Klinicheskaia khirurgiia最新文献

{"title":"The battle trauma of the esophagus","authors":"O. Usenko, A. Sydiuk, O. E. Sydiuk, A. Klimas, G. Savenko, O. Teslia","doi":"10.26779/2522-1396.2022.7-8.03","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.7-8.03","url":null,"abstract":"Objective. Estimation of efficacy of diagnosis and methods of treatment in patients, suffering the battle trauma of the esophagus. \u0000Materials and methods. In the Division of Thoraco–Abdominal Surgery of the Shalimov National Institute of Surgery and Transplantology the treatment of 7 patients with penetrating esophageal wounds was conducted. In 6 (85.7%) patients the penetrating gun–shot woundings were diagnosed, and in 1 (14.3%) patient – the closed thoracic trauma. Shrapnel woundings prevailed over the bullet woundings, occurring in5 (71.4%) and 2 (28.6%) patients, accordingly. Esophageal trauma as isolated affection, caused by the gun–shot penetraiting wounding was extremely rare – in 1 (14.3%) patient. Efficacy of diagnosis and surgical stationary treatment of esophageal trauma, caused by foreign bodies, was estimated, as well as the terms of the esophagus integrity restoration. \u0000Results. In 2 (2.6%) patients with pleural empyema open toracotomy access with further pleurectomy, pulmonary decortication, and restoration of the esophageal wall integrity was applied. In 4 (57.2%) patients thoracoscopy, pleurectomy, pulmonary decortication, and esophageal suturing were conducted. \u0000Intraoperatively in 6 (85.7%) patients the endoscopic vacuum therapy system was installed locally in the damaged esophagus portion. In 1 (14.3%) patient with local pleural empyema the treatment tactics consisted of the pleural cavity drainage under ultrasonographic control plus endoscopic vacuum therapy. For achievement of its optimal efficacy the pressure value was supported in range from 100 to 120 mm Hg. Endoscopic vacuum system was changed every 4 – 5 days. Average duration of the fistulas healing have constituted 1mo.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86119831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal and stomach varices: physiological and anatomical features of formation","authors":"S. Chooklin, S. Chuklin","doi":"10.26779/2522-1396.2022.7-8.41","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.7-8.41","url":null,"abstract":"Esophageal and stomach varices: physiological and anatomical features of formation","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79418029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological characteristics of the duodenal papilla magna tumors","authors":"O. Usenko, V. Kropelnytskyi, V. Shkarban, K. Tumasova, O. Pidopryhora","doi":"10.26779/2522-1396.2022.7-8.14","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.7-8.14","url":null,"abstract":"Objective. Studying of morphological characteristics of the duodenal papilla magna malignant tumors on the own material of the Division of Pathological Anatomy and Cytology of the Shalimov National Institute of Surgery and Transplantology. \u0000Materials and methods. Into the investigation 82 patients were included, to whom pancreaticoduodenectomy was performed for duodenal papilla magna malignant tumors in 2019 – 2021 yrs with further conduction of morphological analysis of the specimen excised. The average age of the patients have constituted (61.1 ± 8.1) yrs old. \u0000Results. There were revealed 8 histological types of the tumors, most frequent of them – adenocarcinomas of pancreatobiliary and intestinal types. These two variants were compared. They did not differ for the age and gender (р>0,05), but statistically significantly differed for the histological differentiation degree and tumoral spread: р =0.039 and р = 0.003, accordingly. Thus, in the pancreatobiliary type of adenocarcinoma the tumors with low differentiation level (G3) were in 1.9 times more frequent, than in adenocarcinomas of intestinal type: 22.9 and 11.8%, and in 2.8 times more frequently the more spread tumors were revealed (рТ3а–Т3b): 65.7 and 23.5%, accordingly. As well, in the patients with adenocarcinomas of pancreatobiliary type a positive status of regional lymph nodes was revealed more frequently – in 57.1%, than in patients with adenocarcinomas of intestinal type – 44.1%. \u0000Conclusion. Duodenal papilla magna malignant tumors – a heterogeneous group of tumors. Adenocarcinomas of pancreatobiliary and intestinal types are the most prevalent. Pancreatobiliary adenocarcinoma, as a histological type, is more aggressive, than intestinal adenocarcinoma.