Vol 6, No 3 (2013)
- Year: 2013
- Articles: 19
- URL: https://vestnik-surgery.com/journal/issue/view/20
Original articles
Wound Process in Kidney Parenchyma Following Traditional Partial Nephrectomy Versus Laserassisted Partial Nephrectomy in Experiment
Abstract
The purpose of the study To compare the morphological changes in renal tissue following traditional partial nephrectomy versus laserassisted partial nephrectomy. Material and methods 100 mature male Wistar rats were included in experiment. A diode laser-emitting light at a wavelength of 970 nm of ЛСП «ИРЭ-Полюс» model ЛСП 0,97/10 laser was used for partial nephrectomy. General conditions of animals and morphological changes in renal tissue following traditional partial nephrectomy with warm ischaemia and laserassisted partial nephrectomy were evaluated during the experiment. Results and their discussion the reparation of kidney parenchyma in a resection margin was more fluent after laserassisted partial nephrectomy with the laser-emitting light at a wavelength of 970 nm in continuous-wave mode. Also there were not any morphological changes in renal tissue following laserassisted partial nephrectomy. Conclusion the comparative analysis showed that the diode laser-emitting light at a wavelength of 970 nm is promising method for using in clinical practice
Journal of Experimental and Clinical Surgery. 2013;6(3):271-279
271-279
The Results of an Original Method Restrictions of Portocaval Reset in the Formation of the Distal Splenorenal Shunt in Patients with Liver Cirrhosis
Abstract
Relevance In patients with liver cirrhosis (LC) with portal hypertension (PH) distal splenorenal shunt (DSRS) is one of the best types of portosystemic shunting. However, despite its universality and a lot of research on the positive evaluation, remain unresolved issues before the end of the potential of this type of decompression in a pronounced expansion of the splenic vein and the likelihood of developing of deportalisation of portal pool. Materials and methods Developed method of restrictions of portocaval reset in DSRS in patients with severe transformation of the splenic vein with restrictive cuff made from Dacron graft. To compare the results of DSRS with restrictive cuff formed three groups of 231 patients: DSRS with splenic vein diameter 1,5 cm - 194; DSRS with splenic vein diameter greater than 1,5 cm without restrictions - 21; DSRA with splenic vein diameter greater than 1,5 cm with a limited - 14. Results and their discussion The incidence of liver failure was higher in patients where the diameter veins more than 1.5 cm and the restrictive cuff does not applied – 14,3%, whereas the use of an original method reduced the risk of this complication to 6.3%. In the group of patients with splenic vein diameter less than 1,5 cm is a complication observed in 3,1% of cases. The frequency of ascites was 23,8% - in the group of patients with a wide vein without limitation, 12,5% - by using restrictive cuffs and 13,9% - in the group with splenic vein diameter to 1,5 cm. Bleeding from varices of the esophagus and stomach in the early period after DSRS developed in 14,3% of patients with splenic vein more than 1,5 cm, and 3,1% of the diameter veins up to 1,5 cm in the group with restrictive DSRS. Mortality also was the highest in the group with no restrictions DSRS – 9,5% vs. 4,1% and 0% in the other groups. Conclusion The introduction of an original technique of restrictions of portocaval reset in DSRS in patients with severe transformation of the splenic vein in the formation of DSRS, reduced the risk of thrombosis of anastomosis, as well as a full deportalisation of the liver in the remote period.
