Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2019 Vol. 27 No 3

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.249   |  

V.A. LIPATOV 1, S.V. LAZARENKO 1, A.N. BETZ 2, D.A. SEVERINOV 1

CHANGES OF PHYSICO-MECHANICAL PROPERTIES OF VASCULAR PATCHES IN CONDITIONS OF CHRONIC EXPERIMENT IN VIVO

Kursk State Medical University 1,
Kursk Regional Hospital 2, Kursk,
The Russian Federation

Objective. To study the changes of the physical and mechanical properties of the vascular patch canvas (breaking load and tensile elongation at uniaxial tension) in the conditions of a chronic experiment in vivo.
Methods. New samples of vascular patches based on polyethylene terephthalate (PETP) fibers were used for experimental studies. In the group 1 – warp-knitted canvas based on polyethylene terephthalate fibers was used; in the group 2 – woven canvas based on polyethylene terephthalate and fluoronone, additionally impregnated with gelatin; the group 3 – warp knitted canvas based on polyethylene terephthalate fibers, developed by the group of the authors. As a comparison group, the results of the study of the same samples of vascular patches, non-implanted into the tissue of laboratory animals were used.
As the object for implantation, 60 male rats of Wistar line were chosen. Rats were divided into 3 groups (20 in each) according to the number of types of experimental samples and within each group into subgroups (10 according to the time of elimination from the experiment: 15 and 30 days). The test samples were implanted in the paravertebral region to the laboratory animals. Testing of physical-mechanical characteristics was carried out according to standard methods for assessing the strength characteristics using a tensile testing machine REM-0.2-1. The elongation (%) of the implant canals after implantation at 8 N, 16 N was evaluated, the breaking load (N) was recorded.
Results. Samples of vascular patches of polyethylene terephthalate, which do not have additional treatment with gelatin in the production process (group 3), withstood the greatest breaking load - 147 N (on the 15th day of the experiment) and 151 N (30 day), respectively. The percentage of their elongation was from 6% to 49%. In the case of samples with gelatin treatment, it was 66, 5 N and 75 N.
Conclusions. The values of the indices of the studied parameters of the physical mechanical properties of polymeric vascular implants after implantation to laboratory animals are higher in the samples of the group 3 during all periods of the experiment (15 and 30 days).

Keywords: vascular patches, chronic experiment, bursting machine, extensibility, polyethylene terephthalate, implants, vascular surgery
p. 249-255 of the original issue
References
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  12. Kokorev OV, Khodorenko VN, Anikeev SG, Gunther VE. Biocompatibility Of Textile Titanium Nickel Implants With Fibroblast Culture. Biul Eksperim Biologii i Meditsiny. 2015;159(1):98-102. https://elibrary.ru/item.asp?id=22879593 (in Russ.)
  13. Ivanov AV, Lipatov VA, Lazarenko SV, Zherdev NN, Severinov DA. The influence of mechanical characteristics of vascular patches on the formation of capsules. Klin i Eksperim Khirurgiia. Zhurn im Akad BV Petrovskogo. 2016;4(1):51-57. https://cyberleninka.ru/article/n/vliyanie-mehanicheskih-harakteristik-sosudistoy-zaplaty-na-formirovanie-periproteznoy-kapsuly (in Russ.)
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  15. Glushkova TV, Sevostyanova VV, Antonova LV, Klyshnikov KYu, Ovcharenko EA, Sergeeva EA, Vasyukov JYu, Seifalian AM, Barbarash LS. Biomechanical remodeling of biodegradable small-diameter vascular grafts in situ. Vestn Transplantologii i Iskusstv Organov. 2016;18(2):99-109. doi: 10.15825/1995-1191-2016-2-99-109 (in Russ.)
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Address for correspondence:
305041, The Russian Federation,
Kursk, Karl Marks Str., 3,
Kursk State Medical University,
Department of Operative Surgery
and Topographic Anatomy,
Tel: +7 920 262-15-55,
e-mail: dmitriy.severinov.93@mail.ru,
Dmitriy A. Severinov
Information about the authors:
Lipatov Viacheslav A., MD, Associate Professor, Professor of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0001-6121-7412
Lazarenko Sergey V., PhD, Assistant of the Oncology Department, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-7200-4508
Betz Alexander N., Cardiovascular Surgeon, Kursk Regional Hospital, Kursk, Russian Federation.
https://orcid.org/0000-0001-6115-1812
Severinov Dmitriy A., Assistant of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0003-4460-1353
DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.256   |  

R.A. SADYKOV, B.A. ISMAILOV, O.V. KIM

NEW FILM COATING BASED ON CELLULOSE DERIVATIVES FOR LOCAL HEMOSTASIS

Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V. Vakhidov, Tashkent,
Uzbekistan

