Kharkiv Surgical School最新文献

{"title":"PATHOGENETIC CLASSIFICATION OF CHOLANGITIS","authors":"V. Boyko, R. Smachilo, A. Maloshtan, A. A. Neklyudov, M. O. Klyosova, M. S. Chernyaev, V. Omelchenko, O. Volchenko, D. S. Kozlov","doi":"10.37699/2308-7005.1-2.2023.01","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.01","url":null,"abstract":"Summary. Introduction. In the context of a wide variety of forms of acute and chronic cholangitis and a wide range of interventions, it is advisable to create a classification that facilitates the solution of tactical and strategic issues of treating patients with this serious disease. Materials and methods. 200 patients with acute and chronic cholangitis were selected. There were 93 men, 107 women, the average age of the patients was (61.8±2.4) years. Results of the study and their discussion. It is advisable to distinguish four groups of patients with acute and chronic cholangitis: I group. The pathological process is localized only in the lumen of the main ducts. Surgical tactics of treatment of these patients is urgent endoscopic papilosphincterotomy (EPST) and clearence of the ductal system. II group. The walls of the main bile ducts are involved in the pathological process, which led to their deformation and stricture. The vast majority of operations in this group are the reconstruction of the biliary tree. III group. Patients with chronic recurrent cholangitis who have already undergone biliary reconstruction, but which did not prove to be effective or was complicated by various types of new strictures. IV group. Patients with obstruction of the biliary tract caused by a cause localized outside the biliary system. In these patients, as a rule, the phenomena of cholangitis are mild, and the manifesting symptoms are biliary hypertension and liver failure. Conclusions. The use of the proposed classification, based on the pathogenetic features of the development of cholangitis in various pathomorphological conditions, makes it possible to clearly define the issues of surgical tactics.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134262056","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":"FEATURES OF CHOICE OF OPERATIVE TACTICS FOR ACUTE I NTESTINAL OBSTRUCTION AND DIFFUSED PERITONITIS","authors":"O. S. Olefir","doi":"10.37699/2308-7005.1-2.2023.22","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.22","url":null,"abstract":"Summary. The aim of the study was to evaluate and compare the early postoperative outcomes of patients with GKN who received either primary anastomosis or only stoma formation after bowel resection with the identification of factors associated with postoperative complications and mortality in both groups of patients. \u0000Materials and methods. The study included 63 patients with acute intestinal obstruction and peritonitis who underwent resection of the small intestine followed by the formation of a jejunostomy. The factors affecting the choice of the option of completing the surgical intervention were studied. \u0000Research results. Under relatively equal conditions, after resection of the small intestine in patients with acute intestinal obstruction and peritonitis other than vascular etiology, preference should be given to interintestinal anastomoses with a Meidl jejunostomy for the purpose of «unloading», when obstruction caused by vascular pathology is detected — the preference is on the side temporary terminal uenostomy with staged interventions according to indications. \u0000Conclusions. After resection of the small intestine in case of non-vascular etiology, preference should be given to interintestinal anastomosis or Y-shaped anastomosis according to Meidl. The only risk factor for mortality is postoperative multiple organ failure.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"170 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116639274","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":"VIDEOLAPAROSCOPIC DIAGNOSTIC INTERVENTIONS IN THE OPTIMIZATION OF SURGICAL TACTICS IN PATIENTS WITH URGENT SURGICAL ABDOMINAL PATHOLOGY","authors":"O. V. Kapshitar, O. O. Kapshitar, A. V. Bachurin","doi":"10.37699/2308-7005.1-2.2023.03","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.03","url":null,"abstract":"Summary. The purpose of the study: to study the possibilities of video laparoscopy (VLS) in the diagnosis of urgent abdominal surgical pathology and to optimize surgical tactics. \u0000Material and methods. VLS was performed in 55 patients with urgent abdominal surgical pathology with an unclear diagnosis, accounting for 7 % of all operated patients. \u0000The results. Established nosological forms of urgent abdominal surgical pathology, complicated in 87.3 % of patients (peritonitis, infiltrate, abscess, obstruction, hemoperitoneum). Optimized surgical tactics by dividing patients into 2 groups. Group A — 58.2 % of patients preferred and performed various video laparoscopic operations (VLSO) without complications. 