V. Polyovyy, A. Y. Savchuk, R. Sydorchuk, P. V. Kyfyak, І. M. Plehutsa
{"title":"THE SІGNІFІCANCE OF CHANGES ІN PRІMARY HEMOSTASІS DURІNG ABDOMІNAL SEPSІS AS A POSSІBLE MECHANІSM OF SPІKE FORMATІON","authors":"V. Polyovyy, A. Y. Savchuk, R. Sydorchuk, P. V. Kyfyak, І. M. Plehutsa","doi":"10.37699/2308-7005.1-2.2023.19","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.19","url":null,"abstract":"Summary. Introduction. Abdominal sepsis (AS) is the most serious complication of inflammatory processes in the abdominal cavity, characterized by high mortality and morbidity. Violation of hemostasis is one of the key components of the pathogenesis of sepsis. \u0000Goal. Establishing the pattern of violations in the system of thrombocyte-vascular hemostasis in patients with abdominal sepsis in the postoperative period, as a prerequisite for the occurrence of adhesions. \u0000Materials and methods. The study covers observation of 52 patients with various forms of AS, aged 18-69 years (41.93±3.47). The control group consisted of 17 patients who underwent planned surgical interventions not related to the peritoneal cavity. The dynamics of the content of soluble fibrin-monomer complexes, prostacyclin and thromboxane were determined by the content of their stable metabolites in the blood. \u0000Results and discussion. Probable correlative dependences between the content of fibrin-monomer complexes in the blood and the concentration of TxB2 (positive correlation) and the level of prostacyclin in the blood plasma (negative relationship) were revealed. Identified violations in the system of primary hemostasis in patients with AS indicate the need for active correction of changes in thromboxane-prostacyclin systems in order to prevent thrombotic postoperative complications of a septic nature. \u0000Conclusions. Identified violations in the system of primary hemostasis in AS already on the first day after surgery indicate the need for active correction of changes in thromboxane-prostacyclin systems in order to prevent thrombotic postoperative complications of a septic nature. Taking into account the high risk of adhesion formation due to inflammatory processes of the peritoneum, it is advisable to consider the identified violations of primary hemostasis as a factor in the pathogenesis of adhesion disease.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"9 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":"132325596","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}
S. Vildanov, A. Nykonenko, V. Gubka, I. Rusanov, R. Budaghov
{"title":"THROMBOSIS OF ARTERIO-VENOUS FISTULA: QUESTION OF FEASIBILITY OF PERFORMING THROMBECTOMY","authors":"S. Vildanov, A. Nykonenko, V. Gubka, I. Rusanov, R. Budaghov","doi":"10.37699/2308-7005.1-2.2023.27","DOIUrl":"https://doi.org/10.37699/2308-7005.1-2.2023.27","url":null,"abstract":"Abstract. Introduction. Thanks to the use of renal replacement therapy at the current stage of medical development, full medical and social rehabilitation of patients with end-stage chronic renal failure is possible. The key to effective programmed hemodialysis is the formation of adequate permanent vascular access. Ensuring the optimal use and functioning of vascular access is a multidisciplinary problem. Currently, none of the known options for access is ideal, but the native arteriovenous fistula meets the requirements to a great erextent. Complications from vascular access for hemodialysis remain relevant for their solution today. The most common complication of vascular access is arteriovenous fistula thrombosis. For patients with end-stage renal failure who are on programmed hemodialysis, thrombosis of vascular access is a great danger, which ultimately can lead to the impossibility of further hemodialysis and it is the main reason for hospitalization and high mortality of this contingent of patients and needs an urgent solution. \u0000Purpose of the work improving the immediate and long-term outcomes of patients receiving programmed hemodialysis treatment by determining the feasibility of thrombectomy for early and late arteriovenous fistula thrombosis in the postoperative period as a method of ensuring the effective functioning of the permanent vascular access. \u0000Materials and methods. A retrospective analysis of the clinical data of 17 patients who underwent thrombectomy from a subcutaneous “fistula” vein of the upper extremity was performed. The age