Vol 10, No 4 (2017)

Original articles

Results of portosystemic shunting in patients with hepatic cirrhosis and ascites syndrome

Nazyrov F.G., Devyatov A.V., Ibadov R.A., Babadjanov A.K., Irmatov S.K., Baybekov R.R.


Purpose. Assess the results of portal systemic shunting (PSSh) in patients with liver cirrhosis (LC) with ascitic syndrome.

Materials and methods. Analyse the results of PSSh in 556 patients operated a year from 2000 to 2015. The basis of the analysis taken all the features related to the development and progression of ascitic syndrome. Depending on the shunt type, research conducted with most frequently performed shunts groups.

Results. Initial decompensated cirrhosis by edema-ascites syndrome significantly increases the risk of specific complications such as hepatic insufficiency from 6.9% to 13.5%, hepatic encephalopathy from 12.1% to 16.2% and increase in ascites from 7.2% to 16.2%, and the mortality rate from 2.1% to 3.8%. The main cause of early mortality after PSSh is a risk of thrombosis of the anastomosis with recurrent bleeding, whereas other specific complications, conservative measures allow neutralizing the difference in the index of satisfactory results of the operation (96.2% — in the group with ascites before PSSh against; 97.9% — in the group without ascites). Quantitative and qualitative analysis of ascites showed that in the coming period after the shunt (3-5 days) the development of this complication depends on the type of bypass surgery, so when the distal splenorenal shunts (DSRS) production of ascites significantly increased (P <0,01), while total protein component fluid significantly (P <0,02) higher than in patients in ascites with central bypass type. This fact is due to the formation of the selective type of bypass on the background of DSRS, and the growth of ascites does not depend on the presence of complications before surgery, indicating that the impact factor of the severity of portal hypertension and therefore the adequacy of decompression of the portal vein system, against which a decrease in blood albumin fraction and increase it in ascites (R2 = 0,57) may be indicative of a high residual portal pressure.

Conclusion. In patients with cirrhosis after PSSh in 70.2% of cases of decompensation of ascites syndrome is caused directly with cirrhotic process and the growth of functional impairment of hepatocytes, the remaining 29.8% of cases, the formation of the complications associated with the progression of PH syndrome on the background of anastomotic thrombosis.

Journal of Experimental and Clinical Surgery. 2017;10(4):256-264
pages 256-264 views

The role of bacteriophages in the complex treatment of peritonitis of appendicular origin (experimental study)

Mokhov E.M., Morozov A.M., Kadykov V.A., Askerov E.M., Serova N.E.


Relevance: with the management of laparoscopic methods of surgical treatment of acute appendicitis, the problem of the occurrence of early postoperative complications has not changed at present, which makes it necessary to carry out preventive measures.

Objective: to study the possibility of improving the results of surgical treatment of peritonitis, the most frequent complication of acute appendicitis, by reducing the number of postoperative complications of infectious genesis.

Methods: Studies were performed on 47 non-linear white rats weighing 200-250 grams by modelling peritonitis using the biological model as an example, followed by antibiotic therapy and combination therapy using bacteriophages. To model peritonitis, the infection of the abdominal cavity with the E. coli strain 25922 was used. The laboratory animals were divided into 3 groups: the first group was control group, the second group received treatment in the form of a single intraperitoneal injection of Cefipime, the third group received treatment as a single intraperitoneal injection of the Sextapage.

Results: the evaluation of the methods was carried out on the basis of the study of the clinical picture of the course of peritonitis in experimental animals, the data of pathomorphological and histological examination of the sectional peritoneum. As a result of experimental studies, there was no significant difference in the methods of perioperative prevention of complications of acute appendicitis, which makes it possible to perform monotherapy with bacteriophages. Phages in comparison with antibiotics have no less therapeutic efficacy.

Conclusions: Thus, our experimental studies revealed completely satisfactory results of monotherapy of experimental peritonitis with a bacteriophage. According to the morphological data, the inflammatory process in the abdominal cavity is stopped by the phage fast enough and there is a tendency for a faster fading of the inflammation than in the treatment with antibiotics.

Journal of Experimental and Clinical Surgery. 2017;10(4):265-268
pages 265-268 views

Efficacy of Immobilized Prolonged Ammonium Antiseptics in Treatment of Purulent Wounds

Sukovatykh B.S., Grigoryan A.Y., Bezhin A.I., Pankrusheva T.A., Blinkov Y.Y., Gorohova A.S., Tiganov S.I.


