Vol 3, No 4 (2010)

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Acute pancreatitis for several years consistently ranks second, and in some regions - fi rst place in the structure of the urgent surgical pathology, ahead of acute appendicitis and acute cholecystitis. The most common cause of disease is alcohol abuse and gallstone disease in 10-30% of patients the etiology of acute pancreatitis remains unclear. Basis of the study were the results of examination and treatment of 276 patients with destructive forms of acute pancreatitis, ¬ Shih enrolling for treatment at the Clinical Hospital № 23 them. “Medsantrud” in the period from 2006 to 2010. In the studied group did not include the postoperative biliary and infected pancreatic necrosis because of features of pathogenesis. Differentiated approach to surgical treatment in patients with destructive pancreatitis depending on the scale of the initial lesion of the pancreas has allowed an average reduction in the number of purulent complications per patient in 4 times (from 9,8% to 2,2%), lower letalnost of purulent complications 3 times (from 15,3% to 5,5%), and consequently reduce the overall mortality in 2,5 times (from 25,0% to 9,8%).

Treatment results for acute destructive pancreatitis were analyzed. Effi ciency treatment staging for acute destructive pancreatitis is shown. If conservative treatment was ineffective for 1-3 days, indications for surgical treatment were applied. Half-opened method was used (laparotomy, necrosequestrectomy, omentobursostomy, lumbotomy); opened method was used for extended pyo-necrotic complications with development of purulent peritonitis (laparostomy). Our differentiated approach to the choice of drainage methods, combined with adequate antibacterial treatment allowed to reduce mortality from 40,3% to 18,53%. That is why we can suggest that our staged method is effective for treatment of acute destructive pancreatitis in agrarian region. Multistage treatment tactics for pyo-necrotic pancreatitis allows controlling adequately infl ammation process in pancreas and abdomen.

In clinic of hospital surgery 42 patients at whom during an operation the diffi cult duodenal ulcer in a combination to chronic duodenal obstruction is taped were observed. In this situation authors recommend to carry out a Roux’s partial gastrectomy accompanied an end-to-side duodenojejunostomy. This technique allows to take in reliably a duodenal stump and to diminish probability of an alkaline refl ux-gastritis. The comparative analysis of short-term results of this operation with results of a standard Billroth-II partial gastrectomy has shown appreciable depression of a duodenal stump leakage rate. Studying of the long-term results shows relevant better life quality of the basic group patients in comparison with group of the patients who have sustained a Billroth-I partial gastrectomy.

Hydropressive magnetic resonance cholangiopancreatography (HPMRChPG) is a new invasive examination method of the bile-excreting system. In combination with conventional MR imaging and MR cholangiopancreatography, hydropressive magnetic resonance cholangiopancreatography is a highly informative diagnostic procedure of the causes and rate of a biliary hypertension. Increase in hydraulic pressure in the biliary tract allows to increase the information value of the MR cholangiopancreatography. Application of the developed diagnostic method allows to dismiss invasive radio-opaque diagnostic procedures almost completely. Practically in all cases the information obtained in HPMRChPG is suffi cient to choose the therapeutic approach, type and extent of an operative intervention.

Incisional hernias remain one of the important problems of surgery. At the experimental study it is established that on the acellulated with plasma scalpel skin graft less expressed infl ammatory reaction, than on polypropylene mesh. The results of treatment and quality to life were studied in 124 patients, for which had been performed a hernioplasty for incisional hernia in a surgical branch the Smolensk regional clinical hospital at period since 1997 to 2007. The hernioplasty with acellulated skin graft had been performed for 74 patients (main group) and the polypropylene mesh had been implantated for 50 (control group). The follow-up was up to 9 years. The recurrence rate was 6.9% in the main group and 7.9% in control. There is no signifi cant difference between groups. The quality of life was signifi cantly more in main group whereas the pain was signifi cantly less. The conclusion was made that plastic by acellulated skin graft possible to consider the method of the choice at treatment of the incisional hernias.