Journal of Experimental and Clinical Surgery. 2013;6(3):280-286
280-286
Development of Bioimpedance Analysis Algorithm of Tumors on an Experimental Model with Transplanted Rs-1 Tumor
Abstract
Relevance It is difficult to distinguish tumor and normal tissues during surgical treatment of malignant tumors. Bioimpidance analysis is a possible method of diagnostics of tumors and intact tissues. The purpose of the study To investigate biophysical characteristics of RS-1 tumor and surrounding tissues. Materials and methods An experimental investigation was performed on 10 Wistar rats with transplanted RS-1 tumor (signetring cell carcinoma). Invasive bioimpedancemetry was produced by a device “BIM-II” for measuring the electrical impedance of biological tissues (Patent of Russian Federation № 2366360). After bioimpedancemetry histological examination was performed. Results and their discussion Differences between impedance of tumor and intact tissue (p<0,05) were revealed. Histological examination confirmed that the transplanted tumor was the signet-ring cell carcinoma (RS-1). There were not found any malignant cells in tissues surrounding the tumor during histological examination. Conclusion An algorithm based on bioimpedance analysis for the verification of the tumor and intact tissue was developed
Journal of Experimental and Clinical Surgery. 2013;6(3):287-291
287-291
The Possibilities of the Application of Venous Blood Acid-Base Balance Indices of the Lower Extremity to Predict the Effectiveness of Revascularizating Osteotrepanation in Patients with Diabetic Foot Syndrome
Abstract
Relevance Pyonecrotic forms of diabetic foot syndrome (DFS) is the leading cause of lower extremity amputation. The purpose of the study To establish the dependence of the efficiency of the treatment of pyonecrotic forms of diabetic foot syndrome (DFS) by using the tibial osteotrepanation to limb revascularization on the preoperative indices of venous blood acid-base balance (ABB) of the affected extremity. Matherials and methods The studies were performed in 42 patients with pyonecrotic forms of (DFS) (males and females, aged 52– 68 years.) Determination of the partial oxygen pressure (pO2 ), carbon dioxide (pCO2), and lactate concentration in blood taken from the leg veins of the affected limb has been is carried out by the analyzer Radiometer ABL-700 (Denmark). The first group consisted of 15 patients with RvO2 12.6 – 30 mm Hg., the second - 12 persons with RvO2 31,1– 51 mm Hg. and a third group consisted of 15 patients - RvO2 52 – 88 mm Hg. There were no significant differences in age, sex and clinical data in the observed group. Results and their discussion In 12 months after the beginning of the study the patients with low RvO2 level and high lactate concentration the high amputation was performed in 20% of cases, the patients with RvO2 level maximal closed to physiological norm and low lactate level the high amputation was performed in 8.3% of cases and the patients with high RvO2 level in conjunction with elevated lactate level – in 30% of cases. Conclusion The obtained data indicate that the effectiveness of revascularizing osteotrepanation (ROT) is primarily determined by the individual potential of collaterals growth in the lower limb. An indirect factor characterized this process is considered to be the venous blood acid-base balance of the affected limb. The best results of ROT were observed in averages RvO2 (LQ - UQ = 33,4 - 44,2 mm Hg.) in combination with low lactate level (LQ - UQ = 1,25 - 1,66 mmol / l). The worst results was noted in elevated RvO2 (LQ - UQ = 46,8 - 69,9 mm Hg.) in combination with high lactate level (LQ - UQ = 2,01 - 2,49 mol / l). RvO2 and venous blood lactate indices of the affected limb can be used to predict the revascularizating effect of tibial osteotrepanation and the necessity to include this method in the complex treatment of patients with pyonecrotic forms of DFS.
Journal of Experimental and Clinical Surgery. 2013;6(3):292-298
292-298
Axiloofemoral Prosthesis in Treatment of Critical Ischemia of the Lower Extremities at Patients with Predicted Short Life Expectancy
Abstract
The purpose of the study The assessment of the efficiency of the method of axillofemoral prosthesis, which was developed in a clinic, for the treatment of patients with predicted short life time. Materials and methods The analysis of complex examination and treatment of 56 patients with critical ischemia of lower limbs, based on bilateral lesions of aorto-iliac segment of atherosclerotic etiology, was carried out. The patients were divided into 2 groups. The control group included 21 patients, the typical axillofemoral alloprosthesis was made for them. The main group consisted of 35 patients for whom the axillofemoral alloprosthesis of an original way with the imposition of the proximal anastomosis between an axillary artery and an artificial limb "end to end" was made. The diagnostic program included reovasography, Doppler sonography, photoplethysmography, scanning of the upper and lower limbs, heart and a shunt for an indentification of blood flow and magistral blood flow type, the level of microcirculation, occlusive - stenotic lesions of arteries, cardiac hemodynamics, the blood flow with the help of shunt after the surgery. Results and their discussion All Patients had severe concomitant diseases in an decompensation stage with the fraction of left ventricular ejection less than 40%. The use of original treatment technology allows in an immediate postoperative period to increase the volume blood flow through the shunt in 2 times, to reduce the number of postoperative complications in 1.6 times. In the postoperative period the average term of shunt functioning increases in 3 times, the clinical status rises on 19.5%, the physical health component - 12.8%, and the mental component - 9.1% and the lethality is reduced in 2.5 times in comparison with the control group of patients. There was no one patient of the main and control groups with complaints of undue fatiguability of upper limbs, where blood flow was switched to the ischemic lower limb. Conclusion The developed method improves the hemodynamic characteristics of blood flow of the proximal anastomosis and simplifies the imposition of the proximal anastomosis between the axillary artery and the artificial limb.