6.2 % of patients died. Group B included 41.8 % of patients who underwent conversion due to the impossibility of completing VLSO due to pathomorphological reasons (severe purulent processes with purulent complications, long-standing intestinal obstruction, the need for naso-intestinal incubation of the small intestine). Complications occurred in 30.4 % of patients. 8.7 % of patients died. \u0000Conclusions. Accurate VLS diagnosis of urgent abdominal surgical pathology made it possible to optimize surgical tactics and establish the advantages of low-traumatic VLSO over traditional ones.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126692294","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":"USE OF MODERN TECHNOLOGIES IN THE CHOICE OF TREATMENT AND DIAGNOSTIC TACTICS FOR COLORECTAL CANCER","authors":"S. Savvi, D. P. Zamyatin, P. Zamyatin, E. A. Novikov, V. V. Zhidetsky, S. Rudenko","doi":"10.37699/2308-7005.1-2.2023.16","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.16","url":null,"abstract":"Summary. Introduction. The problem of tumor lesions of the colon remains one of the main in clinical medicine due to the widespread prevalence and tendency to increase colorectal cancer (CRC), the lack of effective methods for preventing and treating dangerous complications that often develop. \u0000Aim. The improvement of the results of surgical treatment of patients with CRC by studying the possibilities of video laparoscopy and choosing the optimal tactics based on assessing the severity of the condition and cytokine status of the patient. \u0000Material and methods. The results of treatment of 155 patients with CRC who were treated at the clinic of the State Institution “Zaitsev V.T. IGUS of the National Academy of Medical Sciences of Ukraine”, which is the clinical base of the Department of surgery #1 of KhNMU, were studied. When choosing treatment tactics for patients, the stage of the tumor lesion, the level of acute intestinal obstruction (AIO), the level of endogenous intoxication assessed on the APACHE II and SAPS severity scales, as well as the state of the immune system – on the level of IL-6 in the blood were taken into account. \u0000Results. In all cases, the nature and time of preoperative preparation was determined based on the study of clinical and laboratory parameters of the IL-6 level in the blood serum, as well as a point assessment of the severity of the physiological state of patients on the APACHE II and SAPS integral scales. With the correct selection of patients, laparoscopically assisted operations were performed, which give a lower percentage of complications, a more favorable postoperative period, and a shorter hospitalization period than traditional operations. Thus, in emergency patients, intestinal motility appeared on the third day after surgery (3.85±0.11), and gas discharge began 4 days later (4.33±0.04), the appearance of independent emptying was noted on the fifth day after surgery. \u0000Conclusions. Integral point assessment of the condition of patients with AIO in CRC using the APACHE II and SAPS systems allows you to choose the optimal amount of surgical intervention: \u0000– in 1-2 degrees of severity of the condition on the APACHE II objectification scales (< 20) and SAPS (< 11) and the level of IL-6 concentration in the blood serum up to 100 pg/ml - extended pathogenetically determined, radical surgical interventions; \u0000– in the 3rd degree of severity of the condition on the APACHE II objectification scales (>20) and SAPS (> 11) and the level of IL-6 concentration in the blood serum of more than 100 pg/ml - a minimum, palliative volume of surgery, which allows you to eliminate the phenomena of GKN. \u0000Laparoscopically assisted surgery – left-sided Hemicolectomy, sigmoid colon resection, anterior rectal resection: are optimal, which promotes early recovery of intestinal peristalsis and early activation of patients, as well as reduces postoperative bed-day.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133444837","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 EFFECT OF ENTEROSORPTION AND INTRATISSUE ELECTROPHORESIS OF ANTIBIOTICS ON THE COURSE OF THE WOUND PROCESS IS IN CASE OF THERMAL BURNS","authors":"B. V. Petryuk, V. P. Polovyi, О. V. Rоtаr, J. М. Мyshkovsky, І. І. Bіlyk","doi":"10.37699/2308-7005.1-2.2023.18","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.18","url":null,"abstract":"Summary. Aim. Investigation of the enterosorption impact of the Enterosgel and intratissue electrophoresis (ITE) of antibiotics on the course of the wound process in case of widespread dermal thermal burns. \u0000Materials and methods. The clinical efficacy of this combination was studied in 22 patients with superficial and deep dermal burns (Vishnevsky grade IIIA-B) with an area of 25 % to 62 % of the total body. Enterosgel in the