COMPLICATED FORMS OF DIVERTICULAR DISEASE OF THE COLONIN THE PRACTICE OF EMERGENCY SURGERY

Case histories of patients with complicated forms of diverticular disease of the colon were retrospectively studied. Diverticulum perforation prevailed in the structure of the complications of diverticular disease of the colon. The most common complication was perforation of diverticulum, of sigmoid colon. In the age + group the patients of 50—60 years dominated. Both one-step operations and multi-stage intervention, were used in the surgical treatment of patients with perforations of diverticulum of the colon. The preference was given to surgical interventions with the formation of colostomy

Mechanisms of oxygen-dependent microbicidal system of neutrophils in the prognosis of acute pancreatitis

We observed 42 patients with, confirmed diagnosis of acute pancreatitis. We studied, the dynamics of spontaneous and stimulated. NBT-test and. the myeloperoxidase activity in conjunction, with, traditional clinical and. hardware methods of examination. The benchmarks of oxygen-enzyme systems of neutmphils and their conelation are important. Analysis of these indices makes it possible to predict the seventy of the disease, to determine the optimal timing opemtion and possible complications in the postoperative period

DIAGNOSTIC AND PROGNOSTIC VALUE OF ALKALINE PHOSPHATASE OF NEUTROPHILS AT THE ACUTE PANCREATITIS

We examined 1546 patients with, acute pancreatitis. Activity of alkaline phosphatase (АР) of neutrophils was studied in dynamics in 227 patients with, acute pancreatitis. The study was conducted on the 1st, 3rd, 5th, 7—10th days at the conservative therapy and. on the 1st, 2nd, 3rd, 5th, 7th, 10th and. 12th days after the operation, and. then — as necessary. Activity of АР of neutrophils in patients with acute pancreatitis regardless of the degree of gravity is reliably increased, and. the more severe disease process is the higher activity of alkaline phosphatase of neutrophils is. IAAN has more diagnostic and. prognostic value. When interpreting the AAN index it is expedient to mark out two values of IAAN from our point of view. The first value is when IAAN is in the range from +1 to 0, it shows that destructive process is unlikely and. the patient needs conservative treatment. The second, value is a negative value of IAAN from 0 to 1. When using these values of IAAN destructive process doesn't cause doubts and. these patients need surgeries

Risk stratification of thromboembolic complications development in surgical patients

Aim. Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment.Material and Methods. This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data.Results and Discussion. Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%.Conclusion. The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs

The results of surgical treatment of patients with open abdominal injury

Objective: To study the evolution of approaches to surgical treatment in patients with open abdominal trauma.Material and methods: The results of surgical treatment of 141 patients with open abdominal trauma at the age of 32.6 ± 7.3 years have been studied. In the main group of 73 patients, surgical tactics have been determined according to the results of the Focused Assessment with Sonography for Trauma (FAST) protocol and diagnostic video laparoscopy. In the control group of 68 patients, indications for laparotomy have been presented based on the proven fact of a penetrating wound in the abdominal cavity.Results: In patients with unstable hemodynamics and signs of peritonitis there is no need for additional verification of the damage nature. In these cases, an emergency laparotomy is justified. In debatable cases diagnostic video laparoscopy should be the method of choice for the diagnosis. In 19 (27.9%) patients in the control group with the proven fact of a an abdominal penetrating wound during primary surgical treatment (PST), no injuries were detected during the examination of the abdominal organs and the laparotomy was exploratory.Conclusion: A rational approach to assessment of the injuries severity using the FAST protocol and diagnostic video laparoscopy in patients of the main group made it possible to completely avoid exploratory laparotomy and increase the proportion of minimally invasive interventions to 50–70%. The accuracy of laparoscopic diagnostics was 98%

FEATURES OF SURGICAL TACTICS OF TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS OCCURRING AGAINST THE BACKGROUND OF DIABETES MELLITUS