Journal of Experimental and Clinical Surgery. 2013;6(3):299-304
299-304
Sorbtion Methods Correction Metabolic Disorders for Mediastinitis
Abstract
Relevance The urgency is not due to a tendency to reduce the number of patients with acute mediastinitis. An important moment of the correction of endotoxemia, which is celebrated by introducing diseases is enterosorption. Unlike hemosorption plasmapheresis eneterosorbtion is noninvasive and does not require specially trained personnel, has no absolute contraindications, clinically significant side effects. The purpose of the study To assess enterosorbtion patients with acute mediastinitis using enterosorbent "Litovit." Materials and methods In the treatment of 29 patients with acute mediastinitis in 13 addition to the primary treatment method used enterosorbtsii drug "Litovit." All patients underwent incision and drainage of the mediastinum vneplevralnym way. Enterosorbent "Litovit" appointed for 2 - 3 days after surgery, up to the transfer of the patient from the intensive care unit in the profile department. The route of administration through a nasogastric tube or gastrostomy. Results and their discussion Inclusion in a comprehensive program of treatment in the early postoperative period enterosorption using drugs such as "Litovit" in the treatment of patients with acute mediastinitis increased the effectiveness of intensive therapy. Application enterosorbtion accelerated the rate of decline in the inflammatory process and improve liver function. Application enterosorbtion reduced the rate of final products lopoperoxidation and increase the antioxidant system. Conclusions Use as a sorbent "Litovit" accelerated the rate of decline in the inflammatory process, improve the treatment of patients with acute mediastinitis.
Journal of Experimental and Clinical Surgery. 2013;6(3):305-311
305-311
The Influence of Ontogeny Parathyroid Glands on their Topographic Anatomy Particular
Abstract
Relevance The issues of parathyroid glands embryological origin are allow more fully understand the topography and embryology parathyroid glands and predict their location. The purpose of the study On the basis of the principles of parathyroid glands embryogenesis, the specifics of their topographic anatomy and prepare a theoretical basis for volume modeling parathyroid glands location in front of the neck. Matherials and methods The objects of study were 217 bodies of people who died suddenly from diseases not related to the pathology of the neck. Measured parameters describing the shape of parathyroid glands and their location in space. Since parathyroid glands functionally and morphologically closely related to the thyroid, much attention is paid to their relative syntopy. Results and their discussion Using the criteria proposed in the paper, and based on the received laws, we propose guidelines for the determination of parathyroid glands preoperative topography. Parathyroid glands found in zones 2-3, 3 and 3-4 are derived fourth branchial arch. Parathyroid glands found in zones 1, 1-2, 2, 4-5 and 5 are parathyroid glands III. Parathyroid glands, located at the lower third of the thyroid (zone 4), may have different origins. Conclusions The proposed principle study of the topography parathyroid glands clinically caused. Active implementation of the proposed criteria for the practice of surgeons, oncologists and pathologists, allow perform preoperative prediction of topography parathyroid glands and intraoperative imaging, improving the quality of operations on the thyroid and parathyroid glands.
