INDICATIONS AND CONTRAINDICATIONS FOR REMOVAL OF FOREIGN BODIES OF LUNGS OF FLAMMABLE ORIGIN

2021 ◽  
pp. 43-47
Author(s):  
V. Kupriyanchuk ◽  
Y. Bunin ◽  
R. Mikhailusov ◽  
V. Negoduyko ◽  
E. Khoroshun ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Foreign Bodies ◽  
Comparison Group ◽  
Gunshot Wounds ◽  
Northern Region ◽  
Main Group ◽  
Surgical Instruments ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Surgical Department

Summary. The purpose of the study is to establish the indications and contraindications for the removal of foreign bodies of lungs of gunshot origin. Materials and methods. In the surgical department of the surgical clinic of the Military Medical Clinical Center of the Northern Region, 207 wounded who received gunshot wounds penetrating the chest were examined. The wounded were divided into 2 groups depending on the operational tactics used. The main group of 97 wounded who were treated using modern video endoscopic technology and magnetic surgical instruments. The comparison group consisted of 110 wounded who received traditional treatment. Results and their discussion. Using video endoscopic technologies and magnetic surgical instruments during surgery, 42 (54.5%) in the main group were removed, in the comparison group — 23 (27.4%) foreign bodies. The amount of surgery should not exceed the amount of damage that minimizes surgical trauma. The article presents indications and contraindications to the removal of foreign bodies of pulmonary origin. The differential approach allows to determine the surgical tactics depending on the location of the foreign body, its size and the fit of foreign bodies to the vessels, bronchi, mediastinum. Adherence to the rules of removal of foreign bodies of the lung, depending on the location of its location and size leads to a decrease in inappropriate surgical interventions and postoperative complications. Conclusions. 1. The distribution of foreign bodies by location and size allows you to clearly determine the tactics of treatment and avoid postoperative complications. 2. Surgical interventions to remove foreign bodies should be performed in the first days after stabilization of the patient’s condition using minimally invasive technologies.

scholarly journals EVOLUTION OF VIEWS ON THE DEVELOPMENT AND IMPLEMENTATION OF MODERN SURGICAL MAGNETIC INSTRUMENTS ON THE CASE OF INFLAMMATORY PENETRATING INJURIES OF THE BREAST

2020 ◽  
pp. 113-118
Author(s):  
Yu. V. Bunin ◽  
P. M. Zamyatin ◽  
R. M. Mihаylusov ◽  
V. V. Negoduyko ◽  
S. O. Beresnyev ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Pleural Cavity ◽  
Gunshot Wounds ◽  
Surgical Instruments ◽  
Internal Organs ◽  
Surgical Interventions ◽  
Magnetic Nozzle ◽  
Endoscopic Laser ◽  
Laser Visualization ◽  
Magnetic Instrument

Summary. The arms — to analyze the evolution of the development of modern surgical instruments in gunshot wounds chest. Materials and methods. 80 cases of using a modern magnetic surgical instrument for penetrating gunshot wounds of the chest were analyzed. Intraoperatively used: a magnetic multifunctional tool for the diagnosis and removal of metallic ferromagnetic foreign bodies, a flexible device for removing ferromagnetic foreign bodies, a magnetic tool for endovideoscopic diagnosis and removal of metallic ferromagnetic foreign bodies from the abdominal and pleural cavities, a magnetic nozzle for video endoscopic surgical interventions. When removing metal foreign bodies, the following methods were used: a method for preliminary determination of the material and properties of a foreign body, a method for video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. Results. Foreign bodies of the pleural cavity were diagnosed in 80 (100 %) wounded according to СT. Ferromagnetic metal foreign bodies of a gunshot origin of the pleural cavity were removed both during thoracotomy or minithoracotomy, and during thoracoscopic surgical interventions using the method of video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. The most convenient tool was the endoscopic magnetic tool for removing foreign bodies from the pleural or abdominal cavities. A magnetic nozzle for video endoscopic surgical interventions allows navigation both in the pleural cavity and along the wound channel. Conclusions. 1. The development of a surgical magnetic instrument was phased and began with the improvement of a surgical magnetic instrument to remove ferromagnetic foreign bodies of soft tissues. 2. The improvement of the tool took place as the restrictions on the use of the existing tool were established, which was a prerequisite for the development of a new tool. 3. It is advisable to create a special set of surgical magnetic instruments for video endoscopic surgery.

