THE IMPORTANCE OF THE PROGNOSTIC SCORE FOR THE CHOICE OF CHIVA HEMODYNAMIC SURGERY AS A TREATMENT METHOD FOR VARICOSE VEINS OF THE LOWER EXTREMITIES.

OBJECTIVE: The aim: To work out the predictive system that can help to determine the group of patients to whom the hemodynamic surgery of varicose disease, CHIVA, is beneficial. PATIENTS AND METHODS: Materials and methods: Results of examination and treatment of 58 patients of the main group who underwent hemodynamic surgery and 65 patients of the comparison group who underwent stripping. Patients of both groups were evaluated in the preoperative period using an evaluation scale, and divided into three subgroups depending on the scores: 5- 8, 9 - 11, and 12 - 15 points. RESULTS: Results: The best treatment results with the lowest number of relapses were obtained in the subgroup of patients with low scores on the prognostic scale (5-8 points) after hemodynamic treatment and in the subgroup of patients with a high the number of points (12 -15 points) after the classic stripping (p < 0.05). The same subgroups received more improvement in the quality of life of patients according to CIVIQ 20 (p < 0.001). The subgroup of patients with a high number of points (12 -15 points) after the stripping received significantly more reduction in scores VCSS (p < 0,01). CONCLUSION: Conclusions: Comprehensive assessment of factors such as the anamnestic duration of the disease, the diameter of the great saphenous vein, the presence of skin complications, dilated varicose collaterals and previous surgical treatment using a prognostic preoperative assessment score allows the surgeon to be more clearly guided in choosing the optimal method of treatment for each patient and achieve the best treatment results.

INTRABDOMINAL PRESSURE AND ITS CORRECTION IN ACUTE SURGICAL PATHOLOGY.

OBJECTIVE: The aim: Improving the results of treatment of patients with acute surgical pathology of the abdominal cavity by correcting intra-abdominal hypertension (IAH). PATIENTS AND METHODS: Materials and methods: The results of examination and treatment of 187 patients with acute surgical pathology, which was accompanied by elevation of IAP. To compare the results, depending on the chosen diagnostic and treatment tactics, patients were divided into two groups: comparison and main. The comparison group (85 people (45,5%) included patients who have been treated with traditional approaches in diagnosis and treatment according to existing treatment protocols. The main group (102 people (54,5%) included patients in whose treatment we additionally used our proposed step-by-step approach in the treatment of IAH. RESULTS: Results: Systemic complications occurred in 12 patients of the main group (11,8%) and in 46 patients of the comparison group (54,1%), while in the second group the frequency of systemic complications was significantly higher (χ2 = 38,6, CI 29,3-53,6, p <0,0001). 20 patients (10,7%) died (2 patients of the main group (1,96%) and 18 patients of the comparison group (21,2%) (χ2 = 17,85, CI 10,4-29,18, p <0,0001). CONCLUSION: Conclusions: Use in the complex treatment of patients with acute surgical pathology of the abdominal cavity, accompanied by IAH, the proposed step-by-step approach has improved treatment outcomes by reducing the incidence of systemic complications from 54,1% to 11,8%, total mortality from 21,2% to 1,96% and postoperative mortality - from 22,4% to 2,4%.