卷 39, 编号 3 (2020)
- 年: 2020
- 文章: 17
- URL: https://journals.eco-vector.com/RMMArep/issue/view/3578
- DOI: https://doi.org/10.17816/rmmar.393
完整期次
Fundamental issues of modern medicine
General surgery department with the i. F. Bush clinic Of the s. M. Kirov military medical academy (historical notes to the 220th anniversary of the foundation)
摘要
The article is dedicated to the 220th anniversary of the founding of the General Surgery Department of the S. M. Kirov Military Medical Academy. During the time the department was headed by famous representatives of surgery of those times. The representatives of the General Surgery Department made a significant contribution to the development of surgery in our country, subsequently being the heads of surgical departments and medical institutions. Historically, the academic disciplines taught at the department were the primary link in the education program in surgery at the academy. Most of the heads of the department had the experience of participating in military campaigns, which is necessary for education at a military university. Traditionally, the department scientific research were devoted to the study of the wound process, wound infection, combat injuries, oncology, vascular and abdominal surgery. At present, there is currently a continuity in the formation of educational and methodological materials for various categories of students, scientific developments on topical problems of surgery have been going on (4 figs, bibliography: 4 refs).
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Educational technology
Experience of distance learning in the discipline “General surgery” during the COVID-19 pandemic
摘要
The article is devoted to evaluating the experience of distance learning in the discipline “General surgery” during the COVID-19 pandemic. Organizational issues and some results of 6-month distance learning in General surgery have been considered.
The most significant changes occurred in the methodology of the main part of classes — in terms of teaching practical skills of medical and diagnostic orientation. Demonstration of appropriate actions in graphic and video materials did not ensure the development of practical skills, and it turned out that distance learning does not have all the properties of clinical training.
It takes much more time a teacher on preparing for classes and test activities for students, including taking the exam remotely.
Further study of distance learning opportunities is required (determining the critical duration of distance learning, the need to change the list of practical skills to be mastered, etc.) in cooperation with clinical departments of surgical and related profiles (bibliography: 8 refs).
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Clinical medicine
Modern approaches in treatment of diabetic foot syndrome
摘要
The article is devoted to practical issues of the clinic, the diagnostic algorithm and tactics of treatment of purulent-necrotic complications of diabetic foot syndrome. Studying the wound process in patients with purulent-necrotic complications of diabetic foot syndrome using modern methods. The efficiency has been proved and an algorithm has been proposed for the use of some physical methods of sanitation in the local treatment of diabetic foot syndrome. The proposed methods of treatment make it possible to reduce the number of amputations and reduce mortality in patients with purulent-necrotic complications of diabetic foot syndrome (1 figure, 1 table, bibliography: 9 refs).
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Choice of surgical treatment for chronic composite hemorrhoid
摘要
A comparative analysis of the treatment of 142 patients operated on chronic hemorrhoid stage III–IV has been passed by way of assess the results of using new version of hemorrhoidectomy. The age of patients ranged from 27 to 80 (mean age was 50.4±6.7). 86 (60.6%) patients were diagnosed with stage III chronic hemorrhoid, at 56 (39.4%) patients — the stage IV. For this study patients were divided into basic and controlled groups. The basic group consisted of 73 (51.4%) patients that have had hemorrhoidectomy using our modification. There were 69 (48.6%) patients in control group that have been operated by Milligan–Morgan method in second modify of State Scientific Center of Proctology using bipolar coagulator LigaSure. The level of pain was assessed in the early postoperative period by numeric rating scale. The patients had been operated by our method mentioned that the pain syndrome was less pronounced (3.2 against 4.9 balls), that required less painkillers in the early postoperative period. In the case of doing semicircle cuts on the border of anocutaneous crinkle and bringing down mucous membrane, the significant excision of the cavernous tissue doesn’t lead to contraction of the anal canal by that reduces the number of functional disorders after hemorrhoidectomy (4 figs, 1 table, bibliography: 7 refs).
