Pub Date : 2022-10-23DOI: 10.26779/2522-1396.2022.9-10.25
E. Horoshun, I. Lurin, V. Nehoduiko, V. Makarov, S. Tertyshnyi, R. Saliutin
Objective. To analyze the mistakes while application of modern surgical magnet instruments for diagnosis and removal of ferromagnetic foreign bodies. Materials and methods. In accordance to the exploitation-clinical criteria, the material, delivered by usages of the magnet instruments (623 respondents), about results of its clinical usage in period from 2014 yr up to nowadays, was analyzed. Results. In total the mistakes while application of surgical magnet instruments may be divided on two groups: the clinical and exploitation-technical Most quantity of clinical mistakes are connected with application of such instruments without indications, basically in absence of ferromagnetic fractures inside the wounds channels and cavities. Other causes of the mistakes were following: failure to include physiologic peculiarities of the wound process course, such as formation of capsule over foreign bodies, characteristic of the wound channel, choice of inappropriate nomenclature specimen and failure to include the vessels and neural trunks projections, leading to development of complications (hemorrhage, neuralgia, paresis), formation of the contraperture incision and mechanical removal of the fracture. Sterilization in a dry-heat wardrobe and physical damage of instruments were taken into account and have been considered as an exploitation-technical mistake. Conclusion. In accordance to the results obtained, the conduction of educational trainings for usage of surgical magnet instruments, guaranteeing reduction of the various mistakes and complications quantity, leading to maximal effect of its application are recommended.
{"title":"Mistakes while application of modern surgical magnet instruments for diagnosis and removal of the ferromagnetic foreign bodies","authors":"E. Horoshun, I. Lurin, V. Nehoduiko, V. Makarov, S. Tertyshnyi, R. Saliutin","doi":"10.26779/2522-1396.2022.9-10.25","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.9-10.25","url":null,"abstract":"Objective. To analyze the mistakes while application of modern surgical magnet instruments for diagnosis and removal of ferromagnetic foreign bodies. \u0000Materials and methods. In accordance to the exploitation-clinical criteria, the material, delivered by usages of the magnet instruments (623 respondents), about results of its clinical usage in period from 2014 yr up to nowadays, was analyzed. \u0000Results. In total the mistakes while application of surgical magnet instruments may be divided on two groups: the clinical and exploitation-technical Most quantity of clinical mistakes are connected with application of such instruments without indications, basically in absence of ferromagnetic fractures inside the wounds channels and cavities. Other causes of the mistakes were following: failure to include physiologic peculiarities of the wound process course, such as formation of capsule over foreign bodies, characteristic of the wound channel, choice of inappropriate nomenclature specimen and failure to include the vessels and neural trunks projections, leading to development of complications (hemorrhage, neuralgia, paresis), formation of the contraperture incision and mechanical removal of the fracture. Sterilization in a dry-heat wardrobe and physical damage of instruments were taken into account and have been considered as an exploitation-technical mistake. \u0000Conclusion. In accordance to the results obtained, the conduction of educational trainings for usage of surgical magnet instruments, guaranteeing reduction of the various mistakes and complications quantity, leading to maximal effect of its application are recommended.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89627452","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 : 2022-10-06DOI: 10.26779/2522-1396.2022.1-2.11
E. Board
Chronic diseases of veins of the lower extremities and pelvis. Clinical and practical recommendations
下肢和骨盆静脉慢性疾病。临床和实用建议
{"title":"Chronic diseases of veins of the lower extremities and pelvis. Clinical and practical recommendations","authors":"E. Board","doi":"10.26779/2522-1396.2022.1-2.11","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.1-2.11","url":null,"abstract":"Chronic diseases of veins of the lower extremities and pelvis. Clinical and practical recommendations","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90553925","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 : 2022-10-06DOI: 10.26779/2522-1396.2022.1-2.03
V. Popov, O. M. Gurtovenko, A. A. Bolshak, V. Boukarim
Objective. To study the possibilities of pharmaco–cold cardioplegia, while doing isolated prosthesis of the aortal valve. Materials and methods. Into the investigation were included 279 patients with aortal failures, operated in Department of Surgical Treatment of the Acquired Failures of the Heart of National Institute of Cardio–Vascular Surgery named after М. М. Аmosov in 2015–2021 yrs. The average age of the patients have constituted (62,5 ± 6,4) yrs old. In all the patients the isolated аоrtal valve correction for aortal failures was performed, using mechanical and biological prostheses. Infusion of “Kustodiol” solution for defense of the myocardium was applied. Results. On the hospital stage 9 patients died (hospital lethality have constituted 3,2%). Іnotropic support (dobutamin) in early postoperative period was applied in dosage of 3 – 4 mcg/kg/min during first 48 h. The levels of cardiac creatine phosphokinase enzyme on the second postoperative day, while exploiting antegrade, аnteretrograde, retroantegrade and retrograde methods of the cardioplegic solution delivery, have hade differences. Conclusion. Retrograde pathway of injection of cardioplegic solution permits to defense the myocardium effectively while correcting of aortal failure.
