Klinichna khirurgiia最新文献

There were studied the skin specimen from 40 dead persons, aged from 23 to 87 yrs, (52 ± 15.6) yrs at average, with the objective to investigate the biochemical properties and establishment of experimental deformation angles. Basing on the biomechanical tissues background of the anterior abdominal wall topographo-anatomic regions there were analyzed the results of treatment in the patients, оperated on for the anterior wall deformities and defects, concerning biomechanical possibilities of the flaps and classic methods of the tissues mobilization applied. There was established, that in borders of possible plastic deformity the tissues pressure distribution have persisted in normal range, and this have promoted the cicatricial tissue formation, which did not differ in characteristics from the adjacent connective tissues structures, what have had guaranteed the uncomplicated course of the wound process. Biomechanical properties of adiposo-cutaneous flaps must be taken into account while manipulating with them with the objective of obtaining an optimal distribution of pressure along the flaps and conditions for obtaining of the tissues adequate reaction on operative trauma, while performing interventions on the anterior abdominal wall for its defects and deformities, guaranteeing better esthetic result of treatment, reduction of postoperative morbidity and stationary stay.

Structure of the gun-shot-explosive woundings (GSEW) of the peacetime, occurred in 35 children, was analyzed with refinement, concerning a weapon kind and motif of application, as well as clinic-epidemiological and clinic-nosological characteristics of injuries. Аnalysis of the data was conducted in accordance to criteria and demands of evidence-based medicine, using the methods of nonparametric statistics and computeric technologies. Clinic-epidemiological characteristic of the wounded persons have had witnessed, that due to the GSEW accidents suffer children, ageing (11.97 ± 0.68) yrs, mainly boys. The main causes of GSEW were: careless handling of weapons - in 52.6% observations, hooligan’s actions - in 28.9%. Clinical peculiarities of a peacetime GSEW in children have had depended upon the injury severity, caused by special kind of traumatic weapon and traumatic missiles applied.

The complex of operative interventions on all levels of medical add was analyzed in 57 wounded persons, treated for the brachial bone gun-shot fracture and for the extremity affection on the humerus level in 2014 - 2015 yrs period. Primary and repeated surgical processing of the wounds was done in 94.7% wounded persons, the core аpparatuses of external fixation were imposed in 85.9%. Vacuum-therapy was conducted in 17.5% wounded persons, free autodermoplasty and autovenous prosthesis of artery was accomplished in 10.5%. Good functional results were achieved in 47.4% wounded persons, satisfactory - in 40.3%, bad - in 12.3%. The management and treatment-diagnostic faults were analyzed.

Results of treatment of 84 patients, to whom simultant operative interventions on abdominal, the small pelvis and retroperitoneal organs were performed for concomitant somatic diseases, were analyzed. The author’s technology of laparolifting was applied in 36 patients, and classical technology with carboxyperitoneum adjustment - in 48. Variants of optimal operative accesses were determined, structure and rate of postoperative complications, peculiarities of the early postoperative period course studied. Indisputable advantages of the lifting laparoscopic operations were established, including reduction of the postoperative complications rate and severity, the postoperative pain syndrome intensity, the concurrent chronic diseases exacerbation rate, and postoperative stationary stay.

Efficacy of the cognitive deficiency prophylaxis was studied in patients, suffering stenotic affection of carotid arteries. Application of intraoperative neuroprotection, using neoton, have permitted to reduce the reperfusion syndrome signs rate from 35.6 to 3.4%, аnd the cognitive deficiency level as well, causing the general occurrence risk of intraoperative or early morbidity lowering. It is expedient to apply the multidisciplinary approach for guaranteeing of adequate quality of clinical monitoring for cognitive functions.

Results of treatment in 2000-2016 yrs of 183 patients for the neck phlegmon were analyzed. In 60 (32.8%) of them a descending purulent mediastinitis (DPM) was diagnosed. The main causes of the DPM occurrence were tonsilogenic and odontogenous factors. Postoperative lethality in DPM have constituted 25%.

The treatment results in patients, suffering chronic hemorrhoidal disease stages III- IV, in accordance to the elaborated method of hemorrhoidectomy, using radio-wave scalpel «Surgitron TM» with further welding of vascular pedicle, applying high-frequency electrocoagulator ЕК-301М1, are presented. In the patients, оperated on in accordance to the method proposed, the intraoperative complications rate and the blood loss severity were essentially lesser than in a comparison group. Owing an adequate level of surgical skills, the operative treatment method elaborated guarantees the reduction of early and late postoperative morbidity, rapid coming back to routine way of living postoperatively.