form of a suspension with water was administered from the 3rd day after the injury, 15–20 g 3–4 times a day for 7–12 days. ITE of Antibiotics were performed from day 2–3 using the “Potok-1” apparatus with a constant current density of 0.03–0.05 mA/cm2 for 45–60 minutes. Visual assessment of the dynamics of the wound process, planimetric and cytological examination of burn wounds exudate in the dynamics on days 1–3, 6–7, 13–14 and 19–21 from the moment of injury were performed. \u0000Results and discussion. The proposed combination of these agents in the complex treatment of victims with widespread dermal thermal burns helps to optimize the course of the wound process in the area of thermal injury. At the same time, both demarcation and cleansing processes as well as reparative regeneration are activated, which increases the clinical effectiveness of the prescribed treatment. \u0000Conclusions. As a result of the clinical study, it was found that the use of intravenous antibiotics in combination with oral administration of enterosgel in the complex treatment of victims with widespread burns is reasonable and appropriate.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130280144","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":"INSTRUMENTAL DIAGNOSIS OF INFECTED FORMS OF PANCREATIC NECROSIS","authors":"A. Merkulov, O. Shevchenko, I. Kulyk, E. O. Bilodid","doi":"10.37699/2308-7005.1-2.2023.07","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.07","url":null,"abstract":"Summary. Through the skin fine-needle aspiration biopsy of parapancreatic fiber under ultrasound control with microbiological study of the biomaterial to verify purulent-septic complications of pancreatonecrosis, 46 patients with acute necrotizing pancreatitis were performed. Using the developed method for diagnosing infected pancreatic necrosis, it was possible to achieve timely detection of infectious complications of pancreatonecrosis, which would lead to a reduction in untimely (early) operations, the number of cases of systemic complications.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117163088","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":"RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC ISCHEMIA OF THE LOWER EXTREMITIES. SHORT-TERM DATA","authors":"V. Shaprynskyi","doi":"10.37699/2308-7005.1-2.2023.26","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.26","url":null,"abstract":"Summary. The aim of the study. To analyze the results of surgical treatment of patients with chronic ischemia of the lower extremities after using modern types of surgical approaches and technologies in the short term. \u0000Materials and methods. The results of surgical treatment of 420 patients were studied. Since 2019, 198 patients (the main group) have been treated using the updated ESVS international guidelines. Both groups of patients (the main group and the comparison group) were comparable in terms of sex, age, location of the lesion, and type of surgical intervention. \u0000A total of 98 (23.3 %) patients were operated on by the open method, 243 (57.9 %) by the endovascular method, and 79 (18.8 %) by the hybrid method. We studied such indicators as: postoperative thrombosis, limb amputations, mortality, as well as repeated operations performed due to complications or unsatisfactory results of the primary operation. \u0000Results and their discussion. The most recent results of surgical interventions revealed that the largest number of complications was found in the group of patients with multilevel occlusive-stenotic lesions of arteries, which correlates with the data of international studies. The direct effectiveness of endovascular interventions is higher than that of open revascularization and hybrid operations, and the trauma of miniinvasive endovascular techniques is significantly less compared to the methods of open reconstructive surgery. \u0000When analyzing the short-term results of surgical interventions, it was found that the largest number of complications was found in the group of patients with multilevel occlusive-stenotic lesions of arteries. The short-term effectiveness of endovascular interventions is higher than that of open revascularizations and hybrid operations, but has a clear tendency to decrease, unlike open operations, the results of which have a clear tendency to improve. \u0000Conclusions. The selected technologies and the selected tactics of surgical intervention allow to increase the efficiency of treatment of patients in the immediate postoperative period and reduce the number of postoperative complications in the main group from 10.5 % to 4.9 %, repeated operations from 9.72 % to 3.06 %, amputations from 5.4 % to 1.84 % and mortality from 3.89 % to 1.84 %. \u0000In the postoperative period, in the short term, the number of postoperative complications decreased from 11.59 % to 3.84 %, reoperations from 11.11 % to 3.04 %, amputations from 4.83 % to 2.3 %, and mortality from 3, 38 % to 1.53 %.