Objective. To study hemostatic activity and biocompatibility of new film coating based on cellulose derivatives on the model of the liver injury in experiment.
Methods. The film coating based on cellulose derivatives was used for investigations. Tensile strength, implant structure evaluation, adhesion force were evaluated using “Zwick” apparatus (Germany), Agilent Technologies atomic force microscope (USA). Hemostatic activity was evaluated by the Lee-White method.
Experimental studies were performed on the model of the liver injury in 32 adult mongrel outbred white rats. Operations were performed under inhalation anesthesia. Animals were removed from the experiment after 1, 3, 12 hours and on the 1st, 3rd, 7th, 14th and 30th day after the operation according to the accepted ethical standards. Macroscopic and microscopic studies were conducted.
Results. The adhesion strength of the film coating was 7.3±0.2 kPa (M±m), the breaking strength – 390.4±4.8 kHz/ cm2 (M±m). The coagulation time was 2.4±0.6 minutes (M±m) in the presence of polymer.
The use of the film coating allowed stopping bleeding rather quickly in the parenchyma bleeding from the liver injury (5.3±3.1 seconds). Sequential observations of the animals showed that 1 hour after the operation the implant was kept on the liver surface as a white coating was not separated from the wound surface. No signs of bleeding were noted. Histological studies of the liver biopsy specimens revealed a mild inflammatory disease with complete degradation of the coating on the 14th day after the operation.
Conclusions. The designed new film coating based on cellulose derivatives causes effective hemostasis, has good adhesiveness to the injured liver tissue and sufficient tensile strength. Biodegradation of the implant occurs within 2 weeks after application to the liver wound without a severe inflammatory reaction.

Keywords: biologic coating, hemostasis, morphology, carboxymethylcellulose, oxidized cellulose, hemostatic agent
p. 256-263 of the original issue
References
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Address for correspondence:
100115, Uzbekistan,
Tashkent, Kichik Khalqa Yoli, 10,
Republican Specialized Scientific and Practical
Medical Center of Surgery
Named after Academician V. Vakhidov,
Experimental Surgery Department.
Tel. +99 890 351-03-34,
e-mail: bahodirismailov@gmail.com,
Bakhodir A. Ismailov
Information about the authors:
Sadykov Rustam A., MD, Professor, Head of the Experimental Surgery Department, Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
https://orcid.org/0000-0003-4524-1484
Ismailov Bakhodir A., Junior Researcher of the Experimental Surgery Department, Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
https://orcid.org/0000-0001-6150-9386
Kim Olga V., Junior Researcher of the Experimental Surgery Department, Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
https://orcid.org/0000-0002-1703-1554

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.264   |  

S.A. BELOV 1, A.A. GRIGORYUK 2

INFLUENCE OF THORACOPLASTY ON THE EXTERNAL RESPIRATORY FUNCTION

Seaside Regional Antituberculous Dispensary 1,
Pacific State Medical University 2, Vladivostok,
The Russian Federation

Objective. To evaluate the function of external respiration after thoracoplasty using the polypropylene mesh.
Methods. 42 cases of collapse surgical treatment of fibrous-cavernous pulmonary tuberculosis were studied. Patients were divided into 2 groups. The 1st group (n=21) – patients who were performed the author’s method of extrapleural upper-posterior thoracoplasty using the mesh «Surgipro» implant; the 2nd group (n=21) – patients who underwent traditional extrapleural upper-posterior thoracoplasty. The function of external respiration, perfusion of the lungs, dead space ratio and efficiency of surgical method were compared.
Results. Pre-surgery spirographic study revealed the violation of the external respiration function in all patients. There was a change in the gas composition of the blood and ventilation-perfusion relations on the first day after the intervention in both groups. In the second group, there was a significant decrease in lung capacity, forced expiratory volume, the percentage of arterial blood oxygen saturation (p<0.05) and the development of respiratory and metabolic acidosis. In the first group, thoracoplasty using the mesh implant «Surgipro» revealed no violation of the ventilation-perfusion balance and a significant decrease in external respiration compared to the original figures (p>0.05). Clinical and x-ray examination of patients three weeks after the operation indicates that in the group with the use of polypropylene mesh, the occurrence of complications and the preservation of bacterial excretion is much lower. The developed method of extrapleural upper-posterior thoracoplasty using a mesh polypropylene implant can solve the problem of chest reconstruction, reduces the risk of paradoxical breathing and increases the degree of compression necessary to close the defects in the lungs.
Conclusions. Breach of the skeleton of the chest lowers the release of carbon dioxide from the body. The use of the mesh implant in the formation of a new pleural dome reduces the coefficient of dead space and prevents the development of the respiratory imbalance.

