Medicni perspektivi, 2018;23(4 part 1)

    Title of the issue

Content

2018 Vol. XXIII N 4 part 1

Published
2018-10-29

Trofimov M.V., Barannik S.I., Muntian S.O., Kryshen V.P. Pedagogical and research-practical achievements of the department of general surgery(to 100-th anniversary of the department of general surgery)

https://doi.org/10.26641/2307-0404.2018.4(part1).145649

 

Bereznytskyi Ya.S., Ksikevich L.N. Optimization of administration and monitoring of prevention of venous thrombosis and inflammatory wound complications

https://doi.org/10.26641/2307-0404.2018.4(part1).145650

Key words: venous thrombosis, prophylaxis, wound complications

Abstract. Optimization of administration and monitoring of prevention of venous thrombosis and inflammatory wound complications. Bereznytskyi Ya.S., Ksikevich L.N. Modern surgery and anesthesiology make it possible to perform complex surgical interventions, but at the same time, there are postoperative complications that, on the one hand, worsen the quality of surgical care provided and increase the cost of its implementation, and on the other hand do not exclude the possibility of fatal cases in operated patients. The aim of the work is the development, of on the principles of information technology process of selecting algorithms for the justified administration of preventive measures for the prevention of thrombosis and wound complications in surgical patients. We have developed and implemented the process of selecting preventive measures at the pre-operative stage, including them into the electronic list of medical administrations, the practical use of planned actions in a hospital environment, monitoring the timeliness and scope of their implementation, with further support of these algorithms and taking into account the results achieved as a result of their application. The developed process of administering standardized algorithms for prophylaxis of thromboembolic and wound complications with control of their performance is effective and practically meaningful. 

  

Bilov O.V. The use of a hemostatic collagen sponge for the treatment of suture failure of the lungs

https://doi.org/10.26641/2307-0404.2018.4(part1).145651

Key words: suture of a lung, aerostasis, collagen

Abstract. The use of a hemostatic collagen sponge for the treatment of suture failure of the lungs. Bilov O.V. In the article 10 cases of treatment of an aerostasis failure after interventions on patholologically changed parenchyma of the lung are analysed. The comparative estimation of treatment results in the group of patients with application of a hemostatic collagenic sponge for prophylaxis of suture failure of the lung is carried out. Reduction of the number of postoperative complications, time of a hospital stay and lethality in basic group was noted.

  

Boyko V.V., Kryvorotko I.V., Lykhman V.N., Myroshnychenko D.O. Surgical treatment of complicated locally advanced tumors of the pelvic organs

https://doi.org/10.26641/2307-0404.2018.4(part1).145652

Key words: pelvic tumors, evisceration, syndromes approach, combined operations

Abstract. Surgical treatment of complicated locally advanced tumors of the pelvic organs. Boyko V.V., Kryvorotko I.V., Lykhman V.N., Myroshnychenko D.O. The article presents the experience of surgical treatment of 51 patients who were treated at the State Institution “V.T. Zaitsev Institute of General and Emergency Surgery NAMS of Ukraine" from 2008 to 2018. with locally advanced cancer of the pelvic organs. Compression of the upper and lower urinary tract with the formation of ureterohydronephrosis was observed in 26 (50.1%) patients, acute intestinal obstruction in 22 (43.1%) patients, and formation of recto-vesicular and/or recto-vaginal fistulas in 15 (29.4 %) patients; bleeding in 14 (27.5%) patients. In 26 (50.1%) patients, 2 or more complications were present. Syndromic differentiation of treatment determined the tactics of the combined treatment, taking into account the risk of complications, which made it possible to ensure the radical removal of the primary tumor, as well as to preserve functioning of the pelvic organs when using a staged surgical treatment.

  

Boyko V.V., Lykhman V.N., Tkach S.V., Merkulov A.A., Volchenko I.V. Treatment and prevention of arresive bleeding in patients with pancreonecrosis

https://doi.org/10.26641/2307-0404.2018.4(part1).145653

Key words: necrotizing pancreatitis, pancreatic cyst, arrosive bleeding, minimally invasive methods of treatment

Abstract. Treatment and prevention of arresive bleeding in patients with pancreonecrosis. Boyko V.V., Lykhman V.N., Tkach S.V., Merkulov A.A., Volchenko I.V. The article is devoted to the study of acute necrotizing pancreatitis, which leads to the development of various fluid pathologies different in pathogenesis and time, which in turn can lead to an arrosive bleeding. Diagnostic-treatment is presented algorithm with the active use of modern methods of hemostasis in patients with arrosive bleeding developed against the background of pancreatonecrosis.

