SOCIAL AND ECONOMIC ASPECTS OF SIMULTANEOUS OPERATIONS ON ABDOMINAL ORGANS.

The article presents an analysis of 107 cases of simultaneous operations of big volume with main stage as gastric resections (gastrectomy) or large intestine resections and mean volume interferences as cholecystectomy and removal of abdominal hernias. It was stated, that simultaneous operations compared with two steps treatment of combined surgical diseases obtained the high economical efficacy. This efficacy was determined by a single - stage routine presurgical examination, single anesthetic management, less medical expenses for medication and laboratory - instrumental studies in postoperative period, significant shortening the terms of hospitalization and disability terms.

[Percutaneous endoscopic gastrostomy for long-term artificial enteral nutrition of seriously ill and trauma patients].

Percutaneous endoscopic gastrostomy was performed on 55 patients of anaesthesiology resuscitation clinic of Military Medical Academy during the last 5 years. A surgery duration was about 13.7 ± 0.

[The diagnostic algorithm in patients with severe chronic constipaton without aganglionosis of the large intestine].

The algorithm of special study in patients with severe chronic constipations includes the chronometry of passage of sulphate barium along the gastric tract with the assessment of evacuation function of each part of the large intestine, the irrigoscopy, the fibrocolonoscopy, the investigation of motor function of sigmoid colon. The proposed diagnostic algorithm allows the determination of part or parts of the large intestine with incompetent motor and evacuation functions and decision on the necessary extent of resection of the colon.

[Causes of recurrences of gastrointestinal ulcer bleeding, their prophylaxis and treatment].

The authors have analyzed main causes of recurrences of gastro-intestinal ulcer bleeding which are thought to be the continuing ulcer alteration, lysis of the protective thrombus with gastric juice or the fibrinolysis system. The data obtained allowed determination of laboratory signs of the development of DIC-syndrome and its significance in the appearance of recurrent bleeding and greater lethality. The role of antirecidivation antisecretory therapy and therapeutic endoscopy was studied for prevention of recurrent bleeding depending on the degree of blood loss.

[The role of tumor markers in diagnostics of gastric cancer metastases. Part II: postoperative monitoring].

Complex examination of 32 patients with gastric cancer in terms of more than 6 months after radical operations included endoscopic, radial and laboratory methods with the determination of indices of the carcinoembryonic antigen and carbohydrate antigens 19-1 and 72-4 every six months. It was established that normal concentration of all the three tumor markers within 12 months after surgery was a practically reliable sign of the absence of metastases and recurrence of gastric cancer. The increased level of one or two oncomarkers within 12 months after radical operation points to progression of gastric cancer with probability of 57.

[Microflora of the small intestine in patients with perforating duodenal ulcers].

The toxic phase of peritonitis in patients with perforating duodenal ulcers is accompanied with the development of syndrome of redundant bacterial colonization of the small intestine. However, it is less pronounced than in other forms of intra-abdominal infection. The greatest quantitative growth in all the patients is observed among the species of the family of enterobacteria and aerobic Gram-positive bacilli, the bacterial species dominating in the upper part of the intestine in health being the leading etiological agents of intra-abdominal infection in patients with perforating duodenal ulcers.

[The role of tumor markers in diagnosing metastases of gastric cancer: preoperative diagnostics (part I)].

Preoperative indices of cancer embryonic antigen (CEA), carbohydrate antigens 19-9(CA)19-9, 72-4(CA)72-4, and alfa-fetaprotein (AFP) in 60 patients with gastric cancer were compared with the results of postoperative staging of the malignant process. It was found that increased concentration of one of the tumor markers were not a significant diagnostic sign of the metastases of gastric cancer. CEA is considered as an exception since its more than one and a half elevation (more than 3.

[Associated complications of peptic ulcer and their surgical treatment].

Based on an experience with treatment of 269 patients with complicated peptic ulcer the authors came to a conclusion that the most sparing and radical operation was subdiaphragmatic truncal vagotomy with Finney pyloroplasty with lethality of 6.8%. Resection of the stomach and forced palliative interventions such as suturing of perforated and bleeding ulcers resulted in lethal outcomes in more than 50% of them.

[Correction of a reperfusion dysfunction in acute intestinal obstruction].

An analysis of experimental investigations carried out in 32 dogs and 30 rabbits and laboratory data of 242 patients has shown that the application of antioxidant and antihypoxic medicines decrease reperfusion lesions and endotoxicosis in operative treatment of acute intestinal obstruction.

[Experience in surgery of diastatic ruptures of the colon].

An experience with treatment of 58 patients operated upon for carcinoma of the colon complicated by acute intestinal obstruction and diastatic perforation has been analyzed, 13 patients had incomplete diastatic ruptures (tears) of the colon. In 23 patients the IV stage of the tumor process (remote metastases) were found and the other 35 patients had the III stage. In early terms after operation 37 (63.

[Use of the protocols of organization of the medico-diagnostic care for ulcerous gastroduodenal bleedings in clinical practice].

Results of realization of the protocols of organization of the medico-diagnostic care to patients with bleedings from chronic gastric and duodenal ulcers since 2002 have been analyzed. A simplified scale of the assessment of severity of ulcerous bleedings (UB) at admission including 8 criteria is proposed. Protocols of medical strategy for "severe UB" under conditions of the resuscitation unit are discussed.

[Vagotomy in surgical gastroenterology: legends and reality].

The work has shown high effectiveness of vagotomy in a number of diseases. In 2565 patients with perforated duodenal ulcer operation of suturing finished with lethal outcome in 9.2% of cases and recurrent disease in 54% of patients.

[Choice of a method of plasty of the anterior abdominal wall in patients with postoperative ventral hernias].

The individual characteristics of the structure of the anterior abdominal wall were studied for revealing the anatomical preconditions for the formation of postoperative ventral hernias in order to substantiate efficient methods of surgical treatment. It was established that patients with brachiomorphous build had anatomical features facilitating the formation of ventral hernias. The greatest strength of the fascio-aponeurotic complex of the anterior abdominal wall is characteristic of patients with a dolichomorphous constitution, while the least strength of the fascio-aponeurotic complex of the anterior abdominal wall is characteristic of patients with brachiomorphous constitution.

[Surgical treatment without recurrences ventral hernias as a social problem].

The authors have analyzed social aspects of surgical treatment of postoperative ventral hernias and described results of the surgical treatment of 149 patients. Specific measures used in preoperative preparation and in operative treatment of elderly and senile patients are considered. Long-term results of surgical treatment of 76 patients have been studied who had undergone plasty of the anterior abdominal wall with the application of a reticulate polypropelene explant.

[Acute pancreatitis (protocols of diagnosis and treatment)].

Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed.

[Surgical treatment of perforative gastroduodenal ulcers in elderly and senile patients].

The work is based on experiences with surgical treatment of 206 elderly and senile patients with perforating gastroduodenal ulcers. In 67.5% of cases the perforations took place in duodenal ulcers, in 16%--in the pyloric canal.

[Local and individual features of angioarchitectonics of the stomach and their significance in manifestation of bleedings].

The investigation has shown that on the lesser curvature in the area of the body and cardial part of the stomach there is a 2.3+/-0.3 cm section where there are no large branches of the left gastric artery and tributaries of the coronary vein.