Objective. Elaboration of the correction methodology of mitral stenosis, complicated by massive thrombosis of left atrium, for improvement of immediate and late results of surgical treatment of this pathology. Materials and methods. Into the group analyzed 344 patients with mitral stenosis, complicated by massive thrombosis of left atrium, operated in Amosov National Institute of Cardiovascular Surgery in a period from 1 January 1984 yr to 1 January 2019 yr, were incorporated. In all the patients surgical correction of mitral stenosis and thrombectomy from left atrium was performed. In 161 (46.8%) patients a radical removal of thrombotic mass together with their base–lining was performed, while in 183 (53.2%) – without it. In 256 (74.4%) patients the left atrium auricle was ligated or resected, while in 88 (25.6%) – left intact. Results. The hospital lethality index have had directly proportionally raised with enhancement of degree of the left ventricle auricle: I – 0%, II – 3.9%, III – 5.1% (p<0.05). In a general group during all period of the investigation a directly proportional dependence of index of hospital lethality due to lethal thromboembolic complications on degree of massive thrombosis of the left atrium auricle was observed: I – 0.0%, II – 3.5%, III – 5.2% (p<0.05). Best indices of hospital lethality were achieved in radical removal of thrombi together with their base–lining with ligature or resection of the left atrium auricle as a possible origin of thrombi creation. Conclusion. While doing surgical correction in patients with massive thrombosis of left atrium it is important to remove the thrombotic base–lining and to ligate or resect the left atrium auricle, what significantly lowers the risk of hospital lethality, thromboembolic complications on stationary stage of treatment.
Objective.Studying of morphological characteristics of venous angiodysplasia of the face and scalp. Materials and methods. The operation material (soft tissues of the face and scalp) was investigated in 20 patients for studying of morphological characteristics of venous dysplasia. In the histological investigation frame the material was fixed and processed in accordance to conventional method, the tissue slices were colored with hematoxilin and eosin. In 7 observations immuno–histochemical investigation with CD34 antibodies (clone QBEND10) and S100 (polyclonal) was applied. Results. Basing on patho–histological investigations of the operation material in 8 patients, morphological features, characteristic for arterio–venous angiodysplasia, were revealed, what may constitute the recurrence cause in postoperative period. Conclusion.The recurrence prognosis and further surveillance of patients with venous angiodysplasia demands decision of the question concerning the presence of arterio–venous component in clinically and instrumentally confirmed simple venous angiodysplasia, concerning every patient.
Objective. To share own experience for surgical treatment of pulmonary carcinoid tumours. Materials and methods. During last 13 yrs in Department of Thoracic Surgery and Invasive Methods of Diagnosis of Yanovskyi National Institute of Phthisiatry and Pulmonology were treated 45 patients, suffering pulmonary carcinoid. Average age of the patients have constituted 45 yrs old. Among the patients the women prevailed – 31 (68.9%). Concomitant pathology have had 15.6% patients. In 38 (84.4%) patients the disease was diagnosed accidentally in elective roentgenological examination. Pronounced clinical features of the disease were observed in 3 (6.7%) patients only. Additional 4 (8.9%) patients complained about insignificant worsening in general well-being: moderate dyspnea, dry periodical cough, frequent bronchitis. Results. There were 44 (97.8%) patients operated. The most frequent operation performed in patients with pulmonary carcinoid was lobectomy in various modifications: a classic one – in 16 (36.4%), video-assisted – 13 (29.5%), and bronchoplastic – 5 (11.4%). Operative interventions were performed in accordance to rules for thoracic surgery and for oncological surgery in particular. In a central localization of the process the diagnosis was verified preoperatively in all the patients, while in peripheral carcinoids only - in 2 (25.0%) patients, in whom transthoracic biopsy with histological investigation of biopsies was performed. In other 6 (75.0%) patients, suffering peripheral carcinoid, intraoperative histological or cytological investigations with determination of further surgical tactics were conducted. Conclusion. Pulmonary carcinoid is characterised by slow course and absence of pronounced clinical signs, what causes its late diagnosis. To select an optimal method of surgical treatment histological verification of the diagnosis is mandatory. In treatment of pulmonary carcinoid tumours, surgical method is choosed.
Objective. To study perioperative changes in hemodynamics, the oxygen state and metabolism in patients, suffering an acute calculous cholecystitis, and to determine the methods of their correction. Materials and methods. The investigation was based on 131 patients, suffering an acute calculous cholecystitis, to whom laparoscopic cholecystectomy under general anesthesy was performed. The risk value, determined in accordance to classification of American Society of Anesthesiologists, have constituted Class II-ІV. The patients were divided into two groups. The first one have consisted of 63 patients, in whom intensive therapy, directed on support of vital functions, was conducted, while in a second group (68 patients) the data of indirect calorimetry were used additionally. Results. On the stage of the patients staying in reverse position of Trendelenburg, the adjustment of pneumoperitoneum and the operation beginning the lowering of hemodynamics indices, the oxygen state and metabolic disorders have had more pronounced features in patients of the first group, and their restoration was more durable. The second group patients on background of powered infusion therapy and introduction of glucocorticoids were restored more intensively, they woke up more early, the intensive department stay was shorter, emesis and regurgitation have occurred in them in 2.4 times more rarely, and severity of postoperative pain after waking up was lower (р < 0.05). Conclusion. In patients, suffering an acute calculous cholecystitis, laparoscopic cholecystectomy is more secure on background of the hemodynamics, the oxygen state and metabolism corrected.