  

Veligotskii N.N., Veligotskii A.N., Strakhovetskii V.S., Smetskov D.A., Chebotaryov A.S. Laparoscopic intervention in emergency surgery

https://doi.org/10.26641/2307-0404.2018.4(part1).145655

Key words: emergency surgery, abdominal organs, video-laparoscopic surgery

Abstract. Laparoscopic intervention in emergency surgery. Veligotskii N.N., Veligotskii A.N., Strakhovetskii V.S., Smetskov D.A., Chebotaryov A.S. The article presents the analysis of the effectiveness of video-laparoscopic ope­rations in patients with emergency surgical pathology of the abdominal organs based on the experience of per­forming 5541 interventions at the clinical bases of the Department of Thoracoabdominal Surgery and the Department of Endoscopy and Surgery of the KhMAPE. The advantages of these interventions in comparison with open laparotomies are shown, the indications for their implementation at the present stage are evaluated. 

  

Veligotskii N.N., Komarchuk V.V., Komarchuk Ye.V., Teslenko I.V., Chebotaryov A.S. Features of diagnostics of gastroesophageal and duodenogastric reflux in patients with complicated forms of peptic ulcer

https://doi.org/10.26641/2307-0404.2018.4(part1).145659

Key words: duodenal ulcer, pH monitoring, impedance-pH monitoring, gastroesophageal reflux disease

Abstract. Features of diagnostics of gastroesophageal and duodenogastric reflux in patients with complicated forms of peptic ulcer. Veligotskii N.N., Komarchuk V.V., Komarchuk Ye.V., Teslenko I.V., Chebotaryov A.S. Purpose – to improve the results of surgical treatment of duodenal ulcer due to preoperative diagnosis of concomitant reflux disease and its correction. Before surgery, 46 patients with complicated forms of peptic  ulcer disease underwent pH monitoring and 23 – impedance-pH monitoring. Pathological gastroesophageal reflux was found in 58 cases. Before surgery, esophageal pH monitoring was performed in 46 patients with complicated forms of peptic ulcer disease. Against the background of hyper – and normacidity of the stomach in 39 patients pathological acidic gastroesophageal reflux disease with a significant increase of De Meester index was confirmed. Impedance-pH monitoring was performed before surgery in 23 patients with complicated forms of peptic ulcer and concomitant gastroesophageal reflux. Erosive form of gastroesophageal reflux disease was confirmed endoscopically in all patients with hyperacidity (17) and normal acidity (6) of the stomach. In 19 cases pathological gastroesophageal reflux disease was found. In 13 cases the cause of disorders in anti-reflux barrier was a diaphragmatic hernia of I-II degree. Gastroesophageal reflux disease was caused by increased intragastric pressure due to ulcer stenosis in 6 patients. pH- monitoring in patients with acidic gastroesophageal reflux allows to establish a pathological or physiological reflux. Conducting impedance-pH monitoring allows to determine the number of reflux episodes and their qualitative characteristics (acidic or alkaline; liquid, gas or mixed), as well as to determine the indications for a differentiated approach in the treatment of gastroesophageal reflux. 

  

Verkholaz I.L., Yaroshenko E.A., Malinovsky S.L. Venous thromboembolism in surgical practice