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91315005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of organization of the specialized surgical aid to patients, suffering gastro–intestinal hemorrhage in the City of Dnipro","authors":"V. Desyateryk","doi":"10.26779/2522-1396.2022.7-8.70","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.7-8.70","url":null,"abstract":"History of organization of the specialized surgical aid to patients, suffering gastro–intestinal hemorrhage in the City of Dnipro","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75464111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation of prehepatic portal hypertension and impact of hepatic deportalization on its tissue","authors":"О. Godik","doi":"10.26779/2522-1396.2022.7-8.35","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.7-8.35","url":null,"abstract":"Objective. On the prehepatic portal hypertension pattern, created by partial ligature of venae portae in rats, to estimate the impact of partial hepatic deportalization on its tissue. \u0000Materials and methods. The investigation was conducted on 35 male rats of a Wistar line, aged 4–6 weeks. In 15 laboratory animals the partial ligature of vena porta with formation of stenosis was conducted, and in 15 –false ligature, while the control group consisted of 5 intact laboratory animals. \u0000Results. There were revealed certain connections between conduction of partial ligature of vena porta and critical (lethal) lowering of portohepatic perfusion. \u0000The model of prehepatic portal hypertension, using partial ligature of vena porta, leading to partial lowering of portohepatic perfusion with development of cavernous transformation of vena porta and dystrophic changes in hepatocytes with further fibrous changes in hepatic parenchyma, was applied. \u0000Conclusion. The portal vein narrowing grade in range 52 – 59% constitutes the optimal one for the prehepatic portal hypertension formation with development of zonal adipose parenchymatous hepatic dystrophy and the balloon degeneration of hepatocytes with further development of fibroses in rats of a Wistar line aged 4 – 6 weeks.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89758052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Security and efficacy of intravenous injection of lidocaine in major hepatic resection","authors":"R. А. Zatsarynnyi, O. E. Sydiuk, O. Pidopryhora","doi":"10.26779/2522-1396.2022.3-4.63","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.63","url":null,"abstract":"Objective. To determine in dynamics the blood lidocaine concentration in the patients while performing major hepatic resection with its epidural and intravenous injection for intra– and postoperative anesthesia and to estimate the toxicity potential. \u0000Materials and methods. Into the investigation 27 patients were included, to whom hepatic resection with preservation of 30 – 60% of parenchyma was done. In all the patients multicomponent intraoperative anesthesia was applied. Depending on adjuvant used, the patients were divided into two groups: the first – 7 patients, in whom intravenous lidocaine injection was applied, and the second – 20 patients, in whom multicomponent anesthesia was added by thoracic epidural anesthesia. \u0000Results. In 2 h postoperatively a tendency towards enhanced blood concentration of lidocaine was observed by 28.8% after its epidural injection, comparing with intravenous injection – 2.37 and 1.84 mcg/ml (р=0.29) accordingly without principal difference in 14 h after the operation – 2.85 and 2.62 mcg/ml (р=0.76) accordingly. In no one patient toxic life–threatening reactions were registered. \u0000Conclusion. The adjuvant application of lidocaine for intra– and postoperative anesthesia, using intravenous and epidural introduction in major hepatic resection performance, do not lead to raising of the medicinal compound concentration in the blood higher than conventional toxic content. The blood concentration of the preparation while its epidural introduction may be higher, than in intravenous introduction, witnessing in favor of secureness of intravenous application of lidocaine and at the same time a statistically significant difference between indices of its concentration in various ways of introduction was not observed.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86821660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in muscular wall of artificial bladder in experiment","authors":"R. Savchuk, F. Kostyev, S. Golovko, O. M. Kolosov, A. Zadorognuk","doi":"10.26779/2522-1396.2022.3-4.69","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.69","url":null,"abstract":"Objective. To estimate morphometric changes of the artificial bladder muscular wall, which was formatted of terminal ileum, in experiment in early and late postoperative periods. \u0000Materials and methods. The investigation was conducted in the chronic experiment conditions on 22 mini-pigs, ageing from 16 to 19 mo. After performance of cystectomy to the animals the artificial bladder was formatted, using terminal ileum. In 3, 6 and 12 mo after the artificial bladder formation the animals were removed from the experiment. \u0000Results. Studying of thickness of longitudinal and circular muscular layers of artificial bladder in mini-pigs in 2 mo have shown its statistically meaningful enhancement, comparing with control value in 2,14 - (643.7 ± 53.1) mcm and 3.36 - (1358.11 ± 86.60) mcm times, accordingly, and the common muscular layer thickness