Research is executed on 187 rabbits «Shinshilla». Under a narcosis it was spent laparotomy, in a pilot batch from the greater curvature of a stomach on a vascular leg the serous-muscular fl ap by which the wound of a liver (45 rabbits) was covered simulated lacerated-contused, spleens (45 rabbits) and the left kidney (45 rabbits) was found. In a control series were spent hepatorrhaphy (13 rabbits), wounds of a spleen (13 rabbits) and kidneys (13 rabbits) it was covered by a greater omentum, it was spent link sided nephrectomy (13 rabbits). Terms of supervision - from 1 till 360 day. Defi nition of credits IgG was carried out by reaction indirect hemagglutination with liquid erythrocytal diagnosticum on shigella Flexneri with preliminary addition L-cisztein. The received results have shown, that dynamics serum IgG after investigated operations depends on a kind of operative intervention and from plastic properties used autotransplant. Application of a serous-muscular fl ap of a stomach on a vascular pedicle promotes more intensive output IgG in a blood channel in terms of 5-7 day owing to activation by an operational trauma of immune system of a stomach, in terms of 60-90-120 day owing to effect of «deposition IgG » in required autotransplant and to less intense current of immunity during regeneration of wounds of a liver, a spleen and a kidney in comparison with hepatorrhaphy, omentoplasty and nephrectomy as follow more productive current infl ammatory- reparative process. At safe operations serum IgG it is restored in the nearest terms of the postoperative period. After gastroplasty this restoration occurs more effectively in comparison to an omentum.

Authors analyzed the causes of death for 12 death in patient with anaerobic nonclostridial phlegmons face and neck, on the basis of clinical, laboratory and pathologic-postmortem research. The main complications leading to death associated with the phases of the fl ow of purulent-infl ammatory process (sub- and decompensated). Objectifi cation of the phases of the disease makes it possible to predict and confi rm the fact that circumstantial criteria threat of development or already having sepsis in patients with neklostridialnoy anaerobic infections of soft tissues of the face and neck.

The article represents data about the modern conception of life quality studying in clinical medicine. The survey of basic approaches to the evaluation of this characteristic in patients with ischemic heart disease has been made; general and specifi c questionnaires, which are most frequently used in cardiology and cardio surgery in order to determine life quality level, are represented. In the article the infl uence of surgical myocardial revasculization on this characteristic in the nearest and distant post-operating period has been analyzed, and the dependence of life quality level after coronary bypass/stenting of coronary arteries on demographic and clinical characteristics has been examined as well

The analysis of results of transpedicular fi xation of spine for the purpose of revealing of unsatisfactory outcomes and complications. Results of operative treatment of 103 patients with not complicated thoracic and lumbar vertebras are analyzed. All patients make a backbone osteosynthesis by transpedicular fi xator. Following the results of inspection of patients in terms from 1 till 5 years the received results can be divided as follows: crises of cores of a design with unextracted fragments of a clamp, carrying out of cores by anatomic reference points, presence kyphosis the deformation signifi cantly infl uencing change of an axis of a backbone in a lateral projection, reservation deformity of a vertebra on preoperation level after removal of construction. The conclusion. Use of complex system of preventive maintenance of unsatisfactory outcomes and optimization of operative reception of transpedicular fi xation at not complicated thoracic and lumbar vertebras will allow to improve results of treatment of the given category of patients.

From 178 deaths among children and adults age 42 studied morphometric topographic Anatomy and gistotopografy bladder, ureter, pelvic-ureteral and vesico-ureteral junction sustained. Installed miofascikular structure muscle membranes, is a functional model of the urinary tract. Experiment at 243 puppies and adult dogs 46 justifi ed principles Microsurgical technology in reconstructive plastic surgery of ureter and urinary bladder (ureterocistoneostomie, plastic ureters and bladder, Shah of ureters and ureteral anastomosis).

Patient-controlled epidural analgesia (PCEA) may provide effective postoperative analgesia after surgery. The main goal of our study was to assess the effi cacy and safety PCEA after nephrolithotomy and nephrectomy. We enrolled 60 adult patients. All patients have been divided on 2 groups. After surgery in the fi rst group (n=30) standard epidural analgesia 0,2% naropine with fentanyle 2 mkg/ml and adrenaline 2 mkg/ml was used. In the second group (n=30) we used PCEA 0,2% naropine with fentanyle 2 mkg/ml and adrenaline 2 mkg/ml with a lockout interval of 15 min, a continuous background infusion of 2 ml/h and bolus 4 ml. Pain scores were assessed in rest and coughing by 10-point visual analog scale (VAS) at 6, 12, 24 h. after ICU admission. In addition, the consumption of naropine and the incidence of adverse effects were recorded. Data were compared using Student’s t-test and x2 test. VAS was signifi cantly lower in second group. PCEA was more effective within the fi rst 24 hours.

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