scholarly journals Differentiated approach to radical surgical treatment of elderly patients with tumor diseases of the pancreatoduodenal zone

2021 ◽  
Vol 13 (2) ◽  
pp. 49-56
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Alexey V. Gulyaev ◽  
Malkhaz Yu. Tsikoridze ◽  
Evgeny A. Zakharov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Study Group ◽  
Tumor Diseases ◽  
Results Of Treatment ◽  
Repeated Surgery ◽  
Pancreatic Fistulas

BACKGROUND: In recent years, there has been a widespread increase in the incidence of tumors of the pancreatoduodenal zone, especially noticeable in the older age group. A decrease in the incidence of postoperative complications and mortality after pancreatoduodenal resection made it possible to expand the indications for surgical treatment of elderly and senile patients. AIM: Improvement of the immediate results of pancreatoduodenal resection in the treatment of elderly and senile patients suffering from tumor diseases of the pancreatoduodenal zone. MATERIALS AND METHODS: Pancreatoduodenal resection was performed in 61 elderly and senile patients with tumors of the pancreatoduodenal zone. The main group consisted of 32 patients, whose treatment was carried out in accordance with the developed algorithm for choosing a method for forming a pancreatodigestive anastomosis based on a scale for assessing the risk of developing pancreatic fistulas. The comparison group consisted of 29 patients in whom the method of forming a pancreatodigestive anastomosis was carried out in accordance with the preferences of the operator without taking into account the risk of developing a pancreatic fistula. RESULTS: In the main group, compared with the control group, pylorus-saving interventions were performed significantly more often 27 (84.4%) and 14 (48.3%) (p 0.01). There was also a decrease in the frequency of performing pancreaticojejunostomy 16 (50%) and 22 (75.9%) (p 0.05), due to the use of reservoir terminolateral pancreatojejunostomy 8 (25%) and 0, respectively (p 0.01). Postoperative complications were observed in 14 (43.8%) of the study group and in 21 (72.4%) patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 8 (27.6%) to 2 (6.2%) (p 0.05) in the study group. Repeated surgery was required in 5 (15.6%) patients of the main group and 11 (37.9%) in the comparison group (p 0.05). The lethal outcome was recorded in 3 (9.4%) patients of the main group and in 7 (24.1%) in the comparison group (p 0.05). CONCLUSIONS: The results of performing pancreatoduodenal resection in the treatment of elderly and senile patients can be comparable with the results of treatment of the general population. The use of the developed algorithm made it possible to reliably reduce the incidence of complications from 72.4 to 43.8% (p 0.05), postoperative pancreatic fistulas from 27.6 to 6.2% (p 0.05), as well as the frequency of repeated interventions. from 37.9 to 15.6 % (p 0.05). In addition, a downward trend in mortality was achieved from 24.1% to 9.4%.

scholarly journals Antegrade lithoextraction as perspective rechnique for mechanical jaundice radical treatment

2019 ◽  
pp. 39-43
Author(s):  
A. Y. Popov ◽  
V. Y. Lischishin ◽  
A. G. Barishev ◽  
M. I. Bikov ◽  
A. N. Petrovsky
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Main Group ◽  
Wound Complications ◽  
Control Group ◽  
Study Group ◽  
Radical Treatment ◽  
Clinical Observations ◽  
Rendezvous Technique ◽  
Treatment Application

Material and methods From 2014 to 2017 in our hospital 1158 patients with cholelithiasis complicated by mechanical jaundice have been treated. The group consisted of 59 (5.1%) patients with initially predicted difficulties for endoscopic lithoextraction. In 12 of that group antegrade decompression was the only surgical method for completing treatment. In 2 cases the ‘rendezvous’ technique was used, and in 23 patients the antegrade decompression it was complemented with laparotomy and choledocholithotomy. In 22 patients for verification the nature of the bile-excreting ducts and the cholelithic occlusion revealed at the same time the first stage included an antegrade decompression that allowed to finish surgical treatment by an endoscopic transpapillary lithoextraction.Results In the main group of clinical observations for 59 patients the surgical treatment complemented with an antegrade decompression was without fatal outcomes. All patients were cured of cholelithic occlusion and recovered. In the study group with 1099 patients that were treated with only an endoscopic lithoextraction 8 patients died that showed 0.7±0.2% of operational mortality. Complications, in the form of operational wounds in the main group of observations were found in 7 patients and it was 11.8±4.2%. Other postoperative complications in the main group were not observed. In the control group similar wound complications were seen in 13 patients (1.2%). In the control group with 57 patients we observed intraabdominal complications which resulted in mortality (5.2±0.7%). Of those postoperative reversible pancreatitis was found in 34 patients, 3 patients had fulminant pancreonecrosis, in 4 cases there was profuse bleeding from a papillosphincterotomy area, in 3 cases we observed insertion of Dormia basket at lithoextraction, septic cholangitis was in 11 and duodenum perforation with retroperitoneal phlegmon was in 3 cases.Conclusion Mortality in the group with antegrade treatment application for choledocholithiasis was not found. On the contrary, rather higher rate of complications in the control group testifies in advantage of the antegrade techniques for choledocholithiasis treatment in the shown cases. 