of the patients was 49.0 (44.0-61.0) years. By gender, the studied patients were distributed as follows: women - 9 (53 %), men - 8 (47 %). Among 17 (100 %) operated patients, 12 (71 %) had late thrombosis, 5 (29%) had early arteriovenous fistula thrombosis. \u0000Results. Of 5 (100 %) patients with early arteriovenous fistula thrombosis, thrombectomy was effective in 2 (40 %) patients (p=0.038). On the other hand, in 12 (100 %) patients with late fistula thrombosis, thrombectomy was successful in only 4 (33 %) cases. \u0000Conclusions. Neointimal hyperplasia is the main cause of progressive arteriovenous fistula stenosis and subsequent thrombosis. Thrombectomy is indicated for fistula thrombosis in the early postoperative period (up to 30 days after formation the last one). Thrombectomy alone is not enough to restore the patency of the permanent vascular access in the long term, and the final treatment requires its reconstruction at an early stage or the creation of a new arteriovenous fistula.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"26 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":"125935629","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}
V. Boyko, Y. Avdosyev, D. Yevtushenko, A. Sochneva, I. Taraban, R. Smachilo, D. Minukhin, O. Shevchenko
{"title":"ANTEGRADE ENDOBILIARY INTERVENTIONS IN PATIENTS WITH UNRESECTABLE BILIARY TRACT MALIGNANT NEOPLASMS COMPLICATED BY JAUNDICE","authors":"V. Boyko, Y. Avdosyev, D. Yevtushenko, A. Sochneva, I. Taraban, R. Smachilo, D. Minukhin, O. Shevchenko","doi":"10.37699/2308-7005.6.2022.06","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.06","url":null,"abstract":"Summary. Introduction. The causes of mechanical jaundice are benign and malignant diseases of the organs of the hepatopancreaticoduodenal zone. Literature sources describe the development of mechanical jaundice in 15-40 % of patients with gallstone disease and in the vast majority of patients with malignant neoplasms of the biliary tract. Mechanical jaundice of malignant etiology occurs in 40-67 % of patients. \u0000Aim. To study the results of the use of antegrade endobiliary interventions in patients with unresectable malignant neoplasms of the biliary tract complicated by jaundice. \u0000Materials and methods. An analysis of operative treatment of 62 patients with unresectable malignant neoplasms of the biliary tract, complicated by mechanical jaundice, classified according to Bishmuth-Corlette in the State Institution “Zaycev V.T. Institute of General and Emergency surgery of the National academy of medical sciences of Ukraine”: cholangiocarcinoma – tumor type I, observed in 9 (14.52 %) patients, type II – in 16 (25.81 %), type IIIA – in 10 (16.3 %), type IIIB – in 8 (12.9 %), type IV – in 13 (20.97 %). Cancer of the distal biliary tract was diagnosed in 6 (9.68 %) patients. \u0000External-internal percutaneous transhepatic cholangiodrainage (group 1) was installed in 36 (58.1 %) patients, external percutaneous transhepatic cholangiodrainage was performed in 26 (41.9 %) patients (group 2). \u0000Research results. Complications, which are directly related to the performance of percutaneous transhepatic cholangiodrainage, were found in 13 patients (21.0 %). In 7 (26.9 %) patients after external percutaneous transhepatic cholangiodrainage and in 6 (16.7 %) after external-internal percutaneous transhepatic cholangiodrainage (p>0.05). \u0000Partial migration of cholangiodrainage was observed in 5 (8.06 %) patients. \u0000Cholangiodrainage migration after percutaneous transhepatic cholangiodrainage of the left lobular duct occurred in 1 (1.6 %) patient. Cholangiodrainage migrated in 4 (6.4 %) patients with percutaneous transhepatic cholangiodrainage of the right lobular duct. Cholangitis after external-internal percutaneous transhepatic cholangiodrainage developed in 2 (3.2 %) patients, which was resolved due to sanitation and antibacterial therapy. Bile leakage into the abdominal cavity after percutaneous transhepatic cholangiodrainage in 1 (1.6 %) patient, which was resolved by placing a larger diameter drain. Hemobilia was observed in 2 (3.2 %) patients. In 3 (4.8 %) cases, the setting of the external percutaneous transhepatic cholangiodrainage was ineffective. \u0000Conclusions. In the absence of anatomical and technical limitations, it is more effective to use external-internal drainage in the treatment of patients with unresectable malignant neoplasms of the biliary tract complicated by jaundice, which is more physiological and functional. Deep-internal percutaneous transhepatic cholangiodrainage is accompanied by a lower frequency of complications - 16.7 % compared to externa","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"10 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123453868","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}