Relevance. Purulent complications occur in 35-45% of patients with surgical diseases, lethality rate from these conditions achieves 25%.

The purpose of the study. To investigate the wound process while treating the purulent wounds with immobilized forms of miramistin and benzalkonium chloride in gel of sodium salt of carboxymetylcellulose.

Materials and methods. There were analysed results of experimental study of the wound process on 108 male Wistar rats. Experimental animals were divided into 3 groups, each group included 36 rats. In a comparison group ‘Levomekol’ ointment was used for treatment. In the first experimental group treatment was done by the ointment with the following composition: 0,01% solution of miramistin — 100 g, metronidazol –1,0 g, sodium salt of carboxymetylcellulose — 4,0 g, while in the second experimental group ointment composition included benzalkonium chloride 0,02 g, metronidazol — 1,0 g, sodium salt of carboxymetylcellulose — 4,0 g, purified water — up to 100,0 g. The wound process was evaluated by planimetric, microbiological and histological methods of investigation.

Results and its discussion. The reduction of wound area in the first experimental group was higher than in a comparison group on the 3rd day of the experiment by 9,7%, on the 5th day — by 7,6%, on the 10th and 15th days — by 10,5%, while in the second experimental group the change was 37,2%, 27,3%, 13,8% and 6,9% respectively. In the first experimental group microbial contamination of the wound was less than in a comparison group by 5,8х106, on the 5th day — by 3,1х105, on the 10th day — by 6,1х104, while in the second experimental group on the 3rd day there were no differences, on the 5th day — by 6,3х105, on the 10th day — 1,1х104. Histological investigations of the wound biopsies on the 10th day of experiment showed that in a comparison group the bottom of the wound was covered by granulation tissue without signs of epithelization, there was full coverage of the wound with a newly formed epithelium in experimental groups.

Conclusions. The use of prolonged quaternary ammonium antiseptics in treatment of purulent wounds is pathogenetically justified and efficient.

Journal of Experimental and Clinical Surgery. 2017;10(4):269-276
pages 269-276 views

The possibilities of early diagnosis by innovative methods of studying biopsies of colon mucosa in determining the scope of a surgical operation

Manuylov A.A., Kaushanskaya S.Y., Kaushansky V.B., Bakhmutsky N.G., Dryaeva L.G.


Objective: to increase the effectiveness of treatment of oncological diseases of the gastrointestinal tract by increasing the informative value of establishing the necessary volume of the surgical operation.

Material and methods. In the high-frequency electric field visualization of the glow of 82 biopsy specimens of the large intestine taken for histological analysis was performed to solve the question of the scope of the operative intervention.

Results. There was an edge luminescence in all biopsy materials in the high-frequency, while there was internal luminescence in the biopsy of a cancerous tumor. The glow covered the entire cancerous growth. By biopsy glow in the high-frequency electric field, in comparison with the endoscopy data, there were discrepancies in the diagnosis, in particular, internal glow observed in 2 patients with the initial diagnosis of "diverticulum", in 2 patients with the diagnosis of "villous tumor", 6 patients with a diagnosis of "polyp", which indicated the presence of a malignant tumor. Histological analysis confirmed this and the primary volume of the surgical operation was changed for these patients.

The conclusion. The given data of visualization of luminescence of biopsy specimens can be the basis for creating an endoscopic express diagnostic method and increasing the informative value of establishing the necessary volume of a surgical operation.

Journal of Experimental and Clinical Surgery. 2017;10(4):277-282
pages 277-282 views

The question of the influence of the dosed tissue stretching on the concentration of the hypoxia-inducible factor (HIF-1α) in the stretched flap

Bagryantsev M.V., Pavlenko I.V., Shelchkova N.A., Mironov A.A., Ryabkov M.G., Beschastnov V.V.


Relevance: the method of dosed dermotension as one of the options for plastic reconstruction of the foot with the soft tissue defects of various etiologies (including diabetes mellitus) are widely used in surgery. Local circulatory compensated hypoxia, occurs when dosed dermotension, stimulates proliferation of blood vessels, but to date no proven link between measured growth and the concentration of cytokine HIF-1α.