Objective. To determine the optimal regimes of application of a low-temperature electric welding of soft living tissues in formation of suture in pulmonary parenchyma, the pulmonary hilum preparation, and its lymph nodes ablation, basing on microbiological estimation of action of various regimes on the tuberculosis mycobacteria and densitometric indices of pulmonary parenchyma and to estimate its efficacy in far remote postoperative period. Materials and methods. The work is based on the results of postoperative investigations in 275 patients with the aim to determine the impact of a low-temperature electric welding of soft living tissues on pulmonary parenchyma and mediastinal lymph nodes. Results. There was established, that application of minimal automatic regime of a low-temperature electric welding of soft living tissues in phthisiosurgery guarantees effective elimination of microflora in 98.3% of patients. The revealed emphysematous processes and fibrous changes are occurring in parallel and essentially impacts the development of pulmonary-pleural complications. Conventional density of pulmonary parenchyma was noted in 57.5% of patients in the investigation group and in 49.7% patients of the control group. In both groups, the enhanced superdensity of pulmonary parenchyma in far remote postoperative period was not observed. Density of mediastinal lymph nodes was compared, and statistically significant difference between densitometric indices of mediastinal lymph nodes was absent. While application of a low-temperature electric welding of soft living tissues in minimal power regime of the complex there was noted essential characteristic as well: lesser rate of fibrous transformation of pulmonary parenchyma, than in the control group – in 13.3 and 15.5%, accordingly. Conclusion. Application of a low-temperature electric welding of soft living tissues in phthisiosurgical interventions for the lymph nodes ablation have shown the presence of effective bactericidal regimes with preservation of lymphatic circulation, and low rigidity of pulmonary parenchyma in postoperative period. While a low-temperature electric welding of soft living tissues applied, the signs of lymphostasis, the lymphatic outflow disorders and pulmonary-pleural complications in postoperative period after phthisiosurgical interventions with the lymph node ablation procedure do not occur, as well as the risk of iatrogenic damages while performing dissection and excision of mediastinal lymph nodes.
Objective. Clinical assessment of combined application of the calculated dermolipectomy with improved hernioabdominoplasty in treatment of patients, suffering hernias and external abdominal deformities, who have excessive tissues of abdominal wall. Materials and methods. The investigation is based on data of paraoperative examinations and own results of surgical treatment of 67 patients with hernias and external abdominal deformities. Rational methods of their operating were substantiated on background of morphometric characteristics, determined in accordance to the ventral deformity dimensions, and percentages of adipose-containing, fibrous-cicatricial and pathological components content. Results. The program unit «Statistica 6.1» was applied for statistical elaboration of the results obtained. Algorithm of quantitative investigations of the ventral tissues excessives, which have had predominantly supraaponeurotic localization, was elaborated for the first time. Preoperatively calculated volumes of preventive dermo- and fibrolipectomies, which were performed together with hernio- and abdominoplasties in accordance to new principle «without excesses of parahernial tissues» in various hernias and venral deformities, have reduced essentially the local complications rate - to 2% (р < 0.05) and improved the indices of quality of life and the patients’ health. Conclusion. Practical application of the «tension-free» and «nonrebundant» principles in operating of hernias constitute the base for further elaborations of reconstructive-plastic interventions and a real component of the problem decision in medico-social and esthetic rehabilitation of certain herniological patients.
Objective. To formulate clinic-morphological substantiation for application of calculated excision of excessive and pathologically changed parahernial tissues together with performance of improved abdominoplasty in surgical interventions in patients with hernias in conditions of ventral obesity. Materials and methods. The investigation is based on data of paraoperative examinations and own results of surgical treatment of 58 herniological patients. Rational methods of their operating are substantiated by patho- and morphometric characteristics, determined in accordance to the observed dimensions of ventral hernia deformation, and content of the fat-containing, fibrous-cicatricial and inflammatory-pathological components in it. Results. The program set «Statistica 6.1» was applied for elaboration of the results obtained. In accordance to own algorithm of the ventro- and sonometric investigations there was established, that the parahernial tissues extras in the patients with external hernias are localized and originated supraaponeurotically. Preoperative considerations concerning determination of optimal volumes of conduction of dermo- and fibro-lipectomies, performed before hernio-abdominoplasties on various hernias with signs of ventral obesity, have permitted to prevent the local purulent-inflammatory complications and to improve the indices of quality of life in the patient operated on. Conclusion. Application of the «with no surpluses» operating principle constitute a practical base for improvement of reconstructive-plastic interventions results in external abdominal hernias and a real component of the problem decision in medic-social and esthetic rehabilitation of herniological patients with obesity.