{"title":"Pharmaco–cold cardioplegia during isolated prosthesis of the aortal valve","authors":"V. Popov, O. M. Gurtovenko, A. A. Bolshak, V. Boukarim","doi":"10.26779/2522-1396.2022.1-2.03","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.1-2.03","url":null,"abstract":"Objective. To study the possibilities of pharmaco–cold cardioplegia, while doing isolated prosthesis of the aortal valve. \u0000Materials and methods. Into the investigation were included 279 patients with aortal failures, operated in Department of Surgical Treatment of the Acquired Failures of the Heart of National Institute of Cardio–Vascular Surgery named after М. М. Аmosov in 2015–2021 yrs. The average age of the patients have constituted (62,5 ± 6,4) yrs old. In all the patients the isolated аоrtal valve correction for aortal failures was performed, using mechanical and biological prostheses. Infusion of “Kustodiol” solution for defense of the myocardium was applied. \u0000Results. On the hospital stage 9 patients died (hospital lethality have constituted 3,2%). Іnotropic support (dobutamin) in early postoperative period was applied in dosage of 3 – 4 mcg/kg/min during first 48 h. The levels of cardiac creatine phosphokinase enzyme on the second postoperative day, while exploiting antegrade, аnteretrograde, retroantegrade and retrograde methods of the cardioplegic solution delivery, have hade differences. \u0000Conclusion. Retrograde pathway of injection of cardioplegic solution permits to defense the myocardium effectively while correcting of aortal failure.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89603136","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 : 2022-10-06DOI: 10.26779/2522-1396.2022.1-2.08
B. V. Luhts
Objective. To study and assess the rates and degree of severity of early and late radiation complications in patients after application of preoperative radiation therapy in complex treatment of the patients, suffering cancer recti. Materials and methods. Analysis of the treatment results in 113 patients, suffering locally–advanced (сT3с–4N1–2M0) cancer recti, who have obtained preoperative oncotherapy in 2019–2022 yrs in the Department of Radiation Therapy of Zakarpattya Antitumoral Centre, was performed. Results. Most frequent early radiation affection was rectitis, which have occurred – in 86 (76,1%) patients of 113. Early radiation affections of the reproductive system organs were noted in 5 (4,4%) patients. Late radiation affections were registered in 9 (7,9%) patients, mostly frequent in the gut system – in 5 (4,4%) patients. Conclusion. Аnalysis of the complex treatment results, performed in 113 patients with cancer recti, have shown, that preoperative radiation therapy do not enhance the rate of occurrence of early radiation complications and hematological toxicity. The rate of early radiation affections was 76,1%, and of the late – 7,9%.