Aim: the aim was to identify patterns between local circulatory compensated hypoxia created by carrying out the dosed dermotension and cytokine concentration of HIF-1α in stretched the flap when closing the wound of the soft tissues.

Materials and methods: the experiment was carried out on 18 experimental animals, which was simulated wound scapular area and conducted a hardware apparatus dermotension under the control of laser Doppler flowmetry, formed the skin samples and performed enzyme-linked immunosorbent assay to determine the concentration of cytokine HIF-1α after 30 minutes, 24 hours from the beginning of tissue stretching.

Results: the concentration of HIF-1α in the skin before the start of the dermotension was (Me [Q1; Q3]) 110 [98,1; 114,8] ng/ml. A statistically significant increase in the concentration of HIF-1α to 148 [122,2; 221,7] ng/ml (p=0.008) recorded in the group of animals who underwent tissue stretching within 30 minutes, research also showed that the concentration of HIF-1α increased to 330 [246,4; 463,3] ng/ml (p=0.007) after 24 hours from the start of the dosed strains.

Conclusion: the concentration of cytokine HIF-1α in stretched the flap increases with dosed dermotension. Thus, the regulation of adaptation of the skin to stretching is performed by increasing the concentration of the cytokine HIF-1α.

Journal of Experimental and Clinical Surgery. 2017;10(4):283-287
pages 283-287 views

The Study of the Gastrocolicomentum Influence on the Healing of the Intestinal Anastomosis in a Blood Supply Disorders of the Small Intestine

Markos`yan S.A., Lysyakov N.M., Belyaeva M.U.


Topicality. Currently, the problem of intestinal anastomosis reliability remains one of the most important, especially when the volume of surgical interventions is associated with significant disturbance of the blood supply to the intestine. According to the literature, the incidence of intestinal anastomosis incompetence after intestinal resection remains high and ranges from 4 to 10.2%.

The aim of the study is experimental assessment of the efficiency of omentoenteropexy application for prophylaxis of intestinal anastomosis incompetence.

Materials and methods. Experiments were carried out on 20 dogs divided into 2 groups. The first group consists of animals which were formed intestinal anastomosis and ligated mesenteric vessels, the second group is the animals, which in addition to the aforesaid activities were realized omentoenteropexy. Of the venous vessel, directly adjacent to the ischemic area of the small intestine, within 25 minutes after the formation of intestinal anastomosis was performed blood sampling, followed by the study of a number of indicators hemomicrocirculatory: сapillary filtrate, plasma protein loss, blood viscosity, coefficient deformation erythrocytes, erythrocyte sedimentation rate. In addition, the blood flow in the vessels of the small bowel mesentery, adjacent to the zone of ischemia, was investigated. During the postoperative period pathomorphological changes were estimated in the peritoneal cavity, mechanical strength of the junctions and stricture formation index were defined.

Results. Capillary filtrate and plasma protein loss in the ischemic area of the small intestine with the anastomosis increase by 6.4 times (p <0.01) and 250% (p<0.05). Blood viscosity increased by 30.6% (p <0.01), erythrocyte sedimentation rate decreased by 30.9% (p <0.01). The number of functioning capillaries is equal to 48.5+1.8% (P <0.01). In 1 case pneumopressia test revealed intestinal anastomosis incompetence. The postsurgical period was accompanied by a significant development of adhesions in the abdominal cavity. In the study hemomicrocirculatory rates in the ischemic area of the small intestine with anastomosis, covered the greater omentum, we didn't detect reliable differences to those of the first group of animals. In all cases intestinal anastomoses were competence and adhesions in the abdominal cavity was represented by single commissures.

Discussion. The paper presents the results of an experimental research on the morphological and functional changes in the ischemic area of the small intestine with the anastomosis in absense of omentoenteropexy and after covering the ischemic part organ with anastomosis by dint of the gastrocolic omentum and subsequent suturing it to the avascular part of the bowel mesentery.

Performed research determined significant change of hemomicrocirculatory rates in the ischemic area of the small intestine with anastomosis in flowing venous blood from it and in the mesentery of the small intestine, directly adjacent to the avascular area.

