[MODERN VIEW ON INTENSIVE THERAPY OF GASTRO-INTESTINAL HEMORRHAGE].

Basing on analysis of the treatment results in 47 patients for gastro-intestinal hemorrhage, the experience of application of a tranexamic acid in a content of infusion therapy and hemaxam per os was adduced. The data obtained witness the expediency of hemaxam application in a content of therapy on the stage of a hemorrhage letup and for the recurrence prevention.

[Manual-assisted laparoscopic interventions in coloproctologic diseases].

Feasibility of manual-assisted laparoscopic surgery in the treatment of coloproctologic diseases was designated. The investigation included 25 patients operated on for diseases of the colon. In 11 of them made manual-assisted laparoscopic surgery. Length of cut with manual-assisted laparoscopic interventions in 3.8 times less conventional laparotomy section, the total blood loss was 2.3 times less than in open surgery. Duration of patients rehabilitation after such surgery is 1.8 times less than after laparotomy. Laparoscopic surgery of the hand asystens in coloproctology mini-invasive is, however, retain the advantages of open surgery. At the present stage of coloproctology are, on the one hand, is the first step to classic laparoscopic surgery on the other--an alternative to conversion.

[Modern methods of perforative duodenal ulcer treatment].

The results of treatment of 150 patients, suffering gastroduodenal perforative ulcer, using laparoscopic method, were studied. Depending on the operations volume, they must be divided on palliative, conditionally radical and radical. The operation volume choice has depended on the patient age, the ulcer disease duration and the course character, as well as the conservative therapy efficacy. Laparoscopic interventions were performed in 138 (92%) patients and laparoscopically-associated--in 12 (8%). Complications in the early postoperative period have had occurred in 4 (2.7%) patients. Postoperative recurrence of ulcer was revealed during three years in 14 (9.3%) patients.

[Optimization of surgical treatment of patients with recurrent inguinal hernia].

The results of surgical treatment of 687 patients, ageing 22-78 yrs old and suffering inguinal hernia recurrence, are analyzed. The operative intervention choice was established in accordance with presence of the certain hernia type as well as inguinal dehiscence height and degree of atrophic changes in musculo-aponeurotic structures of inguinal channel. After the operation inflammatory complications were observed in 50 (7.3%) patients and they were eliminated, using adequate conservative measures. In 2 (0.3%) patients the operative wound suppuration have occurred. In 2 (0.36%) patients the hernia recurrence have occurred in far remote period as a consequence of the operative wound suppuration.

[Application of the puncture-drainage interventions under ultrasonographic control in the treatment of pancreatic pseudocysts].

Results of the puncture-drainage interventions under ultrasonographic investigation in the treatment of 100 patients, suffering pancreatic gland pseudocysts in various stages of its formation, were presented. The data obtained witness the method efficacy, permitting to achieve, in complex of treatment, reconvalescence of 74.7% patients, while external drainage application, and of 26.9%--while puncture sanation performance.

[Peculiarities of course of an acute varicose thrombophlebitis in elderly and senile patients and effect of age on tactics of surgical treatment and operative treatment volume].

Examination was conducted in 244 elderly and senile patients (60-89 yrs old), suffering an acute varicosothrombophlebitis (AVTH), of them 240 were operated on. The AVTH course peculiarities were studied up, which influenced the tactics choice and have had determined the indications for surgical intervention performance.

[Miniinvasive interventions under ultrasonographic guidance in the treatment of patients with hepatic abscesses].

The results of application of the puncture methods of treatment, applied in 28 patients, suffering hepatic abscesses of various etiology and localization, were adduced. The methods of transcutaneous transhepatic puncture and drainage were applied. The data obtained witness a high efficacy of the proposed method, which guarantee reconvalescence of 96.4% of the patients. The indications and methods of the abscesses drainage, the patients sanation and management methods while postoperative period were established. Small invasiveness, good endurance by malnourished and septic patients, the absence of necessity in narcosis, economic and cosmetic effects constitute the advantages of the method.

[Application of laparoscopic technologies in the treatment of peritonitis, caused by duodenal ulcer perforation].

Results of treatment of 105 patients suffering peritonitis, caused by duodenal ulcer perforation, using laparoscopic technologies were studied up. In terms up to 6 hours from the perforation occurrence 68 (64.8%) patients were admitted to the hospital, from 6 to 12 hours--23 (21.9%), from 12 to 24 hours--14 (13.3%). Local peritonitis was diagnosed in 12 (11.4%) patients, extended one--in 71 (67.6%), general--in 22 (21%). Serous peritoneal exudate was revealed in 65 (61.9%) observations, serofibrinous one--in 27 (25.7%), fibrinopurulent--in 13 (12.4%). The peritoneal cavity sanation, depending on the inflammation character and extension, was performed using from 1 to 91 of antiseptic solution and assistance of irrigation-aspiration system. Necessity to perform conversion have occurred in 3 (2.8%) patients in presence of intestinal paresis, necessitating the intestinal intubation performance. In 7 (6.7%) patients, admitted to hospital in terms later than 12 hours from the ulcer perforation moment, in 12-24 hours after laparoscopic operation performance the elective videolaparoscopic sanation of peritoneal cavity was done.

[The treatment of pyloroduodenal ulcer complicated by perforation]. / Likuvannia piloroduodenal'noï vyrazky, uskladnenoï perforatsiieiu.

During ten-year period 1191 patients with perforative pyloroduodenal ulcer were operated on. Palliative intervention was conducted in 206 patients, conventionally radical one--in 677 and radical--in 308. Postoperative mortality have constituted 5.2%.

[Use of delayed selective proximal vagotomy in the treatment of perforated duodenal ulcer in patients with diffuse peritonitis]. / Zastosuvannia vidstrochenoï selektyvnoï proksymal'noï vahotomiï v likuvanni perforatyvnoï vyrazki dvanadtsiatypaloï kyshki u khvorykh z rozlytym perytonitom.

There were 76 patients operated with perforative duodenal ulcer, complicated by diffuse peritonitis and endotoxicosis stage II. In 48 patients (Ist group) the conventional treatment was conducted, in 16 (2nd group)--selective proximal vagotomy (SPV) was performed, in 12 (3d group)--programmed laparotomy. Postoperative mortality in the first group had constituted 6.25%, in the third--8.3%, in the second all the patients are alive.