https://doi.org/10.26641/2307-0404.2018.4(part1).145660

Key words: surgery, prevention, thromboembolic complications

Abstract. Venous thromboembolism in surgical practice. Verkholaz I.L., Yaroshenko E.A., Malinovsky S.L. A statistical retrospective analysis of the results of treatment of patients undergoing inpatient treatment in the surgical clinic, proctology and urology departments for 5 years was conducted, total number of patients – 27771, of them operated – 14849 (53.5%), postoperative mortality – 448 patients (3.0%), the overall mortality – 989 patients (3.6%). According to the analysis of the medical documentation, the total number of patients with pulmonary embolism (PE) was 98 (0.35%), the number of patients diagnosed during treatment – 56 (57.1%), at the time of pathoanatomical examination – 42 (42.9%); in 72 patients PE was directly responsible for death, 26 patients were cured by conservative methods. Of 98 patients with PE in 56 (56.1%), the main disease was oncological disease, in most cases in neglected form with distant metastases. A reduction in postoperative lethality by 40% was obtained, the reason for which, in our opinion, are: mandatory adherence to the recommended timing of the prevention of acute thromboembolic complications; prolongation of the prophylaxis term in patients who have undergone major surgical interventions or with postoperative complications that lead to a prolonged limitation of the patients' motor activity; a wider use of low molecular weight heparins.

  

Gulmamedov P.F. Kondratenko A.P. The first experience of the simultaneous application of ultrasound scalpel and laser in the treatment of hemorrhoids

https://doi.org/10.26641/2307-0404.2018.4(part1).145662

Key words: hemorrhoids, hemorrhoidectomy, ultrasound scalpel, laser hemorrhoidectomy

Abstract. The first experience of the simultaneous application of ultrasound scalpel and laser in the treatment of hemorrhoids. Gulmamedov P.F., Kondratenko A.P. In recent decades in Ukraine, there has been a steady increase in the incidence of hemorrhoids among the working people, which makes it an important socio-economic problem. Due to the exacerbation of hemorrhoids, the quality of life is significantly reduced. The choice of tactics for the treatment of chronic hemorrhoids is still not a complete solution to the problem. The article describes a comparative analysis of the technique of performing hemorrhoidectomy using the ultrasound "Harmonic" scalpel, as well as the combination of the laser «Lika surgeon» with the ultrasound "Harmonic" scalpel.

  

Desiateryk V.I., Kotov O.V., Mikhno S.P., Dunai O.H., Shapovaliuk V.V. Individual-active form of training of surgeons in their postgraduate education

https://doi.org/10.26641/2307-0404.2018.4(part1).145665

Key words: postgraduate education, teaching methodology, innovation

Abstract. Individual-active form of training of surgeons in their postgraduate education. Desiateryk V.I., Kotov O.V., Mikhno S.P., Dunai O.H., Shapovaliuk V.V. Training physicians at the courses not only should increase their general level of education in the specialty, but also provide opportunities for self-improvement through in-depth analysis of their practical activities and introduction of modern techniques and technologies into their own surgical practice. To implement this approach, we have improved the well-known methodology for conducting seminar sessions - the "round table". The main actors in individual seminars were the most experienced doctors. Each of them, if desired, chose the topic of the lesson, which best suited his specialization and work experience. The material was presented in the form of a presentation and consisted of the following main parts: introduction, theoretical and practical parts and conclusions. The most valuable was the practical part, in which the speaker presented his own results of diagnosis and treatment of the pathology that was being considered. Obligatory in this part of the presentation was the section "complications and mortality." The speaker analyzes the new methods of treatment he introduced personally, gives examples from his own practice and demonstrates data of laboratory, radiation, endoscopic diagnostics, photos and video materials. All doctors take part in the discussion. The teacher places the main accents and outlines the ways of further development of science in one or another direction. All 144 listeners who took part in this positively evaluated the innovation. At the same time, 106 (75%) of listeners defined positively the role of the teacher as a moderator of the educational process, and 119 (82,6%) indicated an increase in the motivational component. The fact of obtaining new knowledge and its practical importance was noted by 84 (58,3%) of the listeners. Comparative analysis of the traditional and proposed methods showed the advantage of the latter: 87,4% of positive responses to test assignments based on the proposed method of teaching, versus 71,3% for traditional ones. Thus, the improved “round table” method used has allowed to significantly improve the level of professional training of doctors and to increase the motivational component of lifelong learning.

  

Yekhalov V.V., Yehorov S.V., Bahunina O.A. Hypnotherapy in children with surgical pathology

https://doi.org/10.26641/2307-0404.2018.4(part1).145667

Key words: hyponatremia, electrolyte disorders, children

Abstract. Hypnotherapy in children with surgical pathology. Yekhalov V.V., Yehorov S.V., Bahunina O.A. The article presents the data obtained during the examination of children with acute surgical pathology. The frequency of development, the severity of hyponatremia, and the effect of the syndrome of inadequate secretion of antidiuretic hormone on the development of hyponatremia have been established.

