Klinichna khirurgiia最新文献

Results of surgical treatment for various clinic-morphological forms of chronic pancreatitis were presented. Efficacy of surgical treatment of the patients, using elaborated individual tactics, was analyzed. There was noted, that morphological changes in the pancreatic gland tissue determines peculiarities of surgical tactics for individual patient. Оperative interventions must be performed for the pain syndrome, for the foregut and common biliary duct impaction, as well as acidic affection of pancreatic gland, fibrous pancreatitis. Indications for miniinvasive operations for chronic pancreatitis were substantiated. While estimating efficacy of miniinvasive and radical operative interventions for chronic pancreatitis a lesser postoperative morbidity and lethality rate was noted, when miniinvasive procedures were applied.

Acute necrotic pancreatitis was followed by disorders of intestinal functions in 96.7% of patients and in 68% — its failure was occurred what had directly influenced on frequency of purulent—septic complication and mortality rate. It was proved that citrulline plasma level had been objectively reflected the severity of enteral failure and served as independent lethality criteria in patients with acute necrotic pancreatitis.

Vacuum therapy of an acute and chronic wounds was used in a complex of surgical treatment of 228 patients, suffering diabetic foot syndrome.There was established a positive local and systemic action of this method for the treatment of the wound defect. Vacuum therapy of the wounds guarantees the wound process clinical course stabilization, improvement of microcirculation, reduction of their microbial soiling, stimulation of regenerative processes, elimination of endogenous intoxication.

The efficacy and prognostic significance of the forced intraarterial injection of medicinal preparations in complex of treatment in patients, suffering chronic ischemia of the lower extremities tissues, was studied. In experimental conditions of the main blood flow blockade the forced intraarterial injection of medicinal preparations have promoted the release of vessels from cellular aggregates and the blood clots; and in the ischemia of degree ІІ - ІІІа – has determined more pronounced clinical improvement. Appearance of reactive hyperemia of the foot in terms more than 2 min have witnessed the hopelessness of the extremity saving.

Local morphological changes were studied in dynamics in 215 patients, suffering diabetic foot syndrome. While an adequate local treatment conduction, in accordance to the standards elaborated, the histological investigations data have shown the oedema, the cellular infiltration and microcirculatory disorders reduction in the wound boundary zone. In 1 week of treatment in biopsies a young granulating tissue was observed, consisting of big quantity of vascular loops, oriented perpendicularly towards the wound surface and multiple bundles of fibroblasts. In a period of 2 weeks an active multilayered wound defect epithelization was seen. The stratum creeps, right from the skin secured, covering the wound surface.

Comparative analysis of two variants of transcutaneous nephrolithotripsy (TCNLT) in 45 patients, suffering nephrolithiasis, was performed. In 17 patients (the first group) the ultra-mini (UM) TCNLT, using tubus 11Сh, was done, and in 28 patients (the second group) – TCNLT, using a standard tubus 24Сh. The operation duration in the first group have had constituted (86.2 ± 16.3) min at average, and in the second group – (51 ± 13.6) min. The method of UМ TCNLT is a secure, miniinvasive, owing low rate of morbidity, comparing with a standard procedure, but with equal efficacy, concerning the «stone free» status (accordingly, 95.3 and 96.5%) in patients when calculi’s diameter up to 2 sm. Тubus 11Ch guarantees lesser risk of hemorrhagic complications occurrence, permits to conduct UM TCNLT without nephrostomic draining of the renal calyx and pelvis system more confidently.

Experience of differential diagnosis of pleural diseases, accompanied by pleuroabdominal pain syndrome, simulating «an acute abdomen», was summarized. In a pleural exudate syndrome such a course was noted in 17 (3%) patients, of them 7 (1.23%) were operated on; and in a syndrome of spontaneous pneumothorax – in 3 (1.7%), 1 (0.4%) was operated. Diagnostic algorithm was proposed.

Results of 242 patients treatment, suffering the trunk and extremities covering tissues defects, which have had occur as a consequence of mechanical injury in a 2008 – 2016 yrs period, were analyzed. There were 697 оperative interventions performed, of them 492 (70.6%) – aiming to restore the tissues injured.The choice of method of the correcting intervention and the tissues defects covering have depended upon the wound dimension and depth, as well as peculiarities of hemodynamics in the area injured. Application of differentiated approach to choice of method for the wound surfaces closure, which were created as a consequence of mechanical injury, have had permitted to achieve satisfactory results in 98.75% of patients.

There were examined 87 patients, suffering prostatic gland diseases, in whom the level of general prostate-specific antigen (PSA) in the blood have constituted 0.5 – 30 ng/ml. In 27 of them prostatic gland diseases were not revealed, in 28 – prostatic cancer was diagnosed, and in 32 – benign prostatic hyperplasia. There was proved, that rate of prostatic cancer and benign prostatic hyperplasia have correlated with prostatic gland volume and depended upon PSA and its isoforms concentration in the blood. The [-2] proPSA in the blood serum level have differed in all three groups, and the level of general and free PSA – in patients of group I, comparing with that in the groups 2 and 3. That have witnessed the possibility of determining of the [-2]proPSA content as alternative biomarker of early and differential diagnosis of prostatic cancer.