Kharkiv Surgical School最新文献

{"title":"DISORDERS OF IMMUNE RESPONSE IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS","authors":"V. P. Poliovy, R. V. Salytin, O. Rotar, M. Y. Romanovsky, A. Palyanytsia, O. I. Horokhov","doi":"10.37699/2308-7005.4-5.2022.09","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.09","url":null,"abstract":"Summary. Aim. To study the cytokine regulation of the immune response in patients with severe acute necrotic pancreatitis (ANP). \u0000Material and methods. A prospective cohort study of 22 patients with severe ANP who were treated in the clinic during 2014-2020 has been performed. We studied changes in blood cells expressing clusters CDIIa+, CD162+, CD95+, CD16+, HLA-DR+ molecules, levels of interleukins IL-2, IL-4, IL-6. The efficacy of treatment was determined by the duration of the organ failure, the level of postoperative complications and mortality. \u0000Results. Low expression of CD11a+ and CD162+ on immunocompetent cells together with two time reduction of the content of CD95+ cells was observed in patients with severe ANP, which caused a decrease in the concentration of IL-6 at the same time with a slight increase in IL-4. A permanent reduction of the content of CD11a+-, CD162+- and CD95+-leukocytes simultaneously with a drop of the concentration of IL-4 and an excessive increase in the levels of IL-2 and IL-6 was associated with a negative course of the disease. \u0000Conclusions. The imbalance of cytokine regulation of the immune response develops in patients with severe ANP. Progressive and excessive increase of plasma concentrations of IL-2 and IL-6 occurs as well as complete absence of IL-4 occurs in patients with an adverse course of the disease.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126244322","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":"RISKS OF DEVELOPMENT OF ANASTOMOTIC SUTURE FAILURE DEPENDING ON THE METHOD OF DISSECTION OF THE TISSUES OF THE ORGANS OF THE GASTROINTESTINAL TRACT AND THE FEATURES OF THEIR FORMATION","authors":"O. I. Tsivenko, S. Bichkov, R. M. Grynyov, L. Dushyk, N. Cherkova","doi":"10.37699/2308-7005.4-5.2022.23","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.23","url":null,"abstract":"Summary. The purpose of the study: experimental and clinical study of the peculiarities of the course of reparative processes in the area of gastro- and colostomy wounds after carrying out various types of dissection and justification of the technique of forming anastomoses of the gastrointestinal tract. \u0000Research materials and methods. The paper presents the results of an experimental and clinical study of the processes occurring in the area of gastro-, entero-, and colostomy wounds made with electrosurgical or ultrasonic scalpels, immediately after exposure to tissues and within thirty days. \u0000Research results. Data were obtained that indicate a significant difference in destructive and reparative processes after various types of dissection. The use of ultrasonic dissection made it possible to maximally reduce ischemia of tissues and the internal ridge of anastomoses, in connection with which the reparative processes proceeded favorably and the patency through the anastomosis was not disturbed. The obtained results made it possible to scientifically substantiate the necessary distance of the needle from the edge of the dissection, depending on the type of dissection of the wall of the gastrointestinal tract. \u0000Conclusions. Ultrasonic dissection of the gastrointestinal tract is characterized by a relatively gentle effect on biological tissues, which is accompanied by the formation of much smaller areas of necrosis and necrobiosis than with electrosurgical exposure. In addition, biological welding of the edges of the wound, reliable hemostasis is achieved; there are no carbonization of fabrics, their sticking to the surface of the manipulator, smoke, sparks and other effects. \u0000It was established that after electrosurgical dissection, the phenomenon of prolonged necrosis develops, i.e., the necrosis zone spreads within three days, including due to the necrobiosis zone. This fact must be taken into account when applying seams. \u0000Adherence to the technical rules for the formation of gastrointestinal anastomoses, based on experimental data, made it possible to eliminate the risks of developing postoperative complications, first of all, their failure.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114331946","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 THE USE OF COMPOSITE MATERIALS FOR THE TREATMENT OF PURULENT WOUNDS OF THE LOWER EXTREMITIES WITHOUT THE USE OF ANTIBIOTICS","authors":"V. Bielai, V. P. Shevchenko, I. А. Danylenko","doi":"10.37699/2308-7005.4-5.2022.19","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.19","url":null,"abstract":"Summary. Introduction. The reasons for the long-term healing of TU of the lower extremities are bacterial contamination of ulcers with the formation of biofilms and growing antibiotic resistance. \u0000The urgency of the problem. The number of purulent wounds, microbial resistance and a significant frequency of recurrences of TU of the lower extremities (20–70 %) determine and substantiate the relevance of the problem. \u0000Goal. Increasing the effectiveness of treatment of patients with TU of the lower extremities against the background of CVI, without the use of antibiotics, \u0000Materials and methods. Patients with TU were divided into two groups. The first (main) group (n=57) included patients who were treated with an apatite polymer drainage bandage, the second group (comparison) included patients who were treated with traditional methods (n=53). Smears from the wound surface of TU were studied. \u0000Results and their discussion. The intensity of microbial contamination of TU before the start of treatment was 107 CFU/ml, on the 3rd day after APDB application — 104 CFU/ml, on the 5th day — 103 CFU/ml. The average rate of wound healing was 0,42 cm2/day of wound surface area. \u0000Conclusions. Application of APDB without the use of antibiotics leads to a decrease in microbial contamination. The average duration of treatment in the main group was 19,6 days, in the comparison group — 28,2 days. The speed of wound healing in patients of the main group is 2,1 times higher. In the biopsies of patients of the main group on the 14th day of treatment, a significantly greater order of collagen fibers and a greater number of fibroblasts were found.