Klinichna khirurgiia最新文献

Dynamical sonoelastography with technology of acoustic radiation force imaging (ARFI)and estimation of the shear wave elastography(SWE) were applied in 78 patients, suf'fering venous thrombosis (VTH), while presence of floating proximal part of thrombus.Empirical border index SWE is adduced, its value constitutes 2.5 m/s. Basing on theinvestigations results data, three categories of the VTH embologenic risk were estab'lished: high (SWE up to 2 m/s), middle (SWE 2 — 3 m/s), low (SWE over 3 m/s), whatpredicts the treatment tactics. Dynamical sonoelastography with ARFI technology andthe SWE estimation permits to reveal embologenic forms of VTH objectively and tochoose adequate tactics of the patients' treatment.

Immediate and late results of the combined gastrectomy (CG) performance in 719patients, suffering locally—spread gastric cancer (LSGC), were analyzed. Additionalresection of adjacent оrgans was performed in 165 observations. In early postoperativeperiod complications in 116 (16.1%) patients have had occurred, including surgicalcomplications — in 77.7%, and nonsurgical — in 22.3%. Lethality in 30 postoperativedays have constituted 11.1%. Тhe patients' postoperative life time was at average (22.9± 1.67) mo, mediana— 9.3 mo; indices of 3—year and 5—year survival — (18.9 ± 1.72)and (12.9 ± 1.51)%,accordingly. Essential difference in favor of subtotal distal gastricresection was established, basing on comparison data between this procedure and CG.The data obtained witnessed the expediency of combined operative interventions, whathave had widened possibilities of the patients' radical treatment for LSGC.

Incidence of cancer recti (CR)in Ukraine constitutes 38 in 100 thousands of population.There are two main trends in surgical treatment of precancerous states and early stageCR: radical rectal resection and local transanal excision of the affection zone. After asingle—port procedure introduction into laparoscopic surgery the alternative method ofrectal tumors resection have had evolved — a transanal minimally invasive surgery withsingle—port (TAMIS). In the clinic the TAMIS procedure was applied in 3 patients foradenomatous rectal polyps. Оperative intervention was done using transanal videoen'doscopic excision of villous rectal tumor. First experience of application of TAMIS wit'nessed the method efficacy, its relatively low cost and low risk of complications occur'rence. Application of this adopted procedure contributes for improvement of the treat'ment results in rectal tumors.

The investigation objective was to estimate the peritoneal adhesions formation risk inchildren with phenotypic signs of the connective tissues dysplasia (CTD—syndrome).On the first stage the formalized phenotypic clinical signs were estimated in accor'dance to χ2 Pearson criteria (p<0.05). On the second stage a prognostic value of genet'ic polymorphism of N—аrylacetyltransferase—2 (NAT2) gene for determination of riskfor the occurrence of postoperative adhesive process in abdominal cavity, using themethod of allele—specific amplification of NAT2 аllele with the help of polymerase chainreaction (PCR), was determined. In accordance to results of investigation, obtained inchildren with CTD—syndrome a genetic polymorphism NAT2 was revealed rather morefrequently, responsible for "rapid аcetylation", they constitute the risk group for theadhesion ileus occurrence, in them complex prophylactic measure must be undertak'en, beginning from intraoperative stage.

Retrospective analysis of the multispiral computer tomography results was conductedin 52 children, suffering portal hypertension (PH). Three types (А, В, С) of thesplenomesenterial confluence (SMC) structure were delineated. Basing on anatomicalpeculiarities of SMC, possibility of the mesocaval shunting (МCSH) performance inaccordance to procedures of side—to—side or of a Н—like MCSH (Н—MCSH) in aSMC types А and С is nearly similar; in a SMC types В the possibility of Н— МCSH per'formance is exceeding that of MCSH in a side—to—side fashion. Decompression prop'erties and changes in portohepatic perfusion (PHP) after application of MCSH in vari'ous SMC types were analyzed. The greatest decompression and preservation of PHP inSMC types В and С were achieved after performance of MCSH in a side—to—side fash'ion. In a SMC type А the essential difference of these indices in various kinds of MCSHwas not observed.

Analyzed the results of surgical treatment of 132 patients, including 68 — for cancer ofthe pancreatic head (in 46 — with jaundice) and 64 — chronic pancreatitis (CP) with aprimary lesion of the pancreatic head (16 — with jaundice). The distribution of patientsinto groups was carried out with a maximum value of classification functions calculatedby special formulas. Next studied indicators of endothelial dysfunction for differentialdiagnosis. A certain threshold of VEGF = 346 pg / ml, in which the patients were divid'ed into groups: СP and cancer on the pancreatic head. It was even more accurate indi'cator threshold VEGF = 248 pg / ml. To predict the severity of the pathological process,along with the use of diagnostic data, using the method of classification trees.Pancreatoduodenal resection for Whipple was performed in 23 patients, for Traverso—Longmire — in 8, subtotal right sided pancreatectomy for Fortner — in 3, hepaticoje'junostomy by Roux — in 8, duodenopreserving resection for Beger — in 6, her Berneseoption — in 7, operation Frey — in 51. In 26 (19.7%) patients, minimally invasive inter'vention for removal of bile were spread through the final primary pathological processand severe general state. Postoperative complications occurred in 18 (13.6%) patients,died 3 (2.3%).

Impact of the autologous cells transplantation in complex of treatment of complicatedarterial form of thoracic outlet syndrome was estimated. In accordance to the proce'dure proposed 18 patients were operated on, in 16 patients a standard decompressiveand reconstructive operative interventions were performed. The proposed procedureapplication have promoted improvement of the patients' treatment results due to opti'mization of microcirculation and angiogenesis.

The investigation objective was to improve the immediate results of surgical treatmentof the aortal valve failure, applying minimization of operative trauma and, accordingly,rapid functional rehabilitation of patients. The aortal valve prosthesis, using minimallyinvasive access, was conducted in 44 patients. There was proved, that conduction ofministernotomy for strict indications is effective and have significant advantages, com'paring with classic median sternotomy, because it provides minimal surgical trauma,preservation of the thoracic cage frame, and better cosmetic effect.

Detailed statistic alanalysis of the treatment results in patients, who have had sufferedgastroduodenal ulcer hemorrhage, in The Gastro—Intestinal Hemorrhage Centre, wasperformed. Application of exteriorization procedure, using original method of doublesticking and out sticking of the needle bilaterally from ulcerative defect, for duodenalulcer, complicated by hemorrhage, have had guaranteed mechanical squeezing of theperiulcer zone vessels and effective removal of the ulcer out side the gut lumen. Thishave had promoted improvement of the patients' treatment results.