scholarly journals "FAST-TRACK" IN SIMULTANEOUS OPERATIONS AGAINST THE BACKGROUND OF WIDESPREAD PERITONITIS

2018 ◽  
Vol 25 (5) ◽  
pp. 141-146
Author(s):  
V. Yu. Mykhaylichenko ◽  
O. Yu. Gerbali ◽  
U. I. Basnaev ◽  
N. E. Karakursakov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Fast Track ◽  
Comparison Group ◽  
Clinical Laboratory ◽  
Average Duration ◽  
Main Group ◽  
Simultaneous Operations ◽  
Duration Of Hospitalization ◽  
Recovery Program

Aim. This research was conducted to study the possibility and effectiveness of the "Fast-track" fast recovery program application when performing simultaneous operations against the background of widespread peritonitis.Materials and methods. In the course of the study were examined 66 patients, the ratio of woman/man was 45:21. The main group – 32 (48,5%) patients with the major disease of constricted postoperative hernia complicated by the widespread peritonitis and chronic calculous cholecystitis (a prospective analysis of surgical treatment). The comparison group – 34 (51,5%) patients with the identical pathology – the retrospective analysis of surgical treatment. The treatment of patients of the main group was supplemented with the application of the elements of the «Fast-track» program. Whereas, the treatment of patients of the comparison group was performed exclusively according to the standard scheme of the patient management with widespread peritonitis.Results. Clinical, laboratory and instrumental data indicate the positive effect of the "Fast-track" program on the process of rehabilitation of patients in the postoperative period. There was a significant acceleration in the recovery of motorevacuation function of the intestine in patients of the main group in relation to the comparison group and a smaller number of complications in the main group in relation to the comparison group against the background of the application of this technique. As a result, the average duration of hospitalization of patients from the comparison group was 10- 5 days (average 12±2,4 days). While the average duration of hospitalization of patients from the comparison group was 17-20 days (on average 18±1,2 days).Conclusion. The use of the "Fast-track" program in simultaneous operations does not increase the effectiveness of surgical treatment, thereby accelerating the process of rehabilitation of patients in the postoperative period. 

DIENOGEST IN POST OPERATIVE MANAGEMENT’S OF PATIENT’S WITH ENDOMETRIOSIS

2020 ◽  
pp. 22-26
Author(s):  
Porsukova B.D. ◽  
Dzhumagulova D.D.
Keyword(s):  
Surgical Treatment ◽  
Combination Treatment ◽  
Postoperative Period ◽  
Comparison Group ◽  
Clinical Manifestations ◽  
Hormonal Treatment ◽  
Early Postoperative Period ◽  
Main Group ◽  
Uterine Ligaments ◽  
Severity Of The Disease

To assess the effectiveness of using dienogest in combination with postoperative interventions in patients with endometriosis. There were enrolled 102 patients with signs of external endometriosis underwent examination and surgical treatment, subdivided into 2 groups: 67 – main group (after surgical treatment, received dienogest 2 mg/day for 6 months), 35 – comparison group received no hormone therapy in the postoperative period. Surgical treatment included removal of endometrioid ovarian cysts, endometriosis foci on the pelvic peritoneum and sacral uterine ligaments. Course of the early postoperative period (up to 1 month after the intervention) as well as the long-term dynamics of the disease manifestations (3, 6, 12 and 15 months later) were assessed. Dienogest was administered after surgical treatment due to endometriosis that reduced the severity of dyspareunia and intensity of chronic pelvic pain by 3.5- and 2-fold, respectively. The probability of achieving control over uterine bleeding 6 month after the onset of treatment due to endometriosis manifested with metrorrhagia showed that combination treatment (consisting of dienogest) was 3.19-fold higher compared to surgical treatment alone (OR = 3.19; 95 % CI = 1.70–11,0; p < 0,05). Recovery of normal menstrual cycle in 63 (94.0%) women of the main group was established 1.5–2 months after completing of hormonal treatment, while in the comparison group pain and dysmenorrhea relapsed in some patients at the 6-month follow-up. Decreased libido as a side effect in patients who treated with dienogest was observed in 2 (3.0 %) women. Dienogest was highly effective in the combination treatment of patients with verified endometriosis that resulted in reduced severity of pain and metrorrhagia. The drug was featured by low level of side effects. Thus, a combination treatment of endometriosis containing dienogest at a dose of 2 mg/day applied during postoperative period allows to reduce the severity of the disease clinical manifestations and improve treatment outcome.