Aim. The study was conducted to improve the results of the surgical treatment of acute calculous cholecystitis occurring against the background of diabetes mellitus. Materials and methods. In course of our study, we analyzed the treatment results of 687 patients with acute calculous cholecystitis. Depending on the presence of diabetes, all patients were divided into two groups. The main group with concomitant diabetes mellitus included 68 (9,9%) patients, whereas the control group without diabetes included 619 (90,1%) patients. Laparoscopic cholecystectomy was performed on 636 (92,6%) patients, and open cholecystectomy was performed on 51 (7,4%) patients. Results. According to the histological study, the greatest number of destructive forms occurs in patients with concomitant diabetes, operated after 24 hours. The least postoperative complications occur in patients of both groups operated from 12 to 24 hours. However, the incidence of complications is 4-5 times higher in patients with diabetes mellitus. Postoperative complications in patients with acute calculous cholecystitis occurring on the background of sugar diabetes were observed after open cholecystectomy in 33,3% of cases and in 6,5% of cases after laparoscopic surgery.Conclusion In patients with acute cholecystitis and concomitant diabetes, surgical treatment should be performed on the first day after the preoperative preparation during the first 12 hours, aimed at compensating for diabetes and improving microcirculation. The preference should be given to laparoscopic cholecystectomy, which reduces the number of postoperative complications by 5 times and mortality by 4.5 times

About effektinosti simultaneous operations in patients with a combination of acute cholecystitis with gastric ulcer and/or duodenal ulcer

A retrospective study of immediate and gave-represented results of surgical treatment of 112 patients with acute cholecystitis combined with gastric ulcer and/or duodenal ulcers who were treated in surgical departments in Krasnodar city hospital ambulance (SCC emergency hospital) from 2010 to 2015

OPTIMIZATION OF SURGICAL TACTICS ULCEROUS GASTRODUODENAL BLEEDING

The aim of our research is to determine ways of improving the results of surgical treatment of gastroduodenal ulcer bleeding. A promising trend is to be recognized a surgical strategy based on the prediction of recurrence of bleeding. The results of therapy of 2365 patients with bleeding-forming ulcers of gastroduodenal zone, who have been taking steady-nary treatment in MBHI KCC HEMC Krasnodar from 2009 till 2016 years. The have been analysed recurrence of bleeding effect in hospital was registered in 419 cases (17,7 %). The main criteria for the choice of tactics of treatment of gastroduodenal ulcer bleeding are: the degree of stability of the hemostasis of the ulcer, the severity of the bleeding and degree of the "operation risk". Additional criteria include: location, size of ulcers and the criteria for the violation of hemostasis. Differential approach based on the prediction of recurrence of bleeding, will help to improve treatment and reduce postoperative mortality in gastroduodenal bleeding

Monitoring the effectiveness of application of the method of ascending gas-liquid flow in the treatment of the generalized peritonitis

In the treatment of 12 patients with generalized purulent peritonitis was the method of ascending gas-liquid flow (AGF). Using the AGF assumed at elevated intra-abdominal pressure. The influence of increased intra-abdominal pressure on the possibility of developing abdominal compartment syndrome in a number of clinical-ray and laboratory parameters. It is shown that increase of abdominal pressure to 16+2 mm. Hg. Art. when using the method AGF in the treatment of generalized peritonitis does not lead to abdominal compartment syndrome, but the risk of its development is the highest in the 1st day after the operation

TACTICS OF THE SURGEON IN URGENT COMPLICATIONS OF COLON CANCER

Aim. The aim of the work is to develop the tactics for the treatment of complicated colon cancer (tumor perforation, tumor bleeding, acute obturation obstruction).Materials and methods. The clinical development included 324 patients with urgent complications of colon cancer. 269 patients were operated urgently and immediately, 56 operations were deferred. The diagnosis was based on anamnesis, clinical, laboratory and special research methods (ultrasound, CT, EGD, colonoscopy, histological examination). Results. Postoperative mortality in urgent complications of colon cancer was 3.5%.Conclusion. The rationale for the choice of method and volume of surgery, depending on the location and nature of complications of colon cancer, is provided