Klinicheskaia khirurgiia最新文献

{"title":"Renovated Tokyo’s Clinical Guidelines for treatment of an acute cholangitis and an acute cholecystitis, 2018 yr (Tokyo Guidelines, 2018)","authors":"O. Usenko, V. Desyateryk, S. P. Mіkhno, E. O. Okhotnik","doi":"10.26779/2522-1396.2021.7-8.03","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.7-8.03","url":null,"abstract":"Renovated Tokyo’s Clinical Guidelines for treatment of an acute cholangitis and an acute cholecystitis, 2018 yr (Tokyo Guidelines, 2018)","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80966709","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":"Postoperative acute pancreatitis","authors":"S. Chooklin, S. Chuklin, R. Barylyak","doi":"10.26779/2522-1396.2021.7-8.49","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.7-8.49","url":null,"abstract":"Postoperative acute pancreatitis","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86319112","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 changes of parameters of the systemic inflammatory answer syndrome on early stages of complicated acute pancreatitis","authors":"R. M. Agayev, A. A. Mamadov, F. S. Idrisov, E. A. Iskandarov, E. Aliyeva","doi":"10.26779/2522-1396.2021.9-10.11","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.9-10.11","url":null,"abstract":"Objective. To determine a prognostic validity of parameters of the systemic inflammatory answer syndrome for early diagnosis of an acute pancreatitis severity and prognostication of the pathological processes exacerbation. \u0000Materials and methods. The treatment results in 71 patients, suffering an acute pancreatitis, were analyzed. An acute pancreatitis in a light form was diagnosed in 39 patients (Group I), and in a severe one-in 32 patients (GroupII). In the patients while hospitalization and in consequent two days an absolute quantity of leucocytes, relative quantity of immature granulocytes and value of neutrophil-lymphocytic ratio, concentration of C-reactive protein were investigated. ROC-curve was applied while doing calculation of the «cut-off» point for neutrophil-lymphocytic ratio and studied a three-week survival, using Kaplan-Meyer method. \u0000Results. In the Group II patients the leucocytes quantity was trustworthily more - (15.4 ± 2.3) × 109/l, than in patients of Group I - (12.7 ± 1.2) × 109/l. Relative quantity of neutrophils and immature granulocytes was high in Group II, but absolute quantity of lymphocytes in these patients was lower, than in the patients of Group I. In accordance to the neutrophil-lymphocytic ratio in the admittance day the Group II differed from Group I statistically significant - 12.6 ± 1.4 and 9.78 ± 1.3 accordingly. In Group I during consequent two days this marker have lowered, аnd in Group II demonstrated further raising (p < 0.05). Optimal point of «cut-off» for neutrophil-lymphocytic ratio was determined as 10.5. The three-week survival of patients with the neutrophil-lymphocytic ratio value 10.5 has constituted 95,9%. In the values of neutrophil-lymphocytic ratio more than 10.5 a survival have lowered down to 79.2%,and mortality have been raised up to 21/8%. Relative quantity of immature granulocytes in Group I have constituted (0.39 ± 0.21)%, and in Group II - (1.7 ± 0.51)%. Doing analysis of square under the ROC-curve the threshold meaning for immature granulocytes was determined as 0.81%. In the admittance day the Groups did not differ for index of C-reactive protein. But, on the second day the C-reactive protein concentration have been enhanced by 55.3% in Group II and was significantly higher, than in Group I. Multifactorial analysis have shown, that diabetes mellitus constitutes independent predictor of risk for the septic complications occurrence. Negative impact of hepatic adipose dystrophy on occurrence and progress of polyorgan insufficiency in patients with pancreonecrosis were revealed as well. \u0000Conclusion.There was proved, that studying of values of neutrophil-lymphocytic ratio permits to prognosticate the survival indices in patients, suffering an acute pancreatitis of early stage. The level of C-reactive protein on the second day after admittance takes effect of prognostic significance and must be applied as a marker for the further clinical signs prognostication. In controversial cases the","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89784111","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 method of distant preconditioning and results of its application in renal transplantation from the living family donor","authors":"M. Kyrychenko, A. V. Bilyayev, N. Davydenko, A. Bychkova, O. V. Storozhuk","doi":"10.26779/2522-1396.2021.9-10.38","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.9-10.38","url":null,"abstract":"Objective. Elaboration of method for the intraoperative ischemic-reperfusion trauma softening - distant ischemic preconditioning and investigation of results of its introduction into clinical practice. \u0000Materials and methods. The method of distant ischemic preconditioning elaborated have included four procedures the