have enhanced in 2.84 times – (2001.81 ± 143.40) mcm, caused by its hypertrophy. In 6 mo more intense processes of muscular wall hypertrophy were seen in artificial bladder of experimental animals: the longitudinal muscular layer thickness have had statistically significantly enhanced in 3.61 times, while of a circular one – in 5.42 times, and of a common - in 4.65 times. In 12 mo after ileocystoplasty in muscular wall of artificial bladder a statistically significant enhancement of longitudinal layer thickness was noted, comparing with according index of intact animals in 5.52 times, while a circular one – in 5.58, and a common – in 5.13 times. \u0000Conclusion. The main processes of the artificial bladder muscular wall hypertrophy occur during first 6 mo after its formation, especially intensively in period from 3 to 6 mo. In consequent six-month period  a statistically significant enhancement of the longitudinal muscle layer thickness of artificial bladder in 0.91 times was noted, comparing with according index in previous 6 mo and the indices of the longitudinal and circular muscle layers thickness, which did not differ statistically with according results of experimental investigations in previous 6 mo. The urine reservoir, formatted of the ileum part, was not accustomed for performance of new functions, because in its wall evolution and transformation occurs in a version of hypertrophy in longitudinal and circular layers as a result of the intestinal tube denervation and the urine impact.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83252356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress and surgical diseases of thyroid gland in environment of the armed conflict (review of literature and own observations)","authors":"O. Usenko, I. Khomenko, A. E. Kovalenko, R. Saliutin","doi":"10.26779/2522-1396.2022.3-4.73","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.73","url":null,"abstract":"Stress and surgical diseases of thyroid gland in environment of the armed conflict (review of literature and own observations)","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78232489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Densitometric substantiation of the application regimes in a low-temperature electric welding of soft living tissues in phthisiosurgery","authors":"E. Maietnyi","doi":"10.26779/2522-1396.2022.3-4.29","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.29","url":null,"abstract":"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. \u0000Materials 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. \u0000Results. 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. \u0000Conclusion. 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.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79509397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The methods of prophylaxis of the pancreatic fistula occurrence after pancreato–duodenectomy","authors":"V. M. Kopchak, L. Pererva, R. Saliutin, V. Kropelnytskyi, I. Khomiak, O. Duvalko, V. P. Schkarban, Y. Khilko, V. Trachuk, V. Khanenko, A. O. Danyliuk","doi":"10.26779/2522-1396.2022.3-4.18","DOIUrl":"https://doi.org/10.26779/2522-1396.2022.3-4.18","url":null,"abstract":"Objective. To elaborate the measures system, which permit to reduce the occurrence of pancreatic fistula and other severe complications after performance of pancreato–duodenectomy. \u0000Materials and methods. There were analyzed the results of treatment of 327 patients, in whom pancreato–duodenectomy was performed. In accordance to the scheme proposed, using the elaborated scale of risk for the postoperative pancreatic fistula occurrence with estimation of sarcopenia presence and application of certain prophylactic measures 98 patients were operated in period from November 2018 to December 2020 yr. (the main group). Into the control group 229 patients were included, operated on in the clinic from January 2015 to October 2018 yr. without estimation of risk for the pancreatic fistula occurrence and presence of sarcopenia. The method of pancreato–jejunoanastomosis formation was selected by operating surgeon. \u0000Results. Postoperative complications have occurred in 94 (41.0%) patients of the control group and in 28 (28.6%) patients of the main group (c 2 = 4.56, p=0.03). Clinically significant postoperative pancreatic fistula of B Degree have occurred in 9 (9.2%) patients of the main group, what was statistically significantly lower, than in the control group, in which postoperative pancreatic fistula of B or C Degree have occurred in 64 (27.9%) patients (c 2 = 11.6, p=0.0007). Lethality was 2.2% in the control group and 1.02% – in the main one. \u0000Conclusion. Introduction of the measures system elaborated have permitted to lower the postoperative pancreatic fistula rate statistically significantly from 27.9 to 9.2%, and of other postoperative complications – from 41.0 to 28.6% and lethality from 2.2 to 1.02%.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89376866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}