scholarly journals Postoperative management of patients with endometriosis

2020 ◽  
Vol 14 (2) ◽  
pp. 182-191 ◽  
Author(s):  
Ju. E. Dobrokhotova ◽  
D. M. Kalimatova ◽  
I. Yu. Ilyina
Keyword(s):  
Surgical Treatment ◽  
Combination Treatment ◽  
Postoperative Period ◽  
Comparison Group ◽  
Clinical Manifestations ◽  
Hormonal Treatment ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Main Group ◽  
Uterine Ligaments

Aim: to assess the effectiveness of using dienogest in combination with postoperative interventions in patients with endometriosis.Materials and methods. There were enrolled 102 patients with signs of external endometriosis underwent examination and surgical treatment, subdivided into 2 groups: 67 – main group (after surgical treatment, received dienogest 2 mg/day for 6 months), 35 – comparison group received no hormone therapy in the postoperative period. Surgical treatment included removal of endometrioid ovarian cysts, endometriosis foci on the pelvic peritoneum and sacral uterine ligaments. Course of the early postoperative period (up to 1 month after the intervention) as well as the long-term dynamics of the disease manifestations (3, 6, 12 and 15 months later) were assessed.Results. Dienogest was administered after surgical treatment due to endometriosis that reduced the severity of dyspareunia and intensity of chronic pelvic pain by 3.5- and 2-fold, respectively. The probability of achieving control over uterine bleeding 6 month after the onset of treatment due to endometriosis manifested with metrorrhagia showed that combination treatment (consisting of dienogest) was 3.19-fold higher compared to surgical treatment alone (OR = 3.19; 95 % CI = 1.70–11,0; p < 0,05). Recovery of normal menstrual cycle in 63 (94.0%) women of the main group was established 1.5–2 months after completing of hormonal treatment, while in the comparison group pain and dysmenorrhea relapsed in some patients at the 6-month follow-up. Decreased libido as a side effect in patients who treated with dienogest was observed in 2 (3.0 %) women.Conclusion. Dienogest was highly effective in the combination treatment of patients with verified endometriosis that resulted in reduced severity of pain and metrorrhagia. The drug was featured by low level of side effects. Thus, a combination treatment of endometriosis containing dienogest at a dose of 2 mg/day applied during postoperative period allows to reduce the severity of the disease clinical manifestations and improve treatment outcome.

scholarly journals Dynamical lymphadenectomy as a component of multidisciplinary approach while doing operative interventions for pancreatic cancer

2019 ◽  
Vol 86 (7) ◽  
pp. 42-45
Author(s):  
O. Yu. Usenko ◽  
M. Yu. Nychytailo ◽  
M. S. Zagriichuk ◽  
V. V. Kropelnytskyi ◽  
N. E. Klochkova ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Lymph Nodes ◽  
Multidisciplinary Approach ◽  
Comparison Group ◽  
Average Duration ◽  
Main Group ◽  
Morbidity Rate ◽  
Results Of Treatment ◽  
Duration Of Hospitalization ◽  
Clinically Significant