O. V. Burjan, N. O. Yurevich, Yu. Yu. Kuchmiy, V. O. Zmeyev
{"title":"PREVENTION OF INFECTIOUS COMPLICATIONS OF TRACHEOSTOMY IN PATIENTS WITH HEAD AND NECK CANCER PATHOLOGY","authors":"O. V. Burjan, N. O. Yurevich, Yu. Yu. Kuchmiy, V. O. Zmeyev","doi":"10.37699/2308-7005.6.2022.05","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.05","url":null,"abstract":"Summary. Introduction. A tracheostomy is still widely used in the head and neck oncology practice, but the rate of infectious complications remains high. \u0000Goal. Optimization of the prevention and treatment of the tracheostomy complications in patients with oncological pathology of the head and neck based on taking into account the flora that is seeded from the tracheostomy. \u0000Materials and methods. The 1st stage of the study consisted in examining of the 100 patients after tracheostomies performed in the period 2018-2022 (planned — 76, emergency — 24). The age of the patients ranged from 40 to 70 years old. The indication for the tracheostomy was obstruction of the respiratory tract by a tumor process of the larynx and the laryngopharynx. All surgery operations were performed under the local infiltration anesthesia, according to the standard technique for the permanent tracheostomy. At the 2nd stage, the proposed methods of the postoperative management of the patients to prevent the infectious complications were evaluated: processing of the cannula with a combination of 0.01 % solution of the miramistin with 10 mg of the chymotrypsin or a combination of 0.5 % solution of the dioxidin and 10 mg of the chymotrypsin. \u0000Results and their discussion. At the 1st stage of the study, various complications were detected, but in all cases there were infectious complications. Most often, after 7 days, Pseudomonas aeruginosa was cultured from the trachea, followed by Acinetobacter baumannii in 2nd place. The use of 0.02 % chlorhexidine solution to process the cannula was not effective. The flora that is cultured determines the antiseptic agent that should be used to process the cannula. \u0000Conclusions. 1. Infectious complications after the tracheostomy are inevitable due to disruption of the natural path of air movement. 2. The flora sown from the tracheostomy cannula within 14 days after the tracheostomy is diverse. 3. It is advisable to use double-lumen tracheostomy cannulas, the inner part of which should be processing with the antiseptics depending on the flora found in the tracheal contents. 4. The combination of the 0.01 % miramistin solution with 10 mg chymotrypsin for the cannula processing is effective against P. aeruginosa. A combination of 0.5 % dioxidin solution and 10 mg chymotrypsin is effective against S. aureus, A. baumanii and K. pneumoniae.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123560349","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}
V. Boyko, A. Krasnoyaruzhskiy, V. O. Hashchyna, A. Serenko, V. Groma, E. Groma
{"title":"TREATMENT OF BRONCHOPLEURAL FISTULAS","authors":"V. Boyko, A. Krasnoyaruzhskiy, V. O. Hashchyna, A. Serenko, V. Groma, E. Groma","doi":"10.37699/2308-7005.6.2022.01","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.01","url":null,"abstract":"Summary. The article is due to consideration of the etiology, diagnosis and treatment of patients with bronchopleural fistula. Bronchopleural fistula (BPF) most often occurs after surgery for lung resection (pneumonectomy, lobectomy, segmentectomy), with a frequency of 1.5 to 4.5 % after pneumonectomy and 0.5 to 1 % after lobectomy. \u0000The development of BPF can be influenced by the technique of closing the bronchi (manual or mechanical suture). Other etiologic factors include complications of malignancy treatment, including chemotherapy, radiation therapy, and chest trauma. Most patients develop BPF in the first two weeks (<14 days) after lung resection, but the exact proportion is unknown. BPF can be assumed in a patient with lung resection. The diagnosis of BPF is made using a