Keywords: pulmonary tuberculosis, external respiration, thoracoplasty, polypropylene mesh, implant
p. 264-268 of the original issue
References
  1. Fu Y, Duanmu H, Fu Y. Surgery for Pulmonary Tuberculosis and Its Indications. In: Lu Y, Wang L, Duanmu H, Chanyasulkit C, Strong A, Zhang H. (eds). Handbook of Global Tuberculosis Control. Springer, Boston, MA; 2017. p 225-34 doi: 10.1007/978-1-4939-6667-7_14
  2. Ots ON, Chushkin MI, Struchkov PV. Post tuberculosis lung function impairment. Pul’monologiia. 2017;27(5):656-63. doi: 10.18093/0869-0189-2017-27-3-656-663 (in Russ.)
  3. Dewan RK, Moodley L. Resurgence of therapeutically destitute tuberculosis: amalgamation of old and newer techniques. J Thorac Dis. 2014 Mar;6(3):196-201. doi: 10.3978/j.issn.2072-1439.2013.12.19
  4. Kuhtin O, Veith M, Alghanem M, Martel I, Giller D, Haas V, Lampl L. Thoracoplasty-Current View on Indication and Technique. Thorac Cardiovasc Surg. 2018 May 17. doi: 10.1055/s-0038-1642633
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  6. Korpusenko IV. Application of minimally invasive extapleural thoracoplasty in patients with bilateral tuberculosis of the lungs. Novosti Khirurgii. 2015;23(1):37-43. doi: 10.18484/2305-0047.2015.1.37 (in Russ.)
  7. Vishnevskii AA, Rudakov SS, Milanov NO. Khirurgiia grudnoi stenki: ruk. Moscow, RF: Vidar; 2005. 312 p. http://kingmed.info/knigi/Hiryrgia/Torakalnaya_hirurgiya/book_2032/Hirurgiya_grudnoy_stenki-Vishnevskiy_AA_Rudakov_SS_Milanov_NO-2005-pdf (in Russ.)
Address for correspondence:
690041, The Russian Federation,
Vladivostok, Pyatnadtsataya Str., 2,
Seaside Regional Antituberculous Dispensary,
4th Pulmonary Surgical Department.
Tel. mobile: +7 914 734-35-74,
e-mail: sur_belove@mail.ru,
Sergei A. Belov
Information about the authors:
Belov Sergei A., PhD, Thoracic Surgeon, 4th Pulmonary Surgical Department, Seaside Regional Antituberculous Dispensary, Vladivostok, Russian Federation.
http://orcid.org/0000-0001-5325-2891
Grigoryuk Alexandr A., PhD, Associate Professor, Institute of Surgery, Pacific State Medical University, Vladivostok, Russian Federation.
http://orcid.org/0000-0002-7957-5872
DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.269   |  

S.N. ZAVGORODNIY, M.A. KUBRAK, M.B. DANYLIUK

SIMULTANEOUS OPERATIONAL INTERVENTIONS IN PATIENTS WITH THYROID PATHOLOGY

Zaporizhzhia State Medical University, Zaporizhzhia,
Ukraine

Objective. To improve the diagnostic of combined surgical diseases and evaluate the results of simultaneous surgical interventions performed in patients with thyroid pathology.
Methods. A retrospective analysis of case histories of 564 patients with the thyroid gland (TG) diseases was performed. The main group consisted of 247 (43.8%) hospitalized patients who were examined according to the developed diagnostic algorithm for combined surgical pathology. The comparison group included 317 (56.2%) patients examined according to the diagnostic and treatment protocols for patients with endocrine pathology approved in Ukraine. The levels of detection of combined surgical pathology, its structure, indicators of simultaneous operations, postoperative complications and mortality in both groups were evaluated using statistical methods of analysis.
Results. In the comparison group, 21 (6.6%) patients had a combined surgical pathology. In the main group – in 61 (24.7%) of the examined. 55 (90.2%) patients of the main group and 18 (85.7%) operated on in the comparison group underwent simultaneous surgical intervention. The level of simultaneous operations in the main group was 22.3%, in the comparison group – 5.7%. In 7 (12.7%) patients of the main group and in 2 (11.1%) of the comparison group, postoperative complications occurred. Lethal cases in both groups were not recorded.
Conclusions. The use of the developed algorithm for examining patients with thyroid pathology allowed an increase in the diagnostic of combined surgical diseases from 6.6% to 24.7%, χ2=9.342, p<0.01. This made it possible to increase the number of simultaneous operations performed from 5.7% to 22.3%, χ2=8.692, p<0.01. An increase in the percentage of simultaneous surgical procedures performed does not increase in mortality rates and postoperative complications.

Keywords: diagnostic techniques, endocrine system, surgical pathology, thyroid diseases, operations
p. 269-275 of the original issue
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Address for correspondence:
69035, Ukraine,
Zaporizhzhia, Mayakovsky Ave., 26,
Zaporizhzhia State Medical University,
Department of Surgery and Anesthesiology
Of the Post-Graduate Training Faculty.
Tel. +38 095 700-78-93,
e-mail: braviorio@gmail.com,
Mykhaylo A. Kubrak
Information about the authors:
Zavgorodniy Sergey N., MD, Professor, Head of the Department of Surgery and Anesthesiology of the Post-Graduate Training Faculty, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
http://orcid.org/0000-0003-3082-3406
Kubrak Mykhaylo A., Senior Laboratory Assistant of the Department of Surgery and Anesthesiology of the Post-Graduate Training Faculty, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
http://orcid.org/0000-0003-4051-9336
Danyliuk Mykhailo B., PhD, Assistant of the Department of Surgery and Anesthesiology of the Post-Graduate Training Faculty, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
http://orcid.org/0000-0003-4515-7522
DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.276   |  

V. SIHOTSKY 1, 2, I. KOPOLOVETS 1, 3, M. KUBIKOVA 1, 2, P. STEFANIC 1, 2, V. KATUCH 2

RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH AORTOILIAC ATHEROSCLEROSIS

Eastern Slovak Institute of Cardiovascular Diseases 1,
Pavol Jozef Safarik University 2, Kosice,
the Slovak Republic
Uzhhorod National University 3, Uzhhorod,
Ukraine