Postoperative relaparotomy showed pronounced morphological disturbances in the ischemic area of the small intestine with the anastomosis, the presence of significant adhesions in the abdominal cavity. Intestinal anastomosis incompetence was diagnosed in 1 case. Covering explored part of the small intestine by dint of the gastrocolic omentum has contributed to a more favorable regeneration flow without the development of postoperative complications in the intestinal anastomosis. There was an insignificant adhesion in the abdominal cavity in most cases.

Conclusion. Thus, covering the ischemic area of the small intestine with anastomosis by dint of the gastrocolic omentum and suturing it to the avascular part of the mesentery resulted in a significant improvement in the regeneration of the intestinal anastomosis and reduction of intraperitoneal adhesions.

Journal of Experimental and Clinical Surgery. 2017;10(4):288-292
pages 288-292 views

The Algorithm For Obtaining Referential Meanings Of Biochemical And Complete Blood Tests Coagulogram In Wistar Male Rats At Blood Sampling From Carotid Artery

Kinzerskiy A.A., Korzhuk M.S., Dolgich V.T.


Background. At present time there are few works throwing some light on the details of solving a problem in a field of experimental medicine by the "how to do it" principle which after having studied them give readers a good grasp of reproducing the offered technique on their own. It also concerns blood sampling with the aim of assessing certain indicators at small laboratory animals.

Objectives. To work out the technique of carotid artery catheterization for detecting the referential meanings of biochemical and complete blood tests coagulogram on Wistar male rats. To define more precisely the obtained values by the bootstrap method and to compare them with the data to have published before.

Materials and methods. The research was conducted on Wistar male rats (n=42) weighing 270-380 g. The access to the left carotid artery was implemented with taking into account some anatomic features of an animal being anesthetized with tiletamin/zolazepam (20-40 mg/kg intramuscularly) + xylazine (5-10 mg / kg. intramuscularly). Statistical treatment has been conducted in the programming language R with using the statistical packages "boot", "car", "sm", "coin", "VIM" and "mice". The referential meanings have been defined by the bootstrap method.

Comparing with literature data was executed by the permutational test with p-level correction for multiple comparisons by using the Benjamini-Yekutieli method, the level α was accepted as equal 0,05.

Results and Discussion. The rational access to a carotid artery and its catheterization way have been developed. The referential meanings of biochemical and complete blood tests coagulogram were developed and defined by using the bootstrap method on Wistar male rats. While comparing the indicators to have received earlier from Wistar male rats by other researchers, the statistically significant differences were received in all indicators, except the quantity of leucocytes, thrombocytes, and indicators of hematocrit and total bilirubin. The received differences are likely to be connected with different climatic conditions, the character of anesthesia care, accessing to blood sampling, and wide range of the compared rats’ age. Clinically differences are insignificant.

Conclusion. The developed algorithm for obtaining referential meanings of blood tests samplings from rats can be considered to be rational and reproduced and the received indicators’ values should be considered to be referential.

Journal of Experimental and Clinical Surgery. 2017;10(4):293-303
pages 293-303 views

Theoretical bases of calculation of energy parameters of laser radiation for thermotherapy of Baker's cyst.

Zhilyakov A.V., Chernyadiev S.A., Aretinskiy A.V., Sivkova N.I., Korobova N.Y., Gorbatov V.I.


Actuality: Interstitial application of light energy to pathological tissues of small volume always raises concerns about the possible negative impact of excessive thermal effects on the surrounding unchanged structures. At the same time, insufficient thermal exposure does not allow achieving the desired result of manipulation. In particular, with a similar problem, there are surgeons performing laser-induced thermotherapy of cysts of different localization.

Objective: Determine the time to reach the desired temperature required for the irreversible coagulation of the wall of the Baker cyst, depending on the power of the laser radiation and the volume of the intracystic fluid.

Materials and methods: Several series of experiments were carried out in which different volumes of aqueous lidocaine solution were heated in disposable syringes by laser radiation fed along a flexible light-bearing fiber. Registration of infrared radiation from this system was performed by a portable thermal imager CONDTROL IR-CAM (Russia). The time for heating the syringe to 70 ° C was measured at different radiation powers.

Results: In all series of experiments, a predetermined temperature of 70 ° C was achieved, providing instantaneous protein coagulation. Attention is drawn to the fact that the calculated time by the formula (ideal) in all cases is less, which can be explained by the effect of heat removal from the walls of syringes. The higher the power of laser radiation, the less the effect of heat removal on the heating rate of the aqueous solution, and, accordingly, the time to reach the set temperature.