Journal of Experimental and Clinical Surgery. 2013;6(3):312-319
312-319
Importance of Choice Surgical Access for Operative Treatment Diaphysis Clavicle Fracture
Abstract
Relevance According to articles published in Russia clavicle fractures are 12.5 - 26.1% of the cases among all fractures, and in 76.8 - 80.0% of cases the fracture is located in the area of the diaphysis. The number of patients receiving surgery for a broken collar bone in the middle third are increased.. The number of complications grow parallel after surgery treatment. The purpose of our study To examine the number of complications arising after open reposition and osteosynthesis of fractures of the middle third of the clavicle during using different surgical access. Materials and methods We studied patients with a fracture of the middle third of the clavicle, who had surgical treatment with using a horizontal transclavicular access, horizontal access with release of the branches of supraclavicular nerve and miniinvasive vertical access, during their staying in the hospital and after 3, 6,12, and 24 months after surgery . Results and their discussion We have not observed complications such as pseudarthrosis, deep infection, or metallosis. The greatest number of complications were noted in the group with using of the horizontal transclavicular surgical access. Mainly it is the presence of gipostezii in the proximal part of the chest and lateral surface of the shoulder. In the group with vertical miniinvasive access such complications we havent observed. Conclusions We think that the best surgical access in the surgical treatment of fractures of the middle third of the clavicle is a vertical miniinvasive access which allows not only to reduce the number of complications associated with damage of the branches of the supraclavicular nerve, but also to get a better functional and cosmetic results.
Journal of Experimental and Clinical Surgery. 2013;6(3):320-323
320-323
The Morphological Features of Reparative Process after Sutureless Plasty of Abdominal Wall with Mesh Use
Abstract
Relevance The basic surgical procedure in hernia repair of abdominal wall is the tension-free plasty with mesh use. The study of nearest results after mesh plasty with different methods of its fixation to the abdominal wall is actual question of modern hernia repair. The purpose of the study Eexperimental research of morphological features of reparative process after sutureless plasty with mesh use. Matherials and methods We modeled the intraperitoneal plasty with mesh use in rabbits. The polypropylene, polyvinylidenfluoride and reperene endoprosthesis were used. In basic group the sutureless technique was performed. In control group the typical fixation of mesh was performed. The area of implantation was studied with optical microscopy in 30 – 180 days after operation. Results and their discussion The stages of reparative process were common for all mesh types and surgical techniques. In basic group the area of neoperitoneum was maximal, the vascularization was optimal. We noted in basic group low level of collagen, but neoperitoneum was complete and no fenestrated. The connective tissue was found soft in the basic group in contrast with control. Morphological changes were estimated as uncomplicated flow of reparative process after mesh implantation. The sutureless technique is optimal for IPOM plasty. Conclusion The patterns of current repair process after IPOM plasty are common to all the studied implants and methods of its fixation. Features and results depend on the material of mesh and the method of fixing the endoprosthesis. Free positioning of the mesh in the plasty area associated with minimal presence of an inflammatory component, adequate angiogenesis, and the formation of soft connective tissue and high grade of neoperitoneum.
Journal of Experimental and Clinical Surgery. 2013;6(3):324-330
324-330
Analysis of the Ratio of Collagen Types I and III in Skin and Aponeurosis in Patients with Ventral Hernias
Abstract
Relevance Disorder of the connective tissue remodeling in patients after surgical treatment of ventral hernias is the great problem of modern herniology. Pathology of the connective tissue is considered as the main cause of this disorder, and is closely connected with the disturbance of collagen metabolism in the zone of post operation scar. The purpose of the study Study the relationship between collagen type I and III of the connective tissue in skin and aponeurosis in patients with hernia disease and with another surgical pathology. Materials and methods Comparative investigation of the skin and aponeurosis connective tissue structure was performed in 95 patients, suffering from ventral hernias, with the help of polarization microscopy. All patients were divided into two groups: 46 patients with ventral hernias and 49 patients with another surgical pathology. Results and their discussion In patients with hernias had significantly lower ratio of TC (p≤0,001) as in the preparation of the skin, and aponeurosis compared with patients without hernia. It was revealed strong direct correlation dependence between the connective tissue structure of skin and of aponeurosis, which makes the prognosis of ventral hernia development possible with the help of investigation of the skin structure. Conclusion In patients with WG had significantly (P ≤ 0,001) lower ratio of TC in the skin and aponeurosis. Collagen composition of the connective tissue of the skin and aponeurosis are in a strong direct correlation (r=0,72), which makes it possible to judge the changes in the structure of the aponeurosis in terms of the ratio of collagen in the skin. The use of polarization microscopy to determine the proportion of collagen types I and III in the preparations of the skin and aponeurosis is highly informative in the verification of hernia disease
Journal of Experimental and Clinical Surgery. 2013;6(3):331-334
331-334
Concerning Determination of Indications for Staging Abdominal Cavity Sanitation at the Extentive Purelent Peritonitis
Abstract
The purpose of the study To assess advisability of staging abdominal cavity sanitation and multimodality therapy efficiency of extensive purulent peritonitis patients with compensated multiple organ dysfunction. Materials and methods Prospective results estimation of therapy 438 extensive purulent peritonitis patients with multisystem disorders is represented in work. The base of individual care was operative intervention, including nidus peritonitis eradication, nasogastricintestinal intubation and peritoneal lavage within the set of staging procedures, which were carried out by video laparoscopic method. The efficiency of remedial measures was assessed with the help of physical, clinical laboratory, biochemical and special diagnostic techniques (bacteriological, gas-liquid chromatography, computer phonoenterography, cystomanometry). Results and their discussion In the course of therapy of extensive purulent peritonitis at the stage of compensated multiple organ dysfunction, the main problems were connected with the solution of a question concerning necessity of staging sanitations. For this purpose, intraoperative assessment of abdominal membrane lesion was taken into consideration. In the event that abdominal cavity index was in “blind” interval from 10 to 13 scores (indications of occasional sanitation can be interpreted as doubtful), dynamics of volatile fatty acids in biological objects took on special significance. Tendency to rising the level of acetic, propionic and butyric acids in blood, and also “stagnation” of its quantity in peritoneal exudates at the level of 0,150±0,004; 0,00012±0,00002; 0,00008 ±0,00001 mmol/L respectively, indicated on after sensation of ill being in abdomen. Accordingly, twenty four hours later, after original surgery video laparoscopy was carried out for 28 patients. For 9 of them full endoscopic sanitation was carried out in the connection with identifications of signs protract peritonitis. For the rest patients, the totality of received information allowed to give up peritoneal lavage. Conclusion At therapy organization of patients with extensive purulent peritonitis in the stage of compensation multiple organ dysfunction for determination of indications to staging abdominal cavity, the role of “secondary endpoint” can implement the assessment of changes volatile fatty acids content in blood and peritoneal exudates during 24-28 hours after the original surgery.Video laparoscopic technique of staging sanitation among the most of patients allows to lower intervention traumatism up to the level of diagnostic test. Evaluating it, the lethality at the level of 0, 5% as a whole proves the accuracy of chosen method of such patients’ management.
Journal of Experimental and Clinical Surgery. 2013;6(3):335-342
335-342
The Choice of Method of Urinary Diversion after Cystectomy
Abstract
Relevance Decision on the choice of urinary diversion after cystectomy due to the increased incidence of bladder cancer is an important issue at present in urology. The purpose of the study Evaluation of the surgical treatment of patients with functional and organic disorders of the bladder operated on using the methods of intestinal derivation of urine. Materials and methods Analyzes the results of treatment of 110 patients who underwent cystectomy with different types of urinary diversion by original techniques. Transactions are recorded at length bowel resection, the technique of formation and shape of the bladder, pre-calculated amount of orthotopic bladder antireflux technique was used to create ureteral-intestinal anastomoses. Results and their discussion The use of original methods of formation of orthotopic bladder or intestinal reservoir has reduced the number of postoperative complications. In the early postoperative period, the volume of the bladder reaches its scheduled during surgery. During the first 6 months after surgery in 93% of patients with orthotopic bladder incontinence stopped. The results of urodynamic studies show an adequate urination in this group of patients. Quality of life was higher in patients in the group with orthotopic bladder, compared with a group of patients with heterotopic urinary reservoir, but at a later date statistically significant difference between the groups of indicators not. Conclusion Results of the study show the effectiveness of the procedures used to ensure in the future quality of life of patients.
