials and methods. The investigation was conducted on the base of Odessa Regional Clinical Hospital during 2018 - 2021 yrs. Retrospective analysis of clinical results in treatment of 69 patients with complex choledocholithiasis was accomplished. \u0000Results. The tactics of treatment choice in complex choledocholithiasis must be maximally individualized and depend on a patient state and presence of concurrent diseases. In severe state of a patient the treatment must be started with transhepatic drainage of biliary ducts. It permits to eliminate the cholangitis signs, to improve a patient state and to prepare him to more complex operative interventions. \u0000Conclusion. In complex choledocholithiasis it is expedient to perform a two-staged interventions with preliminary drainage of biliary ducts for the cholemia level lowering. Tactics of treatment of complex choledocholithiasis must be selected, taking into account the patient state and age, presence of concomitant pathology and the clinic-anatomic peculiarities of the disease course (dimensions of calculi, stenosis, diverticulas of common biliary duct, etc). The extended endoscopic interventions constitute the most secure option.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79179046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.25
V. Popov, O. Bolshak, V. Boukarim
Objective. To study the possibilities of the «labyrinth» procedure in combination with the left atrium reduction. Materials and methods. Into the investigation 261 patients, suffering isolated failure of a mitral valve Stage IV, operated in the National Institute of Cardio-Vascular Surgery n. a. M. M. Amosov, were included. The left atrium plasty with objective to reduce and prevent the waves spread re-entry was performed in 139 (53.2%) patients. Fragmentation in the left atrium was made in regime of low radiofrequencies (25 - 35 Вт) in accordance to schemes of Maze ІІІ, ІV. Results. In the hospital period 5 patients died (the hospital lethality have constituted 1.9%). While discharge from the hospital the sinus rhythm was noted in majority of the patients after the left atrium plasty, than in the alternative group - in 119 (85.6%) of 139 and in 79 (64.8%) of 122 patients, accordingly. Conclusion. The «labyrinth» procedure in combination with the left atrium plasty owes significant clinical advantages, including restoration and persistence of the sinus rhythm in patients, suffering pathology of a mitral valve.
目标。探讨“迷宫”手术联合左心房复位术的可能性。材料和方法。本研究纳入了261例在国立心血管外科研究所(National Institute of cardivascular Surgery n.a. m.m. Amosov)接受手术的孤立性二尖瓣IV期衰竭患者。139例(53.2%)患者行左心房成形术，目的是减少和防止心波扩散再入。根据Maze ІІІ， ІV的方案，在低射频(25 - 35 Вт)下对左心房进行碎片化。结果。住院期间有5名患者死亡(医院死亡率为1.9%)。在出院时，大多数左心房成形术患者出现窦性心律，而在另一组中，139例患者中有119例(85.6%)，122例患者中有79例(64.8%)。结论。“迷宫”手术联合左心房成形术具有显著的临床优势，包括恢复和维持二尖瓣病变患者的窦性心律。
{"title":"The «labyrinth» operative procedure with the left atrium plasty in correction of isolated failure of a mitral valve","authors":"V. Popov, O. Bolshak, V. Boukarim","doi":"10.26779/2522-1396.2022.3-4.25","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.25","url":null,"abstract":"Objective. To study the possibilities of the «labyrinth» procedure in combination with the left atrium reduction. \u0000Materials and methods. Into the investigation 261 patients, suffering isolated failure of a mitral valve Stage IV, operated in the National Institute of Cardio-Vascular Surgery n. a. M. M. Amosov, were included. The left atrium plasty with objective to reduce and prevent the waves spread re-entry was performed in 139 (53.2%) patients. Fragmentation in the left atrium was made in regime of low radiofrequencies (25 - 35 Вт) in accordance to schemes of Maze ІІІ, ІV. \u0000Results. In the hospital period 5 patients died (the hospital lethality have constituted 1.9%). While discharge from the hospital the sinus rhythm was noted in majority of the patients after the left atrium plasty, than in the alternative group - in 119 (85.6%) of 139 and in 79 (64.8%) of 122 patients, accordingly. \u0000Conclusion. The «labyrinth» procedure in combination with the left atrium plasty owes significant clinical advantages, including restoration and persistence of the sinus rhythm in patients, suffering pathology of a mitral valve.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76688701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.93
V. Vashchuk, T. P. Kyryk, M. Kushnirchuk, R. P. Baidala, M. Y. Krat, T. V. Khomchenko
Strategy of elimination of antibiotcoresistance to carbapenems – actual modern problem
消除碳青霉烯类抗生素耐药策略——现实的现代问题
{"title":"Strategy of elimination of antibiotcoresistance to carbapenems – actual modern problem","authors":"V. Vashchuk, T. P. Kyryk, M. Kushnirchuk, R. P. Baidala, M. Y. Krat, T. V. Khomchenko","doi":"10.26779/2522-1396.2022.3-4.93","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.93","url":null,"abstract":"Strategy of elimination of antibiotcoresistance to carbapenems – actual modern problem","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73339321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.54