Conclusion. In the energy regimes and volumes of the aqueous solution studied, the optical fiber with end radiation emission is not capable of causing carbonization and damage to surrounding tissues. Accordingly, contactless perforation of the cyst wall by laser radiation with a wavelength of 1.47 μm is impossible. The obtained data testify to the advisability of calculating the energy to reach the set temperature and keeping it for a period sufficient for coagulation transformation of the more external layers of education

Journal of Experimental and Clinical Surgery. 2017;10(4):304-309
pages 304-309 views

Obstetrics Patients with the Uterus Scar and Low Insertion of Placenta: Prophylaxis of Hypotonic Hemorrhage

Vukolova V.A.


Relevance. The issue of obstetric bleeding has always been acute. In the last decades, there has been a significant improvement in prophylaxis techniques as well as bleeding control during both vaginal and operative delivery. Yet, hemorrhage complications continue to endanger the mother's life and require a lot of effort from the hospital staff. Thus, it is essential that we develop more efficient prophylaxis techniques when dealing with obstetrics patients with the uterus scar and low insertion of placenta.

The aim of the research was to assess the hemostasis when using hemostatic uterus suture (by Radzinsky modification).

Materials and methods. The surgery process was analysed together with the post-surgical period in relation to obstetrics patients with the second cesarean transection and low insertion of placenta. For prophylaxis of hypotonic hemorrhage, a compression suture (by Radzinsky modification) was applied to the lower uterus segment. Maternity patients were administered perioperative antibiotic prophylaxis and methylergometrine (1,0 ml) immediately after the extraction of infant from uterus. Intraoperative bleeding was assessed gravimetrically. It was followed then by monitoring the postsurgical period, including the temperature reaction, clinical blood analysis, ultra sound diagnosis of the uterus involution and the control of the uterine arteries.

Results. There were no complications during the postsurgical period, as well as nosological consequences, including sub involution and lochiometritis; also, the temperature did not exceed 37,0 С and the blood tests did not show high white blood cell count at the time the patients were released. The uterine arteries had unchanged blood circulation, similar to the condition before pregnancy. All the obstetrics patients under analysis were released with no complications on 4-5 day after the delivery.

Conclusions. The compression suture can be considered an efficient and safe method for prophylaxis of hypotonic hemorrhage in relation to the high risk group of obstetrics patients.

Journal of Experimental and Clinical Surgery. 2017;10(4):310-314
pages 310-314 views


Clinical case of the treatment of venous leg ulcers in a patient with Sjogren disease

Aralova M.V., Glukhov A.A.


Relevance. Trophic ulcers on the background of systemic diseases are characterized by long flow and cause greater difficulties in treatment due to the reduced regenerative capabilities of the body. As a result of taking hormones muscles and skin become atrophic changes. Thinning and dry skin are particularly susceptible to trauma. Trophic ulcers in systemic connective tissue diseases often have no specific signs. Indicate systemic disease can atypical localization (thighs, buttocks, torso, upper extremity, head, mucosa of the oral cavity) wound, long for ulcers, with no tendency to regenerate, the big help in diagnostics renders the identification of syndromes, evidence of systemic autoimmune lesions of organs and tissues (polyarthritis, polyserositis, damage internal organs).

Purpose: description of the case of the treatment of the patient with Sjogren disease.

Materials and methods. In this report a clinical case of treatment of ulcers of the tibia on the background of long-term hormonal therapy. Patient more than 20 years of suffering from Sjogren's disease. Diagnosis of Sjogren’s disease (chronic, moderate activity (II) expressed stage), dry keratoconjunctivitis, parenchymatous parotitis, xerostomia, Raynaud's Syndrome, trophic ulcer of left tibia and varicose disease of the lower extremities, 2.

Sjogren’s disease - a systemic autoimmune disease characterized by involvement of exocrine glands, mainly salivary and lacrimal, with the gradual development of secretory failure, combined with various systemic manifestations. Local treatment of trophic ulcers took place against the background therapy of the underlying disease. In the first stage for cleansing the surface of trophic ulcers used for the contact controlled cryodestruction was carried out hydropressing treatment of the wound. The result - on the 5th day the wound was completely cleansed from necrotic tissue. Further, the local treatment consisted in the creation of optimal conditions for regeneration. After 4 weeks the wound is almost completely epithelization.