Objective. To improve the results of treatment of pancreatic cancer, using modification of volumes of lymphadenectomy and application of multidisciplinary approach. Materials and methods. Into the investigation 16 patients, suffering a moderately differentiated (G2) adenocarcinoma of the pancreatic gland head (II stage of the disease) were included. There were 10 men and 6 women. The average age of the patients have constituted 62.4 yrs old. The patients were divided into two groups – the main and the comparative one, equally - by 8 of every group. In all the patients pancreaticoduodenal resection was done. All the patients in postoperative period have obtained gemcitabine in combination with 5-fluorouracyl. In patients of the main group a dynamical personalized intraoperative lymphadenectomy in accordance to our elaborated scheme, was performed. In patients of the comparison group lymphadenectomy was performed in accordance to the volumes adjusted, and it is called a standard one. Results. Average duration of the operation have constituted (347 ± 48) min, lymphadenectomy – (42 ± 12) min in the main group, and (31 ± 9) in the comparison group. Average volume of the blood loss have constituted (342 ± 272) ml. Average duration of hospitalization have constituted (8.2 ± 4.3) days, general rate of postoperative complications – 24.3% in both groups. After the operation the mortality was absent. Clinically significant lymphorrhea was observed in 3 patients in the main group, and in 5 – from the comparison group. In patients of the main group 9 ± 2 lymph nodes were excised, and in a comparative one – 13 ± 2, there were revealed 7 ± 1 (77.7%) and 9 ± 2 (60%) lymph nodes affected, accordingly. Postoperative diarrhea have occurred in 4 patients: in 3 – from comparative group, and in 1 – from the main group. Duration of the recurrence-free period in the main group have constituted (18 ± 2.3) mo, and in a comparative one – (13 ± 1.5) mo. Two years have survived 12/16 (75%) patients. In the main group one patient died, and in a comparative one - 3. The two-year survival in the main group have constituted 87.5%, and in a comparative one – 62.5%. Conclusion. Dynamical lymphadenectomy as a component of multidisciplinary approach gives possibility to reduce the quantity of the lymph nodes excised, unaffected by the tumor, to enhance the quantity of the excised lymph nodes trustworthily affected by the tumor, to lower the morbidity rate and to prolong the duration of the recurrence free period.

Surgical treatment of patients with deep infiltrating endometriosis of the rectovaginal septum

2021 ◽  
Vol 20 (4) ◽  
pp. 5-11
Author(s):  
E.A. Galliamov ◽  
◽  
L.N. Aminova ◽  
V.A. Alimov ◽  
A.G. Kozub ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Comparison Group ◽  
Chronic Pelvic Pain Syndrome ◽  
Main Group ◽  
Pelvic Pain Syndrome ◽  
Deep Infiltrating Endometriosis ◽  
Rectovaginal Septum ◽  
Infiltrating Endometriosis

Objective. To optimize the tactics of surgical treatment of deep infiltrating endometriosis of the rectovaginal septum, including with bowel involvement. Patients and methods. The study included 122 patients diagnosed with deep infiltrating endometriosis of the rectovaginal septum, who underwent surgical interventions of different volumes using laparoscopy. The patients were divided into a main group and a comparison group. The main group consisted of 92 patients with deep infiltrating endometriosis of the rectovaginal septum who underwent surgical treatment using the original technique of systematic approach; the comparison group consisted of 30 patients who were operated using the generally accepted technique. Results. There was a statistically significant decrease in the operation duration, intraoperative blood loss, as well as more effective relief of dysmenorrhea and chronic pelvic pain syndrome, less complications and relapses in the main group compared to the comparison group. In addition, it was found that the combination of three symptoms such as dysmenorrhea, dyspareunia and chronic pelvic pain increase the likelihood of deep infiltrating endometriosis up to 93%. Conclusion. Based on the results obtained, the proposed method of surgical treatment of deep infiltrating endometriosis is more efficient and safer in comparison with the generally accepted technique, which can be considered as a valid reason for its wide introduction into clinical practice. Key words: deep infiltrating endometriosis, bowel endometriosis, surgical treatment of endometriosis, treatment algorithm

scholarly journals MODERN METHODS OF PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ESOPHAGO-ORGAN ANASTOMOSIS AT ESOPHAGOPLASTY

2020 ◽  
Vol 73 (8) ◽  
pp. 1696-1699
Author(s):  
Volodymyr O. Shaprynskyi ◽  
Yevhen V. Shaprynskyi ◽  
Mustafa Bassam Hussein ◽  
Oleg O. Vorovskyi ◽  
Yaroslav V. Karyi ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Diagnostic Algorithm ◽  
Main Group ◽  
Instrumental Method ◽  
Complication Risk ◽  
Esophageal Strictures ◽  
Bed Days

