RESUMO
Results of treatment of 78 patients, in whom atherosclerotic gangrene of lower extremity had occurred, were analyzed. There was proposed the method of the extremity amputation on level of femur, using two flaps, and apparatus for formation of cutaneomuscular flap as well, introduction of which have allowed to reduce frequency of purulent-septic complications to 7.1%. Lethality had lowered from 13.1 down to 5.3%.
Assuntos
Abscesso/etiologia , Abscesso/prevenção & controle , Amputação Cirúrgica , Arteriosclerose/cirurgia , Gangrena/cirurgia , Extremidade Inferior/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Arteriosclerose/complicações , Feminino , Gangrena/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The results of surgical treatment of 224 patients with perforated pyloroduodenal ulcers were analyzed. 110 patients were operated using pyloruspreserving and pylorusreducing methods. The new method of pyloroduodenoplasty is suggested. Duodenogastral reflux after pyloruspreserving operations is arised in 4.5% of observations, after pylorusdestructive--in 46.7%.
Assuntos
Úlcera Duodenal/cirurgia , Úlcera Péptica Perfurada/cirurgia , Antro Pilórico/cirurgia , Terapia de Salvação , Feminino , Seguimentos , Humanos , Masculino , Vagotomia/métodosRESUMO
Method of endoscopic choledochoduodenostomy was elaborated and introduced in clinical practice. Results of formation of endoscopic biliodigestive anastomosis in 12 patients for 1990-2000 yrs period were analyzed. In 7 (5.8%) patients complications occurred, 1 (0.8%) patient died.
Assuntos
Adenoma/cirurgia , Coledocostomia/métodos , Neoplasias do Ducto Colédoco/cirurgia , Endoscopia/métodos , Cálculos Biliares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Results of treatment of 240 patients with an acute pancreatitis were analyzed. There were assigned two groups taking into account stage of severity of pancreonecrosis and stage of polyorganic insufficiency. In 147 patients with mild stage and moderate stage conservative treatment was undertaken, in 93 patients with severe course different operative interventions were performed in urgent and emergent order and in period of postnecrotic complications occurrence. Application of such an approach have permitted to lower the postoperative complications frequency in 1.9 the value. Mortality had constituted 22.6%.
Assuntos
Laparoscopia/métodos , Pancreatite Necrosante Aguda/terapia , Doença Aguda , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/cirurgiaRESUMO
Anatomo-topographical studies, performed in 100 human corpses established that predispositions to development of the extravasal compressions (EC) of the coeliac trunk (CT) may be observed at high location of the aortal canal mouth, which is usually observed in case of dolichomorphic constitutional type. Complications of not diagnosed coeliac trunk extravasal compressions were the possible reason in 3% of sections. Acute substernal angle (< or = 70 degrees) is an easily determined and significant indicator of dolichomorphic type. This should be taken into account by clinicians in cases of unclear abdominal syndrome.
Assuntos
Abdome/irrigação sanguínea , Isquemia/patologia , Adolescente , Adulto , Idoso , Suscetibilidade a Doenças , Feminino , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Probabilidade , Prognóstico , Fatores de Risco , SíndromeRESUMO
Surgical treatment of 293 patients with diseases of an operated on stomach is analysed. Relapse of peptic ulcer after closure of a perforation was encountered in 170 patients, the dumping syndrome in 54, peptic ulcer of the anastomosis in 60, the afferent loop syndrome in 6, and a rare type of diseases of an operated on stomach in 3 patients. Classification of diseases of an operated on stomach according to the syndromes and differential diagnosis of functional syndromes are presented. Indications for surgical correction depending on the type and severity of the pathological condition were developed. The late-term results were studied in 266 patients. The results were good in 72%, satisfactory in 21%, and poor in 7% of cases. The late-term results in surgical correction of functional syndromes were good in 29%, satisfactory in 51.6%, and poor in 13.5% of patients. Mortality after all repeated operation was 1.3%.
Assuntos
Síndromes Pós-Gastrectomia/cirurgia , Complicações Pós-Operatórias/cirurgia , Estômago/cirurgia , Síndrome da Alça Aferente/diagnóstico , Síndrome da Alça Aferente/cirurgia , Diagnóstico Diferencial , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/cirurgia , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/cirurgia , Síndromes Pós-Gastrectomia/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Recidiva , Úlcera Gástrica/complicações , Úlcera Gástrica/etiologiaRESUMO
Study showed that the suggested method for appraising the severity of the inflammatory process makes it possible to decide whether peritoneal lavage is necessary in each concrete case. The authors examined 217 patients with acute generalized peritonitis (AGP). Four degrees of the risk of a severe course of AGP were distinguished conditionally. Patients with the first degree of risk do not need intraabdominal lavage. To remove the noted inflammatory changes in the peritoneum it was sufficient to cleanse thoroughly and drain the abdominal cavity and introduce antibiotics into it during complex treatment. Intraabdominal lavage is indicated for patients with the second degree of risk and with marked inflammatory changes in moderate circulatory changes. Abdominal lavage with peritoneostomy is indicated for patients with pronounced inflammatory (N = 3.8 cond. units) and microcirculatory disorders (Y = 0.2 cond. units). Peritoneal lavage is not indicated in patients (third and fourth degrees of risk) with considerable inflammatory (N = 4.04 cond. units) and microcirculatory disorders (Y = 0.4 cond. units).