scholarly journals Вплив лікувально-профілактичних заходів на показники ротової рідини та клінічний стан тканин пародонта у дітей 6–7 років, хворих на гінгівіт

2017 ◽  
Author(s):  
O. V. Avdeev ◽  
Y. K. Zmarko ◽  
A. B. Boykiv ◽  
R. O. Drevnitska
Keyword(s):  
Clinical Supervision ◽  
Oral Fluid ◽  
Urease Activity ◽  
Comparison Group ◽  
Local Therapy ◽  
Main Group ◽  
Control Group ◽  
Results Of Treatment ◽  
Comparative Group ◽  
Anti Inflammatory

The high prevalence of inflammatory processes in the periodontitis of children, the ineffective effectiveness of preventive and curative measures can contribute to the development of generalized periodontitis, therefore it remains urgent to develop pathogenetic effects in the treatment of chronic catarrhal gingivitis.The aim of the study – a comparative assessment of the traditional treatment of chronic catarrhal gingivitis in children aged 6–7 years with therapy using an anti-inflammatory gel with neovitin.Materials and Methods. 61 children aged 6–7 years, suffering from chronic catarrhal gingivitis, were taken under clinical supervision and divided into groups: the main (30 children) and the comparative (31 children). All children underwent conventional therapy in accordance with the protocols for the provision of medical care – basic therapy. In the main group, for a month, pathogenetic agents were used: an anti-inflammatory gel with neovitin, hygiene products were recommended. In the comparative group, 3 % hydrogen peroxide solution was used for local therapy, for rinsing of the mouth (during the first week of treatment) – Rotokan, a therapeutic and prophylactic toothpaste.Examination and control examinations were carried out with the hygienic state of the mouth determined by the hygienic index of Yu. A. Fedorov and V. V. Volodkina, prevalence and intensity of the inflammatory process in the gums with the help of the Schiller-Pisarev test and the PMA index, oral fluid index (lysozyme content, formation of oxydradicals, urease activity, degree of dysbiosis, pH and viscosity).Results and Discussion. After the treatment, elimination of gum inflammation in patients of the main group was accompanied by a decrease in the PMA index by 3.8 times; formation of oxyradicals decreased in children of the main group by 6.35 %; in the comparative group – by 6.15 %. Urease activity decreased in children of the main group by 16.37 % (p<0.05), the viscosity of the oral fluid of children decreased in 2.65 times in the main group and in 2.13 times in the comparative group (p<0.05). The lysozyme content increased in children of the main group by 15.61 % (p<0.05) in the comparison group – by 9.63% (p<0.05). The treatment after 0.5 years caused an increase in the lysozyme content in the oral fluid of the children of the main group to the level of the control group. The degree of dysbiosis decreased in the main group, in the comparison group tended to increase.Conclusions. The use of the proposed therapy with gel with neovitin contributed to the best results of treatment: reducing the degree of inflammation of the gums, the number of visits to the doctor, improving the indices of nonspecific protection in the oral fluid of 6-7 years-old children and, to a greater extent, six months after the treatment.

scholarly journals Surgical treatment of patients with osteoarthritis of the ankle joint

2012 ◽  
Vol 93 (1) ◽  
pp. 38-43
Author(s):  
Yu A Plakseychuk ◽  
R Z Salikhov ◽  
V V Soloviev
Keyword(s):  
Surgical Treatment ◽  
Ankle Joint ◽  
Bone Grafting ◽  
Comparison Group ◽  
Functional Results ◽  
Main Group ◽  
Radiographic Evaluation ◽  
Results Of Treatment ◽  
Ilizarov Apparatus

Aim. To evaluate the results of treatment using the authors’ proposed method of arthrodesis of the ankle and subtalar joints, based on the combination of bone grafting with compression in the Ilizarov apparatus. Methods. Conducted was a clinical and radiographic evaluation of the results of arthrodesis in the Ilizarov apparatus in 286 patients with osteoarthritis of the ankle and subtalar joints (during the last 15 years). 36 (12.6%) patients (the main group) were operated on using the authors’ proposed technique. Results. Bone adhesion as a result of arthrodesis was achieved in all patients of the main group. Excellent functional results were achieved in 11 out of 36 patients (30.5%), good results - in 22 (61.1%) patients, satisfactory results - in 3 (8.4%) patients. Bone adhesion as a result of arthrodesis in 250 patients of the comparison group was achieved in 243 patients (97.2%). In this group excellent functional results were achieved in 76 out of 250 patients (30.4%), good results - in 145 (58%) patients, satisfactory results - in 21 (8.4%) patients, poor results - in 8 (3.2%) patients. Conclusion. The proposed method of biarticular arthrodesis makes it possible to improve the trophism of the arthrodesis zone, to conduct the correction of posttraumatic deformities in the region of the ankle and subtalar joints, provides a durable and solid bone ankylosis of the ankle and subtalar joints, and makes it possible to achieve adhesion even in severe forms of osteoarthritis of the ankle and subtalar joints.