air inflation into the flap for the arterial pressure measuring by 40 mm Hg over the level of systolic arterial pressure, 5 min of duration in every one, with consequent 5-minute intervals for the air release from the flap. The procedure of a distant ischemic preconditioning was conducted after introduction into narcosis, but before the donor's nephrectomy in 30 patients (the main group). The procedure was not conducted in 30 such patients. \u0000Results. The procedure elaborated permits to enhance the glomerular filtration significantly in 6 and 12 mo, to reduce the rate of partial delay of the transplant functioning, its acute rejection and primary dysfunction. \u0000Conclusion. The procedure of a distant ischemic preconditioning elaborated improves the transplanted kidney function.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81097149","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":"Solid pseudopapillary tumor of the pancreas (Frantz’s tumor)","authors":"D. Coco, S. Leanza, R. Campagnacci","doi":"10.26779/2522-1396.2021.7-8.69","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.7-8.69","url":null,"abstract":"Solid pseudopapillary tumor of the pancreas (Frantz’s tumor)","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75385924","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":"Surgical treatment of the inferior vena cava (IVC) leiomyosarcoma","authors":"V. I. Rusin, S. O. Boiko, V. Rusin, F. V. Gorlenko, S. Boiko, O. V. Syma","doi":"10.26779/2522-1396.2021.9-10.44","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.9-10.44","url":null,"abstract":"Objective. To propose and introduce a diagnostic-treatment algorithm for the inferior vena cava (IVC) leiomyosarcoma into clinical practice. \u0000Materials and methods. During last 30 years in Zakarpattya Regional Clinical Hospital Named After Andriy Novak and Zakarpattya Antitumoral Centre were operated 8 patients, suffering the IVC leiomyosarcoma - 7 (87.5%) women and 1 (12.5%) man. Median of the patients' age have constituted 57 yrs old. For characterization of the affection localization in accordance to own views on the subject the classification of the IVC division into 7 segments was applied: infrarenal, іnterrenal, suprarenal, retrohepatic, іnfradiaphragmatic, supradiaphragmatic,іntracardial. Іntravasal localization of the tumor was observed in 3 (37.5%), extravasal - in 1 (12.5%), mixed - in 4 (50%) patients. In all the patients the open laparotomy approach was applied: in 1 (12.5%) patient median laparotomy was performed, and in 7 (87.5%) - bilateral subcostal laparotomy of a «Chevron» type. For the IVC alloprosthesis in 6 (75%) patients a politetrafluoroethylene prosthesis was applied, while in 2 (25%) - Gore-tex prosthesis of 18-22 mm in diameter. In 5 (62.5%) patients circular resection with the IVC alloprosthesis was done, in 2 (25%) - circular resection, the IVC alloprosthesis and іmplantation of right and left renal veins into the prosthesis, and in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of left renal vein into prosthesis. \u0000Results. The operation median duration have constituted 215 (160 - 320) min, while the average volume of the blood loss - 305 (250 - 500) ml. The Degree II postoperative complications in accordance to classification of Clavien-Dindo were registered in 2 (25%) patients. Pulmonary thromboembolism, venous thrombosis, thrombosis of prosthesis, as well as intraoperative or immediate postoperative lethality were not observed. In 7 (87.5%) patients a radical intervention was performed. In 3 (37.5%) patients a remote hepatic and pulmonary metastases have been developed, leading to their death in terms from 10 to 34 mo. General one-, two- and a three-ear survival have constituted 87.5, 75 and 62.5%, accordingly. \u0000Conclusion. Surgical approach of a «Chevron» type and the staged dissection of IVC guarantees an adequate visualization of its іnfra-, іnter- and suprarenal segments. The «piggyback» procedure of hepatic mobilization and Pringle maneuver constitute necessary parts on the stage of dissection in retrohepatic, infradiaphragmatic and supradiaphragmatic segments of IVC. Radical tumoral excision with the IVC prosthesis and implantation, when needed, of renal or hepatic veins - is the only one possibility for improvement of the patients' quality of life in the IVC leiomyosarcoma.