Assuntos
Lavagem Peritoneal , Peritonite/terapia , Doença Aguda , Antibacterianos/uso terapêutico , Terapia Combinada , Humanos , Peritonite/cirurgia , Fatores de RiscoRESUMO
Under analysis there were 14 patients operated upon for fibrous periarteritis. In 10 patients there was a retroperitoneal localization of the pathological process, and 4 patients had the mediastinal localization. The both localizations have similar features of etiology, pathogenesis, clinical course and lead to the formation of a stenosing scarry housing around the arteries with an issue into the occlusion. The operation volume for the retroperitoneal and mediastinal localization of the fibrous periarteritis depends on the stage of the disease: decompression and arteriolysis at first stages for stenosis and reconstructive operations for occlusions of the arteries.
Assuntos
Arteriopatias Oclusivas/etiologia , Doenças do Mediastino/complicações , Mediastino/patologia , Fibrose Retroperitoneal/complicações , Adulto , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Doença Crônica , Feminino , Fibrose , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Doenças do Mediastino/cirurgia , Pessoa de Meia-Idade , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/cirurgiaAssuntos
Doenças Vasculares Periféricas/etiologia , Artéria Poplítea , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/cirurgia , Artéria Poplítea/anormalidades , Artéria Poplítea/lesões , Artéria Poplítea/cirurgiaRESUMO
There were 140 patients operated for the celiac trunk (CT) and renal arteries extravascular compression (FC) in diaphragmatic aorta segment. The clinical syndromes of chronic abdominal ischemia and vasorenal hypertension were depicted. The predisposing factors of CT EC is the patients' dolichomorphic constitution with epigastric angle of < or = 70 degrees. The effectiveness of differentiated tactic choice of operative intervention magnitude according to the disease stage was shown. The late follow-up results witnesses the necessity of timely and adequate treatment.
Assuntos
Abdome/irrigação sanguínea , Artéria Celíaca , Isquemia/etiologia , Artéria Renal , Adolescente , Adulto , Aorta Abdominal , Artéria Celíaca/cirurgia , Doença Crônica , Diafragma , Feminino , Seguimentos , Humanos , Hipertensão Renovascular/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Artéria Renal/cirurgia , Síndrome , Fatores de TempoAssuntos
Pressão Sanguínea , Músculo Esquelético/fisiopatologia , Artéria Poplítea/fisiopatologia , Artéria Subclávia/fisiopatologia , Braço/irrigação sanguínea , Constrição Patológica/diagnóstico , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Humanos , Perna (Membro)/irrigação sanguínea , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/fisiopatologia , Doenças Vasculares Periféricas/cirurgia , SístoleRESUMO
Clinical follow-up results of 876 patients with operated stomach malady, 342 of whom were operated on, were analyzed. In 58% of patients after the perforation closure the ulcer recurrence occurred, in 26% after gastric resection--peptic ulcer, in 26%--functional pathological syndrome. Surgical tactics depended on character of previously conducted procedure, general condition and age of the patient, secretory function of stomach and operative situation. Complications occurred in 6.1% of patients. Mortality was 1.2%.
Assuntos
Síndromes Pós-Gastrectomia/cirurgia , Idoso , Síndrome de Esvaziamento Rápido/cirurgia , Duodeno/cirurgia , Gastroenterostomia , Humanos , Jejuno/cirurgia , Recidiva , Estômago/cirurgia , VagotomiaRESUMO
The paper describes the clinical features, a scheme of pathogenesis and a classification of extravasal compressions of the celiac trunk in 106 patients who have undergone surgery. The scope of operations depended on the stage of the disease, in uncomplicated cases, decompression was carried out. In periarterial fibrosis it was supplemented by arteriolysis or changes of blood flow to the liver. At Stage IV reconstructive operations were performed and secondary complications were corrected. A total of 92.3% of excellent and good results were obtained, including 100% of clinical recoveries at Stages I-II, indicating the necessity of early surgical treatment.