scholarly journals Modern approaches to treatment of echinococcal diseases

2021 ◽  
Vol 99 (5-6) ◽  
pp. 333-338
Author(s):  
R. S. Sultanova ◽  
R. T. Mejidov ◽  
S. M. Magomedova
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Length Of Hospital Stay ◽  
Disease Recurrence ◽  
Main Group ◽  
Long Term Results ◽  
High Tech ◽  
Disease Treatment ◽  
Surgical Interventions

Purpose. To evaluate the results of treatment of echinococcal liver disease, to determine the most effective method of echinococcectomy and its role in the prevention of of the disease recurrence. Material and methods. The analysis of 1072 cases (1358 cysts) of echinococcal liver disease was carried out. Radical (closed) echinococcectomy with the use of high-tech resection devices was performed in 258 patients, including the use of ultrasonic dissectors and aspirators in 105 patients (main group), other resection devices (LigaSure, argon plasmic scalpel) — in 153 patients (comparison group). Results.Length of hospital stay in the main group was 9.4 ± 2.1 bed-days, in the comparison group — 11.6 ± 1.7. Postoperative complications in the main group were recorded in 4.6% of cases, in the comparison group — in 11.0% respectively. Recurrence of the disease in the comparison group was noted in 2.3% of cases, in the main group there was no secondary echinococcusinduced liver injury. The quality of life of patients in the main group was 73.5 ± 1.8 points, in the comparison group — 72.8 ± 1.7 points. There were no deaths among patients who underwent echinococcectomy with the use of resection technologies.Conclusion. The most effective way of echinococcal liver disease treatment is radical echinococcectomy: cystpericystectomy, liver resection. Ultrasound resection technologies are the most optimal for radical surgical interventions, they reduce intraand postoperative complications and improve the immediate and long-term results echinococcal liver disease treatment .

scholarly journals Surgical and intervention treatment of secondary pancreatic infections

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 49-55
Author(s):  
I. A. Krivoruchko ◽  
V. V. Boyko ◽  
Y. V. Mushenko ◽  
A. G. Drozdova
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Main Group ◽  
Controlled Study ◽  
Surgical Approaches ◽  
International Consensus ◽  
Surgical Interventions ◽  
Pancreatic Infection ◽  
Complications And Mortality

Introduction. Many experimental and clinical studies have improved our understanding of the pathophysiology of acute pancreatitis. Today, there are no disagreements over the timing and basic indications for surgery in this disease, but there are still various surgical approaches. Methods. A retrospective and prospective twocenter controlled study was conducted in 582 patients with acute pancreatitis treated in 2004–2018. Age of patients was 53 ± 12,5 years. The classification of the disease was used according to the recommendations of the International Consensus 2012. Patients included in the study were treated in accordance with the IAP/APA (2013) recommendations adapted to local resources and procedures. Of 582 patients, 387 (66,5%) patients with mild to moderate heaviness performed complex treatment, including 89 patients undergoing surgery. According to the goals and objectives of the study, other patients were divided into two groups: the main group – 103 patients with secondary pancreatic infection, who used the tactic of treatment «step-up approach»; а comparison group – 92 patients with open surgical intervention. Results. In the comparison group were used open necrosectomy and drainage. Postoperative complications have arisen in 52 (56,2%) patients. After surgery died 26 patients (28,3%), 19 had a 30-day mortality and 7 had a 90-daymortalityof them. In the main group 62 (60,2%) patients were treated by percutaneous controlled ultrasound intervention, 26 (25,2%) by videolaparoscopic necrosectomy and drainage and at 5 (4,9%) drainage through the wall of the stomach or duodenum. In 10 (9,7%) open operations were performed (minilumbotomy, upper medial, left or right-winged minilaparotomy with formation of mini-bursostomy) with pancreatic necrosectomy, including at 5 decompressive VAC-laparostomy local access. Postoperative complications have arisen in 33 (32%) patients. After surgery died 15 patients (14,6%), 6 had a 30-day mortality and 9 had a 90-day mortality of them. When comparing the two strategies of the treatment-tactical approach, the number of postoperative complications and mortality were lower than in the group of patients who performed only open surgical interventions (x2 = 6,976, p = 0,011). Conclusion. The our research showed that an individualized approach to patients with secondary pancreatic infection using the step-up approach provides a reduction in the number of laparotomic pancreatic necrosectomies and allows postponing «open» surgical interventions for a period after the 4th week from the onset of the disease and reducing the number of postoperative complications and mortality (x2 = 6,976, р = 0,031). Keywords: acute pancreatitis, secondary pancreatic infection, diagnostics, tactics «step-up approach», surgical treatment.

