Проаналізовано результати лікування 411 хворих, оперованих в екстреному і невідкладному порядку з приводу обтураційної товстокишкової непрохідності, яких поділено на основну групу -262 пацієнти (I група) і групу порівняння -149 хворих (II група). Для профілактики неспроможності швів анастомозу в I групі проводили назоінтестинальну і трансанальну інтубацію тонкої і товстої кишок з інтра-та післяопераційною декомпресією, внутрішньокишковим діалізом оксигенованими розчинами. У I групі неспроможність кишкового анастомозу спостерігали у 3,6 %, в II групі -у 16,3 %. Впровадження комплексу заходів із профілактики неспроможності швів кишкових анастомозів після екстреної та невідкладної резекції кишки дозволило зменшити частоту ускладнень на 12,7 % у хворих основної групи порівняно з контрольною.Results of treatment of 411 patients operated on an emergency and urgently obstructive bowel occlusion, who were divided into the main group -262 patients (I group) and comparison group -149 patients (II group). To prevent failure of anastomotic sutures in group I we conducted nazointestinal and transanal intubation of small and large intestine of intra-and postoperative decompression, intracolonic oxygenated dialysis solutions. In group I intestinal anastomosis failure was observed in 3.6 % in group II -in 16.3 %. Implementation of measures for prevention of failure sutures after emergency intestinal anastomoses and emergency bowel resection reduced the incidence of complications on 12.7 % in patients of the main group compared with the control one.Постановка проблеми і аналіз останніх до-сліджень та публікацій. У пошуках вирішення проблеми неспроможності швів кишкових анас-томозів до сьогодні немає радикальних змін, не-зважаючи на успіхи техніки з'єднання анастомо-зованих тканин, використання сучасних шовних матеріалів, способів захисту анастомозу і ранньої діагностики [5,6]. Це питання набуває особливої актуальності при екстреній та невідкладній резек-ції кишки на тлі гострої кишкової непрохідності, перитоніту, ракової і гнійної інтоксикації у хво-рих похилого та старечого віку [3].Серед різноманітних причин виникнення не-спроможності велика роль належить підвищенню внутрішньокишкового тиску, внаслідок чого на-стають гемодинамічні зміни в зоні анастомозу з порушенням мікроциркуляції і розвитком ішемії кишки, які вже в перші години після операції мо-жуть призвести до його пошкодження. Скупчен-ня застійного вмісту в просвіті кишки з високим рівнем патогенної мікрофлори призводить до ін-фікування швів анастомозу. Розвинувшись, інфек-ційно-запальний процес порушує захисну функ-цію кишкової стінки і створює умови для розви-тку анастомозиту й ендотоксикозу [1][2][3][4][5][6][7][8][9].Для профілактики даного ускладнення вико-ристовують різні методи і засоби захисту анасто-мозу, такі як зміцнення кишкових швів фібрин-ко-лагеновою субстанцією ТахоКомб, застосування аутофібринового клею, перитонізація зони анас-томозу демукозованим сегментом клубової киш-ки, санація ділянки анастомозу антибактеріаль-ними препаратами [1,5,6, 9] і т. ін. ...
The purpose of the work. Compare the effectiveness of PRP and general accepted methods of local therapy for long-term unhealed wounds in patients with diabetic foot syndrome. Materials and methods. A study was performed in 33 long-term patients unhealed wounds on the foot and leg in the neuropathic form of diabetic foot syndrome. Patients were divided into two groups depending on the nature of the received therapies - PRP and local therapy according to generally accepted principles. The effectiveness of therapy was assessed by the nature of changes in the microflora and c wound cell composition, as well as wound surface area on the 1st day, 8th and 22nd after starting treatment. Results. The use of PRP allowed to observe on the 8th day regenerative-inflammatory type of cytogram, have manifestations of vascularization and epithelialization, reduce the number of patients with infected wounds by 2.7 times and reducing the wound surface area by 1.7 cm, which is 3.4 times more than in the second group (0.5 cm). The introduction of the second dose of PRP is even more stimulating reparative changes in the wound, manifested by the regenerative type of cytogram, reducing the number of infected wounds by 8 times, and reducing the area wound surface 2 times from the first measurement, while in the second group only on the 22nd day there were positive changes that were characteristic of the first group on the 8th day. Conclusion. Thus, the use of PRP in therapy is long unhealed wounds in diabetic foot syndrome, is a promising area of regenerative therapy. PRP is a way to obtain a natural concentration of internal factors of growth with minimal invasiveness and low costs. Proposed method of biological therapy in such patients is simple and affordable for both patient and for the doctor.
Objective. The aim of the study was to analyze the effectiveness of modern treatments in 485 patients with chronic hemorrhoids stage II-III-IV over the past 3 years. Results. An individual-combined approach to the treatment of hemorrhoids has been introduced, as many patients can have nodules at different stages of the disease at the same time. Used a combination of methods with different ways to influence the pathogenesis of hemorrhoids. Thanks to the introduction of a set of systemic measures, good results were obtained, namely the healing time of postoperative wounds was reduced by 35-40% and the intensity of postoperative pain was reduced by 3-4 points on a 10-point analog visual scale. Conclusions. The use of an individual integrated approach to each patient in choosing the tactics of surgical treatment of hemorrhoids and the widespread introduction of modern techniques, has reduced the duration of the postoperative period, preserve radical intervention and reduce the likelihood of recurrence.
Objective. The purpose of the study is to reveal the features of the course of the wound process in patients with acute paraproctitis against the background of diabetes. Methods. An analysis of the results of treatment of acute parаproctitis against the background of diabetes in 328 patients over the past 5 years was carried out. Results. It was found that these patients are define by extensive tissue damage in area and the predominance of gram-negative bacteria in mixed aerobic flora, the addition of anaerobic flora is the cause of the spread of the purulent process and deep destruction of tissues. The synergism of the aerobic-anaerobic flora in combination with the pathogenetic factors of diabetes contribute to a severe and prolonged course of the inflammatory process, as evidenced by the preservation of a high index of intoxication until the 14th day. Conclusions. The criteria for choosing the method of operation are based on the localization of the abscess and the main purulent course, its relationship to the elements of the external anal sphincter, the nature of the scarring process in the area of internal diversion and the function of the closing apparatus of the rectum.
Purpose of the study. Was to reveal the peculiarities of surgical treatment of acute paraproctitis in patients with diabetes mellitus. Materials and methods. The analysis of results of treatment in 1591 patients for the last 8 years is carried out. In 90 (6,8%) patients, the process proceeded against the background of diabetes mellitus. Results. The criteria for choosing the mode of operation are based on the location of the abscess and the main purulent course, its relation to the elements of the external anal sphincter, the nature of the cicatricle process in the zone of the internal opening and the function of the rectum apparatus. Conclusion. In complex cases, surgical treatment should be two-stage and organ-preserving. To the possibility and timing of the removal of the inner hole should be approached individually. Keywords: acute paraproctitis, diabetes mellitus, surgical treatment.
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