  

Zaporozhchenko B.S., Kolodiy V.V., Shpak S.V., Gorbunov A.A., Muravyov P.T., Sharapov I.V., Shevchenko V.G., Ishchenko V.S. Experience of using MRT imaging in specifying diagnosis of obstructive diseases of the biliopancreatoduodenal zone

https://doi.org/10.26641/2307-0404.2018.4(part1).145668

Key words: magnetic resonance tomography, pancreatoduodenal resection, pancreatic cancer

Abstract. Experience of using MRT imaging in specifying diagnosis of obstructive diseases of the biliopancreatoduodenal zone. Zaporozhchenko B.S., Kolodiy V.V., Shpak S.V., Gorbunov A.A., Muravyov P.T., Sharapov I.V., Shevchenko V.G., Ishchenko V.S. The article presents the experience of surgical treatment of 12 patients with pancreatic cancer who were treated at the clinic of the Department of Surgery No. 2 of the ONMEDU during 2017. As a preoperative diagnosis, an MRI scan was performed in these patients. In general, the intraoperative size of the tumor was not significantly different from MRI - sizes: the medians of their differences were only + 5.5 mm and + 3.5 mm for the average and maximum MRT sizes. The calculated sensitivity and specificity of the method of MRTand CT in the assessment of artery invasion was 83.3% and 71.4% respectively, in the assessment of vein invasion - up to 50.0% and 42.9%, respectively. The combination of MRI and CT with intravenous contrast is the best option for planning surgical tactics today.

  

Ivanova Yu.V., Klimova O.M., Prasol V.O., Korobov A.M., Mushenko Ye.V., Kiriienko D.O., Didenko S.М. Plastic closure of wounds in patients with ischemic form of diabetic foot syndrome

https://doi.org/10.26641/2307-0404.2018.4(part1).145669

Key words: diabetic foot, diabetes, complex treatment

Abstract. Plastic closure of wounds in patients with ischemic form of diabetic foot syndrome. Ivanova Yu.V., Klimova O.M., Prasol V.O., Korobov A.M., Mushenko Ye.V., Kiriienko D.O., Didenko S.М. In the work the analysis of the results of treatment of 48 patients with ischemic and neurotrophic forms of diabetic foot syndrome has been performed. All patients had diabetes mellitus and IV degree of ischemia by Fontaine. After carrying out revascularization operations, a complex treatment was used that included phototherapy, the phase closure of tissue defects with synthetic coating with the application of fibrin clot and plasma enriched with platelet growth factor, vacuum therapy of wounds, autodermoplastics by Tirsch, free autodermoplastics with split skin scar. The im­plementation of the developed tactics allowed to achieve complete wound healing in 91.7% of patients, partial healing – in 8.3% of patients and to avoid high amputations. 

  

Kanikovskyi O.Ye., Osadchyi A.V., Mosondz V.V., Kotsiura O.A. Possibilities of ultrasonographic determination of the distribution of purulent-necrotic lesions of the anorectal and urogenital areas in acute paraproctitis complicated by sepsis

https://doi.org/10.26641/2307-0404.2018.4(part1).145670

Key words: acute paraproctitis, sepsis, acute purulent infection

Abstract. Possibilities of ultrasonographic determination of the distribution of purulent-necrotic lesions of the anorectal and urogenital areas in acute paraproctitis complicated by sepsis. Kanikovskyi O.Ye., Osadchyi A.V., Mosondz V.V., Kotsiura O.A. An urgent problem of the present day is an acute purulent infection, a significant part of which are patients with acute purulent pathology of the pararectal area. The aim of the work is to determine the ultrasonographic criteria of purulent-necrotic lesion in acute paraproctitis. Endorectal sonography makes it possible to determine the nature of pathological changes in cell spaces with a high probability and to conduct differential diagnostics of acute paraproctitis with diseases of neighboring organs. The use of ultrasonographic system control in clinical practice in the purulent-necrotic lesion of the anorectal and urogenital zone significantly improved the results of treatment. Intraoperative use of ultrasonographic examination allowed less traumatic and adequate drainage of the pelvic space in purulent-necrotic lesions.