Objective. To investigate the results of surgical treatment of patients with aortoiliac pathology in the early postoperative period.
Methods. In the study 103 patients with aortoiliac pathology were included, who were referred to the Clinic of Vascular Surgery from 2015 to 2017 years. 53 patients were operated on because of aortoiliac atherosclerosis and 50 patients – because of abdominal aortic aneurysm. The indications for surgery were limiting claudication, critical limb ischemia or acute thrombosis of the aorta in patients with aortoiliac atherosclerosis. The indication for surgery in patients with abdominal aortic aneurysm was the aneurysm over 5.5 cm in the transverse diameter or the ruptured aneurysm. Early results of patients’ surgical treatment were assessed by the frequency of postoperative complications and deaths.
Results. 49 (92.5%) out of 53 patients with aortoiliac atherosclerosis were operated on as planned and 4 (7.5%) patients were operated on urgently. 52 (98.2%) aortobifemoral bypasses and one (1.8%) aortofemoral (unilateral) bypass were performed. Three complications (6.1%) occurred postoperatively in patients operated on according to plan and one complication (25%) – in patients operated urgently. The mortality rate was 25% in urgent patients and 2.0% in planned patients. 28 patients with asymptomatic abdominal aortic aneurysm and 22 with the ruptured abdominal aortic aneurysm were operated on. The mortality in the planned patients was 3.6%. 40.9% mortality rate was registered in the ruptured abdominal aortic aneurysm patients.
Conclusions. Early good and satisfactory results of the routine surgical treatment of symptomatic aortoiliac atherosclerosis in the early postoperative period accounted 98%, asymptomatic aortic aneurysm – 96.4%. Mortality after urgent surgery with aneurysm rupture made up 40.9%. Surgical treatment of aortic aneurysm is indicated in patients with low and moderate surgical risk.

Keywords: atherosclerosis, aortic aneurysms, critical limb ischemia, aortoiliac reconstructions
p. 276-283 of the original issue
References
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Address for correspondence:
04001, Slovakia,
Kosice, Ondavska Str., 8,
Eastern Slovak Institute
of Cardiovascular Diseases.
Tel. + 421 055 789-15-10,
e-mail: i.kopolovets@ gmail.com,
Ivan Kopolovets
Information about the authors:
Sihotský Vladimir, PhD, Deputy Head of the Clinic of Vascular Surgery for Pedagogical Work, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
https://orcid.org/0000-0002-1446-8216
Kopolovets Ivan, PhD, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic, Researcher of Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-2721-6114
Kubikový Maria, PhD, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
https://orcid.org/0000-0001-5628-8814
Stefanic Peter, PhD, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
http://orcid.org/0000-0002-0396-3676
Katuch Vladimir, PhD, Head of the Neurosurgery Clinic, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
http://orcid.org/0000-0001-8044-4012

MAXILLOFACIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.284   |  

A.A. KABANOVA

VACUUM THERAPY IN COMPLEX TREATMENT OF PATIENTS WITH ODONTOGENIC INFLAMMATORY PROCESS OF THE MAXILLOFACIAL AREA AND NECK

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To evaluate the effectiveness of the vacuum system in the complex treatment of patients with odontogenic inflammatory diseases of the maxillofacial area and neck.
Methods. The examination of 178 patients with acute odontogenic osteomyelitis of the jaw, complicated by phlegmon of the adjacent tissue spaces, was conducted. To manage the patients of the main group vacuum system was additionally used. Patients in the comparison group were treated using standard methods. The control group consisted of 50 healthy individuals. The erythrocyte deformability (ED) was evaluated by the time of their suspension passing of a standard distance through a porous filter. The adhesion of leukocyte-platelet suspension (LTS) was investigated by recording the changes in the light transmission of the leukocyte’s suspension before and after incubation with a fibrous substrate using the AR 2110 «SOLAR» aggregometer.
Results. When vacuum therapy was included in the medical complex, in shorter terms (5 (5-6) days) the pain during palpation of the inflammatory focus was stopped; the face configuration was restored on the 7 (5-8) day; the skin redness was stopped on the 5 (5-6) day; purulent exudation from the wound was stopped on the 6 (5-7) day; favorable conditions were created for the beginning of the formation of granulations on the 7 (6-8) day. A decrease in treatment terms (9 (8-10) days) of the main group of patients in relation to the duration of treatment in patients with standard complex treatment (10 (8-12) days) was revealed. Vacuum therapy at the end of treatment helps to reduce microcirculation indices elevated at the beginning of treatment to the level of healthy individuals.
Conclusions. The use of vacuum therapy in the treatment of patients with acute odontogenic osteomyelitis of the jaw, complicated by phlegmon of the adjacent tissue spaces, reduces the wound healing terms and reduces the duration of treatment from 10 (8; 12) days to 9 (8; 10) days. Normalization of the rate and degree of aggregation of LTS, DE in the blood plasma was revealed at the end of patients’ treatment using negative pressure.