Assuntos
Abdome/irrigação sanguínea , Abdome/cirurgia , Arteriopatias Oclusivas/cirurgia , Artéria Celíaca/cirurgia , Isquemia/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Síndrome , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Analysis of the observations of 431 patient with acute diffuse peritonitis is presented. Use of intraabdominal flowing lavage is recommended in patients with inflammatory phenomena against the background of moderately pronounced changes in microcirculation in the parietal peritoneum. The maximum clinical effect of hemosorption and lymphosorption was noted at the first 3 days after the operation in cathepsin-D activity in the blood equal to 14-17 activity units/(min.mg) and lymphorrhea over 700 ml/day. Lethality was 18.8%.
Assuntos
Peritonite/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Terapia Combinada , Drenagem , Feminino , Humanos , Intestinos/cirurgia , Masculino , Pessoa de Meia-Idade , Irrigação Terapêutica , Fatores de TempoRESUMO
The chemotaxic activity of neutrophil granulocytes was studied in 112 patients with duodenal ulcer disease complicated by perforation and peritonitis with a different degree of spreading. Sharp decrease in spontaneous migration of leukocytes (SML) was revealed in generalized peritonitis. In diffuse peritonitis, the index didn't differ from that in normal subjects. In patients with the complicated course of the postoperative period, SML stimulation under the influence of the own serum was noted. At day 3-9 after the operation, the stimulating activity of the humoral factors of immunity was gradually decreasing. Use of the stimulators of migrative activity of phagocytes contributes to normalization of their function. In patients who had the immunocorrigative agents been prescribed, aggravation of peritonitis and purulent-septic complications were noted 1.4-fold less often than in absence of such treatment.
Assuntos
Úlcera Duodenal/imunologia , Neutrófilos/imunologia , Úlcera Péptica Perfurada/imunologia , Peritonite/imunologia , Fagócitos/imunologia , Adulto , Inibição de Migração Celular , Úlcera Duodenal/complicações , Úlcera Duodenal/cirurgia , Gastrectomia , Humanos , Masculino , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/cirurgia , Peritonite/complicações , Peritonite/cirurgia , Período Pós-Operatório , Vagotomia Gástrica ProximalRESUMO
An analysis of the results of the examination and treatment of 379 patients undergoing transthoracic interventions showed that the use of the target-aimed selective immunomodulation, short-term antibacterial prophylaxis, inhibitors of arachidonic acid metabolites, active elimination of the circulating immune complexes and medium-weight molecular peptides and adequate local analgesia after the interventions providing normalization of the laryngeal reflex and early activation of the patients permitted the incidence of the pulmonary complications to be decreased by 2.5 times, pleural complications by 1.7 times, suppuration of the postoperative wound by 1.8 times and the total expenses by 25.6 per cent.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Empiema Pleural/prevenção & controle , Abscesso Pulmonar/prevenção & controle , Pneumopatias/cirurgia , Linfopenia/terapia , Infecção da Ferida Cirúrgica/prevenção & controle , Linfócitos T/imunologia , Terapia Combinada , Empiema Pleural/etiologia , Humanos , Contagem de Leucócitos , Abscesso Pulmonar/etiologia , Pneumopatias/imunologia , Linfopenia/complicações , Linfopenia/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Linfócitos T/patologia , Fatores de TempoRESUMO
The results of treatment of 137 patients with acute cholecystitis complicated by cholangitis are presented. The causes and clinical signs, and tactics for operative treatment of the disease are described. Progressive hepatic failure is one of the causes of lethality. Use of the developed method of cholesorption permitted to reduce the incidence of hepatic failure development, decrease postoperative lethality to 9.5%.
Assuntos
Bile , Colangite/terapia , Colecistite/terapia , Cuidados Pós-Operatórios/métodos , Desintoxicação por Sorção/métodos , Doença Aguda , Adulto , Colangite/etiologia , Colecistite/complicações , Terapia Combinada , Drenagem , Emergências , Feminino , Humanos , Falência Hepática/etiologia , Falência Hepática/terapia , Masculino , Pessoa de Meia-IdadeRESUMO
The results of diagnosis and treatment of the thoracic outlet syndrome (TOS) in 35 patients have been analysed. Compression of the subclavicular neurovascular bundle at the site of its outlet from the thoracic cavity was most frequent cause of TOS development. A degree of compression was assessed quantitatively by the data of a modified functional dynamic test. The modified operation, including resection of the I rib (and of a cervical one in its presence), scalene muscle, musculus pectoralis minor, periarterial sympathectomy of the subclavicular artery, was performed. In narrow (less than 1.5 cm) costoclavicular space, the II rib was additionally resected. An excellent long-term result is indicative of the effectiveness of the method.