Vol 5, No 4 (2012)

Научный Центр сердечно-сосудистой хирургии им. А.Н.Бакуле

Новосибирский государственный медицинский университет

Азербайджанский медицинский университет, г. Баку, Азербайджан Институт общей и неотложной хирургии АМН Украины, г. Харьков

Ижевская государственная медицинская академия

Мордовский государственный университет им. Н.П.Огарева

Воронежская государственная медицинская академия им. Н.Н.Бурденко Городская клиническая больница скорой медицинской помощи №1, Воронеж

Воронежская государственная медицинская академия им. Н.Н.Бурденко НУЗ «Дорожная клиническая больница на ст. Воронеж – 1 ОАО «РЖД»

В эксперименте на 40 кроликах-самцах породы шиншилла с помощью световой микроскопии изучены структур- ные изменения тонкой кишки, печени и сердца при экспериментальном распространенном гнойном перитоните. Установлено, что уже через 6 часов после инициации перитонита наблюдались системные структурные и гемоди- намические изменения указанных органов, которые характеризовались выраженными дистрофическими и некро- тическими процессами, интерстициальным отеком, воспалительной нейтрофильной инфильтрацией, гиперемией сосудов, стазом в микроциркуляторном русле и диапедезными кровоизлияниями. Применение в послеоперационном периоде при экспериментальном распространенном гнойном перитоните жировой эмульсии, содержащей омега-3- жирные кислоты, «Омегавен» способствует восстановлению структуры тонкой кишки, печени и сердца, снижению выраженности воспаления, препятствует развитию дистрофических и некротических изменений. Положительное системное действие препарата указывает на целесообразность его применения в комплексном лечении распростра- ненного гнойного перитонита.

Case histories of 217 patients who were hospitalized and underweat treatment at the surgical department of city clinical hospital № 8 (Ufa) during the period from 2005 to 2010 were investigated. The control group included 103 patients who received therapy according to the standards of providing medical aid envisaged for this pathology as well as symptomatic treatment and therapy for concomitant pathology. Antibacterial therapy was given to all patients. The main group under study consisted of 114 patients who received antibacterial therapy in our modification (the first subgroup received concomitant systemic enzymatic therapy the second subgroup received therapy in combination with intramuscular injections of oxytocin, the third subgroup received prolonged antibacterial therapy on the surface of lymphatic vessel endothelium. The use of systemic enzymotherapy, namely flogenzyme in combination with antibiotics at the beginning of the therapy course resulted in more rapid improvement in patients general condition (patients of the main group), decrease of body temperature, reduction of intoxication and normalization of laboratory findings. Among 40 patients who received antibacterial therapy concomitantly with systematic enzymotherapy by intramuscular injection of oxytocin no recurrences were observed during the period of 3 years. Lymphotropic antibacterial therapy of erysipelatous inflammation in all patients resulted in the decrease of body temperature, reduction of skin hyperemia and swelling that were observed on 2d - 3d day after treatment whereas in patients of the control group these indices were reduced only on the 5-th – 6-th day. The duration of in hospital treatment decreased on average by 3, 8 days.

Immediate and long-term results of combined endovascular and surgical treatment of 10 patients with locally advanced rectal cancer accompanied by colonic obstruction are presented. In the period of up to 24 hours after the simultaneous selective oily chemoembolization of the upper, middle and lower rectal arteries the positive result was obtained in 100% cases: resolution of colonic obstruction, decrease in size of tumor and improvement of the condition of the mesorectum were confirmed by magnetic resonance imaging and transrectal ultrasound. In nine cases radical surgical treatment was conducted after 2-3 days. The overall 3-year survival rate was 87.5%, disease-free survival rate was 75%. In all cases distant metastases in the liver were not observed.

К обсуждению статьи Ю.Л.Шевченко и соавт. "К вопросу о дренировании брюшной полости при перитоните" (Вестник экспериментальной и клинической хирургии 2012; t.v, №2; 376-379)

The problem of purulent and inflammatory complications upon duodenum-preserving pancreatic head resection (Beger procedure) the relevance of research. Were carried out anatomical studies of the greater omentum, developed and clinically tested methods of isolation of the stump of the pancreatic head and pancreaticojejunoanastomosis pedicled greater omentum, formed in the form of drained “bursae omentalis”. The results from 20 patients with chronic pancreatitis who were surgically treated by means of duodenum-preserving pancreatic head resection using the developed methods presented in article.

Patients with diabetes, especially diabetic foot syndrome, are at high risk of mycotic infections of feet. The presence of fungal infections is much heavier during the diabetic foot, as an additional risk factor for complicated forms and more protracted healing of wounds sanitized. For this reason, the appointment of antibiotic therapy in all patients with foot ulcer and diabetes mellitus should be based on the results of bacteriological seeding with the definition of fungal infection. In the presence of mycotic contamination of the wound antibiotic therapy is useful to combine c antifungal agents.

The models of local tissue and mesh endoprothesis hernioplasty in 30 Vistar white rats shown that usage the of biological active suture materials for operations decreases an inflammatory tissue reactions and promotes a good reparation in the site of plastic surgery. Analysis of abdominal wall hernias surgery in 301 patients revealed that use of biological active suture materials for hernioplasty promotes the statistically reliable decrease of wound complications and disease recurrence frequency.

Нижегородская государственная медицинская академия