I. Duzhyi, V. Shimko, G. І. Pyatikop, O. Sytnik, V. Pak
Objective. To study the peculiarities of antibiotics accumulation in appendix vermiformis after various methods of their introduction. Materials and methods. The investigation was conducted in 160 patients, to whom antibiotic was introduced by various methods: 53 – intramuscularly; 52 – intravenously; 55 – lymphotropically. In part of the patients the antibiotic was introduced at 1 h preoperatively, and to the rest – at 2 h. After performance of appendectomy from each third part of the appendix vermiformis (proximal, middle and distal) excised a homogenate was made, which was sowed into Petri dish on the laboratory culture of E. coli. In a day there were stunting growth zones registered in this laboratory culture in millimeters, and in accordance to their dimensions the level of the antibiotic accumulation was determined. Results. After intramuscular introduction the antibacterial preparation in tissues of appendix vermiformis did not accumulate. After intravenous introduction of ceftriaxone at 1 h preoperatively it have accumulated in 65.4% patients in proximal and middle thirds of appendix vermiformis, in 34.6% patients in the appendix vermiformis apex the antibiotic accumulation was not observed. After the antibiotic introduction 2 h preoperatively its concentration have diminished in two times. After lymphotropic introduction the antibiotic have accumulated in all parts of appendix vermiformis, and in 2 h its quantity have enhanced significantly. Conclusion. Accumulation of antibiotic in the appendix vermiformis after it intravenous introduction have rapidly reduced, and after a lymphotropic one – enhanced, witnessing the advantage of lymphotropic method, which must become the alternative one in appendicitis, due to its targeticity and property for accumulation.
{"title":"Peculiarities of course of operational and postoperative periods in appendectomy after various methods of the antibiotics introduction","authors":"I. Duzhyi, V. Shimko, G. І. Pyatikop, O. Sytnik, V. Pak","doi":"10.26779/2522-1396.2022.3-4.54","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.54","url":null,"abstract":"Objective. To study the peculiarities of antibiotics accumulation in appendix vermiformis after various methods of their introduction. \u0000Materials and methods. The investigation was conducted in 160 patients, to whom antibiotic was introduced by various methods: 53 – intramuscularly; 52 \u0000– intravenously; 55 – lymphotropically. In part of the patients the antibiotic was introduced at 1 h preoperatively, and to the rest – at 2 h. After performance of appendectomy from each third part of the appendix vermiformis (proximal, middle and distal) excised a homogenate was made, which was sowed into Petri dish on the laboratory culture of E. coli. In a day there were stunting growth zones registered in this laboratory culture in millimeters, and in accordance to their dimensions the level of the antibiotic accumulation was determined. \u0000Results. After intramuscular introduction the antibacterial preparation in tissues of appendix vermiformis did not accumulate. After intravenous introduction of ceftriaxone at 1 h preoperatively it have accumulated in 65.4% patients in proximal and middle thirds of appendix vermiformis, in 34.6% patients in the appendix vermiformis apex the antibiotic accumulation was not observed. After the antibiotic introduction 2 h preoperatively its concentration have diminished in two times. After lymphotropic introduction the antibiotic have accumulated in all parts of appendix vermiformis, and in 2 h its quantity have enhanced significantly. \u0000Conclusion. Accumulation of antibiotic in the appendix vermiformis after it intravenous introduction have rapidly reduced, and after a lymphotropic one – enhanced, witnessing the advantage of lymphotropic method, which must become the alternative one in appendicitis, due to its targeticity and property for accumulation.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90733844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.48
N. Valiyev