Conclusions. When Sjogren's disease treatment of ulcerative defects of the skin of the lower extremities takes place on the background of long-term hormonal medications. An important condition for wound healing is to decrease the dose of hormones to the minimum necessary. In this clinical observation in local treatment was applied the technique of contact controlled cryodestruction of pathological tissues on the surface of the ulcer.

Journal of Experimental and Clinical Surgery. 2017;10(4):315-319
pages 315-319 views

Review of literature

Adhesive disease of the abdominal cavity

Andreev A.A., Ostroushko A.P., Sotnikova E.S., Kiryanova D.V., Britikov V.N.


After operations on the abdominal adhesions occur in 80-90% of cases, adhesive disease develops in 12-64% of cases. First about the causes of adhesions said George Punter in 1793. For the first time in the Russian literature on intraperitoneal adhesions mentioned V.P. Dobrovolsky in 1838. According to modern notions, adhesive disease is a separate nosological form, characterized by the formation of intra-abdominal adhesions, as a rule, manifested by recurrent episodes of intestinal obstruction or pain. The basis for the development of peritoneal commissures in abdominal cavity are a complex, diverse violations of the functions of various body systems. Trigger in the development of adhesion formation in abdominal cavity considered: mechanical, physical, infectious, implant, chemical factors and congenital anomalies (bands of lane, membranes of Jackson and others). As a result of inflammation of the peritoneum dystrophic process, accompanied by desquamation of the mesothelium and other connective tissue layers of the peritoneum, there is an allocation of exudate, coagulation of protein components and formation of fibrinous adhesions, which under normal fibrinolytic activity within 24-72 hours lysed. There are four degrees of prevalence of adhesions: grade I – local adhesions, occupying not more than 1/3 of one floor; II degree – additionally determined by single spikes in other areas. III and IV degree – adhesions, occupying 1/3 and 2/3 of the abdominal cavity, respectively. The clinical picture of adhesive disease is expressed aching pain in the abdomen, changing its character with the change of body position; periodic bloating, unstable chair; vomiting during exercise or after violation of the diet, the phenomena of complete or partial adhesive intestinal obstruction. Diagnostic informativeness of traditional x-ray methods is only 50-60%. The most informative is the use of contrast enterography and ultrasound examination of the abdomen with a directed study of problem areas of the abdomen. Prevention of adhesions is an important problem of practical surgery. Methods of preventing the formation of adhesions are the following: reduction of abdominal trauma, reducing inflammation in the area of operations, reducing the likelihood of deposition of fibrin in the free abdominal cavity, the suppression of postoperative paresis of the intestine, delimitation of the damaged serosal surfaces and interfere with adhesion by applying a protective film on the mesothelium. Application drugs does not negate the careful attitude to the tissues and accurate surgical interventions. Conservative treatment includes: electrophoresis lidazy, hydrocortisone, application of paraffin, ozokerite on the anterior abdominal wall, injection antispasmodics, nasogastric drainage, staging of hypertension and cleansing enemas and others. Indications for operative intervention are: absence of effect of conservative treatment, the deterioration of the patient, the symptoms of acute intestinal obstruction. The following types of surgery: enteroclysis, the imposition of intestinal anastomosis with or without bowel resection laparoscopic lysis of adhesions, entropicalia.

Journal of Experimental and Clinical Surgery. 2017;10(4):320-326
pages 320-326 views


GOSTISHCHEV Victor Kuzmich (to the 80-th anniversary from birthday)

Andreev A.A., Ostroushko A.P.



Journal of Experimental and Clinical Surgery. 2017;10(4):327-328
pages 327-328 views

BULYNIN Viktor Ivanovich (to the 85-anniversary from birthday)

Andreev A.A., Ostroushko A.P.



Journal of Experimental and Clinical Surgery. 2017;10(4):329-330
pages 329-330 views

OPPEL Vladimir Andreevich (1872-1932) to the 145 anniversary from the birthday

Andreev A.A., Ostroushko A.P.



Journal of Experimental and Clinical Surgery. 2017;10(4):331-332
pages 331-332 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies