Vol 11, No 4 (2018)

Relevance. Treatment of patients with calculous cholecystitis is an important task of modern surgery. Laparoscopic cholecystectomy become the "gold standard" for the treatment of cholelithiasis. The safety of laparoscopic cholecystectomy can be ensured by rational approach to the placement of laparaports.

The aim of the study is to improve the results of laparoscopic cholecystectomy on the basis of determining the optimal angle of spatial orientation of the viewing laparoscope during cholecystectomy with the help of mathematical modeling.

Materials and methods. Clinical studies were based on data of 122 patients with acute and chronic calculous cholecystitis who underwent endovisual analysis of anatomy of the structures and organs of the upper sector of abdominal cavity, depending on the spatial orientation of the viewing laparoscope during cholecystectomy.

Results. As result of the multiple regression analysis, there has been developed the model that makes it possible to calculate the optimal angle of spatial orientation of the viewing laparoscope during cholecystectomy, which is important for preventing complications and improving the results of laparoscopic cholecystectomy.

Сonclusion. Using the obtained model, it is possible to determine the optimal angle of spatial orientation of the viewing laparoscope for cholecystectomy, which is an important condition for improving the results of laparoscopic cholecystectomy and for the prevention of complications. The above model makes it possible to reduce the duration of inpatient treatment and the rebilitation period.

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Most patients with esophageal cancer die from relapses or metastases, with a 5-year survival rate ranging from 15% to 25%. The most common places of metastasis are the liver, lungs, bones and adrenal glands. Metastases in the kidney are extremely rare.

We present the clinical case of a 61-year-old patient who was surgically radically treated at the A.V. Vishnevsky Surgery Center about esophageal cancer. The lesion was localized in the middle third of the esophagus along the posterior one, with spreading to the right wall, protruding into the lumen, slightly narrowing it. The situation was complicated by the fact that preoperatively the patient was diagnosed with coronary artery stenosis: the middle third of the anterior interventricular branch (AIB) of 80%, the proximal third of the envelope of the left coronary artery to 70%, the right coronary artery in the middle third to 50%. In this connection, the first stage of treatment was performed by stenting of AIB and the envelope of the left coronary artery. With the dynamic observation of the patient's condition, metastasis to the kidney was revealed in two years, and the patient was also operated on.

This clinical case demonstrates the possibility of using a complex radiology (including X-ray, ultrasound, MSCT and angiography) at the stages of examination and treatment of such category of patients, allowing timely detection and correction of both the manifestations of the underlying pathology and concomitant diseases.

Acute destructive pancreatitis refers to severe surgical pathology with high mortality. Destructive changes in this case cover both adjacent and distant structures. The aim of the study was to achieve a more accurate injection of the liquid contrast agent to the tissues of the retroperitoneal space affected by the purulent-necrotic process. We have developed a method that involves the use of a special device with a metal goniometer with a gradation of up to 180° with clamps to fix the syringe with a needle. Syringe with a needle is fixed in the device at an angle of 40° to 50° depending on the figure and the nature of the nutrition patients. The paper presents the results of contrast study of retroperitoneal tissue using the proposed device. The results of 63 cases of retroperitoneal space contrasting study through the right and left lumbar regions are considered. The use of the proposed method of contrast retroperitoneal area taking into account the figure and the nature of nutrition allows more accurately determine the variant of lesion of the pancreas and adjacent adipose tissue. The previously proposed methods of retroperitoneal tissues puncture in acute destructive pancreatitis (ADP) did not fully take into account the figure and the nature of nutrition of the subjects. A significant number (35%) of patients have an excess weight, especially among mesomorphs and endomorphs (91,4%). The figure and the nature of the nutrition of the subject should be provided in bringing the contrast into the retroperitoneal tissue, since this determines the angle of fixation of the needle in the device and the depth of its advancement. Puncture through the right lumbar region was carried out at I and II, through the left lumbar region - at III and IV types of ADP. Purulent necrotic lesions often equally cover the right and left parts of retroperitoneal tissue with type V of ADP.