Objective. Studying of mutual role of the main pathogenetic factors of abdominal sepsis – the inflammation origin and intraabdominal hypertension, from the one side, endotoxicosis and the abdominal compression syndrome (ACS), from the other side. Materials and methods. Into the investigation 196 patients with abdominal sepsis were included, in whom after the certain preliminary preparation the operative procedure was done. The levels of neutrophils, macrophages, interleukin–6, interleukin–10 in peritoneal exudate were studied as indices of the inflammation source for abdominal cavity. These indices were characteristic for systemic answer on general reaction, the degree of which have determined the abdominal sepsis course and result. Determination of intraabdominal pressure was applied for estimation the intraabdominal hypertension role in abdominal sepsis. Results. The ratio of the endotoxicosis and the ACS indices in the complications structure, not dependent on some differences due to the complication type present, was practically similar. Conclusion. The results of the investigation conducted, witnesses the presence of interrelationship of roles of endotoxicosis and the abdominal compression syndrome in pathogenesis of abdominal sepsis, their indices changes are characterized by mutual activity strengthening, accompanied by clinical manifestations of the organs dysfunction, determining the severity of course and result of pathological process in the organism.
{"title":"Interrelationship between endotoxicosis and syndrome of intraabdominal hypertension in pathogenesis of abdominal sepsis.","authors":"N. Valiyev","doi":"10.26779/2522-1396.2022.3-4.48","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.48","url":null,"abstract":"Objective. Studying of mutual role of the main pathogenetic factors of abdominal sepsis – the inflammation origin and intraabdominal hypertension, from the one side, endotoxicosis and the abdominal compression syndrome (ACS), from the other side. \u0000Materials and methods. Into the investigation 196 patients with abdominal sepsis were included, in whom after the certain preliminary preparation the operative procedure was done. The levels of neutrophils, macrophages, interleukin–6, interleukin–10 in peritoneal exudate were studied as indices of the inflammation source for abdominal cavity. These indices were characteristic for systemic answer on general reaction, the degree of which have determined the abdominal sepsis course and result. Determination of intraabdominal pressure was applied for estimation the intraabdominal hypertension role in abdominal sepsis. \u0000Results. The ratio of the endotoxicosis and the ACS indices in the complications structure, not dependent on some differences due to the complication type present, was practically similar. \u0000Conclusion. The results of the investigation conducted, witnesses the presence of interrelationship of roles of endotoxicosis and the abdominal compression syndrome in pathogenesis of abdominal sepsis, their indices changes are characterized by mutual activity strengthening, accompanied by clinical manifestations of the organs dysfunction, determining the severity of course and result of pathological process in the organism.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91203753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.08
T. Tamm, I. G. Zulfugarov, V. V. Nepomnyashchiy, O. P. Zackarchuck, I. Mamontov, K. Kramarenko, O. M. Rechetnyack
Objective. To improve quality of diagnosis of paravesical complications in patients, suffering an acute cholecystitis, using demonstration of interrelationship of changes in the gallbladder wall histostructure and its echogram data. Materials and methods. Comparative analysis of the gallbladder wall echogram and results of the gallbladder wall morphological investigation was conducted in 520 patients with an acute cholecystitis to determine the kind of paravesical complications. Results. Morphological investigation of the gallbladder wall have shown that the gallbladder dimensions and the wall thickness enhancement are not universal characteristic features for an acute cholecystitis. To determine the kind of its inflammation (phlegmonous, gangrenous or catarral) is also impossible. In accordance to ultrasonographic criteria an acute cholecystitis diagnosis is established, аnd patho-morphologist determines the inflammation form. Sclerotic processes with overgrowth of dense connective tissue were revealed in the gallbladder wall while presence of a long-term inflammatory process. That's why in the patients, suffering an acute cholecystitis, the gallbladder wall echograms may show excessively white signal with delineated contours, but at the same time the gallbladder volume may be not changed or even reduced. This data may impact the choice of operative procedure. Ultrasonographic signs of presence of paravesical infiltrate and abscess were established as well. Conclusion. Echographic changes of the gallbladder wall indicates its inflammation, but do not give possibility to find which form it has. The gallbladder volume may be reduced in an acute cholecystitis, if inflammation occurs on background of recurrent process. The gallbladder wall demonstrates excessively white positive echographic signal, if in its structure connective tissue and collagen fibers prevail.
