Klinichna khirurgiia最新文献

Results of treatment in 2010 - 2015 yrs of 187 patients, suffering haemodynamically significant stenosis of carotid arteries, on background of upcoming surgical treatment of the lower extremities tissues chronic ischemia, an ischemic heart disease or diseases of digestive system, were analyzed. In generalized atherosclerosis and an acute disorder of the brain blood circulation in anamnesis it is necessary to conduct the carotid arteries affection screening. In haemodynamically significant stenosis of carotid arteries in patients, suffering an ischemic heart disease and the digestive system diseases, as a first stage a carotid endarterectomy was performed for reduction of the occurrence risk for ischemic insult after operation performed for the main disease.

The method of restorative treatment for experimental spinal cord trauma (SCT), using implantation of synthetic matrix in combination of neurogenic stem cells, was introduced. Motor function of posterior іpsilateral extremity (PIE) was estimated in accordance to Basso–Beattie–Bresnahan (ВВВ) scale. Application of the method proposed have promoted essential enhancement of early neuroprotecting impact of the implanted NeuroGelTM, reducing time of early restoration of the PIE function.

In the clinic surgical interventions on the ENT-оgans were designed and improved, using electric welding technology, including bipolar electric instruments, which were elaborated, in team with the staff members of Institute of Paton Electric Welding. The elaborated operative interventions owe advantages in aspects of their enhanced quality and the duration reduction. Application of the elaborated bipolar electric instruments permits to reduce the intraoperative blood loss severity significantly.

The changes in antibiotic sensitivity of the purulent-necrotic processes agents under the low-intensive laser irradiation impact were studied in experimental part of the investigation. There were 156 patients, suffering neuropathically-infected form of the diabetic foot syndrome, examined and treated, in 41 of them the iodine deficiency was revealed. Durable regional intaarterial infusion, low-intensive laser irradiation and preparations of iodine in a daily dose of 200 mcg were applied. High efficacy of the antibacterial therapy photomodification was proved, it have permitted to improve the results of treatment, to refuse from disabling operations in majority of the patients, to secure the foot bearing function. While the iodine deficiency presence the results of treatment are improved due to application of the iodine preparations.

Possibility of application of the living tissues electric welding technologies in the treatment of varicose disease of lower extremities, using endovenous electric welding (EVEW) of large subcutaneous vein (LSV), was studied, its optimal parameters were determined. ЕVEW have provided effective impact on venous vessel, and guaranteed secure obliteration of LSV. The method may be used successfully in the treatment of varicose disease. Optimal parameters of EVEW, secure and safe in clinical conditions, were determined in experiment. Absence of negative impact of EVEW towards adjacent tissues have permitted to perform intervention without tumescent anesthesia. Further improvement and introduction of the EVEW method opens new possibilities for enhancing of quality of the varicose disease surgical treatment.

Results of examination and treatment of 12 children, operated on in various clinics for Hirschprung’s disease, in whom chronic constipation and other signs of anorectal dysfunction have occurred, were analyzed. In 8 patients Duhamel-Bairov operation was conducted, in 2 – Soave-Lenyushkin operation, and in 2 – Soave-Boley operation. The main cause of postoperative chronic constipation occurrence after Duhamel operation is the colorectal septum preservation. The only one radical method of treatment of this complication is a transanal removal of colorectal septum. The cause of anastomotic narrowing after Soave-Boley operation was absence of myotomy intraoperatively and of bougienage – after it. Elimination of chronic constipation in such patients, using long-standing bougienage and complex conservative treatment. The main cause of chronic constipation and nocturnal encopresis after Soave-Lenyushkin operation was preservation of the tissue excess while doing resection of a large bowel stump and creation of the narrowed ring, looking like a pendent plica. Complete reconvalescence of such patients is possible in transanal method of excision of stenosing ring and conduction of complex treatment.

Experience of performance of a pulmonary autograft operation (PAO, оperation of Ross) was analyzed, results were estimated, the ways of overcoming a procedure conduction problems were determined. Remote result was investigated in 151 patients: the aortal valve stenosis was diagnosed in 99 (65.6%) patients, insufficiency - in 42 (27.8%), combined aortal valve failure - in 10 (6.6%). Hospital lethality have constituted 3.6%, and a general one – 7.9%. Reoperations were performed in 52 patients. PAO constitutes one of surgical procedures for the aortal valve failure in children of different age. Improvement of surgical technique and application of a new procedures have promoted improvement of the investigation results – lethality lowering from 15.1 to 0.8%. Application of surgical modifications with the aortal radix strengthening have reduced the reoperations on neaortal valve risk trustworthy.

There were examined in dynamics 724 patients, in whom complicated diabetic foot syndrome (DFS) was diagnosed, and in 71 (9.8%) of them the disease was complicated by sepsis. The state severity in a DFS patients have depended upon duration of purulent-necrotic process on the foot, in septic patients such dependence was not revealed. All the DFS patients without sepsis were operated on. In total 36 died (lethality 5.5%), in presence of sepsis - 42 (lethality 59.1%). The cause of sepsis in the patients, suffering complicated DFS, was predominantly a wet gangrene of the lower extremities. Among those, who were not operated on, 13 (30.9%) septic patients died, of them 5 – who refused operative intervention performance - died in first hours after admittance to hospital due to irreversible injury of organs and systems.

Laparoscopic hernioplasty, of them in 19 - for recurrence of hernia after auto- (in 10) and alloplasty in accordance to Liechtenstein procedure (in 9), and in 11, suffering bilateral hernias - were performed in 2011-2016 yrs in 149 patients. All the patients are alive. Complications have occurred in 21 patients. The main technical complexities have occurred in injury of upper epigastric vessels. Оperative interventions, using laparoscopic procedures are effective, pathogenetically substantiated, guaranteeing comfortable course of postoperative period and possibility of early rehabilitation of the patients.

The results of miniinvasive transcutaneous interventions for purulent—septic complications of pancreonecrosis are presented. The computeric tomography (CT) and the ultrasound investigation data where compared while choosing of transcutaneous access towards purulent focus. Peculiar attention was drawn to searching of extraperitoneal trajectory for the drain conduction way. The drains were installed, using a one—staged method with a stylet catheters, owing 10 — 12 Fr in diameter, or a two—staged one. While comparing various methods of treatment of the pancreonecrosis purulent—septic complications there was established efficacy of miniinvasive interventions, performed for pancreatogenic abscesses and relatively delimited purulent foci in retroperitoneal cellular tissue.