Keywords: vacuum therapy, inflammatory diseases, maxillofacial area, wound cleansing, microcirculation
p. 284-290 of the original issue
References
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Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Maxillofacial
Surgery and Surgical Dentistry
With a Course of Advanced
Training and Retraining of Medical Specialists.
Tel. +375 29 295-33-54,
e-mail: arinakabanova@mail.ru,
Arina A. Kabanova
Information about the authors:
Kabanova Arina A., PhD, Associate Professor, Head of the Department of Maxillofacial Surgery and Surgical Dentistry with a Course of Advanced Training and Retraining of Medical Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-0121-1139

ONCOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.291   |  

YU.V. SLABADZIN, E.A. ADUTCKEVICH, S.A. SIDOROV

LAPAROSCOPIC SURGERY OF COLORECTAL CANCER UNDER THE CONDITIONS OF ADHESIVE PROCESS OF THE ABDOMINAL CAVITY ORGANS

Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk,
The Republic of Belarus

Objective. To assess safety and radicality of laparoscopic surgery of colorectal cancer in conditions of adhesive process of the abdominal organs.
Methods. 124 patients took part in the retrospective study, 41 of them were performed against the background of the existing adhesive process of the abdominal organs. Patients were divided into 2 groups: the main group (41 patients) – patients operated on for colorectal cancer on the background of the adhesive process of the abdominal cavity and control group (comparison group) – 83 patients operated on for colorectal cancer and not having any adhesive process in the abdominal cavity. In order to assess the severity of the adhesive process, as well as the places of fixing the intestinal loops to the anterior abdominal wall, to determine the point of possible installation of the first trocar, preoperative ultrasound examination was performed. Places through which it is possible to introduce trocars were marked. The severity of the adhesive process was assessed intraoperatively according to the scale of the peritoneal adhesion index.
Results. When installing the first 10 mm trocar or Veress needle, there was no damage to the internal organs in any case. The duration of surgical interventions was 40-50 minutes longer in the main group, this time was required for adhesiolysis. Mean hemorrhage in the first and the second group was minimal. Adhesive process of the abdominal cavity and laparoscopic method of surgical intervention did not violate the necessary lymph dissection. In the main and control groups in remote macroparts the proximal and distal margins of the resection were negative from the tumor process, which indicates the correct volume of resection and the possibility of performing laparoscopically in conditions of the adhesive process of the abdominal cavity.
Conclusions. Ultrasound examination of the abdominal cavity at the preoperative stage allows choosing the right points of the trocar entrance into the abdominal cavity. Execution of adhesions by laparoscopic method increases the visualization of the operation area and the quality of the conducted adhesiolysis, which increases the safety of the performed surgical intervention.

Keywords: laparoscopy, colorectal cancer, adhesions, adhesion index, adhesiolysis
p. 291-299 of the original issue
References
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  5. Roscio F, Boni L, Clerici F, Frattini P, Cassinotti E, Scandroglio I. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment. Surg Endosc. 2016 Oct;30(10):4372-82. doi: 10.1007/s00464-016-4755-7
  6. Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative, Kwon S, Billingham R, Farrokhi E, Florence M, Herzig D, Horvath K, Rogers T, Steele S, Symons R, Thirlby R, Whiteford M, Flum DR. Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2012 Jun;214(6):909-18.e1. doi: 10.1016/j.jamcollsurg.2012.03.010
  7. Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol. 2016 Jan 14;22(2):704-17. doi: 10.3748/wjg.v22.i2.704
  8. Zaevskaya EV. Prognosis of the complicacy of the laparoscopy in the patients with the adhesive disease of the abdominal cavity. Tavr Med-Biol Vestn. 2009;12(3):134-35. http://dspace.nbuv.gov.ua/bitstream/handle/123456789/25301/33-Zaevskaya.pdf?sequence=1 (in Russ.)
Address for correspondence:
223028, The Republic of Belarus,
Minsk region, Zhdanovichi, 81/5,
Republican Clinical Medical Center
Of the Presidential Administration
of the Republic of Belarus,
Surgery Department.
Tel. mobile.: +375 29 230-66-84,
e-mail: s.i.d.o.r.o.v@mail.ru,
Sergey A. Sidorov
Information about the authors:
Slabadzin Yury V., PhD, Surgeon, Deputy Chief Physician for Surgery, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7881-8326
Àdutñkevich Ekaterina A., Oncologist, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-0127-9042
Sidorov Sergey A., Surgeon, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7609-5427

ANESTHESIOLOGY-REANIMATOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.300   |  

K.V. NIKITSINA

EARLY RESPIRATORY SUPPORT IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To analyze the results of carrying out the early respiratory support in patients with acute necrotic pancreatitis.
Methods. 53 patients with acute necrotic pancreatitis in the fermentative phase are surveyed. Patients have been divided into 2 groups: 1 group (n=29) – patients with standard intensive therapy; 2 group (n=24) – patients who were subject to the mechanical ventilation of the lungs from the first day. Patients of both groups had a severe course of the disease (Ranson >4 points and APACHE II >11 points). The research was conducted in 3 stages: the 1st stage – on admission to the intensive care unit; the 2nd stage – 1 day afterwards, 3 stage – after 4 days. The gases indicators of the arterial blood (pCO2, pO2, pO2/FiO2, lactate) were analyzed as well as the respiratory complains, intra-abdominal pressure, duration of respiratory therapy and mortality. The received results were compared in dynamics, between groups; their interrelation was analyzed.
Results. Carrying out of early respiratory support in patients with acute necrotic pancreatitis reduces the level of intra-abdominal pressure and normalizes the respiratory index, complains and the level of lactate. Indications for early respiratory support in patients with acute necrotic pancreatitis are the following: a severe course of the disease ≥4 points on scale Ranson and ≥11 points on APACHE II scale, intra-abdominal hypertension, low level of respiratory index <300 mm hg, high indicators of lactate >3.5 mmol/l.
Conclusions. Development of intra-abdominal hypertension in patients with acute necrotic pancreatitis aggravates the indicators of the respiratory status. Early mechanical ventilation of the lungs reduces the level of intra-abdominal pressure, normalizes the respiratory status indicators in the fermentative phase.