combination of clinical, X-ray, and bronchoscopic findings that confirm air leakage from the main, lobe, or segmental bronchus into the pleural cavity. There are no specific laboratory findings, although some patients with an infected pleural space (due to BPF) may have leukocytosis or elevated C-reactive protein. The presence of a fistula is often visible on an X-ray of the chest organs, and is more effectively evaluated on a chest computed tomography (CT). \u0000BPFs do not close spontaneously and almost always require any surgical or bronchoscopic intervention, so all patients require a multidisciplinary discussion. Since most BPFs occur early in the postoperative period and do not become infected, most patients undergo surgical treatment with a satisfactory outcome. Bronchoscopic techniques have variable success rates and are applicable to patients in whom surgery is contraindicated, including patients with septic shock and severe hypoxemia, as well as patients on mechanical ventilation, patients in whom surgery is risky, and patients for whom it is stage before surgery. \u0000So, bronchopleural fistula (BPF) is a connection between the main trunk, a segmental or segmental bronchus and the pleural space. \u0000Patients with BPF may have symptoms that range from acute symptoms of tension pneumothorax (eg, shortness of breath, chest pain, tracheal deviation to the contralateral side) to subacute symptoms of empyema (eg, fever, cough with copious amounts of purulent sputum), persistent air defecation through pleural drainage. \u0000All patients with BPF require an interdisciplinary approach. For patients who have failed surgery or bronchoscopy, options include reoperation, an alternative bronchoscopic approach, or, in some cases, thoracostomy. \u0000BPF is associated with significant morbidity and mortality, ranging from 21 to 71 %, especially in the setting of post-pneumonectomy empyema. The best results of the treatment of patients were obtained with demonstrated aggressive surgical professionalism.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124543444","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}
S. Skoroplit, K. G. Mykhnevich, P. Zamyatin, E. Khoroshun, V. O. Borodai, S. Tertyshny, D. P. Zamyatin, V. Cheverda
{"title":"FEATURES OF COMBAT TRAUMA AND ORGANIZATION OF MEDICAL CARE","authors":"S. Skoroplit, K. G. Mykhnevich, P. Zamyatin, E. Khoroshun, V. O. Borodai, S. Tertyshny, D. P. Zamyatin, V. Cheverda","doi":"10.37699/2308-7005.6.2022.10","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.10","url":null,"abstract":"Summary. The article deals with the features of combat trauma at the present time., first of all – mine-explosive. The types of weapons that are most often injured are described. The etiology of wounds, their epidemiology, classification and pathogenesis are presented in detail. Much attention is paid to factors that affect the nature and severity of the injury. Methods of transportation of wounded, their sorting and stages of medical care in different branches and groups of troops are described. a new clinical protocol for emergency medical care is presented.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133230378","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}
V. Boyko, P. M. Zamiatin, V. Boroday, D. Zamiatin, K. Mykhnevych, L. V. Provar, V. Cheverda
{"title":"MEDICAL AND DIAGNOSTIC MEASURES FOR DAMAGE TO THE ABDOMINAL ORGANS IN THE WOUNDED AND VICTIMS WITH CATATRAUMA AGAINST THE BACKGROUND OF EXPLOSIVE AND TECHNOGENIC INJURIES","authors":"V. Boyko, P. M. Zamiatin, V. Boroday, D. Zamiatin, K. Mykhnevych, L. V. Provar, V. Cheverda","doi":"10.37699/2308-7005.6.2022.09","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.09","url":null,"abstract":"Summary. In the context of a large-scale war of the russian federation against Ukraine, the problem of injuries received as a result of catatrauma is urgent. \u0000Materials and methods. 203 cases of catatrauma-related injuries were analyzed. 128 such wounded were examined and treated. \u0000Results and their discussion. 