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122275572","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 ROLE OF APPLIED SORBENTS IN THE COMPLEX TREATMENT OF PURULENT-NECROTIC PROCESSES IN DIABETIC FOOT SYNDROME","authors":"V. V. Kryzhevs’kyy, O. Bilyayeva, O. Myronenko, A. R. Bitin’sh","doi":"10.37699/2308-7005.1-2.2023.24","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.24","url":null,"abstract":"Summary. Aim. The development and implementation into clinical practice methods of local treatment of purulent-necrotic wounds in patients with diabetes, based on the use of modern sorbent drugs. \u0000Materials and methods. In 2021, 121 patients with various stages of diabetic foot syndrome were treated. The main group included 27 patients in whom Ornidasil sorbent was used for local treatment. The comparison group included 31 patients in whom hypertonic solution and ointment bandages were used for local treatment. \u0000Research results. The treatment of purulent-necrotic wounds in patients with type II diabetes with diabetic foot syndrome was analyzed. \u0000Conclusions. Diabetic foot syndrome is a serious complication of diabetes. Application sorbent consisting of ornidazole and nanosilica is an effective tool in the treatment of wounds with diabetic foot syndrome.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122192139","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":"INDICATIONS FOR BILIARY DECOMPRESSION AND CHOICE OF BILIODIGESTIVE ANASTOMOSIS IN PANCREATICODUODENAL RESECTION","authors":"M. M. Velygotsky, S. Arutyunov, I. Teslenko, M. Klymenko","doi":"10.37699/2308-7005.1-2.2023.10","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.10","url":null,"abstract":"Summary. Objective. To develop an algorithm for choosing the method of biliary decompression and to determine the optimal method of biliodigestive anastomosis in pancreaticoduodenal resection (PDR). \u0000Materials and methods. Pancreaticoduodenal resection was performed in 302 patients with obstructive diseases of the pancreaticoduodenal zone. Biliary decompression was performed in 62 (20,5 %) patients, the following methods were used: percutaneous perhepatic cholangiodrainage, endoscopic stenting, various variants of cholecystostomy, biliodigestive anastomosis. At the reconstructive stage of PDR biliodigestive anastomoses were performed: hepaticojejunoanastomosis, choledochojejunoanastomosis, cholecystojejunoanastomosis. \u0000Results and discussion. Percutaneous perhepatic cholangiodrainage was performed in 22 (35.5 %) patients, endoscopic stenting – in 21 (34.4 %), cholecystostomy – in 9 (14.5 %), biliodigestive anastomo-sis – in 10 (16.1 %). At the reconstructive stage of pancreaticoduodenal resection, a biliodigestive anastomosis on a single loop of jejunum (along with pancreaticjejunoanastomosis and gastroenteroanastomosis) was performed in 282 (93,4 %) patients, on a separate loop – in 10 (6,8 %) patients, reconstruction of the biliodigestive anastomosis – in 4 (1,3 %) patients, in 6 (2,0 %) patients the biliodigestive anastomosis was preserved for the purpose of biliary decompression at the first stage of treatment. \u0000Conclusions. Among the methods of biliary decompression, the use of percutaneous coronary intervention and endoscopic stenting is preferable, which allows performing pancreaticoduodenal resection with minimal perioperative complications; in the choice of biliodigestive anastomosis for pancreaticoduodenal resection the optimal is the performance of hepaticojejunoanastomosis.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"124 29","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113945772","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":"CLINICAL EFFECTIVENESS OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE THROMBOSIS OF LOWER LIMBS","authors":"D. Oklei, I. Taraban, V. Prasol","doi":"10.37699/2308-7005.1-2.2023.25","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.25","url":null,"abstract":"Summary. Examination and treatment of 274 patients with acute deep vein thrombosis of the lower limbs (DVT) was carried out. Thrombolytic therapy (TLT) as a basic method of treatment was used in 98 (35.8 %) patients. Of these, 44 (16.1 %) underwent catheter-guided thrombolysis and 54 (19.7 %) patients underwent systemic thrombolytic therapy. Anticoagulant therapy (ACT) was the basic method of treatment in 176 (64.2 %) patients. In the distant period, the positive results of TLT significantly exceeded the results of ACT. Thus, only 14 (15.7 %) patients after TLT had pronounced signs of postthrombotic disease in the remote period, while during treatment with anticoagulants 40 (30.8 %) patients had clinical manifestations of severe forms of CVI.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127236788","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}