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 The choice of surgical treatment method of patients with bacterial liver abscesses

2012 ◽  
Vol 93 (2) ◽  
pp. 265-269 ◽  
Author(s):  
A P Tolstikov
Keyword(s):  
Postoperative Complications ◽  
Ultrasound Guidance ◽  
Comparison Group ◽  
Average Duration ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Main Group ◽  
Early Postoperative Complications ◽  
Liver Abscesses ◽  
Bed Days

Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.

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 THE POSSIBILITIES OF APPLICATION OF DECIMETER-WAVE THERAPY IN DESTRUCTIVE APPENDICITIS CHILDREN

2019 ◽  
Vol 23 (1) ◽  
pp. 4-8
Author(s):  
Ekaterina R. Soloveva ◽  
O. V. Karaseva ◽  
M. F. Vasileva ◽  
S. V. Petrichuk
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Comparison Group ◽  
Abdominal Ultrasound ◽  
Main Group ◽  
Inpatient Stay ◽  
Decimetric Wave ◽  
Insufficiency Syndrome ◽  
Common Laboratory ◽  
Inflammatory Effect

Introduction. The article presents a comparative study of the postoperative period after laparoscopic appendectomy for destructive appendicitis in children with and without application of decimetric-wave therapy (DMWT). Material and methods. The study included 299 children aged from 3 to 17 years, the average age of children accounted for 10.7 ± 3.3 years. Patients were operated on for various forms of destructive appendicitis. The patients observed included 201 boys (67.3%) and 98 girls (32.7%), Destructive appendicitis (DA) was diagnosed in 129 (43.1%) children, appendicular peritonitis (AP) - in (56.9%). Patients of the main group received DMWT, starting from the 1st day after surgery. Patients in the comparison group did not receive physiotherapy. To assess the effectiveness of the use of UHF-therapy in the postoperative period, the following groups were taken into account: 1) intestinal insufficiency syndrome (ISS) and systemic inflammatory response syndrome (SSRS); 2) postoperative complications; 3) abdominal ultrasound data; 4) the dynamics of common laboratory indices 4) the duration of the inpatient stay. Results. In DA cases without peritonitis, ISS and SSRS in the main group were observed by 15.7 and 12.8 times less than in the comparison group, with the duration of ISS decreased by 2.13 times, SSRS by 3.3 times. In AP patients the frequency of ISS decreased by 1.68 times, SSRS - by 1.97 times. By the 5th day of the postoperative period in the main group, both in DA and AP cases, there was a significant increase in the incidence of patients with both leukocytes and lymphocytes count normal for the age, LII, CRP. The inpatient stay in the main group decreased by 1.0±0.7 days in DA patients, in AP cases - by 3.3±0.7 days. Conclusion. Evaluation of the postoperative period, as well as traditional laboratory indices, confirm the effectiveness of DMWTin the postoperative period in DA cases YES, in that the local and systemic anti-inflammatory effect is more pronounced in with AP patients.

scholarly journals PROLONGED EPIDURAL ANALGESIA AFTER COLORECTAL SURGERY IN ELDERLY PATIENTS