4 clinical groups of wounded and injured people were identified. The severity of injuries was assessed by the number of affected abdominal organs (AO), the nature and extent of their injuries. There are 4 types of falls highlighted. Leading symptoms: peritoneal (16.3 % of cases), symptoms of intra-abdominal bleeding (38.6 %), urinary tract symptoms (3.2 %). In 50.2 % of cases, these symptoms were combined with simultaneous damage to the hollow and parenchymal organs. One of the most frequently damaged organs in catatrauma is the spleen. Surgical tactics for wounds associated with catatrauma are presented in detail, and an algorithm for the treatment and diagnostic process for catatrauma is developed. \u0000Conclusions. In the conditions of war, there is a need to develop a clear algorithm of actions, which includes identification of the site of damage, a complex of studies and consultations of related specialists is necessary, taking into account the development of possible complications and deaths, which also requires a number of detailed diagnostic techniques. The developed algorithms of the diagnostic approach in various cases of catatrauma allow us to form practical actions for paramedics and medical personnel.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115566212","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}
O. Maloshtan, R. Smachylo, A. A. Nekliudov, M. O. Klosova, T. Kordon, K. O. Bychenko, D. S. Kozlov
{"title":"STATE OF THE PHAGOCYTIC LINK OF IMMUNITY IN CHOLANGITIS","authors":"O. Maloshtan, R. Smachylo, A. A. Nekliudov, M. O. Klosova, T. Kordon, K. O. Bychenko, D. S. Kozlov","doi":"10.37699/2308-7005.6.2022.02","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.02","url":null,"abstract":"Summary. Aim. To study the condition of the phagocytic part of immunity in cholangitis. One of the main ways of elimination of bacterial contamination of the body is the work of the immune system, namely phagocytosis. This especially applies to acute and chronic cholangitis. \u0000Materials and methods. Depending on the magnitude of pathological changes in the biliary system, we have identified three groups of patients in whom cholangitis occurs in conditions that progress and worsen. Group I – cholangitis in conditions of choledocholithiasis, group II – cholangitis in conditions of iatrogenic strictures of the main bile ducts, and group III – cholangitis in conditions of already performed reconstruction of the duct system. The functional activity of phagocytic cells was studied. \u0000Results and their discussion. It was established that the functional capabilities of neutrophils are depleted in proportion to the severity of cholangitis and its duration. In case of chronic undulating cholangitis, there is an insufficiency of the phagocytic link, phagocytes work on the verge of exhausting their reserve capabilities. Adhesion forces and the potential of intracellular lysosomal enzymes are especially affected. \u0000Conclusions. The functional capacity of phagocytic cells in cholangitis is characterized by a deficiency, the degree of virulence is to lie down in the severity of inflammation and thrive. The greatest manifestations of changes were revealed in acid-independent mechanisms of phagocytosis, which were characterized by impaired adhesion and the release of intracellular lysosomal enzymes.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130149242","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}
V. Boyko, K. L. Gaft, E. V. Nakonechnyi, T. Z. Aleksandrov, A. Chikin
{"title":"MODERN ASPECTS OF DIAGNOSTIC AND SURGICAL TREATMENT OF PATIENTS WITH GALLSTONE DISEASE AND HIATAL HERNIA COMORBID COURSE","authors":"V. Boyko, K. L. Gaft, E. V. Nakonechnyi, T. Z. Aleksandrov, A. Chikin","doi":"10.37699/2308-7005.6.2022.03","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.03","url":null,"abstract":"Summary. Introduction. As of today, the issue of timely diagnosis and surgical treatment of gallstone disease (GD) and hiatal hernia (HH) comorbid course is extremely relevant and in need of attention. \u0000Aim. Improvement of diagnosis and surgical treatment of patients with GD and HH comorbid course by performing simultaneous laparoscopic surgery. \u0000Materials and methods. The main group consisted 16 patients, who were treated for the comorbid course of GD and HH by performing simultaneous laparoscopic surgery. The comparison group was made of 15 patients with similar pathologies with laparoscopic surgical treatment during two patients visits to the hospital. The study was carried out on the basis of the GI «V. T. Zaitsev IGЕS NAMSU». \u0000Results of the research. The average duration of simultaneous laparoscopic surgery in the main group of patients was ((87.5±17.5) min, p<0.05) and was significantly