目标。目的:研究和评价术前放疗在肿瘤直肠患者综合治疗中应用后患者早期和晚期放射并发症的发生率和严重程度。材料和方法。对2019-2022年在Zakarpattya抗肿瘤中心放射治疗科接受术前肿瘤治疗的113例局部晚期( t3 - 4n1 - 2m0)肿瘤患者的治疗结果进行分析。结果。最常见的早期放射影响是直肠炎，在113例患者中有86例(76.1%)发生。5例(4.4%)患者有生殖系统器官的早期放射损害。9例(7.9%)患者出现晚期放疗影响，主要发生在肠道系统，5例(4.4%)患者出现晚期放疗影响。结论。Аnalysis对113例直肠癌患者进行的综合治疗结果显示，术前放疗不会增加早期放射并发症和血液毒性的发生率。早期放射损害的发生率为76.1%，晚期为7.9%。
{"title":"Early and late radiation complications after application of preoperative radiation therapy in complex treatment of cancer recti","authors":"B. V. Luhts","doi":"10.26779/2522-1396.2022.1-2.08","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.1-2.08","url":null,"abstract":"Objective. To study and assess the rates and degree of severity of early and late radiation complications in patients after application of preoperative radiation therapy in complex treatment of the patients, suffering cancer recti. \u0000Materials and methods. Analysis of the treatment results in 113 patients, suffering locally–advanced (сT3с–4N1–2M0) cancer recti, who have obtained preoperative oncotherapy in 2019–2022 yrs in the Department of Radiation Therapy of Zakarpattya Antitumoral Centre, was performed. \u0000Results. Most frequent early radiation affection was rectitis, which have occurred – in 86 (76,1%) patients of 113. Early radiation affections of the reproductive system organs were noted in 5 (4,4%) patients. Late radiation affections were registered in 9 (7,9%) patients, mostly frequent in the gut system – in 5 (4,4%) patients. \u0000Conclusion. Аnalysis of the complex treatment results, performed in 113 patients with cancer recti, have shown, that preoperative radiation therapy do not enhance the rate of occurrence of early radiation complications and hematological toxicity. The rate of early radiation affections was 76,1%, and of the late – 7,9%.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81837907","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 : 2022-10-06DOI: 10.26779/2522-1396.2022.1-2.42
E. Board
Supplement tо clinic-practical recommendations “Chronic diseases of veins of the lower extremities and pelvis”
补充《下肢和骨盆静脉慢性疾病》的临床实用建议
{"title":"Supplement tо clinic-practical recommendations “Chronic diseases of veins of the lower extremities and pelvis”","authors":"E. Board","doi":"10.26779/2522-1396.2022.1-2.42","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.1-2.42","url":null,"abstract":"Supplement tо clinic-practical recommendations “Chronic diseases of veins of the lower extremities and pelvis”","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81360576","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 : 2022-01-12DOI: 10.26779/2522-1396.2021.11-12.59
I. Karol
Objective. To investigate pathogens in peritonitis. Materials and methods. In 2021 yr in Department of Surgery of Brovary Multidisciplinary Clinical Hospital were treated 360 patients with an acute peritonitis of various genesis: 186 (51.7%) women and 174 (48.3%) men. Results. In the patients 391 strains of microorganisms, which are optionally-anaerobic and aerobic of Gram-negative and Gram-positive pathogens were isolated: Escherichia coli – in 144 (36.8%), Streptococcus spp. – 52 (13.3%), Enterococcus faecalis – 47 (12.0%), Staphylococcus aureus – 37 (9.5%), Klebsiella pneumoniae – 31 (7.9%), Citrobacter – 25 (6.4%), Staphylococcus haemolyticus – 23 (5.9%), Pseudomonas aeruginosa – 14 (3.6%), Acinetobacter baumannii – 13 (3.3%), and Proteus mirabilis – 5 (1.3%) strains. Conclusion. Majority of microorganisms, isolated in patients, suffering peritonitis, was characterized by significant antibiotic resistance. Most frequently Escherichia coli was sowed – 36.8%. All strains of Escherichia coli isolated were resistant to vancomycine, clindamycine and linezolide.