2018 ◽  
Vol 12 (3) ◽  
pp. 175-182
Author(s):  
Alexander V. Savushkin ◽  
E. A Khachaturova ◽  
E. V Balykova
Keyword(s):  
Elderly Patients ◽  
Epidural Analgesia ◽  
Comparison Group ◽  
Enhanced Recovery ◽  
Randomized Study ◽  
Early Mobilization ◽  
Main Group ◽  
Bolus Administration ◽  
Surgical Interventions ◽  
On Demand

Objective: to compare the effectiveness of prolonged epidural analgesia by continuous infusion or bolus administration on demand, as well as the timing and volume of early mobilization with two methods of postoperative analgesia. Material and methods: prospective randomized study enrolled 161 patients with colorectal cancer aged from 60 to 89 years, operated by means of laparotomy and laparoscopy. In the main group (n=80), postoperative prolonged epidural analgesia was carried out using individual pumps with an initial rate of 0.2% ropivacaine solution of 4-6 ml/h. In the comparison group, epidural analgesia was provided by bolus administration of 4-6 ml of 0.2% ropivacaine solution on demand. Results: In the main group with open surgical interventions, in contrast to the comparison group, prolonged epidural analgesia provided a decrease in the intensity of pain on the second (2.7 ± 1.8 and 4.1 ± 1.4 score, p < 0.001), third (2.6 ± 1.6 and 3.9 ± 1.1 score, p < 0.001), fourth day (2.3 ± 1.7 and 3.5 ± 1.2 score, p < 0.001). Prolonged epidural analgesia in the main group allowed more patients to be activated on the second (64.2% (52 of 81), p < 0.001), third (97.5% (79 of 81), p < 0.001) and fourth (100%, p < 0.002) days. The average time of activity in the main group was three times higher on the third day and twice - on the fourth day (p < 0.001). Conclusion: Postoperative prolonged epidural analgesia is highly effective in elderly patients during their treatment with enhanced recovery methods.

scholarly journals Pathomorphological features of conjunctival and scleral regeneration associated with intraoperative application of Cyclosporin A

2019 ◽  
Vol 18 (3) ◽  
pp. 46-52
Author(s):  
T. A. Zhigalskaya ◽  
O. I. Krivosheina ◽  
A. N. Dzyman ◽  
I. A. Khlusov
Keyword(s):  
Cyclosporin A ◽  
Comparison Group ◽  
Main Group ◽  
Reparative Regeneration ◽  
Phase Changes ◽  
Surgical Trauma ◽  
Ciclosporin A ◽  
Group A ◽  
Migration Of Cells

Purpose. In experiment in vivo to study the features of regeneration of the conjunctiva and sclera of rats after surgery with intraoperative application of a 0.05% Ciclosporin A.Materials and methods. Еxperimental animals (rats) (n = 48) were divided into the main group, including the subgroups a (n = 16) and b (n = 16) and the comparison group (n = 16). Performed a through cut of the conjunctiva and damage to the surface layers of the sclera one of the eyes of all animals. Further on the surgical trauma zone in the main group, the intraoperative application of the cytostatic was performed. In the subgroup a with a duration of 3 minutes, in the subgroup b – 6 minutes. In the comparison group a hemostatic sponge without a cytostatic was used intraoperatively.Results. In the comparison group postoperative period proceeds with a stereotyped dynamics of cell phase changes in damaged tissues. In the end the development of dense conjunctival-scleral fusion in the area of surgical trauma was noted. Intraoperative application of 0.05% Cyclosporine A leads to a slowing of regeneration, preventing formation of rough conjunctival-scleral scar.Conclusions. Intraoperative applications of 0.05% Cyclosporin A change the stereotyped dynamics of the inflammatory-reparative regeneration in the surgical intervention zone, inhibiting the migration of cells almost in 3 times and significantly (in 2 times) prolonging the duration of the macrophage phase. This causes a slowdown of reparative regeneration, prevents excessive scarring in the operating area. 

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.

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