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Experience in treatment of diaphragm hernias
摘要
Hernias of the diaphragm are a common pathology that negatively affects the quality of life of patients and in some cases requires high-quality surgical correction. This pathology has a progressive course, which leads to an increase in the severity of clinical manifestations with the age of the patient. The article presents the experience of surgical treatment of hernias of the diaphragm on the basis of general surgery clinics of the military medical academy. The aim of the study is to determine the effectiveness of surgical treatment of hernias of the diaphragm in different categories of patients. The total number of treated patients was 216. All patients were operated on. Thirty-four patients underwent a sympultal laparoscopic cholecystectomy. The operation used laparoscopic access. The closest excellent and good results of clinical treatment occurred in 92% of cases, satisfactory and unsatisfactory results accounted for 5.4 and 2.7%, respectively. According to the results of the instrumental survey, 40.6 and 54%, respectively, achieved excellent and good results; Satisfactory and unsatisfactory — 2.7 and 2.7%. The introduction of laparoscopic techniques in surgery has reduced the number of early and late post-operative complications in the treatment of hernias of the diaphragm. The recommendations of the American Association of Endoscopic Surgeons for the operational treatment of gastroesophageal reflux disease shows the positive effect of laparoscopic fundoplications in 85–93% of patients whose medicinal therapy has proved ineffective. In general, the results of the immediate and long-term outcomes of the surgical treatment of hernias of the diaphragm at the General Surgery Clinic of Military Medical Academy showed similar results (8 figs, bibliography: 16 refs).
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The case of the multistage treatment of acute pancreatitis using a variety of minimally invasive techniques
摘要
Treatment of acute pancreatitis and infectious complications is a complex multidisciplinary task. The use of traditional surgical procedures for the rehabilitation of foci of pancreatogenic infection often aggravates the course of the disease, leads to the development of postoperative complications, does not improve the results of treatment. On the contrary, the use of minimally invasive techniques avoids additional surgical injury. The case of stage treatment of acute pancreatitis and its purulent-septic complications with the use of minimally invasive technologies is presented to the readers.
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Endoscopic techniques and their effectiveness in the treatment of the boerhaave´s syndrome (clinical observation)
摘要
Minimally invasive endoscopic methods are gradually being introduced in all areas of medicine. Esophageal surgery is no exception. Recently, endoscopic clipping of the mucous membrane for fresh ruptures, stenting of the esophagus and Vacuum Assisted Closure have been used in the treatment of injuries of the esophagus when radical surgery is impossible and purulent complications develop. As the techniques were mastered, they were introduced into the clinic. This article presents a clinical observation of the treatment of a 56-year-old patient with a spontaneous rupture of the esophagus (Boerhaave΄s syndrome), who at certain stages of treatment used certain endoscopic techniques that allowed to stabilize the patient in the early stages of treatment and preserve the esophagus and its functionality in the future. The duration of the patient΄s treatment in the clinic was 45 days. Subsequent follow-up examinations did not reveal any abnormalities in the patient΄s health that required surgical correction. This observation allowed us to look at the problem of treating this group of patients from a different angle and form new algorithms for treating patients using minimally invasive methods (6 figs, bibliography: 10 refs).
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Long-term results of combined treatment of a patient with cancer of the upper ampullary rectum Complicated by bleeding
摘要
The clinical observation the results of combined treatment of a patient with locally advanced rectal cancer complicated by bleeding with the use of selective chemooil embolization of the superior rectal artery have been presented (1 figure, bibliography: 4 refs).
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Result of using a minimally invasive method of surgical treatment of purulent-necrotic complications in a patient with diabetic foot syndrome
摘要
The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).