{"title":"Morphological substantiation of ultrasonographic criteria of an acute cholecystitis and its paravesical complications","authors":"T. Tamm, I. G. Zulfugarov, V. V. Nepomnyashchiy, O. P. Zackarchuck, I. Mamontov, K. Kramarenko, O. M. Rechetnyack","doi":"10.26779/2522-1396.2022.3-4.08","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.08","url":null,"abstract":"Objective. To improve quality of diagnosis of paravesical complications in patients, suffering an acute cholecystitis, using demonstration of interrelationship of changes in the gallbladder wall histostructure and its echogram data. \u0000Materials and methods. Comparative analysis of the gallbladder wall echogram and results of the gallbladder wall morphological investigation was conducted in 520 patients with an acute cholecystitis to determine the kind of paravesical complications. \u0000Results. Morphological investigation of the gallbladder wall have shown that the gallbladder dimensions and the wall thickness enhancement are not universal characteristic features for an acute cholecystitis. To determine the kind of its inflammation (phlegmonous, gangrenous or catarral) is also impossible. In accordance to ultrasonographic criteria an acute cholecystitis diagnosis is established, аnd patho-morphologist determines the inflammation form. Sclerotic processes with overgrowth of dense connective tissue were revealed in the gallbladder wall while presence of a long-term inflammatory process. That's why in the patients, suffering an acute cholecystitis, the gallbladder wall echograms may show excessively white signal with delineated contours, but at the same time the gallbladder volume may be not changed or even reduced. This data may impact the choice of operative procedure. Ultrasonographic signs of presence of paravesical infiltrate and abscess were established as well. \u0000Conclusion. Echographic changes of the gallbladder wall indicates its inflammation, but do not give possibility to find which form it has. The gallbladder volume may be reduced in an acute cholecystitis, if inflammation occurs on background of recurrent process. The gallbladder wall demonstrates excessively white positive echographic signal, if in its structure connective tissue and collagen fibers prevail.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90690324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.59
I. Karol
Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer. Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV. Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome. Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.
{"title":"Surgical tactics in peritonitis, caused by complicated course of colorectal cancer","authors":"I. Karol","doi":"10.26779/2522-1396.2022.3-4.59","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.59","url":null,"abstract":"Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer. \u0000Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV. \u0000Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome. \u0000Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90720215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.03
O. Usenko, Y. Voitiv
Objective. To improve the results of treatment in patients, suffering insufficiency of sutures of intestinal anastomoses, using analysis of rate in the genes polymorphous variants of the matrix metalloproteinase Type 2 (C-1306 →T) and the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A), as well as the result of elaboration of genetic diagnosis and prognostication of such complication. Materials and methods. In 32 patients, suffering insufficiency of intestinal sutures, which were treated in Shalimov National Institute of Surgery and Transplantology during 2016 - 2021 yrs, there were conducted the laboratory, genetic, immunohistochemical and statistical investigations. Results. Genetic and statistical analysis for the genes polymorphism of the matrix metalloproteinase Type 2 (C-1306 →T) and the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A) have permitted to determine the genotypes variants, associated with risk for the sutures insufficiency occurrence in the hollow gut organs anastomoses. Basing on the data obtained, the prognostication method was elaborated for the sutures insufficiency occurrence in intestinal anastomoses. Such complications are occurred in 1,36 times more frequently in carriers of homozygous СС genotype in gene of the matrix metalloproteinase Type 2 and in two times lesser (5.9%) in carriers the minor homozygotes ТТ, than in the control - 10% (p>0.05). Among the patients with the sutures insufficiency of intestinal anastomoses a statistically significant in 1,6 times more frequent rate of carriers of the homozygous GG gene variant the tissue inhibitor of the matrix metalloproteinase Type 2 was revealed. Carriers of the minor homozygotes