The aim: To improve the results of operative treatment of esophageal strictures by decreasing the rate of failure and stricture of cervical esophago-organ anastomoses. Materials and methods: There were 45 patients with post-burn corrosive gullet strictures, 17 patients with postoperative corrosive strictures, 10 patients with peptic strictures secondary to reflux-esophagitis, 42 patients with esophageal cancer strictures. The patients were divided into two groups: the comparison group – 55 persons and the main group – 59 persons. Patients of comparison group underwent surgical treatment of esophageal strictures according to classic protocols and standards. In the main group of patients we applied proposed diagnostic algorithm with prediction of complication risk and the designed method of esophago-organ anastomosis formation. Results: The results of operative treatment in patients with esophageal strictures showed the development of early postoperative complications in 59 individuals (51.75 %). In the postoperative period six patients died: four – in the comparison group and two – in the main group. Failure of cervical esophago-organ anastomosis and esophageal strictures occurred in 7 patients (11.86 %) of main group and 20 patients (36.36 %) of the comparison group (p<0.05). Conclusions: Application of method predicting the risk of complications of cervical anastomosis, treatment program and instrumental method of formation anastomosis resulted in reduced incidence of failure and strictures of esophago-organ anastomosis from 36.36 % to 11.86 % (p<0.05); decreased time of hospitalization - from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), postoperative period - from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality - from 7.27 % to 3.39 %.

THE USE OF THORACOPLASTY IN THE TREATMENT OF DESTRUCTIVE PULMONARY TUBERCULOSIS

2021 ◽  
pp. 18-28
Author(s):  
Andrey V. Ivanov ◽  
Alexey A. Malov ◽  
Vadim A. Kichigin ◽  
Vasily A. Ivanov ◽  
Larisa V. Tarasova
Keyword(s):  
Drug Resistance ◽  
Body Weight ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Pulmonary Tuberculosis ◽  
Comparison Group ◽  
Main Group ◽  
Negative Reaction ◽  
Normal Body ◽  
Normal Body Weight

Despite a decrease in the incidence of pulmonary tuberculosis in the Russian Federation in recent years, among the newly diagnosed patients there remains a significant proportion of patients with bacterial excretion and destructive pulmonary tuberculosis. In patients with destructive pulmonary tuberculosis, surgical treatment is often the only possible method for saving lives. We studied the results of extrapleural posterosuperior thoracoplasty in 42 patients with destructive pulmonary tuberculosis. The comparison group consisted of 30 patients who received medicamentous therapy. The mortality rate for 3 years of follow-up in the conservative treatment group was 36.7%, in the surgical treatment group it was 23.8%, p = 0.237. Among patients with more than 2 years of disease experience, mortality was 45% in the main group, 88% in the comparison group, p = 0.070. In the absence of drug resistance, mortality in the main group was 4%, that in the comparison group – 14.2%, p = 0.283. Mortality in individuals with normal body weight was lower in the group of patients who underwent thoracoplasty than in the comparison group: 17.6% vs. 33.3% (p = 0.202). Among those who did not achieve sputum negative reaction, mortality was lower, and passing to the 3rd group of dispensary care was more common in the surgical treatment group – 41.7% vs. 71.4% (p = 0.077) and 33.3% vs. 21.4% (p = 0.426). Among patients with drug resistance or low body weight or unachieved sputum negative reaction, mortality rates were comparable in both groups. Thus, thoracoplasty, in comparison with conservative therapy, makes it possible to improve treatment results in patients regardless of the length of the disease in groups with Mycobacterium tuberculosis sensitive process, with normal body weight, with preservation of elimination of bacilli. The effectiveness of thoracoplasty decreases in patients with an increase in the disease duration.

scholarly journals Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Comparison Group ◽  
Care Delivery ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Group ◽  
Lung Capacity ◽  
Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

scholarly journals SURGICAL TREATMENT OF CAROTID STENOSIS IN PATIENTS WITH CORONARY HEAR+T DISEASE IN ORDER TO PREVENT ISCHEMIC STROKE

2020 ◽  
pp. 124-126
Author(s):  
I. S. Pulyaeva ◽  
V. A. Prasol
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Carotid Stenosis ◽  
Postoperative Period ◽  
Stable State ◽  
Length Of Hospital Stay ◽  
Early Postoperative Period ◽  
Main Stage ◽  
Simultaneous Operations ◽  
Ischemic Attack