scholarly journals Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis

2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Second Stage ◽  
Standard Operations

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.

scholarly journals «FAST-TRACK» SURGERY OF ACUTE DESTRUCTIVE CHOLECYSTITIS

2020 ◽  
pp. 27-30
Author(s):  
A. N. Veligotsky ◽  
A. S. Chebotaryov ◽  
V. S. Strakhovetsky ◽  
S. G. Fedorovskyi ◽  
A. S. Fomina
Keyword(s):  
Experimental Study ◽  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Fast Track ◽  
Control Group ◽  
Study Group ◽  
Fast Track Surgery ◽  
Results Of Treatment ◽  
The Right

Summary. Aim. Introduction of «FAST-TRACK» principles in laparoscopic surgery of acute destructive cholecystitis. Materials and methods. The paper presents the results of an experimental study of the treatment of 210 patients with acute destructive cholecystitis, 104 patients in the control group and 106 comparative patients who were hospitalized and operated on in the clinic for the period from 2012 to 2019. Results and their discussion. In the control group, conversion and cholecystectomy were performed by lateral mini-access in the right hypochondrium. In the study group of patients performed laparoscopic cholecystectomy in similar conditions, but using original methods. Conclusions. As a result of the study it was possible to improve the results of treatment by 3.2 % and reduce the patient’s stay in the hospital from 6.5 days to 5.4 and reduce the number of postoperative complications by 80 % from 5 to 1 complication.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

scholarly journals The effect of A-PRP-therapy on reparative regeneration of bone tissue with acute bone fractures of the limbs

2019 ◽  
pp. 32-38
Author(s):  
A. N. Blazhenko ◽  
I. A. Rodin ◽  
O. N. Ponkina ◽  
M. L. Mukhanov ◽  
A. S. Samoilova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bone Fractures ◽  
Platelet Rich Plasma ◽  
Control Group ◽  
Study Group ◽  
Reparative Osteogenesis ◽  
Results Of Treatment ◽  
Regeneration Of Bone Tissue ◽  
Fracture Consolidation ◽  
Regeneration Of Bone

Material and methods The study consisted of two parts – in the first part we studied the effect of A-PRP-therapy on the model of a comminuted fracture created in the operating room, an experimental study conducted on 40 Mature rabbits of the Flander breed, all animals were divided according to the principle of analogues into 2 groups (20 animals): in the study group – on the 5th day after osteotomy, platelet-rich plasma was injected into the fracture area, in the comparison group – the fusion occurred without the influence of any drugs. The second part presents the results of clinical testing of A-PRP-therapy, analyzed the results of treatment of 16 women with low-energy fractures of the distal radius metaepiphysis. The study group consisted of 6 patients whose surgical treatment was supplemented by A-PRP-therapy on 7, 14 days after surgery. The control group consisted of 10 patients who underwent surgical treatment without A-PRPtherapy.Results: The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5±1.1%.Conclusion Platelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective procedure. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the Use of a-PRP-therapy to stimulate the maturation of bone calluses. Results The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5±1.1%.Conclusion Platelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective alternative to the methods considered. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the use of PRPtherapy to stimulate the maturation of bone calluses. 

scholarly journals Immediate results of surgical treatment of peripheral hepatic cholangiocarcinoma in elderly and senile patients

2020 ◽  
Vol 87 (9-10) ◽  
pp. 48-53
Author(s):  
O. Yu. Usenko ◽  
O. V. Hrynenko ◽  
A. І. Zhylenko ◽  
O. O. Popov ◽  
A. V. Husiev
Keyword(s):  
Surgical Treatment ◽  
International Study ◽  
Main Group ◽  
Control Group ◽  
Results Of Treatment ◽  
Peripheral Cholangiocarcinoma ◽  
Acute Pulmonary Thromboembolism ◽  
Clinically Significant ◽  
Selection Of