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124370204","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 NEAREST AND SHORT-TERM RESULTS OF TREATMENT OF PATIENTS WITH OCCLUSIVE-STENOTIC LESIONS OF THE MAIN ARTERIES OF THE INFRARENAL AORTA","authors":"V. Shaprynskyi","doi":"10.37699/2308-7005.4-5.2022.20","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.20","url":null,"abstract":"Resume. The aim of the study. To analyze the immediate and short-term results of treatment of patients with occlusive-stenotic lesions of the main arteries of the lower extremities after using modern types of surgical approaches and technologies. \u0000Materials and methods. The immediate and short-term results of treatment of 420 operated patients were analyzed. 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. \u000098 (23.3 %) patients were operated on by the open method, 243 (57.9 %) by the endovascular method, 79 (18.8 %) by the hybrid method. We evaluated 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 analysis of the immediate results of surgical interventions showed 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. \u0000As a result of the analysis of 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 the 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 tactics and selected surgical intervention technologies 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 short-term postoperative period, 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":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130057490","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":"OBSERVATION OF A CLINICAL CASE OF TREATMENT OF A PATIENT WITH FILARIASIS","authors":"K. Parkhomenko, A. Drozdova, M. V. Suplychenko, K. A. Prokopenko","doi":"10.37699/2308-7005.4-5.2022.30","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.30","url":null,"abstract":"Summary. According to WHO data, about 4.5 million people are affected by parasitic diseases. In the last decade, the attention of clinicians has been drawn to parasitic diseases caused by helminth larvae of animals that are not characteristic of humans. Filariasis is the only transmissible human helminthosis in Ukraine. Despite the fact that there is an opinion that helminthiasis has become “forgotten diseases” in modern conditions, there is a tendency to underestimate their medical and social importance all over the world. In confirmation of the above, the article describes the case of treatment of a patient with filariasis. This clinical example demonstrates that this topic is relevant not only for effectionist doctors, but also for doctors of other specialties. Helminthiasis is often the last point in the chain of differential diagnostic thinking of the doctor. The urgency of the problem is due primarily to the significant prevalence, the pronounced negative impact on the human body, the polymorphism of clinical manifestations, which complicates the differential diagnosis of diseases, the lack of sterile immunity and specific methods of prevention.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"235 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124585426","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 AND CONSEQUENCES OF LYMPHOTROPIC ANTIBIOTIC THERAPY IN PATIENTS WITH APPENDICULAR INFILTRATE","authors":"I. Duzhyi, H. Pyatikop, M. H. Kononenko, V. Shimko, O. Sytnik, V. P. Shevchenko, O. V. Kravetz","doi":"10.37699/2308-7005.4-5.2022.02","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.02","url":null,"abstract":"Summary. The aim of the work was to study the possibility and effectiveness of antibiotic therapy for appendicular infiltrate using the proposed lymphotropic technology. The results of treatment of patients with appendicular infiltrate of the two studied groups were analyzed. In the main group (47 patients), lymphotropic administration of antibacterial drugs was performed. The comparison group (47 people) received standard antibiotic therapy. At the same time, it was possible to reduce the period of inpatient treatment from 12-14 days to 6-7. In the late period, during surgical treatment of patients of the main group, no adhesions were found in the abdominal cavity, and in patients of the comparison group, such changes were found in 74 % of the operated patients, which indicates a positive effect of lymphotropic antibiotic therapy. The proposed method of antibiotic therapy improves the results of treatment, saves financial costs for treatment and ensures the timely return of the operated person to socially useful work.