Summary. Goal. To analyze the results of surgical treatment of carotid stenosis in patients with coronary heart disease in order to prevent ischemic stroke. Materials and methods. The analysis included 18 patients treated in the SI «V. T. Zaitseva IGUS of NAMNU» from 2017 to 2019 in combined atherosclerotic lesions of the coronary and carotid arteries which evaluated the reserve brain. Results and discussion. All patients with two-stage treatment of the first and second groups were discharged in a stable state, one had a clinic of transient ischemic attack in the postoperative period. Conclusions. Simultaneous operations are advisable in patients with a reduced reserve of both coronary and cerebral circulation. The risk of developing cerebral and cardiac postoperative complications is comparable with the results of phased operations, reducing the length of hospital stay of the patient. The results of the hypoxic test serve as an additional criterion for the decision to impose an internal intra-arterial shunt. This allows you to reduce the time of the main stage of carotid endarterectomy and to avoid additional possible complications in the early postoperative period.

scholarly journals Metabolic support of patients with myocardial infarction and liver dysfunction

2019 ◽  
Vol 26 (1) ◽  
pp. 40-48
Author(s):  
M. I. Shved ◽  
O. A. Prokopovych
Keyword(s):  
Myocardial Infarction ◽  
Liver Dysfunction ◽  
Comparison Group ◽  
Clinical Laboratory ◽  
Main Group ◽  
Hemodynamic Parameters ◽  
Liver Disorders ◽  
Conduction Disorders ◽  
Complex Therapy ◽  
Antioxidant Protection System

The aim – to improve the existing therapeutic programs for patients with myocardial infarction (MI) by differentiated approach to therapy depending on the presence or absence of liver dysfunction. Materials and methods. 149 patients with acute MI were included to the study – 114 (76.5 %) men and 35 (23.5 %) women of average age 59.9±1.0 years. A comparative clinical-laboratory and instrumental examination was performed in these groups: 107 patients with MI with functional liver disorders (main group) and 42 patients with MI without functional liver disorders (comparison group). For the study of intracardiac hemodynamics, echocardiography was performed in B-mode. 52 patients of main group and 22 patients of comparison group received standard treatment for MI (ACE-inhibitors, β-blockers, clopidogrel and acetylsalicylic acid, anticoagulant therapy, statins). The other 55 patients of main group and 20 patients of comparison group received modified treatment with the addition of the antioxidant bioflavonoid – quercetin to the standard scheme. Results and discussion. In the initial condition of patients of main group there are more pronounced violations of central and peripheral hemodynamics which cause the disorders of protein synthesis, detoxification, energetic dysfunction of liver and lipid metabolism. At the same time there is an excessive activation of lipid peroxidation, suppressed activity of enzymes of the antioxidant protection system, deepening of pathological processes in the heart and in the liver. Inclusion of bioflavonoid quercetin to the complex therapy of patients with myocardial infarction provided the improvement of hemodynamic parameters – increased EF by 22.89 % and elimination of diastolic dysfunction, which were accompanied by normalization of clinical and laboratory parameters of liver function disorders – normalization of levels of bilirubin and ALT, GGT, ALP on 14-th day and reduction of LDL-level by 25.61 % after 3 weeks was marked. Conclusions. Introduction of bioflavonoid quercetin to the complex therapy of patients with MI provided improvement of hemodynamic parameters and restoration of oxidation-reduction equilibrium, reduction of clinical and laboratory manifestations of liver dysfunction and contributed to a significant decrease in the frequency of MI complications development. Restoration of parameters of cardiac hemodynamics, metabolic processes and liver functions provides a significant reduction in the rate of development of acute heart failure by 63.9 %, early post-infarction angina by 22.2 %, rhythm and conduction disorders by 43.6 %.

scholarly journals URGICAL TACTICS IN WOUNDS OF PHARYNX AND CERVICAL ESOPHAGUS

2019 ◽  
pp. 95-98
Author(s):  
M. Yu Syzyi
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Cervical Esophagus ◽  
Penetrating Injuries ◽  
Twofold Decrease

Summary. The results of surgical treatment of 98 patients with penetrating injuries to the pharynx and cervical esophagus are presented. The patients were divided into the main and the comparison group. In the comparison group, the traditional principles of intervention were used. In the main group, surgical intervention was performed with a mini access on the neck 3-4 cm in length using a ring-shaped retractor. In the main group there was a twofold decrease in the frequency of purulent complications after surgical treatment of penetrating injuries to the pharynx and cervical esophagus, in comparison with the comparison group.

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