{"title":"Microbiological aspects of peritonitis","authors":"I. Karol","doi":"10.26779/2522-1396.2021.11-12.59","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.11-12.59","url":null,"abstract":"Objective. To investigate pathogens in peritonitis. \u0000Materials and methods. In 2021 yr in Department of Surgery of Brovary Multidisciplinary Clinical Hospital were treated 360 patients with an acute peritonitis of various genesis: 186 (51.7%) women and 174 (48.3%) men. \u0000Results. In the patients 391 strains of microorganisms, which are optionally-anaerobic and aerobic of Gram-negative and Gram-positive pathogens were isolated: Escherichia coli – in 144 (36.8%), Streptococcus spp. – 52 (13.3%), Enterococcus faecalis – 47 (12.0%), Staphylococcus aureus – 37 (9.5%), Klebsiella pneumoniae – 31 (7.9%), Citrobacter – 25 (6.4%), Staphylococcus haemolyticus – 23 (5.9%), Pseudomonas aeruginosa – 14 (3.6%), Acinetobacter baumannii – 13 (3.3%), and Proteus mirabilis – 5 (1.3%) strains. \u0000Conclusion. Majority of microorganisms, isolated in patients, suffering peritonitis, was characterized by significant antibiotic resistance. Most frequently Escherichia coli was sowed – 36.8%. All strains of Escherichia coli isolated were resistant to vancomycine, clindamycine and linezolide.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83569453","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 : 2022-01-12DOI: 10.26779/2522-1396.2021.11-12.47
V. Petrushenko, D. Grebeniuk
Objective. To assess the efficacy of partial embolization of splenic artery in patients after hemorrhage of portal genesis. Materials and methods. Into the investigation 39 patients with verified diagnosis of hepatic cirrhosis, complicated by portal hypertension and hemorrhage from widened varicose esophageal veins, were included. Into the first group (n=17) were included the patients, to whom endoscopic ligature of bleeding varicosities and partial embolization of splenic artery performed; into the second one (n=22) - patients, to whom independent endoscopic ligature of bleeding varicosities performed. The levels of laboratory indices, characterizing hepatic functional state, were assessed monthly. Results. In the first group upon a time a progressive statistically significant improvement of all indices investigated was noted. In the second group a statistically significant improvement of all indices was observed in a period between first and second visit. In further times the changes did not have a statistical significance. While conduction of multifactorial analysis of variance for investigation of embolia impact on the pigmentary metabolism and the system of hemostasis indices a trustworthiness of this impact had grown up upon a time and on the fourth visist became statistically significant. While investigation of the embolization impact on the level of hepatic enzymes and the proteins metabolism indices the trustworthiness of the dependence have been grown upon a time as well, but its gaining of statistical significance was observed on the third visit already. Conclusion. Postoperative period after performance of partial embolization of splenic artery in patients, suffering hemorrhage of portal genesis, is characterized by positive dynamics of laboratory indices in hepatic functional state.
{"title":"Efficacy of partial embolization of splenic artery in patients after hemorrhage of portal genesis","authors":"V. Petrushenko, D. Grebeniuk","doi":"10.26779/2522-1396.2021.11-12.47","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.11-12.47","url":null,"abstract":"Objective. To assess the efficacy of partial embolization of splenic artery in patients after hemorrhage of portal genesis. \u0000Materials and methods. Into the investigation 39 patients with verified diagnosis of hepatic cirrhosis, complicated by portal hypertension and hemorrhage from widened varicose esophageal veins, were included. Into the first group (n=17) were included the patients, to whom endoscopic ligature of bleeding varicosities and partial embolization of splenic artery performed; into the second one (n=22) - patients, to whom independent endoscopic ligature of bleeding varicosities performed. The levels of laboratory indices, characterizing hepatic functional state, were assessed monthly. \u0000Results. In the first group upon a time a progressive statistically significant improvement of all indices investigated was noted. In the second group a statistically significant improvement of all indices was observed in a period between first and second visit. In further times the changes did not have a statistical significance. While conduction of multifactorial analysis of variance for investigation of embolia impact on the pigmentary metabolism and the system of hemostasis indices a trustworthiness of this impact had grown up upon a time and on the fourth visist became statistically significant. While investigation of the embolization impact on the level of hepatic enzymes and the proteins metabolism indices the trustworthiness of the dependence have been grown upon a time as well, but its gaining of statistical significance was observed on the third visit already. \u0000Conclusion. Postoperative period after performance of partial embolization of splenic artery in patients, suffering hemorrhage of portal genesis, is characterized by positive dynamics of laboratory indices in hepatic functional state.