Klinichna khirurgiia最新文献

The impact of surgical method on results of complex treatment in patients, suffering the osteosarcoma metachronous pulmonary metastases, was studied. The survival indices in 93 patients were analyzed, of them in 71, suffering osteosarcoma - with complex treatment, including surgical intervention of complete excision of all metastases (three-years survival – 34.2%), and in 21 – complex treatment with palliative radiation therapy (three-year survival 3.7%). Trustworthy impact on three-years survival indices was proved for such clinical factors, as the terms of the metastases occurrence (6 mo and lesser, and more, than 6 mo) and quantity of metastases (up to 5, 5 and more) present.

Impact of the wounds coverings on the wounds contents pH in the injured persons, suffering superficial burns of skin, was studied. In 75 patients (the main group) the wounds treatment was accomplished under the wounds covering, in 35 of them xenotransplants were applied, and in 40 – coverings made of hydrogel. In 35 patients (the comparison group) the moisture-drying gauze bandages were used. There was established, that the wound indices of pH constitute an important factor for the burn wounds healing. The changes of the media pH towards the acid one under the wounds covering had stimulated the wounds healing and epithelization.

Hepaticojejunoanastomosis (HJА), using the HF-еlectric welding method, was formatted in 14 patients, suffering the bile outflow disorders along main biliary ducts, in 6 of them - with a common hepatic duct stricture, the HJA stricture, purulent cholangitis, iatrogenic injury of biliary ducts, and in 8 – with malignant tumours of periampullary zone. In all the patients the welding averting one-layer termino-lateral or latero-lateral HJА were formatted. Welding anastomoses were hermetic, quite hard, immediately after formation and so on. Comparative analysis of clinic-laboratory postoperative indices has confirmed the best results achievement of the method proposed.

The experience of preoperative application of the intratissue electrophoresis with the dioxysol solution was analyzed for the patients, suffering chronic anal fissure. In the patients, beginning from the first day, there was proved the reduction of the pain syndrome severity, hemodynamic disorders, an acute inflammatory reactions in the anal fissure tissue, the young granulations growth in the edge of the wound and resection. Application of the method proposed have promoted the inflammatory process severity reduction, the reparative processes in anal fissure stimulation, the operation wound epithelization acceleration, the anal sphincter muscle spasmelimination, which constitutes the main pathogenetic mechanism of the disease.

The character and sequence of changes in the tissues structure of the gastrointestinal walls under the impact of the impulse and constant delivery of electric pressure with frequency 440 kHz were studied. The investigation object was squeezed, using the force, measured from 2 to 6 N/mm2. The ЕКВЗ-300 «Patonmed» apparatus was used as a source of supply. Еlectric parameters of the process was fixed, using the analogue-numerical digital converter LCard E20-10 and laboratory oscilloscope Tektronix TDS 3014C. There was established, that electric conjunction of stomach and small intestine include three elements: destroying and disappearance of mucosa, connective tissue and membranes; fusion of the collagen fascicles and the smooth muscle cells; the loss of the collagen fascicles and the smooth muscle structure and creation of homogenous еlectric welding suture. The first two elements of the electric welding anastomosis are occurring simultaneously, but not dependent one from the other. At the welding suture completion the nondestructive changes of the tissues are spreading on a distance not more than 1 mm beyond the borders of the electrods apposition.

Significance of the tissues oedema and its elimination in the course of inflammation and the wound healing was investigated. There were analyzed the results of treatment of 68 patients, suffering inflammatory and necrotic affection of soft tissues, including 65 – a lower one, 3 – an upper. In 47 observations the affection course was an acute, while in 18 – chronic. In 36 patients (control group) a local and systemic antibacterial therapy were conducted, and in accordance to indications – surgical interventions; in 32 (main group) this treatment was added with tight bandaging of the extremity, using elastic bandage. Tight squeezing of tissues with the oedema elimination on background of an adequate antibacterial therapy and surgical sanation of purulent-necrotic focus is accompanied by arrest of infiltrative and exudative stages of an acute inflammation, promotes an active course of the inflammation proliferative stage. While treatment of chronic cutaneous defect, the application of tight squeezing have promoted the granulating shaft resolution, the granulation growth in the wound and its boundary epithelization.

The method of magnet resonance tomography was applied for early diagnosis of the burn depth and dynamics of processes in the tissues in the course of its treatment and verification of occurring complications. Application of the method proposed for diagnosis and control of therapy have permitted to estimate expediency and determination of volume of early surgical treatment objectively.

In experimental research the method for determining of viability of tissue and device for its realization were developed to improve treatment results degloving injuries of limbs.

Results of diagnosis and treatment of 19 injured persons, suffering esophageal damage of various etiology, were analyzed.Peculiarities of clinical signs and diagnosis of esophageal injury on various levels and complications were investigated. Various methods of the injured persons’ treatment, concerning the damage character, terms of appeal for medical care, presence of complications and concurrent diseases, were adduced. Optimal ways of treatment for the injured persons, suffering esophageal damage, were proposed.

The investigation objective was to improve the patients’ management, suffering a single cardiac ventriculus, in whom a total cavа-pulmonary connection (ТСРС) operation was performed together with correction of the atrio-ventricular valves (AVV) insufficiency, basing on analysis of immediate and middle-term results. From 2005 to 2015 yrs in the clinic the ТСРС operation was performed in 132 patients. Of them 24 patients were choosed , in whom moderate and pronounced insufficiency of systemic AVV was diagnosed. Good early and middle-term results were achieved in 92% patients. In 8 observations, while the AVV correcting, in every patient two and more procedures of plasty were applied. Complex approach, using combination of various procedures of plasty, has guaranteed the optimal result. Application of procedures for the fiber ring stabilization have promoted achievement of best results.