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115678684","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":"OPTIMIZATION OF TREATMENT OF PATIENTS WITH PANCREATIC CANCER COMPLICATED BY MECHANICAL JAUNDICE","authors":"K. Parkhomenko, A. Drozdova, K. Y. Payunov, O. V. Shadrin","doi":"10.37699/2308-7005.4-5.2022.13","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.13","url":null,"abstract":"Summary. The aim of the study was to improve the results of surgical treatment of patients with malignant neoplasms of the pancreas complicated by mechanical jaundice, as well as to prove the feasibility of combined treatment and staged approach to it using minimally invasive technologies. \u0000Materials and methods of the study. The results of treatment of 112 patients with pancreatic cancer who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council «Regional Clinical Hospital» from 2018 to 2021 were analyzed. The age of the examined patients averaged (53,2 ± 12,7) (from 37 to 88 years), of which women — 43 (38,0 %), men — 69 (62,0 %). All patients were examined in the laboratory and instrumentally. \u0000Results of the study. Mechanical jaundice was observed in 81 (72,0 %) patients. According to the classification of VE Smirnov (1974), in 16 (14,2 %) patients acute jaundice was observed, in 56 (50 %) — acute prolonged and in 40 (35,8 %) — chronic mechanical jaundice. Among the results of the study of the analyzed patients, the minimum level of total bilirubin in mechanical jaundice was 44 μmol/l, the maximum — 546 μmol/l. All patients with mechanical jaundice underwent endoscopic retrograde cholangiopancreatography. Eight (9,8 %) patients developed complications after endoscopic retrograde cholangiopancreatography: bleeding from a papillotomy wound (4), clinic of acute pancreatitis (3), injury of the posterior wall of the duodenum (1). In 2 cases, the procedure failed due to total obstruction of the large duodenal nipple. Among the 79 patients who managed to undergo endoscopic intervention, only 5 cases, according to the commission on cancer care, were recognized as resectable in the future. \u0000Conclusions. Minimally invasive methods of restoring bile in mechanical jaundice caused by cancer of the pancreas are effective as independent treatment procedures, staged, which may precede laparotomy.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127028228","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":"ERGOTHERAPY AND REHABILITATION OF PATIENTS WITH COLOSTOMES AS A FACTOR AFFECTING THE QUALITY OF LIFE","authors":"V. Lupaltsov","doi":"10.37699/2308-7005.4-5.2022.27","DOIUrl":"https://doi.org/10.37699/2308-7005.4-5.2022.27","url":null,"abstract":"Summary. The analysis of medical rehabilitation of patients with colonic stoma was carried out, the ultimate goal of which is to improve their quality of life. The relevance of these events is evidenced by the creation in many countries of public associations of stoma patients, the opening of societies for the care of patients with colonic stoma. In the USA, specialized medical schools for the training of stoma-therapists are even being created. Medical rehabilitation should become the main component of the comprehensive rehabilitation of stoma patients with financial support from the state.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"194 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134379065","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":"QUESTIONS OF PREVENTION OF RECURRENCE OF ESOPHAGEAL HERNIA","authors":"V. Boyko, D. Yevtushenko, S. O. Nemenko, I. G. Fursov","doi":"10.37699/2308-7005.3.2022.11","DOIUrl":"https://doi.org/10.37699/2308-7005.3.2022.11","url":null,"abstract":"Abstract. The paper presents a review of the literature on the recurrence of esophageal hernia after surgery. The number of early and late postoperative complications varies considerably, their frequency can reach 17 %. The effectiveness of repeated operations varies between 23-89 %. \u0000The recurrence rate of esophageal hernia of laparoscopic fundoplication was (9.3 %) and the most common cause of unsatisfactory results was the destruction of the fundoplication cuff (41.7 %). \u0000Further research and development of an individualized approach to the choice of method of performing fundoplication, determination of criteria for predicting the risk of recurrence of esophageal hernia, definition and development of methods for prevention of recurrence of esophageal hernia.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124701285","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":"ASSESSMENT OF THE SEVERE OF THE PATIENT’S CONDITION IS AN INTEGRAL COMPONENT OF THE TREATMENT PROCESS FOR PATIENTS WITH ABDOMINAL SEPSIS","authors":"V. P. Polovyi, R. Sydorchuk, Yu. M. Solovei, A. S. Palianytsia, M. J. Romanovskyy","doi":"10.37699/2308-7005.3.2022.03","DOIUrl":"https://doi.org/10.37699/2308-7005.3.2022.03","url":null,"abstract":"Abstract. To date, numerous studies continue to identify factors that significantly affect the outcome of treatment of intraperitoneal infections. \u0000The proposed work: to improve existing systems for assessing the severity of the patient’s condition by modification aimed at adapting to the capabilities of most domestic clinics. \u0000Material and methods. Based on the analysis of clinical and laboratory data obtained in 183 patients with acute peritonitis and abdominal sepsis, a scale for assessing the severity of patients was developed. \u0000Results. The developed scale of assessment of the severity of patients (OTSP) coincides with the most widespread system АРАСНЕ (Acute Physiology And Chronic Health Evaluation) II. Some changes and additions are related to the transfer of indicators to the international system of SI measurements, the use of regulatory data adopted in Ukraine, as well as the introduction of two new parameters. The scale system is based on numerical evaluation of clinical, physiological, laboratory and other parameters. The presence of clinical symptoms or deviations of physiological, biochemical parameters from the norm is determined by the number and values relating to one patient, added to the general scale. \u0000Conclusion. The proposed scale for assessing the severity of the patient’s condition is available and informative enough for use in patients with acute peritonitis and abdominal sepsis.","PeriodicalId":405037,"journal":{"name":"Kharkiv Surgical School","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132850202","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}