Journal of Experimental and Clinical Surgery. 2013;6(3):343-348
343-348
The Value of Functional Tests in Patients with Chronic Obstructive Pulmonary Disease and Ventral Hernias in Preoperative Period
Abstract
Relevance Today the prediction of possible respiratory disorders in patients with COPD and ventral hernias in postoperative period is actual by using available functional tests in order to prevent negative hernioplasty by choosing relatively safe herniotomy variant, programs of preoperative and postoperative management of patients. Materials and methods We examined 66 patients with COPD stage 1–2 with the anterior abdominal wall hernias (20 of them - with umbilical hernias, 18 - with linea alba hernias, 28 - with median post-operative hernias). All patients prior to surgery performed spirometry and capnometry before and 20 min after the reduction of hernia bag contents with bandage fixation. Studies were repeated on the second day after hernia repair. Results and their discussion As a result the functional tests using spirometry and capnometry were uneven. Before an operation during the test the parameters of spirometry did not change, while on the 2nd day after surgery in patients with hernia defect size more than 8 cm change in respiratory function parameters were significant. Capnometry test with evaluation of the functional dead space in the alveolar ventilation (FDSAV) was more consistent in terms of forecasting the possible lung function disorders in COPD patients in early postoperative period. No change of FDSAV or increase in the normal range (35% of tidal volume) may indicate a relatively favorable prognosis. If the value is higher than 35%, significant lung function disorders are possible in early postoperative period. Conclusion In patients with COPD and ventral hernias the prediction of possible violations of respiratory system as the syndrome of abdominal compression in the preoperative stage is important as it allows to choose a relatively safe variant of surgery, the management tactics of patient, which may reduce the frequency of postoperative complications, reduce the length of hospital stay
Journal of Experimental and Clinical Surgery. 2013;6(3):349-353
349-353
Robotic-Assisted Resection in Case of Urinary Bladder Feohromotsytome
Abstract
Relevance Urinary bladder chromaffinoma is a rare condition. At that its clinical symptoms acute blood pressure increase, heartbeat, headache after emiction are so specific that allow to suspect the correct diagnosis with high accuracy. Being suspicious in respect of this illness the diagnosis can be easily verified with the complex scan and cystoscopy. Recently active complementation of robotic techniques to minimally invasive surgery takes place. This technology allows to enlarge visible the opportunities of the traditional laparoscopic procedure. The purpose of the study To demonstrate a rare clinical case and a high effectiveness of the robotic complex in the pelvic surgery. Materials and methods In the Surgery Institution Named for A.V. Vishnevskiy in January 2013 first robot-assisted resection of the neck of urinary bladder regarding chromaffinoma in Russia was performed. Results and their discussion Technical aspects of robot-assisted operations for urinary bladder neck tumors were worked out. The interventions are performed according to all oncology principles. At the same time they are up-to-date criteria of less traumatic treatment. Conclusion Recently we think that operation of choice in case of chromaffinoma of the urinary bladder is robot-assisted resection
Journal of Experimental and Clinical Surgery. 2013;6(3):361-366
361-366
Clinical and Morphological Basis of the Vacuum-Therapy Using in Complex Treatment of Patients with Gastroduodenal Ulcer Complicated by Bleeding
Abstract
The purpose of the study To evaluate the effectiveness of the low-dose vacuum in treatment of gastro duodenal ulcer complicated by bleeding. Materials and methods A comparative analysis of treatment of 82 patients with gastro duodenal ulcer. The first group included 46 patients which were treated by H2 -receptor blocks, proton pump inhibitors and antihelicobacter eradication after the final hemostasis. The second group consisted of 36 patients who have a range of treatment was part of a vacuum therapy on the original author's methodology. There were no significantly differences in two groups. For objectification an ulcer healing used a clinical parameters, endoscopy visualization, cytological and histological research. In statistical processing used Pearson's criterion χ2 and Fisher's criterion φ*. For the numerical measure of objective chance events considered the probability 95% (p<0.05). Results and their discussion During the first week of using the vacuum therapy the ulcer was cleaned; the granulator tissue, epithelization and scarring developed. After the short-time increasing of intraepithelial neutrophils number their number in the lamina propria increased on twice (φ* p=0.366). On the 21st day in one of three observations was a compete healing of the ulcer (φ* p=0.366), in other cases visualized active epithelialization and scarring. In cytograms the number of neutrophils decreased on 1.8 times (χ2 =1.073; df=1; p=0.300), in the histogram they achieved a minimum (φ* p=0.074), and in the lamina propria (φ* p=0.241). The number of lymphocytes in the lamina propria was increased to 54.0±20.2 (χ2 =1.441; df=1; p=0.230), correlating with an increase in mitotic activity of epithelium (φ* p=1.000). Conclusion Vacuum therapy, stimulating the regional blood circulation, stimulates the exacerbation of chronic inflammation in the ulcer. Then, with the extinction of "neutrophilic burst" of local inflammation is liquidated. The increase in "population" of the lamina propria lymphocytes is associated with potentiation of their morphogenetic function, which is consistent with increased mitotic activity of the epithelium and confirms the stimulation of reparation in the area of ulcers with help a low vacuum.