Keywords: acute necrotic pancreatitis, mechanical ventilation of lungs, respiratory index, respiratory complains, lactate, intra-abdominal hypertension
p. 300-306 of the original issue
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Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Anesthesiology and Resuscitation
With the Course of Advanced
Training and Retraining of Specialists.
Tel: +375 33 316-10-25,
e-mail: katarinaanaest@gmail.com,
Katsiaryna V. Nikitsina
Information about the authors:
Nikitsina Katsiaryna V, PhD, Associate Professor, Head of the Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-4744-6838

INFORMATION TECHNOLOGIES IN SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.307   |  

I.V. MAKAROV, V.V. ZHIROV, A.V. KOLSANOV, R.A. GALKIN, A.Y. SIDOROV, D.O. KHOKHLOVA

USING PREOPERATING 3D-MODELING IN DIAGNOSTICS AND SURGICAL TREATMENT OF TERTIARY HYPERPARATHYROIDISM

Samara State Medical University, Samara,
The Russian Federation

Objective. To design a patient-specific preoperational 3D model of the neck anatomical formations based on MRI study to facilitate the search and removal of parathyroid adenoma in patients with tertiary hyperparathyroidism (THPT).
Methods. Preoperative 3D modeling was done for 7 patients with tertiary hyperparathyroidism. All patients were on the program renal dialysis because of the terminal stage of chronic renal insufficiency. For obtaining the personified 3D model the results MRI and special software were used. Data in DICOM format were loaded in software; at the same time, individual series of MRI studies were recorded and brought to a single coordinate system, they were segmented – the selection on the images of borders of anatomical structures, and three-dimensional polygonal models of the anatomical structures of the anterior surface of the neck and pathological sites – adenomas of the parathyroid glands were designed.
Results. With the use of preoperation 3D modeling the obtained models of the anatomical formations of neck allowed revealing and removing parathyroid adenomas rapidly, with the smallest time interval. The operation time on the average comprised 60±15 the minutes (M±σ). The operation effectiveness was proved by the results of laboratory investigations and clinical picture on the whole. In the postoperative period, during the following day after operation the median of ionized calcium decreased to 0.88 mmol/L (decrease by 0.32 mmol/L or on 26.7%, with r=0.00001), the median of parathyroid hormone – to 98.2 pg/ml (decrease on 2048.8 pg/ml – 95.4% with r=0.00001); the median of phosphorus – to 1.28 mmol/L (it was lowered on 0.33 mmol/L – 20.5%). The pains in the bones and the joints were clinically stopped in patients.
Conclusions. The suggested method is a reliable technique of the preoperative topical diagnosis of the pathological changes of the parathyroid glands. Its use leads to the decrease of operation time and reduces the need for traumatic and time-consuming neck exploration, necessary to find 4 and more adenomas), thus reducing the risk of post-surgery complications. The given method can be used for objective visualization of parathyroid adenomas during the operation and serve as the effectiveness criterion of surgical treatment adequacy.

Keywords: 3D model, magnetic resonance imaging, tertiary hyperparathyroidism, diagnostics, surgical treatment
p. 307-317 of the original issue
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Address for correspondence:
443099, The Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
Department of Surgical Diseases ¹1.
Tel. +7 903 334-22-59,
e-mail: makarov-samgmu@yandex.ru
Igor V. Makarov
Information about the authors:
Makarov Igor V., MD, Professor, Head of the Department of Surgical Diseases ¹1, Dean of the Pediatric Faculty, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-1068-3330
Zhirov Vladimir V., PhD, Head of the Center for Educational Information Technologies, Programming Engineer of the Augmented Reality Technology Laboratory of the Virtual Technologies Department of the Center for Breakthrough Research “IT in Medicine”, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-3061-1713
Kolsanov Alexander V., MD, Professor of RAMS, Head of the Department of Operative Surgery, Clinical Anatomy with the Course of Innovative Technologies, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-4144-7090
Galkin Rudolf A., MD, Professor of the Department of Surgical Diseases ¹1, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0003-3665-3161
Sidorov Aleksandr Yu., PhD, Associate Professor of the Department of Surgical Diseases ¹1, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-3613-4863
Khokhlova Darya O., Clinical Intern of the Department of Surgical Diseases ¹1, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0003-2913-5876

REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.318   |  

O.A. NAZARCHUK 1, M.O. FAUSTOVA 2, S.A. KOLODII 1

MICROBIOLOGICAL CHARACTERISTICS OF INFECTIOUS COMPLICATIONS, ACTUAL ASPECTS OF THEIR PREVENTION AND TREATMENT IN SURGICAL PATIENTS