  

Kanikovskyi O.E., Pavlyk I.V., Oliinyk I.V. Algorithm of surgical treatment of complicated forms of chronic pancreatitis

 https://doi.org/10.26641/2307-0404.2018.4(part1).145671

Key words: chronic pancreatitis, algorithm of surgical treatment

Abstract. Algorithm of surgical treatment of complicated forms of chronic pancreatitis. Kanikovskyi O.E., Pavlyk I.V., Oliinyk I.V. The purpose of the work was to evaluate the algorithm of surgical treatment of complicated forms of chronic pancreatitis. The results of surgical treatment of 181 patients with complicated forms of chronic pancreatitis were analyzed. 24.5% of patients were admitted with type B pain syndrome. Among them, all patients had multiple strictures of the main pancreatic duct and tissue pressure resistance was >200 mm Hg. Histologically, these patients had stage 4 of pancreatic fibrosis. A combined local resection by Frey-Izbickiy allows to reduce the number of relapses of pancreatic hypertension by 11.1%.

  

Kashtalian M.A., Herasimenko O.S., Yenin R.B., Muradian K.R., Haida Ya.I. The features of surgical treatment of ventral hernias after gunshot wounds of the addomen

https://doi.org/10.26641/2307-0404.2018.4(part1).145673

Key words: ventral hernia, gunshot wound to the abdomen, surgical treatment

Abstract. The features of surgical treatment of ventral hernias after gunshot wounds of the addomen. Kashtalian M.A., Herasimenko O.S., Yenin R.B., Muradian K.R., Haida Ya.I. The results of treatment of 21 patients with postoperative ventral hernias, formed as a result of surgical treatment for gunshot wounds of the abdomen were analyzed. All patients are men aged 21-48 years. 3 patients underwent laparoscopic allohernioplasty according to the IPOM method with Teflon allograft, 10 patients underwent allohernioplasty with a prolenic mesh graft by the sub lay method, 7 patients underwent alloplasty using the on lay method and 1 – autoplasty with local tissues. Suppuration of wounds was not noted. The average bed-day after laparoscopic hernioplasty was 9.5 days, after open operations - 16.2 days. The advantage of laparoscopic hernioplasty over open operations was noted.  

  

Kravets O.V. Modern aspects of the volemic management of patients with acute abdominal pathology

 https://doi.org/10.26641/2307-0404.2018.4(part1).145675

Key words: perioperative infusion therapy, liberal regime, restrictive regime, goal directed therapy

Abstract. Modern aspects of the volemic management of patients with acute abdominal pathology. Kravets O.V. In conditions of urgent surgical care, the age of patients, concomitant somatic chronic pathology are factors that significantly increase the risk of postoperative complications and lethality.  The latter in this group of patients is 30-80% and is associated with the development of hypovolemia.  Treatment of the latter is traditionally provided by the routine conduct of a liberal regimen of infusion therapy (IT) to achieve hypervolemic hemodilution by infusion of crystalloid and colloidal drugs.  It was found that the consequences of the liberal regime of IT is the development of acute hypervolemia.  The accumulation of excess fluid forms the development of interstitial edema of tissues, causing a decrease in tissue oxygenation, the development of coagulation disorders and multi-organ dysfunction ̸ inadequacy, inhibits the healing of wounds.  Therefore, in recent years, a restrictive (restricted) IT regimen has become available for clinical use, the goal of which is to achieve normovolemia.  At the same time, evidence-based clinical studies indicate the possibility of using perioperative optimization of hemodynamics in the clinic by individualizing IT in accordance with the indices of central hemodynamics.

  

Nagaichuk V., Zheliba M., Chornopyshchuk R. Features of teaching thermal injury course for the third-year students at the general surgery department

https://doi.org/10.26641/2307-0404.2018.4(part1).145676

Key words: thermal trauma, credit transfer system, educational process, terrorist attacks

Abstract. Features of teaching thermal injury course for the third-year students at the general surgery department. Nagaichuk V., Zheliba M., Chornopyshchuk R. In the article, on the basis of methodological recom­mendations on the introduction of the European credit transfer system and its documents, current issues of optimizing the educational process, the effectiveness of mastering the material on the topic "Thermal trauma", based on theoretical training and practical skills are elucidated. Lectures, practical classes and skills are formulated taking into account modern terrorist attacks with outlining effective ways of medical self-aid, mutual and first aid.