Journal of Experimental and Clinical Surgery. 2013;6(3):367-375
367-375
Modern Aspects of the Treatment of Acute Appendicitis
Abstract
The problem of surgical treatment of acute appendicitis and today retains its relevance, because of the high morbidity in the population. According to the statistical data, acute appendicitis diagnosed in 1.5% of the population. Among patients in surgical hospitals, up to 50% of patients with suspected acute appendicitis. The percentage of diagnostic errors is very high and often exceeds 25%, and rates of postoperative complications traditional operation in complicated appendicitis reach 30%, and mortality according to the literature - 1% . Today, almost everywhere the method of choice in the diagnosis and treatment of acute abdominal diseases is a diagnostic laparoscopy. Laparoscopic access ensures accurate diagnosis, the ability to a full audit of the abdominal cavity, as well as minimal traumatism of operations; allows to avoid unnecessary appendectomies, reduce the number of postoperative complications and the need for analgesia, reduce the time of stay of patients in hospital, and thereby reduce the cost of treatment. Nevertheless, despite the enormous experience accumulated in this field is still many unsolved methodological issues, such as the «threshold of conversion» in complicated forms of appendicitis, methods of processing of the stump of червеобразного process, etc. No, just a single opinion in respect of the indications and contraindications for laparoscopic appendectomy. The paper presents the evaluation of the advantages and disadvantages of different methods of appendectomy, statistics of various complications depending on the choice of specific methods and ways of their overcoming. Discusses different techniques of processing of the stump and the mesenteric an Appendix.
Journal of Experimental and Clinical Surgery. 2013;6(3):376-385
376-385
Clinical and Anatomical Aspects of Surgical Treatment of Sacrococcygeal Pilonidal Sinus Disease
Abstract
Despite the fact that this disease is the subject of numerous medical journals, monographs, research works, master's and doctoral theses, to date there is no unified approach to the choice of surgical treatment for this disease. High frequency of unsatisfactory results after excision of pilonidal sinus (recurrences - 10% to 19%, wound suppuration - 20-30%) directly depends on the type of surgery. After palliative surgery (incision and drainage of abscess), 73% of patients re-performed surgery, in the treatment of open wounds (excision followed by secondary healing) recurrences occur in 3-8% of the operated. In primary wound healing in 7,5-9,7% of cases are re-occurrence of the disease. Despite the fact that this disease is the subject of numerous medical journals, monographs, research works, master's and doctoral theses, to date there is no unified approach to the choice of surgical treatment for this disease. The analytic review of the national and foreign literature about problem of surgical treatment of sacrococcygeal pilonidal cysts is presented in the article. Here we expound currently available methods of surgical treatment, the main outstanding issue at this point in the treatment of these patients. The basic clinical and anatomical features of the choice of surgery are marked. Shown that the high frequency of the disease and its postoperative complications, as well as long-term temporary disability of patients demonstrate the need of a differential approach to the choice of treatment strategy and surgery. It is also necessary to take into account features of topographic anatomy of the structures of sacrococcygeal region, as well as extent of the inflammatory process
Journal of Experimental and Clinical Surgery. 2013;6(3):386-392
386-392
Clinical and Economic Aspects of Surgical Care Elderly Patients
Abstract
Relevance Study of the modern model of healthcare sector in Russia in terms of effective use of limited health care resources, is
very important. Especially because now there is virtually no research on the clinical and economic features of surgical care elderly
people, whose share in the community has clear upward trend.