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90635566","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 : 2022-01-12DOI: 10.26779/2522-1396.2021.11-12.08
A. Nykonenko, G. Okhrimenko, M. G. Golovko, V. A. Grushka, S. O. Vilkhovoi, A. Aleksandrov
Objective. To study the immediate and remote results of treatment in patients with rectal fistulas, in whom Gabriel operation, Maslyak operation, and the ligature method were applied, as well as to create optimal indications to every kind of surgical intervention. Materials and methods. Results of treatment of 50 patients, suffering rectal fistulas, were analyzed. In 6 (12.0%) patients with intersphincteric and in 26 (52.0%) with transsphincteric fistulas Gabriel operation was performed, in 9 (18.0%) patients with transsphincteric and in 5 (10.0%) with extrasphincteric fistulas – Maslyak operation. In 2 (4.0%) patients with transsphincteric and in 2(4.0%) with extrasphincteric fistulas the ligature method was applied. Results. In 6 mo after Gabriel operation the anal sphincter insufficiency was noted in 2 (6.2%) patients with transsphincteric fistulas. Fistula’s recurrence have had occurred in 1 (7.1%) patient after Maslyak operation. Good remote results were obtained in all patients, operated with application of the ligature method. Conclusion. There was established, that Gabriel operation results are the best for intrasphincteric fistulas. In transsphincteric fistulas application of this operation must be restricted. Maslyak operation and the ligature method are rather effective in transsphincteric and extrasphincteric fistulas – 92.9 and 100.0% good results accordingly.
{"title":"The choice of method and results of surgical treatment for rectal fistulas","authors":"A. Nykonenko, G. Okhrimenko, M. G. Golovko, V. A. Grushka, S. O. Vilkhovoi, A. Aleksandrov","doi":"10.26779/2522-1396.2021.11-12.08","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.11-12.08","url":null,"abstract":"Objective. To study the immediate and remote results of treatment in patients with rectal fistulas, in whom Gabriel operation, Maslyak operation, and the ligature method were applied, as well as to create optimal indications to every kind of surgical intervention. \u0000Materials and methods. Results of treatment of 50 patients, suffering rectal fistulas, were analyzed. In 6 (12.0%) patients with intersphincteric and in 26 (52.0%) with transsphincteric fistulas Gabriel operation was performed, in 9 (18.0%) patients with transsphincteric and in 5 (10.0%) with extrasphincteric fistulas – Maslyak operation. In 2 (4.0%) patients with transsphincteric and in 2(4.0%) with extrasphincteric fistulas the ligature method was applied. \u0000Results. In 6 mo after Gabriel operation the anal sphincter insufficiency was noted in 2 (6.2%) patients with transsphincteric fistulas. Fistula’s recurrence have had occurred in 1 (7.1%) patient after Maslyak operation. Good remote results were obtained in all patients, operated with application of the ligature method. \u0000Conclusion. There was established, that Gabriel operation results are the best for intrasphincteric fistulas. In transsphincteric fistulas application of this operation must be restricted. Maslyak operation and the ligature method are rather effective in transsphincteric and extrasphincteric fistulas – 92.9 and 100.0% good results accordingly.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83597673","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 : 2022-01-12DOI: 10.26779/2522-1396.2021.11-12.03
O. Usenko, I. Lurin, K. V. Gumenuk, V. Nehoduiko, R. Mykhaylusov, R. Saliutin