Stress and surgical diseases of thyroid gland in environment of the armed conflict (review of literature and own observations)
Strategy of elimination of antibiotcoresistance to carbapenems – actual modern problem
Modern tactics for acute variceal bleeding in liver cirrhosis (Baveno VII guidelines)
Objective. The structure of combined osseous–vascular work injury of the lower extremities was studied, and the results of its operative treatment analyzed retrospectively. Materials and methods. The data concerning 147 patients with combined osseous–vascular work trauma of the lower extremities were analyzed. All the patients managed were from 19 to 48 yrs old, and their average age constituted 30.2 yrs old. The mine trauma with injuries of femoral and/or the shin bones and a. poplitea prevailed – in 129 (87.8%) and 116 (78.9%) observations, accordingly. There were performed 92 two–staged interventions in a common operative team with traumatologists. Results. Positive result of operative treatment was noted in 73 (79.3%) patients. The time span between the trauma moment and the operation beginning in this group of the patients have constituted from 2 to 5 h, while the degree of an acute arterial ischemia in accordance to V. S. Savelyev (1973) were signed as IIa–IIb. The operation duration have constituted from 3 to 4 h. All the patients have had a combined shock Degree II. The preoperative blood loss volume has been ranged from 1 to 2.5 l. The a. poplitea injury have had prevailed and occurred in 43 (58.9%) patients. In 6 (6.5%) patients after reconstructive intervention the extremity amputation was performed. Conclusion. Mostly favorable result was obtained in the injured persons, who were delivered early (upto 2 h) to specialized stationaries with conduction of preoperative antishock therapy.
Objective. To study the impact of antibacterial therapy on level of proteolytic enzymes on example of the neutrophils elastase, and clinical course of an acute pancreatitis. Materials and methods. There were investigated two groups of patients: in the main group (n=83) antibiotics were introduced by lymphotropic method, while in a control group (n=85) – in accordance to standard method. The content of the neutrophils elastase was determined in admittance day after 5 days of treatment. Results. In admittance to hospital the enzyme level in patients of both groups did not differ. After 5 days of antibacterial therapy the neutrophils elastase quantity have been reduced more after conduction of lymphotropic therapy than after the standard one. Reduction of level of the neutrophil elastase «deflected» have promoted the reduction of the pancreonecrosis infectioning, leading to reduction in the operative interventions quantity performed in the main group of patients (lymphotropic antibacterial therapy) in 2.1 times as well as their reconvalescence. Conclusion. Positive impact of lymphotropic antibacterial therapy towards «deflection» of proteolytic enzymes in the blood and on the acute pancreatitis course accordingly shows the reasons to recommend its application in this disease as an alternative to standard method.
Methodology of the physicians education on the studying cycles of the Department of Combustiology and Plastic Surgery in modern environment
The ways to improve the ambulatory surgical service in environment of reformation in the health defense sphere of Ukraine
Objective. To raise the efficacy of surgical treatment in patients, suffering chronic pulmonary abscesses, using miniinvasive electro–surgical technologies. Materials and methods. A single centre randomized controlled retro– and prospective investigation, which is based on analysis of the surgical treatment results in 78 patients, suffering chronic pulmonary abscesses, operated on base of the Zaytsev Institute of General and Urgent Surgery (Kharkiv) in a period from 2011 to 2021 yr. Results. Analysis of data of conducted dynamical instrumental control for efficacy in two different methods of treatment in patients, suffering chronic pulmonary abscesses, proves the enhanced efficacy of the treatment program proposed over the standard tactics. Conclusion. The methods of surgical interventions elaborated have permitted to impact in a positive and essential way the endogenous intoxication indices, to escape the resections performance, to lower the postoperative morbidity quantity, to prevent the adjacent organs injuries, to shorten a duration of clinical and social–labor rehabilitation of patients with achievement of stable positive effect.
Objective. To improve the results of surgical treatment in patients with postoperative peritonitis, using the certain algorithm proposed. Materials and methods. Prospective investigation was conducted on 244 patients, suffering postoperative peritonitis (the main group). In accordance to the peritoneal affection size the restricted postoperative peritonitis was present in 125 (51.2%) patients, and the extended one – in 119 (48.8%). Retrospective investigation consisted of studying of 212 cards of stationary patients, operated for postoperative peritonitis (the control group). Results. Miniinvasive operative reinterventions were done in 114 (46.7%) patients, suffering postoperative peritonitis, of them in 55 (48.2%) laparoscopic sanation and drainage of the peritoneal cavity abscess was used. In 19 (55.9%) of 34 patients with postoperative peritonitis in the interloop abscesses a laparoscopic sanation and drainage of the abscess were performed. Open operative interventions were performed in 130 (53.3%) patients. Conclusion. Application of the elaborated algorithm of the postoperative peritonitis surgical treatment have permitted to reduce the patients stationary stay from (14.2 ± 1.6) bed–days (control group) to (10.6 ± 1.2) bed–days (main group) and to reduce the lethality level from 31.6% (control group) to 18.4% (the main group).
Surgery on the war – actual issues of the surgical help delivery in a military time. Theses of reports