The purpose of the study Study the modern clinical and economic model of surgical care to patients of old age, to identify its
weaknesses, to identify ways to optimize.
Materials and methods The subject of the study was contingent elderly patients treated in surgical hospitals in Belgorod. In the
study of the rehabilitation phase of surgical care to patients of old age, the method of interview. The study of the economic aspects
of surgical care performed by studying official documentation of regional fund of obligatory medical insurance and then applying
the method of expert estimates. Materials and Methods: The subject of the study was contingent elderly patients treated in surgical
hospitals in Belgorod. In the study of the rehabilitation phase of surgical care to patients of old age, the method of interview. The
study of the economic aspects of surgical care performed by studying official documentation of regional fund of obligatory medical
insurance and then applying the method of expert estimates.
Results and their discussion Investigated the clinical and epidemiological characteristics of elderly patients surgical: structure
analysis of surgical and comorbidities in patients of older age groups, the impact of polymorbidity on the course of the disease
and surgical treatment strategy of patients. For the analysis of the rehabilitation phase interviewed 98 convalescent 1-2 years after discharge from hospital. Explore different models of health care and care for the sick, a detailed study of the current Russian economic model clinical-surgical care elderly patients, analyzed the possible payment options patient care in the statutory health insurance, consider payment for inpatient hospitalization completed case, used in the Belgorod region. Conclusions The results show the prevalence of disease in the structure of cholelithiasis, acute pancreatitis, and vascular diseases of the lower limbs, and chronic inflammatory diseases. In 58,7% of patients with acute surgical pathology could arrest the conservative methods, but conservative treatment of the treated patients required readmission to 21,5% of patients. Clinical and economic model of surgical care elderly people is focused on reducing the time of treatment, is characterized by the direct dependence on the amount of the income, while at the same time, there is an unjustified reduction in health care, the lack of incentive to limit the overall costs. Important ways to optimize clinical and economic model of surgical care to people of old age is to introduce a system of differentiated tariffs paid per case (outcome) to form a target group of patients, taking into account gender, age of the patients, the complexity of the required medical treatment, as well as the introduction of a full rehabilitation healthcare.
Journal of Experimental and Clinical Surgery. 2013;6(3):393-398
393-398
Experience
Analysis of the Options of the Damaged Structures of the Shoulder Joint, Accompanying Traumatic Shoulder Dislocation
Abstract
Relevance The conventional system of management of patients with traumatic brachial dislocation doesn’t contain a certain list of rules to choose a proper treatment approach depending on the injury type of bone muscular, connective tissual and nervous apparatus of the brachial joint. It leads to a great number of complications. The purpose of the study The aim of the study is to work out a diagnostic and treatment program of brachial traumatic dislocation based on the taking into consideration the variants of bone, cartilage, capsular ligamental, muscular and nervous structures of the brachial joint injuries. Materials and methods 324 patients with traumatic brachial dislocations were treated at the Voronezh Regional Clinical Hospital №1 and the analysis of their treatment has been made during the period from 1999 to 2010. Results and their discussion A classification system of combined injuries of brachium in traumatic dislocation was suggested. Consideration of injury combinations allows choosing optimal approaches of resetting, emphasizing the observation of regeneration dynamic of individual combinations in the cases of brachial structures injuries. The treatment based on the appreciation of different variants of disorders allows to work out a rehabilitation program contributing to the restoration of each impaired brachial structure to avoid ineffective conventional methods. Conclusion It is necessary to make a post-resetting diagnose more carefully. Diagnostic procedures should include the control of all the brachial injury components immediately after the dislocation resetting. Key words Brachial joint, traumatic dislocations, types of injuries, rehabilitation program
Journal of Experimental and Clinical Surgery. 2013;6(3):