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Endoscopic esophageal stenting as a method of selecting and eliminating dysphagia syndrome in esophageal stenosis
摘要
To assess of our study was to analyze the experience of using esophageal stents in dysphagia syndrome. The main questions to which they wanted to get an answer: the formulation of the main indications and contraindications for esophageal stenting; evaluation of the efficiency and feasibility of esophageal stenting with self-expanding metal stents in incurable patients. At the General Surgery Department of the S. M. Kirov Military Medical Academy performed stenting in 78 patients for malignant neoplastic processes and in 2 patients with benign esophageal stricture, who underwent treatment from 2007 to 2020. The patient group included 61 men (76.3%) and 19 women (23.7%). 69 people applied for grade III–IV dysphagia, 6 had tracheo-esophageal fistulas, and 3 had esophageal-pleural fistulas formed during tumor decay, 2 patients were treated for esophageal burn stricture. The stents of the Korean company «M. I. Tech». Installation were performed with short, small diameter endoscopic delivery systems. The onset of feeding, as a rule, began on the next day with satisfactory standing and adequate expansion of the stent, and no displacement. The patient could leave the hospital on the same day. Meals began with the use of water and liquid food with a gradual expansion of the density and consistency of the food. The minimally invasive method for eliminating dysphagia in inaccurate patients is esophageal stenting with self-expanding stents. Esophageal stenting has fewer complications than other invasive surgical techniques for resolving dysphagia. The advantage of palliative treatment of tumor stenoses and fistulas by stenting is to reduce the manifestations of dysphagia, improve the quality and increase the life expectancy of patients (3 figs, bibliography: 15 refs).
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ENDOSCOPIC ESOPHAGEAL STENTING AS A METHOD OF SELECTING AND ELIMINATING DYSPHAGIA SYNDROME IN ESOPHAGEAL STENOSIS
摘要
To assess the experience of stents application, formulate the main indications and contraindications for the esophageal stenting, prove that the esophageal stenting with self-expandable metal stents is considered as the treatment of choice in incurable patients. Within the period from 2007 to 2018. 78 patients have treated for the cancer of esophagus and gastric cardia, 2 patients with benign esophageal strictures were subjected to stenting at the general surgery department of the S.M. Kirov Military Medical Academy. The group of patients included 53 men and 17 women. 60 patients with dysphagia grade III–IV have been examined, 6 of them — with trachea-esophageal, 2 — esophageal-pleural fistulas formed during the tumor disintegration, 2 patients were treated for burn strictures of the esophagus. M. I. Tech's esophageal stents of Korean firm were used. Insertion was carried out by short endoscopic delivery systems of a small diameter. Satisfactory evaluation of the stent state and adequate stent expansion, absence of any misplacement were considered as an indication for starting oral food intake. Patients may be allowed to go home shortly after an esophageal stent procedure (the same day). The first day the patient could use water and foods need to be liquid, moist and soft, in the following days it was possible to increase the density of products. The study found that stenting of the esophagus is a current method of endoscopic surgery, aimed at the expanding and maintaining of the lumen of the esophagus by means of the inserted self-expandable stents. Esophageal stenting possesses by fewer complications unlike other techniques. The role of palliative treatment (for example, stenting) is considered to reduce dysphagia, improve the quality of life and increase life expectancy
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Original articles
Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach
摘要
Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (÷2 = 2.61; p = 0.106), 25.5% within a year (÷2 = 2.75; p = 0.091), for two years after the 25.4% operation (÷2 = 1.47; p = 0.225), for three years 25.5% (÷2 = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p < 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).
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Modern methods for evaluating the process of the wound process
摘要
The article presents the data of a comprehensive assessment of the course of the wound process using modern methods. The effectiveness of additional physical methods of sanitation in local treatment has been proved.
It was found that the proposed diagnostic algorithm made it possible to identify the features of the wound process, as well as the features and patterns of pathomorphological changes. The proposed clinical diagnostic algorithm can be used to assess the effectiveness of various means of local wound treatment, including physical methods of influencing the wound process (2 figs, bibliography: 11 refs).
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Modern drainage interventions in the surgical treatment pancreatic cyst
摘要
Purpose. To evaluate the capabilities of modern minimally invasive interventions under the beam guidance in the surgical treatment of pancreatic cysts.
Materials and Methods. The results of the examination and treatment of 88 patients with pancreatic cysts. Percutaneous puncture drainage under ultrasonographic guidance holds 56 patients, endoscopic transmural drainage of cysts by ultrasonography—- in 32.
Results. After performing percutaneous drainage of cysts positive results were observed in 42 (75,0%) patients. Relapses cystic formations were observed in 14 (25.0%) patients. Endoscopic transmural drainage under ultrasonography noted one intraoperative complication — perforation of the stomach wall. 6 patients had a good result. Term follow up of patients ranged from 10 months to 3 years.
During endoscopic transmural drainage stent dislocation and relapse of cysts were not detected in all operated patients after 6 months, Long-term results were observed only in 11 patients.