National Pirogov Memorial Medical University 1, Vinnitsa,
Ukrainian Medical Stomatological Academy 2, Poltava,
Ukraine

According to the literature data, microbiota of complications in surgical hospitals consists mainly of representatives of Staphylococcus spp., Enterococcus spp., Escherichia spp., Enterobacter spp., Klebsiella spp., and Pseudomonas spp. However, the spectrum of microorganisms differs depending on the location of the lesions, therapy tactics and the type of unit, where a patient is treated. Nowadays the rapid acquisition of resistance to chemotherapeutic agents by pathogens is becoming the most ambitious problem of modern medicine. In hospitals and intensive care units, the situation is aggravated by the emergence of multi-resistant hospital strains of microorganisms. The mechanisms of bacterial resistance to antibiotics are diverse and can be carried out both at the genetic and at the biochemical level.
The incidence of infectious and inflammatory postoperative complications and increase of the problem of antibiotic resistance among microorganisms dictate the need for careful monitoring of the epidemic situation in hospitals and studying the changing tendencies in the spectrum of dominant pathogens. Moreover, developing and introducing into the clinic of new antibiotics and drugs with antimicrobial activity, revision of existing algorithms for the treatment and prevention of complications arising on the background of surgical interventions are necessary.

Keywords: anti-bacterial agents, antibiotic-resistance, infectious-inflammatory, nosocomial, postoperative complications, surgical infection
p. 318-327 of the original issue
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Address for correspondence:
21018, Ukraine,
Vinnitsa, Pirogov Str., 56,
National Pirogov Memorial Medical University,
Microbiology Department,
Tel. +38 097 729-37-61,
e-mail: nazarchukoa@gmail.com,
Oleksandr A. Nazarchuk
Information about the authors:
Nazarchuk Oleksandr A., PhD, Associate Professor of the Microbiology Department, National Pirogov Memorial Medical University, Vinnitsa, Ukraine.
https://orcid.org/0000-0001-7581-0938
Faustova Mariia O., PhD, Lecturer of the Department of Microbiology, Virology and Immunology, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
https://orcid.org/0000-0001-5327-6324
Kolodii Svetlana A., PhD, Associate Professor of the Microbiology Department, National Pirogov Memorial Medical University, Vinnitsa, Ukraine.
https://orcid.org/0000-0001-7511-8108
DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.328   |  

V.S. MATSKEVICH 1, A.N. KIZIMENKO 2

FEATURES OF MICROELEMENTS EXCHANGE IN CRITICALLY ILL CHILDREN

Mogilev Regional Children's Hospital 1, Mogilev,
Vitebsk State Medical University 2, Vitebsk,
The Republic of Belarus

Objective. To study the publications, regarding effectiveness and safe usage of microelements during intensive care in children in critical state.
Methods. PubMed databases from January, 1998 to January, 2018 have been analyzed. The number of articles concerning this subject increased every 5 years in the mentioned period, which testifies to the interest to this problem in the scientific field.
Results. ESPEN and ASPEN recommendations as well as WHO regional recommendations for the European Union countries are given in the article regarding the usage of microelement dosage for children in the intensive care units. According to the study data, changes in the concentration of certain elements such as calcium, phosphorus, iron, zinc, selenium in the blood of children subjecting to intensive care therapy were registered. Also, the article presents the changes in the level of microelements in children with certain pathologies such as HIV, burn injury, chronic renal insufficiency, bronchial obstruction, multiple organ failure, septic shock.
Conclusions. The consumption of microelements and their dynamics during the course of illness has been almost unstudied. There are some incomplete works dedicated to the problem of microelement metabolism in healthy children and in pathology. There are no data about the deficiency of some microelements, which have a significant influence on the disease outcome; therefore, they require a constant control.

Keywords: microelements, children, intensive care, enteral nutrition, parenteral nutrition
p. 328-336 of the original issue
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Address for correspondence:
212025, The Republic of Belarus,
Mogilev, Byalynitsky-Birulya Str., 9,
Mogilev Regional Children’s Hospital,
Anesthesiology and Intensive Care Unit.
Tel. office: 8 0222 41-74-69,
e-mail: domenika31@yandex.by,
Veranika S. Matskevich
Information about the authors:
Matskevich Veranika S., Physician of the Anesthesiology and Intensive Care Unit, Mogilev Regional Children’s Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-7435-3648
Kizimenko Andrei N., PhD, Associate Professor, Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-8468-1269
DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.337   |  

A. SITNIK

TREATMENT OF THE FRACTURES OF THE NECK OF THE TALUS

Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk,
The Republic of Belarus

Fractures of the talus are rare injuries (up to 2.5% from the foot fractures), but the consequences of incorrect treatment are catastrophic, leading to osteoarthritis and long-lasting function impairment. Fearing complication is avascular necrosis of the body of the talus with previously reported incidence up to 50-75%. The changes of surgical strategy during the last decades have led to significant improvement of results and decrease of complications. Urgent treatment is only indicated in open injuries, as well in cases of fracture-dislocations where the displaced bone fragment threatens with skin necrosis. If closed reduction is successful, internal fixation is better to perform in delayed manner after the resolution of soft-tissue swelling. According to the present-day literature data, such an approach does not lead to the increase of the rate of avascular necrosis, but reduces the rate of wound complications and improves long-term results by thorough pre-operative planning and execution of surgery. The use of double surgical approaches (antero-medial and antero-lateral) provides anatomic fracture reduction with maintenance of the tiny blood supply of talus bone.

