Klinichna khirurgiia最新文献

In the experiment on 50 rabbits cholecysto-entero and entero-entero anastomoses were formed on intestinal Roux loop. In 35 animals (the main group) a single layer evert- ing anastomoses by using high frequence (HF) electric welding method were formed, in 15 (the comparison group) single row suture anastomoses has been done. The anas- tomosis sufficiency were performed by using hydropressure, pneumopressure meth- ods and breakload test. It was established that all anastomoses formed by HF-electric welding method were passable and hermetic, also had strong sufficiency. Strength of weld joint in the postoperative period increased in a linear progression and after 3 weeks almost reached strength intact intestine (240-250 mm Hg).

With the aim of the clinical significance studying of the abnormal myocardial deforma- tion (MD) patterns in left ventricle (LV) there were examined 45 patients, in whom oper- ative myocardial revascularization was performed for an ischemic heart disease. Also 31 volunteers were examined. Postsystolic myocardial contruction (PMC) of the LV, depending on its mechanism, was classified: in absence of the affection - PMC-0, in presence of myocardial ischemia - PMC-1, in loss of contractility - PMC-2a, in loss of elasticity - PMC-2b. There were depicted PMC, occurring due to overloading by pressure, delay in a free LV wall activation, protosystolic and intrasystolic delay of myocardial contruction of obscure origin. PMC-1 in the ischemic heart disease was revealed in the LV segments affected only, PMC-2 - in presence of LV aneurysm only. Appearance of PMC-1 constitutes a criterion of the myocardial function restoration. The PMC-2 severity lowering had witnessed improvement of the patients clinical state. The contraction delay of obscure origin may not be considered a criterion of the LV myocardium state.

The method of the implant fixation for prophylaxis of complications after alloplasty of complex abdominal wall defects was proposed. Taking into account physico-mechan- ical parameters of implant, degree of anisotropy, in accordance to mechanical and morphological characteristics of the abdominal wall musculo-aponeurotic structures, it is possible to individualize the choice maximally, to plan the alloplasty kind, and to determine the method of optimal surgical treatment objectively.

Retrospective analysis of the surgical treatment results in 34 patients, operated for intraoperatively diagnosed Mirizzi syndrome (MS), was done. Analysis of intraoperative changes have witnessed, that while transition occurrence of MS from the first to the fifth type a severity of morphological changes in a gallbladder-biliary ducts-duodenum system enhanced with duodenal integrity loss and development of cholecystobiliary or cholecystodigestive fistula. Surgical correction of MS have envisaged cholecystectomy performance or subtotal resection of gallbladder, plastic closure of biliary fistula, using various procedures, external biliary draining and formation of hepaticojejunostomy in accordance to Roux method.

Application of a spongy microporous tampon in accordance to technology elaborated was proposed for enhancement of the mechanical clearance efficacy of the gun-shot soft tissues wounds. A procedure of manufacturing and application of spongy microp- orous tampon for the mechanical clearance of a gun-shot wounds was depicted. The clearance efficacy was improved due to application of the method elaborated, wit- nessing possibility of its usage on all stages of the surgical aid delivery.

Possibilities of laparoscopic technologies application while surgical excision of gas- trointestinal stromal tumors (GIST) were analyzed. In 2000 - 2015 yrs in the clinic 28 patients were operated on for gastric GIST. In 10 of them laparoscopic gastric resec- tion with tumor (in 3 - the tumor excision in borders of nonaffected tissues, in 4 - gas- tric fundus resection or stapler resection of a great curvature together with tumor, in 3 - transgastric excision of the tumor, using staplers) surgery was done. The disease recurrence in 2-5 yrs follow-up was absent. Laparoscopic operations has advantage over open interventions while preserving oncological radicalism.

The rate of the highly differentiated thyroid microcarcinoma methastasizing in central (6th) group of cervical lymph nodes was studied. In the clinic in 2013 - 2015 yrs 62 patients were operated for primary thyroid microcarcinoma. In accordance to TNM (UICC, AJCC, 2009) classification, papillary cancer in stage TlaNOMO was diagnosed in 35 (56.5%) patients, T1aN1MO - in 22 (35.5%); follicular cancer stage T1aNOMO - in 2 (3.2%); papillary cancer, follicular variant in stage T1aN1 MO - in 2 (3.2%); follicu- lar cancer, papillary variant in stage T1aNOMO - in 1 (1.6%). In 8 (12.9%) patients intraorgan multifocal metastasizing into contralateral thyroid lobe was revealed. In accordance to morphological investigation date of the excised samples, in 24 (38.7%) patients the metastases into the 6th group lymph nodes were revealed. In 4 (16.7%) patients, to whom lateral cervical lymphodissection was done, metastases in 2 - 5th groups of lymph nodes on the thyroid affection side were revealed.

Results of 20 patients with a recurrent goiter (RG) surgery were analyzed. All patients were from 37 to 73 years old. One-sided RG was in 6 patients, bilateral RG - in 14. With the purpose of specific intraoperation complications prevention the original method of final hemi- or thyroidectomy was developed. The observance of algorithm of actions during an operation concerning RG allows to prevent the damage of recur- rent laryngeal nerve and parathyroid glands.