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85807069","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":"Gastric duplication cyst","authors":"A. Lavryk, O. Dmytrenko, V. О. Кropelnytskyi, G. М. Lytvynchuk","doi":"10.26779/2522-1396.2021.9-10.99","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.9-10.99","url":null,"abstract":"Gastric duplication cyst","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74349575","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 gun-shot woundings of large bowel as a predictor of severe course of fighting abdominal trauma","authors":"І. A. Lurin, K. Gumeniuk, O. B. Tymchuk, O. Popova","doi":"10.26779/2522-1396.2021.7-8.39","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.7-8.39","url":null,"abstract":"Objective. Analysis of experience of the medical help delivery to the wounded persons, suffering a gun-shot fighting abdominal trauma and treated in Military–Medical Clinical Centre of Eastern Region, determining a further steps, concerning optimization of the treatment-diagnosis measures in this category of patients. \u0000Materials and methods. Medical cards of 27 stationary patients with a gun-shot penetrating woundings of abdominal cavity, who were operated on the first stage in mobile hospitals with further transportation to Military–Medical Clinical Centre of Eastern Region, were studied. Concerning the missile characteristic, causing the wounding, there were 20 fragmentation woundings (іsolated – 2, multiple – 5, combined – 13), the bullet – 7 (іsolated – 1, multiple – 3, combined – 3). There were also 7 thoraco-abdominal woundings, of them 6 – the fragmentation, 1 – the bullet. In 18 patients the treatment consisted of a one-staged operative intervention performance, in 9 of them –in several stages. Among the wounded persons, who needed multi-staged treatment, 77.8% have had the large bowel damage. \u0000Results. The reoperations performance, which were more characteristic for the wounded persons with the large bowel damages, was folllowed by morbidity (adhesional ileus, peritonitis, etc.), enhancement in 2.6 times of purulent complications of postoperative wound, and in 2 times – of the average index of stationary stay, what have demanded a proportionally enhanced expenses from the health-care military system. \u0000Conclusion. Among the gun-shot penetrating woundings of abdominal cavity the multiple and combined fragmentation woundings prevailed. As a result, a statistically significant association between damages of large bowel and enhancement of prediction for the morbidity development and the treatment duration was established, using the method of correlation-regression analysis. \u0000The large bowel woundings constitute a predictor of more severe course of fighting abdominal trauma and development of complications, what leads to necessity for elaboration of differentiated approach to operative treatment of this wounded persons’ category with objective to reduce a stationary stay and possibility of the morbidity development.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78908422","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":"Tubular adenoma of the small intestine","authors":"V. Liakhovskyi, A. V. Sydorenko, I. Nemchenko, T. V. Gorodova-Andreeva, P. V. Savchuk, D. D. Furman","doi":"10.26779/2522-1396.2021.9-10.102","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.9-10.102","url":null,"abstract":"Tubular adenoma of the small intestine","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77462176","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":"Preoperative biliary decompression in patients, suffering tumorogenic obturation jaundice, complicated by cholangitis, and its impact on development of postoperative complications","authors":"O. Dronov, L. Levchenko","doi":"10.26779/2522-1396.2021.9-10.03","DOIUrl":"https://doi.org/10.26779/2522-1396.2021.9-10.03","url":null,"abstract":"Objective.To estimate the impact of preoperative biliary decompression inpatients, suffering tumorogenic obturation jaundice, complicated by ascending cholangitis, on development of postoperative complications. \u0000Materials and methods. The one-centre retrospective investigation of the treatment results was conducted in 136 patients, suffering tumorogenic obturation jaundice. In 84 patients preoperative biliary decompression was done (Group I). In 52 patients preoperative biliary decompression was not performed (Group II).In all the Group I patients an ascending preoperative cholangitis was diagnosed: in 48 (57.1%) -of the I degree severity, in 36 (42.9%) - of the II degree of severity. In 21 (40.4%) patients of Group II preoperative ascending cholangitis I degree of severity was revealed. \u0000Results. Performance of preoperative biliary decompression did not worsen postoperative results, taking into account the postoperative complications structure (p=0.07), but influenced the wound infection development (p=0.01). Additional factors were determined: preoperative ascending cholangitis of I degree (p=0.007) and II degree (p=0.001) of severity; hyperbilirubinemia over 250 mcmol/l (p= 0.03); delay in operative treatment more than by 3 weeks after preoperative biliary decompression (р= 0.02); presence of the antibioticoresistant microflora in a time of preoperative biliary decompression (p=0.009) and at the operation time (p=0.002). \u0000Conclusion. Performance of preoperative biliary decompression raises the risk for the wound infection development, but is not the cause for postoperative prognosis worsening, taking into account the postoperative complications structure.","PeriodicalId":17876,"journal":{"name":"Klinicheskaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82120062","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}