lower than in the comparison group – ((101.2±9.3) min, p<0, 05). The total volume of blood loss was (45.5±11.1 ml, p<0,01) in the main group of patients, while in the comparison group — ((79.1±5.7) ml, p<0,01). The average intensity of the pain syndrome (according to the McGill pain questionnaire) in the postoperative period in the main group of patients was ((3.1±0.8) points, p<0.01), and in the comparison group – ((7.9±0.7) points, p<0.01). The total duration of preoperative examination of patients in the main group was ((1.33±0.5) days, p<0.05) and in the comparison group — ((3.22±0.65) days, p<0.05). The average total number of temporary incapacity of workdays in the main group did not exceed ((5.5±1.1) days, p<0.05), while in the comparison group — ((11.2±0.6) days, p<0,05). \u0000Conclusions. It has been proven that simultaneous laparoscopic surgical intervention is the method of choice for treating patients with GD and HH comorbid course. In addition, the results of the study demonstrate the importance of careful diagnosis of patients for the presence of GD and HH comorbid course, considering of high probability of their combination.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122792458","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":"VACUUM THERAPY VICTORY IN COMPLEX SURGICAL REPAIR OF WOUNDS OF THE LOWER KINTSIVOKS WHICH THE TRIVALO DO NOT START","authors":"Нижніх Кінцівок, ЩО Тривало, НЕ Загоюються","doi":"10.37699/2308-7005.6.2022.08","DOIUrl":"https://doi.org/10.37699/2308-7005.6.2022.08","url":null,"abstract":"Summary. Aim. In the last decade, a new direction of using diffusion-separating membrane processes has been intensively developed in regenerative medicine — VAC therapy, the use of which would help to strengthen the correction of metabolic imbalance in damaged tissues, as well as to remove the most toxic low-molecular compounds and at the same time preserve the factors of regeneration, protection of the body and wound surfaces from infection in patients with wounds of the lower extremities that do not heal for a long time. \u0000Purpose. Improvement of the results of complex surgical treatment of patients with long-term non-healing wounds of the lower extremities. \u0000Materials and methods. The paper presents an analysis of the materials of self-observations and a retrospective study of the medical histories of 168 patients with long-term non-healing wounds who were treated at the surgical disease clinic of the KNP Kharkiv Regional Council “Regional Clinical Hospital” in the period from 2018 to 2022. All patients were divided into 2 clinical groups to assess the clinical effectiveness of the proposed treatment methods: the main group (87 people) – on the background of complex therapy, local wound treatment was carried out using the vac-complex, and a comparison group (81 people), these patients were treated with traditional means (water-soluble ointments, antiseptic solutions, etc.) on the background of complex therapy. \u0000Results. Our clinical data show that the largest number of patients had long-term non-healing wounds formed after purulent-inflammatory diseases of soft tissues (47.1 %), followed by trophic ulcers in varicose disease (28.7 %) and trophic ulcers in diabetes (24.1 %). The following parameters were included in the complex of clinical evaluation of the effectiveness of local treatment: reduction of the size of the wound surface, cleansing of the wound from purulent-necrotic exudate, the appearance of granulations, the beginning of marginal epithelization. The obtained data indicate that the cleansing of the wound and the onset of the second phase in terms of all parameters characterizing the wound process occurred faster when using the VAC bandage than in the comparison group. Bandages were less painful and more comfortable. At the same time, young granulation tissue was not injured, as was observed in patients in the comparison group. \u0000Conclusions. For the local treatment of non-healing wounds for a long time, the use of VAC therapy is recommended, thanks to the use of which, in the main group of patients, faster wound cleansing occurs (6.1±0.8) days, filling with granulations and the appearance of marginal epithelization (8.8±0.5) days, treatment times are reduced (19.5±06) days, p<0.05.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129109232","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}