Objective. To estimate immediate results of surgical treatment of peripheral cholangiocarcinoma in elderly and senile patients. Materials and methods. In 2004-2018 yrs period in the Department of Transplantation and Surgery of the Liver of the Shalimov National Institute of Surgery and Transplantology 84 patients, suffering peripheral cholangiocarcinoma, were radically operated: 31 (36.9%) patients older than 60 yrs (the main Group), and 53 (63.1%) patients, younger than 60 yrs (control Group). Results. Postoperative clinically significant (IIIa-IV degree in accordance to classification of Clavien-Dindo) complications during 90-days of postoperative period were noted in 29.1% patients of the main Group and in 32.1% patients of a control Group (p=0.262), postoperative hepatic insufficiency, in accordance to The International Study Group of Liver Surgery criteria, - in 16.1 and 22.6% accordingly (p=0.473); reoperation was performed in 9.6 and 9.4% patients, accordingly (p=0.973). The causes of postoperative lethality in 2 patients of the main Group were an acute myocardial infarction (1) and an acute pulmonary thromboembolism (1). Conclusion. Hepatic resection is characterized by satisfactory immediate results of treatment of peripheral cholangiocarcinoma in elderly and senile patients, if performed in highly-specialized multidisciplinary centre and thorough selection of patients.

scholarly journals Tactics of surgical treatment of deep intermuscular gluteal region phlegmons

2021 ◽  
Author(s):  
E.N. Byakova ◽  
V.K. Tatyanchenko ◽  
V.L. Bogdanov ◽  
Y.V. Sukhaya ◽  
Y.V. Krasenkov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
New Technologies ◽  
Main Group ◽  
Gluteal Region ◽  
Control Group ◽  
Tissue Pressure ◽  
Results Of Treatment ◽  
Purulent Wound

Purpose. The purpose is to improve the results of treatment of patients with phlegmon of the gluteal region soft tissues by diagnosing the stage of tissue hypertension and determining the tactics of surgical treatment depending on this indicator. Materials and methods. Clinical studies were performed on 74 patients suffering from phlegmon of the gluteal region. All the patients were divided into 2 groups: in the main group (as opposed to the control group), acute tissue hypertension syndrome was diagnosed and decompressive fasciotomy was performed in tissue hypertension (30–35 mm Hg) (patent). The authors performed ultrasound cavitation and ozone therapy of a purulent wound. Results. With phlegmon of the gluteal region of soft tissues, an increase in tissue pressure by 25% above the norm is an indication for fasciotomy in the area of fascial nodes. The time of purulent wound cleaning against the background of normal tissue pressure (8–10 mm Hg) of the surgery in patients of the main group was reduced to 5 days (8 days in the control). In the long-term (0.5–1 years), good results were obtained in 92.8% of patients in the main group (64.7% in the control group). Conclusion. The developed tactics of treatment of patients with phlegmon of the soft tissues of the gluteal region are highly effective due to the development and application of new technologies for the diagnosis and treatment of tissue hypertension.

scholarly journals PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS OF INTESTINAL SURGERY USING IMMUNOMODULATING THERAPY

2020 ◽  
pp. 37-45
Author(s):  
M. Tymchenko
Keyword(s):  
Small Intestine ◽  
Postoperative Complications ◽  
Lipoic Acid ◽  
Comparison Group ◽  
Intestinal Anastomosis ◽  
Interleukin 2 ◽  
Postoperative Mortality ◽  
Main Group ◽  
Immunomodulating Therapy ◽  
Results Of Treatment

Summary. The aim of the study is to develop a method of immunocorrection, which improves the results of treatment of patients with developed peritonitis against the background of the small intestine anastomosis leakege by stopping the cascade of SIRS and MOF. Materials and methods. The work was clinical in nature, was performed in the clinic of the SI «ZIGUS NAMSU» in the period from 2016 to 2019. We examined 58 patients with various diseases of the abdominal organs complicated by peritonitis, in which sections of the small intestine were resected. The Comparison Group included patients who received traditional therapy, patients of the Main Group, the complex of drug therapy included recombinant interleukin-2, galavit and α-lipoic acid. The results of surgical treatment were evaluated according to the classification of D. Dindo, N. Demartinesta, P.-A. Clavien (2004). Statistical analysis was removed from the Statistica 6.0 software (StatSoft, Inc. 2001) and SPSS 7.5 on Apple PC. Results and Discussion. Thus, the results of the use of a comprehensive immunomodulation scheme using IL-2, galavit and α-lipoic acid in the complex treatment of patients with widespread peritonitis against the background of intestinal anastomosis failure suggest that the developed scheme has a targeted immunoregulatory effect and prevents the excess production of inflammatory mediators in the early postoperative the period of the disease, helps to eliminate the cytokine imbalance and prevents the development of secondary immune deficiency. A comparative analysis of the incidence of complications revealed that in patients of the Main Group the average number of complications per patient was 0.53, while in the Comparison Group this indicator was 1.36. Conclusions. The use of a combination of IL-2, galavit and α-lipoic acid in the complex of treatment of common peritonitis helps to reduce the level of systemic and local postoperative complications, as well as the level of postoperative mortality.

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