  

Nepomniashchyi V.V., Tamm T.I., Polianskyi D.P., Shakalova O.A., Zakharchuk O.P. Dynamics of cumulating metronidazole in the gut wall on a model of mechanical ileus

https://doi.org/10.26641/2307-0404.2018.4(part1).145678

Key words: acute obstruction of the intestine, experimental ileus, metronidazole, cumulation of antibacterial drugs

Abstract. Dynamics of cumulating of metronidazole in the gut wall on a model of mechanical ileus. Nepomniashchyi V.V., Tamm T.I., Polianskyi D.P., Shakalova O.A., Zakharchuk O.P. The frequency of acute intestinal obstruction in relation to urgent surgical diseases in Ukraine remains high and reaches 3.8-6%. In the postoperative period, such patients develop a high number of severe purulent-septic complications. For the prevention and treatment of purulent-septic complications, various combinations of antibiotics with metronidazole are used. On the model of experimental mechanical ileus, the ability of the modified bowel wall to retain metronidazole was determined. The experiment was performed on 20 lines of the "Vistar" line in which the mechanical model of the ileus was formed. The results of the study showed that the accumulation of metronidazole in the phlegmonous-altered gut wall at therapeutic concentrations occurs within the first 24 hours and is of a short-term nature. The lack of the possibility of cumulating of antibacterial drugs by the wall of the inflamed gut after 24 hours contributes to the development of purulent complications. 

  

Svitlychnyi E.V., Muradian K.R., Herasymenko O.S., Koshykov M.O., Haida Ya.I., Yenin R.V. Application of the method of ultrasound imaging in the removal of foreign bodies in gunshot wounds

https://doi.org/10.26641/2307-0404.2018.4(part1).145680

Key words: injuries, fragmentation, bullet, ultrasound navigation, surgical treatment

Abstract. Application of the method of ultrasound imaging in the removal of foreign bodies in gunshot wounds. Svitlychnyi E.V., Muradian K.R., Herasymenko O.S., Koshykov M.O., Haida Ya.I., Yenin R.V. Data on the possibility of using ultrasound diagnostics when removing foreign bodies - bullets and fragments from body tissues during primary or repeated surgical treatment are rather limited. The aim of the research – improving the results of treatment of victims with gunshot fragmentation and bullet wounds by using a complex of ultrasound and X-ray navigation in the process of removing injurious elements during primary and repeated surgical treatment. The study included 214 wounded. In group I, the main group (122 wounded), the removal of fragments was carried out using a complex of X-ray and ultrasound navigation. In group II, the control group (92 wounded), only X-ray navigation was used. In group I during primary surgical treatment, foreign objects were removed in 101 (82.8%) of 122 injured and during secondary – in 17 (13.9%). In group 4 (3.3%) patients, the fragments were not visualized: in 1 - in the lateral region of the neck, in 1 - in the muscles of the leg, in 2 - in the chest wall. Complications were not observed. In group II, during primary surgical treatment, foreign objects were removed in 59 (64.1%), and in the secondary – in 18 (19.6%). The reasons for the failures were: deep lieying of fragments - in 6 (6.5%), location near large vessels - in 5 (5.4%), non-X-ray contrast foreign bodies - in 4 (4.3%). Among the complications, bleeding was observed in 2 wounded. The use of ultrasound navigation allows by 18.7% to increase the frequency of detection and removal of foreign bodies - bullets and fragments during the primary surgical treatment of a wound and to reduce the need for repeated interventions by 5.7%. The advantages of the method are: mobility, high information content in structural damages to soft tissues and verification of foreign bodies, the possibility of performing real-time, the absence of exposure to radiation.

  

Trofimov M.V., Kryshen V.P., Zadorozhnyi V.V., Barannik S.I., Muntyan S.O., Guzenko B.V., Panikova T.M., Lyaschenko P.V., Nor N.M., Slesarenko K.S. Current issues of teaching general surgery

https://doi.org/10.26641/2307-0404.2018.4(part1).145685

Key words: credit-module system, general surgery, teaching methods

Abstract. Current issues of teaching general surgery. Trofimov M.V., Kryshen V.P., Zadorozhnyi V.V., Barannik S.I., Muntyan S.O., Guzenko B.V., Panikova T.M., Lyaschenko P.V., Nor N.M., Slesarenko K.S. Analysis of the results of teaching general surgery in a credit-modular system showed that there are issues that need to be solved at different levels. They concern educational and methodological and logistical support of education, the proper methodology of teaching practical skills, the distribution of modular control of mastering level of practical and theoretical knowledge as well as the increase of academic hours a on the discipline in the total and restructuring clinical practice.