АА among the patients with the sutures insufficiency in intestinal anastomoses were absent, while the same genotype was revealed in the control with the 10% (p<0.05) rate. With objective to study the occurrence risk for the sutures insufficiency in intestinal anastomoses in presence of association in the studied genotypes we have analyzed several clinic-laboratory indices. There was revealed the pathogenetic significance of alleles of the genes polymorphic variants of the matrix metalloproteinase Type 2 and the tissue inhibitor of the matrix metalloproteinase Type 2, which were accompanied by hypoproteinemia, high indices of biochemical markers of collagen biodegradation and lowered expression of monoclonal antibodies for α-гладкоmuscular actin and collagen IV, and, finally. have evolved as the risk factors for development of the sutures insufficiency in intestinal anastomoses. Conclusion. The method proposed consists of genetic investigation of the genes polymorphism of the matrix metalloproteinase Type 2 (C-1306 →T) and of the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A). It permits to prognosticate the probability of the sutures insufficiency development in intestinal anastomoses, and, basing on this, to improve the choice of the p
{"title":"The intestinal sutures insufficiency: factors of risk and prognostication, based on genetic investigations","authors":"O. Usenko, Y. Voitiv","doi":"10.26779/2522-1396.2022.3-4.03","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.03","url":null,"abstract":"Objective. To improve the results of treatment in patients, suffering insufficiency of sutures of intestinal anastomoses, using analysis of rate in the genes polymorphous variants of the matrix metalloproteinase Type 2 (C-1306 →T) and the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A), as well as the result of elaboration of genetic diagnosis and prognostication of such complication. \u0000Materials and methods. In 32 patients, suffering insufficiency of intestinal sutures, which were treated in Shalimov National Institute of Surgery and Transplantology during 2016 - 2021 yrs, there were conducted the laboratory, genetic, immunohistochemical and statistical investigations. \u0000Results. Genetic and statistical analysis for the genes polymorphism of the matrix metalloproteinase Type 2 (C-1306 →T) and the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A) have permitted to determine the genotypes variants, associated with risk for the sutures insufficiency occurrence in the hollow gut organs anastomoses. Basing on the data obtained, the prognostication method was elaborated for the sutures insufficiency occurrence in intestinal anastomoses. Such complications are occurred in 1,36 times more frequently in carriers of homozygous СС genotype in gene of the matrix metalloproteinase Type 2 and in two times lesser (5.9%) in carriers the minor homozygotes ТТ, than in the control - 10% (p>0.05). Among the patients with the sutures insufficiency of intestinal anastomoses a statistically significant in 1,6 times more frequent rate of carriers of the homozygous GG gene variant the tissue inhibitor of the matrix metalloproteinase Type 2 was revealed. Carriers of the minor homozygotes АА among the patients with the sutures insufficiency in intestinal anastomoses were absent, while the same genotype was revealed in the control with the 10% (p<0.05) rate. With objective to study the occurrence risk for the sutures insufficiency in intestinal anastomoses in presence of association in the studied genotypes we have analyzed several clinic-laboratory indices. There was revealed the pathogenetic significance of alleles of the genes polymorphic variants of the matrix metalloproteinase Type 2 and the tissue inhibitor of the matrix metalloproteinase Type 2, which were accompanied by hypoproteinemia, high indices of biochemical markers of collagen biodegradation and lowered expression of monoclonal antibodies for α-гладкоmuscular actin and collagen IV, and, finally. have evolved as the risk factors for development of the sutures insufficiency in intestinal anastomoses. \u0000Conclusion. The method proposed consists of genetic investigation of the genes polymorphism of the matrix metalloproteinase Type 2 (C-1306 →T) and of the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A). It permits to prognosticate the probability of the sutures insufficiency development in intestinal anastomoses, and, basing on this, to improve the choice of the p","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73335735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.26779/2522-1396.2022.3-4.35
V. Grubnik, Ya. S. Bereznytskyi, V. Ilyashenko, V. Grubnyk, D. V. Korchovyi, O. Kiosov