Relevance. The number of ventral hernias recurrence after abdominal wall endoprosthetics with the lightweight endoprosthesis is 8-10%.

The purpose of the research is to study the morphological changes of the connective tissue, surrounding a lightweight polypropylene endoprosthesis, at the early stages of implantation at the use of platelet-rich autoplasma.

Materials and methods. The results of experimental research of the course of wound process in the abdominal wall tissues during the implantation of the lightweight polypropylene prosthesis on 50 Chinchilla rabbits divided into 2 groups of 25 animal units each have been analyzed. Subaponeurotic implantation of the prosthesis was carried out in the first group of animals. In the second group, the platelet-rich autoplasma was twice introduced after the implantation of the prosthesis during surgery and on the third day of the postoperative period at the rate of 0,5 ml plasma per 1 cm² of the endoprosthesis. The animals were taken away from the experiment on the 3rd, 7th, 10th, 14th and 21st day. Morphometric and histological study of reactive changes of tissue surrounding the implanted endoprosthesis was carried out.

Results and its discussion. In the animals of the second group, the inflammatory response to prosthesis implantation was 1,3 times lower on the third day, 1,2 times lower on the 7th day, and 1,1 times lower on the 10th day, than in the first group. Fibroblastic response, on the contrary, has increased into 1,2 times on the third day, into 1,14 during the 7th day and into 1,18 during the 14th day after the introduction of autoplasma. The thickness of the connective tissue capsule in the second group was 1,57 times higher than in the first group on the 21st day of the experiment. At this time, in the first group, the immature connective tissue capsule has been represented by the loose collagen fibers and fibroblastic cells without separation into the layers. In the second group, a dense connective tissue frame has been formed by the mature collagen fibers arranged compactly and in parallel to each other. The layer-by-layer structure of the capsule is well expressed: the inner layer consists of the fibroblastic cells, and the outer layer consists of the mature collagen fibers.

Conclusion. The use of platelet-rich plasma to stimulate reparative processes in the implantation of the lightweight polypropylene prosthesis in the abdominal wall is pathogenetically justified and effective.

Relevance. Lethality rates (63-95%) among patients with acute intestinal ischemia remain consistently high during the last decades. Despite the high urgency of the problem and numerous works devoted to visualization, early laboratory and instrumental diagnostics of ischemic bowel disease, clinical results have not changed significantly during the last 15-20 years. Pathogenetic mechanisms of various variants of ischemic intestinal lesion and their pathomorphological manifestations should become the basis for the development of surgical tactics and require specification.

The aim is to study pathomorphological manifestations and to clarify on their basis the pathogenetic mechanisms of ischemic involvement of the small intestine in acute occlusion of the mesenteric artery in the experiment.

Materials and methods. An experimental study was performed on 10 laboratory animals - male rats of the Wistar line. Modeling acute mesenteric ischemia was carried out via dressing of the jejunal artery. The ischemic intestine was collected for a stepwise histological study, the morphometry of the layers of the intestinal wall and the prevalence of necrosis.

Results. At the time of the appearance of macroscopic signs of lack of vitality in the central sector of the ischemic intestine, the wall thickness was 47.6% less than normal and in the adjacent peripheral sectors by 40.6%. Thinning of the intestinal wall was due to alteration of the mucosa with a decrease in its share in the total wall thickness from 86 to 82% (p = 0.021) in all sectors. The share of area occupied by necrosis in groups "B" and "C" was not statistically significant (p = 0.872) and amounted to 17.1 [7.3; 64.9]%. The state of the intramural vessels of the intestinal wall had significantly changed in comparison with the intact intestine. Signs of hypoperfusion in the form of sludge in the microvessels of the mucous membrane and the submucosa had been revealed.

Conclusions. Pathomorphological manifestations of ischemic bowel disease in acute occlusive mesenteric ischemia resulted in a decrease in the total thickness of the wall and a change in the ratio of serous-muscular and mucosal-submucosal layers due to a decrease in the proportion of the latter. The severity of necrosis in the central and peripheral parts of the ischemic intestine did not differ.