  

Khimich S.D., Muraviov F.T., Rudkovska N.G. Analysis of unsatisfactory results of laparoscopic cholecystectomy in patients with cirrhosis of the liver

https://doi.org/10.26641/2307-0404.2018.4(part1).145707

Key words: cholelithiasis, cholecystectomy, cirrhosis of the liver

Abstract. Analysis of unsatisfactory results of laparoscopic cholecystectomy in patients with cirrhosis of the liver. Khimich S.D., Muraviov F.T., Rudkovska N.G. In the work the analysis of the results of the treatment of 168 patients with complicated cholelithiasis, depending on presence or absence of cirrhosis of the liver has been carried out. In 76 (45.23%) patients, cholelithiasis and concomitant cirrhosis of the liver were complicated, in 92 (54.77%) - complicated cholelithiasis without cirrhosis of the liver. The stage of liver cirrhosis was assessed by the Child-Pugh system. It has been established that cholecystectomy with laparoscopic or traditional open-release in the stage of Child A cirrhosis is quite safe, and the risk of development of complications can be compared with the risk in patients without liver cirrhosis. Urgent surgical interventions in patients with cirrhosis of the liver in the stage of Child B and Child C are associated with an increased risk of development of intra- and postoperative complications and mortality.

  

Khomenko I.P., Herasymenko O.S., Haida Ya.I., Muradian K.R., Yenin R.B. The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver

https://doi.org/10.26641/2307-0404.2018.4(part1).145710

Key words: combat trauma to the abdomen, liver damage, ultrasound diagnosis, laparoscopy

Abstract. The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver. Khomenko I.P., Herasymenko O.S., Haida Ya.I., Muradian K.R., Yenin R.B. The problem of diagnostics and stage surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 woun­ded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent lapa­roscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies.

  

Chemerys O.M., Khimich S.D. Relationship between the body mass indices and gender belonging and the severity of received damages in combined of body injuries

https://doi.org/10.26641/2307-0404.2018.4(part1).145711

Key words: body mass index, polytrauma, obesity

Abstract. Relationship between the body mass indices and gender belonging and the severity of received damages in combined body injuries. Chemerys O.M., Khimich S.D. On the clinical material of 107 patients with combined body injury there was found the typical peculiarities of the damage depending on the value of the body mass index (BMI) and gender. The obtained results showed that in the general structure of polytrauma men dominate. The severity of their injuries is directly proportional to the BMI increase. The importance of BMI is less significant in women, as under the conditions of the same mechanisms of injury they received milder injuries.

  

Shapoval S.D., Savon I.L., Ryazanov D.Yu., Maksimova O.O., Slobodchenko L.Yu. Ultrasonic duplex scanning as the standard for diagnostics of periphery arterial diseases of lower limbs in patients with diabetes mellitus in the development of purulent-necrotic complications

https://doi.org/10.26641/2307-0404.2018.4(part1).145714

Key words: diabetic foot, purulent-necrotic complications, ischemia, ultrasound duplex scanning