Conclusions. Percutaneous external drainage of pancreatic cysts is an effective intervention in 75% of patients. A fairly high percentage (25%) of relapses is due to the fact that long-term external drainage do not allow to achieve complete obliteration of the cyst cavity in its connection with the main pancreatic duct and preservation of ductal hypertension of the pancreas. Endoscopic installation of a stent between the hand cavity and the lumen of the stomach allows you to create conditions for a constant outflow of cyst contents into the stomach and eliminate pancreatic hypertension. The effectiveness of internal drainage is determined by the duration of stent functioning, as well as the possibility of forming an internal cystogastric fistula (3 figs, bibliography: 8 refs).
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Transjugular intrahepatic portosystemic shunting in combined treatment of a patient with decompensated liver cirrhosis and malignant neoplasm of the uterus (clinical case)
摘要
Nowadays the treatment of patients with malignant neoplasms of the abdominal organs against the background of decompensated liver cirrhosis is largely an unsolved problem. Complications of portal hypertension syndrome such as ascites, hypersplenism, recurrent bleeding from the veins of the esophagus prevent the implementation of radical surgical treatment. Low trauma of endovascular methods of treatment, low level of complications and mortality are the main advantages of interventional techniques that make it possible to prepare a patient with portal hypertension syndrome for further radical treatment of oncological disease. The presented clinical case describes the results of a combined approach to the treatment of a patient with complications of portal hypertension syndrome and a competing disease — a giant tumor of the uterus. The patient was denied in surgical treatment for the neoplasm due to the presence of decompensated cirrhosis. Liver transplantation is not possible due to the presence of cancer. Transjugular intrahepatic portosystemic shunting led to relief of diuretic-resistant ascites, regression of the degree of esophageal varicose veins, which made it possible to remove the tumor with extirpation of the uterus with appendages. Up to now the observation period for the patient is more than 12 years (4 figs, bibliography: 7 refs).
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Photodynamic therapy in combined treatment of cholangiocellular carcinoma (case report)
摘要
In this article a case report of an effective combined treatment of a patient with locally advanced cholangiocellular cancer who underwent neoadjuvant regional chemotherapy, extended surgery, adjuvant regional chemotherapy, as well as a set of minimally invasive endoscopic and percutaneous endobiliary techniques, which allowed the progression of the disease, including to increase the patient´s survival rate is presented. (5 figs, bibliography: 5 refs).
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The application of long frame draining of pancreatoejunoanastomosis in patient after gastropancreatoduodeonal resection
摘要
Objective. To demonstrate the possibilities of early diagnosis of pancreatoejunonastomosis failure and options for surgical treatment of patients with pancreatic fistula after gastropancreatoduodenal resection using long-term frame drainage of pancreatojejunonastomosis.
Materials and methods. The results of combined treatment of a patient of the Department of General Surgery of S. M. Kirov Military Medical Academy with a intraductal papillary mucinous neoplasms. Pancreatoejunonastomosis failure was diagnosed based on the criteria of the International Research Group for the Study of Pancreatic Fistulas.
Results of the study. Patient B., 61 years old. In January 2019, computer tomography revealed a cystic cavity in the head of the pancreas. An controlled endoscopic ultrasound sonography biopsy was performed. Morphological examination verified the signs of intraductal papillary mucinous neoplasm. On March 11, 2019, the patient underwent gastropancreatoduodenal resection with decompression of pancreatoejunoanastomosis using long-term frame drainage of the main pancreatic duct. On the third day of the postoperative period, x-ray contrast fistulography was used to diagnose the failure of the pancreatoejunonastomosis with the formation of a “B” type fistula. On the 23d day after gastropancreatoduodenal resection, puncture drainage of the non-drained acute fluid collection was performed under ultrasonographic control. On the 36th day of the postoperative period the frame and puncture drains were removed.
Conclusion. The use of long-term frame drainage for decompression of the duct system with staged fistulography, early diagnosis of complications of gastropancreatoduodenal resection in the form of the formation of type B pancreatic fistula, provided the effectiveness of conservative and minimally invasive measures for the treatment of postoperative complications (8 figs, bibliography: 7 refs).
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