Objective. To improve the results of treatment in injured persons with a gun-shot penetrating abdominal woundings with damages of large bowel, using introduction of principle for compliance between volumes of the damage and the primary operative intervention through organ-preserving operations. Materials and methods. There were analyzed 164 gun-shot abdominal woundings of large bowel in 151 injured persons. All the wounded persons were men, aged from 19 to 58 yrs old, (34 ± 5.2) yrs old at average. Penetrating cross-cutting abdominal woundings have occurred in 48 (31.8%) patients, the blunt – in 103 (68.2%). In accordance to character of the large bowel damage there were: deserozation - in 8 (5.3%) injured persons, the blunt wounding – in 57 (37.7%), and a through one – in 86 (57.0%). The bullet woundings have occurred in 31 (20.5%) injured persons, while the comminuted – in 120 (79.5%). The large bowel woundings have had following localizations: coecum – in 37 (24.5%) patients, ascending colon – 19 (12.6%), transverse colon – 32 (21.2%), descending colon – 18 (11.9%), sigmoid colon – 33 (21.9%), and several perts of large bowel – 12 (7.9%). The wounded persons were distributed into two groups, depending on volume of the operative intervention performed: the main – 49 (32.4%) wounded persons, in whom organ-preserving operations were performed, and a control one – 102 (67.6%) wounded persons, in whom resectional methods were applied. The large bowel wall defects suturing with or without formation of unloading colo- or enterostomy were considered as organ-preserving operations. Results. Definite decision, concerning the operative intervention volume, was made immediately after revision of the abdominal cavity organs, estimation of the damages character (special attention was drawn to dimensions, localization and quantity of intestinal defects, the state of its mesenterial edge and adequacy of a blood flow), presence and remoteness of extended peritonitis, general state of a wounded person (the blood loss volume, the sepsis features presence, hemodynamicac indices and common character of the woundings). Оne or several woundings of large bowel, including big in dimensions, were considered as indications for performance of organ-preserving operations (the intestinal wound suturing, the intestinal wound suturing with colo- or jejunostomy, extraperitonization). In patients of the main group, comparing with those of the control group, the stationary stay and the complications rate were reduced. After rehabilitation and staged closure of unloading stomas all wounded persons of the main group went back to service in Military Forces of Ukraine. Conclusion. Selecting the surgical treatment method for the gun-shot woundings of large bowel, it is necessary to base on complex analysis of the battle trauma character, the patient’s state and the risk for іntra- and postoperative complications. The first-line application of organ-preserving interventions as mor
{"title":"Оrgan-preserving operations in the abdominal gun-shot penetrating woundings of large bowel. Experience of the medical help delivery in military environment Аntiterroristic operation/The Joint Forces Operation","authors":"O. Usenko, I. Lurin, K. V. Gumenuk, V. Nehoduiko, R. Mykhaylusov, R. Saliutin","doi":"10.26779/2522-1396.2021.11-12.03","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.11-12.03","url":null,"abstract":"Objective. To improve the results of treatment in injured persons with a gun-shot penetrating abdominal woundings with damages of large bowel, using introduction of principle for compliance between volumes of the damage and the primary operative intervention through organ-preserving operations. \u0000Materials and methods. There were analyzed 164 gun-shot abdominal woundings of large bowel in 151 injured persons. All the wounded persons were men, aged from 19 to 58 yrs old, (34 ± 5.2) yrs old at average. Penetrating cross-cutting abdominal woundings have occurred in 48 (31.8%) patients, the blunt – in 103 (68.2%). In accordance to character of the large bowel damage there were: deserozation - in 8 (5.3%) injured persons, the blunt wounding – in 57 (37.7%), and a through one – in 86 (57.0%). The bullet woundings have occurred in 31 (20.5%) injured persons, while the comminuted – in 120 (79.5%). The large bowel woundings have had following localizations: coecum – in 37 (24.5%) patients, ascending colon – 19 (12.6%), transverse colon – 32 (21.2%), descending colon – 18 (11.9%), sigmoid colon – 33 (21.9%), and several perts of large bowel – 12 (7.9%). The wounded persons were distributed into two groups, depending on volume of the operative intervention performed: the main – 49 (32.4%) wounded persons, in whom organ-preserving operations were performed, and a control one – 102 (67.6%) wounded persons, in whom resectional methods were applied. The large bowel wall defects suturing with or without formation of unloading colo- or enterostomy were considered as organ-preserving operations. \u0000Results. Definite decision, concerning the operative intervention volume, was made immediately after revision of