Abstract. Ultrasonic duplex scanning as the standard for diagnostics of periphery arterial diseases of lower limbs in patients with diabetes mellitus in the development of purulent-necrotic complications. Shapoval S.D., Savon I.L., Ryazanov D.Yu., Maksimova O.O., Slobodchenko L.Yu. Diabetic foot or the syndrome of diabetic foot (SDF) is the problem due to a high frequency of ablations of the lower extremities followed with a significant social, psychological and economic consequences. The research objective is to estimate diagnostic opportunities of ultrasound doppler scanning (UDS) of arteries of lower extremities in the patients with diabetes mellitus (DM) in development of purulent-necrotic complications. The main group consisted of 141 patients with DM who were treated at purulent-septic center «City Hospital N 3» in Zaporizhzhya, during 2017-2018. Control group – 274 patients who were receiving treatment during 2009-2013. The average duration of DM was 12,8±2,9 years. Average age of patients was 56,3±5,3 years. 63 (44,7%) were men, women – 78 (53,3%). The groups were representative by key indicators and the accompanying pathology. During hospitalization patients had signs of purulent-necrotic lesion of the lower extremity. The complex of diagnostic actions included obligatory diagnostics of a vascular bed of the lower extremities by means of UDS. By comparison with retrospective data it was defined that the number of DM patients with vascular problems in development of purulent-necrotic complications has increased. If earlier the percentage of distribution to etiological forms made up: neuropathic - 36,9%, ischemic - 23,4%, mixed – 39,7%, currently, mixed form (p<0,05) is noted in larger percent of patients – 51%. UDS is the best screening of vascular pathology in patients with DM in development of purulent-necrotic complications by means of which it is possible to find hemodynamically significant or critical stenosis of vessels and in due time to offer the patient one of blood supply restoration options.

  

Yareshko V.G., Zhyvytsia S.G., Mikheiev I.O., Kryvoruchko I.V. Diagnosis and differential approach to the choice of treatment of pseudocysts of the pancreas

https://doi.org/10.26641/2307-0404.2018.4(part1).145718

Key words: pancreatic pseudocyst, acute pancreatitis, chronic pancreatitis, diagnosis, surgical tactics

Abstract. Diagnosis and differential approach to the choice of treatment of pseudocysts of the pancreas. Yareshko V.G., Zhyvytsia S.G., Mikheiev I.O., Kryvoruchko I.V. A prospective study of 182 patients with pan­creatic pseudocyst was conducted. By studying changes in ion-acid-alkaline status of cysts cavity, the correlations between these indicators, indicators of proteinogram of blood, findings of ultrasound examination and computed tomography were established. The algorithm for surgical treatment of pancreatic pseudocysts for each of the clinical groups of patients has been developed. Patients of the first group underwent interventions mainly in the cyst, as the structural changes in the pancreas were minor and did not require correction. In the second group 63.16% of patients underwent draining operations, in 57.89% of patients it was the final treatment stage, and 15.80% required the correction of manifestations of chronic pancreatitis. In the third group of patients pancreas was almost completely damaged by chronic inflammation of fibrous-degenerative character, calculosis, ductal hypertension, there with mostly direct interventions were performed on the pancreas. New approaches pathogenetically justify differential surgical treatment strategy for pancreatic pseudocyst using both minimally invasive and open surgery.

  

Yareshko V.G., Marusii A.I. Minimally invasive surgical operations in the treatment of patients with necrotizing pancreatitis

https://doi.org/10.26641/2307-0404.2018.4(part1).145719

Key words: necrotic pancreatitis, minimally invasive methods, surgical treatment

Abstract. Minimally invasive surgical operations in the treatment of patients with necrotizing pancreatitis. Yareshko V.G., Marusii A.I. The results of surgical treatment of 133 patients with necrotic pancreatitis, who underwent 163 operations, were analyzed. 66 (49.6%) patients underwent laparotomy access, minimally invasive procedures – 67 (50.4%). It was shown that the best results were in patients who underwent minimally invasive interventions in comparison with traditional "open" treatment. There were no lethal outcomes in the postoperative period. There were 2 (11.1%) postoperative complications in the form of incomplete pancreatic fistulas, which were closed under the influence of conservative treatment.

  

Trofimov M.V., Kryshen V.P., Gaponov I.V. Methods of predicting the relapsing hemorrhage

https://doi.org/10.26641/2307-0404.2018.4(part1).145720

Key words: ulcer, reccurent bleeding, endoscopic hemostasis

Abstract. Methods of predicting relapsing hemorrhage. Trofimov M.V., Kryshen V.P., Gaponov I.V. In this article the authors presented their own original methods for predicting ulcerous gastroduodenal bleeding defended by Patent of Ukraine. The implementation of these procedures led to substantial lowing of recurrent hamorrhage rate – more than twice. All methods have pathogenetic foundation and are based on ulcerogenesis mechanisms revealed during the longlasting complex clinical and experimental research. In such a way surgeons obtain some possibilities of early diagnostics of bleeding relapses and adequate treatment and effective hemorrhage prevention accordingly. 

  

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