Khirurgiya最新文献

We present successful treatment of a patient with deep sternal wound infection, severe heart failure and sepsis with infection of wound surface, tracheobronchial tree and abdominal cavity. Surgical treatment under limited possibilities for reconstructive surgery is described, and approaches to conservative therapy of comorbidities are discussed.

Computed tomography (CT) is an indispensable tool for preoperative planning in minimally invasive cardiac surgery. In this article, the authors estimate significance of CT for analysis of anatomy and pathology of cardiovascular system. CT provides surgeons with high-quality images and assessment of structural features in the areas of subsequent manipulations. These aspects are essential for individualized surgical plan. CT significantly reduces the risk of postoperative complications due to better understanding of anatomical features. Moreover, CT contributes to safe minithoracotomy. Thus, CT is essential in preoperative planning. This method improves postoperative outcomes and minimizes surgical risks.

Objective: The aim of this study is to evaluate the cost-effectiveness, diagnostic accuracy, clinical outcomes, and radiation exposure associated with rubidium-82 chloride perfusion PET.

Methods: A comprehensive literature search up to October 2024 was conducted to identify key studies assessing the use of rubidium-82 chloride perfusion PET/CT in ischemic heart disease (IHD). These studies included economic analyses, evaluations of diagnostic accuracy, and comparisons with other imaging modalities such as single-photon emission computed tomography (SPECT), stress echocardiography, and invasive coronary angiography.

Results: The reviewed studies demonstrate that rubidium-82 chloride perfusion PET/CT has high sensitivity and specificity in detecting IHD (90% and 91%, respectively) accompanied by significant coronary artery stenosis. Economic analyses show that this method is cost-effective due to a reduction in the use of downstream invasive procedures, leading to overall cost savings. Additionally, the economic impact on healthcare is enhanced by a lower level of radiation exposure compared to traditional perfusion SPECT imaging, reducing associated future radiation risks. The cost-effectiveness and minimum patient throughput required for implementing this modality In Russia were evaluated.

Conclusion: The presented data confirm the cost-effectiveness of rubidium-82 chloride perfusion PET/CT by reducing costs for subsequent diagnostic and therapeutic interventions while maintaining a sufficient patient flow.

We demonstrated successful treatment of patients with complicated central lung cancer, who underwent right upper sleeve lobectomy with carinal resection. We have used the following options for carinal reconstruction: anastomosis of trachea with the left main bronchus and anastomosis of intermediate bronchus with the left main bronchus (clinical case No. 1) or with trachea (clinical case No. 2). Cervicothoracotomy provided correct N-staging and mobilization of trachea with left main bronchus. This approach provided compliance with oncological principles of surgical treatment of lung cancer and significantly reduced tension of anastomosis. These aspects are important for satisfactory immediate functional and oncological results after right upper sleeve lobectomy with carinal resection.

This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.

Objective: To improve the immediate postoperative results in patients with perforated ulcers.

Material and methods: The study enrolled 25 patients with perforated peptic ulcer (diameter of perforation <8 mm). Mean age of patients was 39 years (range 24-56), perforation size - 5.92 mm (range 3-8).

Results: Mean surgery time was 59.8 min (range 50-85). There were no intraoperative and postoperative complications. All patients were discharged.

Conclusion: The proposed method of repair for perforated gastric ulcers is simple, effective, safe and may be recommended for clinical practice.

Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.

The article analyzes literature data on the characteristics of local anesthetics used to perform regional anesthesia, and provides a detailed assessment of the drug "Articaine". The article presents the results of an open randomized study of the action of the anesthetics "Articaine-Binergia" 20 mg/ml and "Ropivocaine" used to perform conduction anesthesia in upper limb surgeries. The results of the study demonstrated a high degree of effectiveness of both drugs, but the safety indicators of the drug "Articaine-Binergia" 20 mg/ml significantly exceeded those of "Ropivocaine". The studies have established that the drug "Articaine-Binergia" 20 mg/ml is characterized by a short latent period, which allows for optimization of the operating room. At the same time, the peculiarity of "Ropivocaine" was the duration of action, which ensures the possibility of performing long surgical interventions, and maintaining the analgesic effect in the first hours after surgery. The results of the studies allowed us to recommend Articaine-Binergia 20 mg/ml as an effective local analgesic with a high degree of safety for widespread practical use in upper limb surgeries. The use of Ropivacaine for conduction anesthesia should be limited to surgical interventions that last longer than the duration of action of Articaine-Binergia 20 mg/ml, which is 2 hours 20 minutes. In addition, highly traumatic surgical interventions in patients with absolute contraindications to the use of painkillers are a limitation.

Objective: Evaluation of the effectiveness of flavonoids in the postoperative management of patients with hemorrhoids.

Material and methods: A single-center randomized controlled clinical trial was conducted. Patients with stage III and IV hemorrhoids aged over 18 years who patients who underwent hemorrhoidectomy were included.

The patients were divided into 2 groups - main and control. Patients in the main group were recommended to use a purified micronized flavonoid fraction - 65 patients. In the control group (70 patients), the use of this group of drugs was not expected.

The observation period was 60 days. After discharge from the hospital, 5 patient visits were scheduled: on the 3rd, 7th, 21st, 40th and 60th day after surgery. Patients independently assessed the intensity of symptoms - pain, tenesmus, itching and bleeding.

The randomization procedure was carried out using the method of simple randomization using envelopes.

Results: 135 patients were randomized. There were no patients who dropped out of the study. The number of participants whose data were included in the analysis was 65 patients in the main group and 70 patients in the control group.

Assessment of symptoms in the first 3 days of the postoperative period did not show a significant difference in the condition of the patients. Over time, we found significant changes in the dynamics of complaints between groups. After 7, 21, 40 and 60 days, a statistically significant lower severity of pain, bleeding and tenesmus was revealed among patients in the main group compared to the control group. This trend was not detected in the assessment of itching. There were no undesirable effects.

Conclusion: The use of purified micronized flavonoid fraction in the postoperative management of patients with hemorrhoids can significantly reduce the degree and duration of pain, bleeding and tenesmus.

A rare case of thyroid foreign body is presented. The swallowed fish bone perforated the pharyngeal wall and migrated to the thyroid gland. The rarity of pathology caused diagnostic difficulties. Despite the correct diagnosis, wait-and-see tactics was initially chosen that delayed surgery and contributed to tissue inflammation. The stages of therapeutic and diagnostic process are analyzed. Endoscopy is not always effective, especially when foreign body migrates from pharyngeal lumen into soft tissues. Ultrasound and CT are necessary for topical diagnosis of migrated foreign body. These methods revealed fish bone migration towards cervical vascular bundle and local complications. Literature data and own experience are analyzed. Early surgical treatment guarantees good results and rapid rehabilitation.