Objective. Studying of complications, connected with application of the net implants in patients with large hiatal hernias. Materials and methods. Retrospective investigation was conducted with objective to study complications, connected with application of the net implants in patients with large hiatal hernias, operated in the clinic during period from 2008 to 2018 yr. Of 1168 patients operated on and suffering gastro-esophageal reflux disease as well as hiatal hernias, 817 have had large hernias. In 353 patients with large hernias for strengthening of cruroraphy sutures the net implants were applied. There were used low-weighted implant-net Ultrapro, the composite net Parietex, self-fixating surgical net ProGrip, absorbable net Vicryl, polytetrafluoroethylene net with nitinol carcass, biological net Bio-A. All the patients symptoms were registered, and the quality of life studied. Results. Complications, caused by the net implants impact, were revealed in 17 (1.5%) patients. In all 17 patients the esophageal structuring have occurred due to pronounced cicatrization in region of the net implant installation. In 6 patients dysphagia due to the net ingrowth into esophageal tissue was observed, and in 2 – chronic inflammatory process in place of the net installation. One patient have had small esophageal perforation with restricted mediastinitis. In 3 patients, in whom the polytetrafluoroethylene nets were installed, their migration into esophageal lumen was revealed. Reoperations were done in all 17 patients. In 7 patients the net was removed completely. In 1 patient the net was removed and mediastinum drained. In 3 patients, in whom polytetrafluoroethylene nets have migrated into esophageal lumen, they were removed endoscopically with further installation of special stents. Results of reoperations were estimated as good in 15 patients. In 2 patients after reoperations dysphagia was observed, which needed a second time balloon dilatation and installation of stent in 1 of them. Conclusion. Nonabsorbable nets ought to be applied with high technical accuracy, it is necessary to prevent their contact with the esophagus. Application of the polytetrafluoroethylene nets with nitinol carcass for plasty of large hiatal hernias must be forbidden.
{"title":"Complications, caused by application of the net implants in the hiatal hernias plasty","authors":"V. Grubnik, Ya. S. Bereznytskyi, V. Ilyashenko, V. Grubnyk, D. V. Korchovyi, O. Kiosov","doi":"10.26779/2522-1396.2022.3-4.35","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.35","url":null,"abstract":"Objective. Studying of complications, connected with application of the net implants in patients with large hiatal hernias. \u0000Materials and methods. Retrospective investigation was conducted with objective to study complications, connected with application of the net implants in patients with large hiatal hernias, operated in the clinic during period from 2008 to 2018 yr. Of 1168 patients operated on and suffering gastro-esophageal reflux disease as well as hiatal hernias, 817 have had large hernias. In 353 patients with large hernias for strengthening of cruroraphy sutures the net implants were applied. There were used low-weighted implant-net Ultrapro, the composite net Parietex, self-fixating surgical net ProGrip, absorbable net Vicryl, polytetrafluoroethylene net with nitinol carcass, biological net Bio-A. All the patients symptoms were registered, and the quality of life studied. \u0000Results. Complications, caused by the net implants impact, were revealed in 17 (1.5%) patients. In all 17 patients the esophageal structuring have occurred due to pronounced cicatrization in region of the net implant installation. In 6 patients dysphagia due to the net ingrowth into esophageal tissue was observed, and in 2 – chronic inflammatory process in place of the net installation. One patient have had small esophageal perforation with restricted mediastinitis. In 3 patients, in whom the polytetrafluoroethylene nets were installed, their migration into esophageal lumen was revealed. Reoperations were done in all 17 patients. In 7 patients the net was removed completely. In 1 patient the net was removed and mediastinum drained. In 3 patients, in whom polytetrafluoroethylene nets have migrated into esophageal lumen, they were removed endoscopically with further installation of special stents. Results of reoperations were estimated as good in 15 patients. In 2 patients after reoperations dysphagia was observed, which needed a second time balloon dilatation and installation of stent in 1 of them. \u0000Conclusion. Nonabsorbable nets ought to be applied with high technical accuracy, it is necessary to prevent their contact with the esophagus. Application of the polytetrafluoroethylene nets with nitinol carcass for plasty of large hiatal hernias must be forbidden.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74788853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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