the abdominal cavity organs, estimation of the damages character (special attention was drawn to dimensions, localization and quantity of intestinal defects, the state of its mesenterial edge and adequacy of a blood flow), presence and remoteness of extended peritonitis, general state of a wounded person (the blood loss volume, the sepsis features presence, hemodynamicac indices and common character of the woundings). Оne or several woundings of large bowel, including big in dimensions, were considered as indications for performance of organ-preserving operations (the intestinal wound suturing, the intestinal wound suturing with colo- or jejunostomy, extraperitonization). In patients of the main group, comparing with those of the control group, the stationary stay and the complications rate were reduced. After rehabilitation and staged closure of unloading stomas all wounded persons of the main group went back to service in Military Forces of Ukraine. \u0000Conclusion. Selecting the surgical treatment method for the gun-shot woundings of large bowel, it is necessary to base on complex analysis of the battle trauma character, the patient’s state and the risk for іntra- and postoperative complications. The first-line application of organ-preserving interventions as mor","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80417563","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 : 2022-01-12DOI: 10.26779/2522-1396.2021.11-12.34
E. Maietnyi
Objective. To determine the application possibilities of objective criteria for volume and spectrum of lymphatic dissection in phthisiatric interventions. Materials and methods. The work was based on results of the treatment analysis of 275 patients, suffering phthisio-surgical pathology, in whom densitonetric indices of pulmonary parenchyma and mediastinal lymphatic nodes were investigated. Results. There was established, that the changed densitometric indices of mediastinal lymph nodes may characterize the prevalence of specific pulmonary process objectively and to present the criteria of choice for the necessary lymphatic dissection borders in phthisio-surgical interventions. If in the affected parts of pulmonary parenchyma the minimal densitometric meanings of 15 U of Hounsfield (HU) are determined, the ipsilateral lymphatic nodes ablation is indicated, while in 15 HU and higher – the ablation of partial and segmentary lymphatic nodes during the operative intervention. Lymphatic dissection was not performed if the pulmonary parenchyma densitometric indices in specific pulmonary process have exceeded 55 HU. Conclusion. Lymphatic dissection in phthisio-surgical interventions («sampling») may be performed in accordance to objective criteria for lowering of the occurrence risk for pleuro-pulmonary complications and prevention of nonsubstantiated extension of operative intervention.
{"title":"The choice between lymphatic dissection in phthisio-surgical interventions, basing on densitometric characteristics","authors":"E. Maietnyi","doi":"10.26779/2522-1396.2021.11-12.34","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.11-12.34","url":null,"abstract":"Objective. To determine the application possibilities of objective criteria for volume and spectrum of lymphatic dissection in phthisiatric interventions. \u0000Materials and methods. The work was based on results of the treatment analysis of 275 patients, suffering phthisio-surgical pathology, in whom densitonetric indices of pulmonary parenchyma and mediastinal lymphatic nodes were investigated. \u0000Results. There was established, that the changed densitometric indices of mediastinal lymph nodes may characterize the prevalence of specific pulmonary process objectively and to present the criteria of choice for the necessary lymphatic dissection borders in phthisio-surgical interventions. If in the affected parts of pulmonary parenchyma the minimal densitometric meanings of 15 U of Hounsfield (HU) are determined, the ipsilateral lymphatic nodes ablation is indicated, while in 15 HU and higher – the ablation of partial and segmentary lymphatic nodes during the operative intervention. Lymphatic dissection was not performed if the pulmonary parenchyma densitometric indices in specific pulmonary process have exceeded 55 HU. \u0000Conclusion. Lymphatic dissection in phthisio-surgical interventions («sampling») may be performed in accordance to objective criteria for lowering of the occurrence risk for pleuro-pulmonary complications and prevention of nonsubstantiated extension of operative intervention.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88800968","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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