Keywords: talus, fracture, treatment terms, osteosynthesis, complications
p. 337-343 of the original issue
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Address for correspondence:
220024, The Republic of Belarus,
Minsk, Kizhevatov Str., 60-4,
Republican Scientific and Practical
Center of Traumatology and Orthopedics,
Laboratory of Adult Traumatology,
Tel. mobile: +375 29 354-00-84,
e-mail: alexandre_sitnik@yahoo.com,
Alexandre A. Sitnik
Information about the authors:
Sitnik Alexandre A., PhD, Associate Professor, Head of the Laboratory of Adult Traumatology, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus.

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.34   |  

T. VYKHTYUK, V. ZHYKOVSKIY

SURGICAL SITE INFECTION IN PATIENTS WITH THE DESTRUCTION OF THE VASCULAR IMPLANT

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Treatment of patients with occlusive-stenotic lesions of the lower limb arteries in the stage of critical limb ischemia and postoperative infectious complications is a pressing issue of modern vascular surgery. If a patient has a vascular prosthesis, the development of a surgical site infection can lead to arrosive bleeding with fatal outcome. The aim of this report is to demonstrate the case of successful surgical treatment of a patient with an infected synthetic vascular implant. The patient, born in 1962, addressed to a vascular surgeon 2 months after the surgical treatment of critical ischemia of the right lower limb with implantation of linear femoropopliteal prosthesis. The patient complained of the development of a wound with discharge and unpleasant odor. After inspection and examination of the patient, the infection of the vascular prosthesis with the formation of the fistula on the medial surface of the lower third of the right thigh was diagnosed. Surgical intervention was performed: removal of the infected femoropopliteal prosthesis with simultaneous autovenous femoropopliteal repeated bypass surgery by the great saphenous vein, performed subcutaneously, extra-anatomically within the healthy soft tissues, bypassing the infected area of the lower third of the thigh. Thus, one was able to save the limb of the patient, to prevent the development of arrosive bleeding and to improve the healing and recovery of the suppurative thigh lesion.

Keywords: surgical infection, critical limb ischemia, surgical site infection, vascular implant infection, vascular reintervention
p. 344 of the original issue
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Address for correspondence:
79000, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Surgery Department ¹2.
Tel. +38 032 275-76-32,
e-mail: vykhtyuk@gmail.com,
Taras I. Vykhtyuk
Information about the authors:
Vykhtyuk Taras I., Assistant of Surgery Department ¹2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-5600-7760
Zhykovskiy Volodymyr S., PhD, Assistant of the Department of Disaster Medicine and Military Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-0594-5316
DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.348   |  

A.G. MAKEEV 1, 2, S.A. KUSHTUMOV 1, 2, E.V. SHINKEVICH 2, P.I. MURAVIEV 2, M.P. GRUZIN 2, V.G. KUTORKIN 2

CHRONIC POSTTRAUMATIC THORACOABDOMINAL AORTIC ANEURYSM COMPLICATED BY RUPTURE

Irkutsk State Medical University 1,
Irkutsk State Regional Clinical Hospital 2, Irkutsk,
The Russian Federation

The article reports a rare clinical follow-up of the patient with chronic posttraumatic thoracoabdominal aortic aneurysm of IV type according to Crawford E.S., complicated with a rupture into the posterior mediastinum and retroperitoneal space. The occurrence of chronic posttraumatic thoracoabdominal aortic aneurysm is suspected to be associated with a blunt trauma of the lumbar region (a fall from own growth height) and with the aortic damage by metal structures implanted four years earlier for transpedicular fixation with intrabody vertebral fusion of the thoracic spine. Aneurysm rupture into the posterior mediastinum and retroperitoneal space, which occurred during the planned in-hospital examination of the patient, indicates the difficulties in predicting the moment of its onset. Timely diagnosis and emergency reconstructive surgery aimed at restoring the continuity of the damaged thoracoabdominal aorta, determined a good result of treatment. There is still no convincing information about the frequency of such complications as the formation of post-traumatic aneurysm after transpedicular fixation with interbody vertebral fusion of the spine; only the descriptions of single observations are presented. This fact stimulated us to describe a rather rare clinical follow-up.

Keywords: spinal trauma, transpedicular fixation, thoracoabdominal aortic aneurysm, aneurysm rupture, aortal prosthetics
p. 348-353 of the original issue
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Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnoye Vosstaniye Str., 1,
Irkutsk State Medical University,
Department of Human Anatomy,
Operative Surgery and Forensic Medicine.
Tel. +7 902 576-75-41,
e-mail: a.makeev@ismu.baikal.ru,
alexandermakeev@rambler.ru,
Alexander G. Makeev
Information about the authors:
Makeev Alexander G., PhD, Associate Professor of the Department of Human Anatomy, Operative Surgery and Forensic Medicine, Irkutsk State Medical University, Cardiovascular Sur