Intestinal resection is one of the most common surgeries performed on urgent indications, the most difficult is the decision in favor of the formation of primary anastomosis in the case of primary infection of abdominal cavity, multiple defects of the intestinal wall, as well as the general serious condition of a patient. In order to improve the methods of diagnosis and prevention of post−surgery complications, as well as personification of surgical tactics of treatment in the patients undergoing anastomotic surgeries in intestine, the results of treatment of 96 patients were analyzed. The level of serum cryoglobulins was determined by the method of A. E. Kalovidoris with modifications. The results of surgical treatment were evaluated according to the classification of D. Dindo et al. (2004). The use of cryoglobulin levels before surgery can significantly affect surgical tactics: at a low degree it is possible to perform resection of a segment of small intestine with the formation of primary small intestinal anastomoses; at average − it is possible to perform small−intestinal anastomoses with unloading intestinal stoma or with the location of the anastomosis extraperitoneally (if possible) and decompression of the anastomosis with an incubation probe; at high − it is expedient to supplement performance of an anastomosis with a variant of an enterostomy or "delayed" anastomoses, at a severe general condition of patients it is expedient to form final small intestinal stoma. Determining the level of cryoglobulinemia as a marker of the prognosis of failure of the sutures of intestinal anastomoses and the use of differentiated surgical tactics depending on the level of this index contributes to a significant improvement in direct results of surgical treatment of the patients undergoing resection of small intestine segments. The proposed tactics virtually eliminate the implementation of multi−stage surgical interventions and helps to reduce the duration of treatment of patients, reduce the level of post−surgery complications and mortality. Key words: cryoglobulinemia, surgical treatment, small intestine, anastomoses.

Мета. Розробка методу герметизації швів тонкокишкового анастомоза в умовах перитоніту. Матеріали і методи. Експеримент виконано на 20 білих щурах-самцях лінії Вістар масою тіла близько 250 г. Догляд за тваринами, зміст та методи експериментальної роботи відповідали принципам Європейської конвенції щодо захисту хребетних тварин, що використовуються для дослідних та інших наукових цілей (Страсбург, 1986). Результати. Проведеним експериментальним дослідженням показано можливості застосування фізичних (хвилі світла певної довжини) та біологічних (тканинні фактори росту) методів у профілактиці і лікуванні гострих запальних реакцій та стимуляції репаративних процесів. Висновки. Перспективним напрямом подальшого дослідження методів профілактики неспроможності тонкокишкових анастомозів є застосування електромагнітного впливу низької інтенсивності світлового спектра в комбінації з аплікацією тканинних факторів росту.

The aim of our study was to determine the indications for expanding the scope of operations in patients with pelvic extraorgan local formations. Materials and methods. The results of surgical treatment of 7 patients with nonorgan tumors of the pelvic localization, who underwent resection on the main vessels in connection with their involvement in the tumor process, are presented. Results and discussion. A total of 7 interventions were performed on the iliac arteries — 2 resections with an end-to-end anastomosis and 5 prostheses (one case — the aorta resection with reconstruction with a bifurcation prosthesis). Patients with pelvic extraorgan tumors are a special cohort of patients, due to the presence of several organs in a narrow space, which inevitably causes them to fit snugly to the tumor. Locally advanced tumor process in extraorganic tumors involving the main vessels of the pelvis and adjacent organs is not a reason to refuse surgery, and despite the complications, repeated recurrences and previous operations, are well tolerated by patients. This is especially important due to the lack of a real alternative to surgical treatment of this group of patients. Conclusions. Surgical intervention in the treatment of pelvic inorganic tumors involving the main vessels is the only radical method of treatment. Invasion of the main arterial and venous vessels is not a contraindication to surgery in patients with pelvic tumors. Combined angioplastic interventions allow to achieve a long without recurrent period even after cytoreductive operations.

У статті розглянуті механізми впливу глюкокортикоїдів при критичних станах, зокрема при сепсисі. Метою проведеного дослідження було порівняння додаткової терапії дексаметазоном і бетаметазоном у пацієнтів із сепсисом при неефективності інфузійної терапії для запобігання симпатикоміметичній резистентності. Дослідження показало, що застосування кортикостероїдів у пацієнтів із тяжким септичним шоком у режимі низьких доз приводить до більш швидкого покращання стану. При порівнянні ефективності дексаметазону та його правообертального ізомеру бетаметазону різниці виявлено не було. Бетаметазон рекомендується для застосування у пацієнтів із септичним шоком при неефективності інфузійної терапії і з розвитком симпатикоміметичної резистентності.

Summary. The aim of the study was to study the dependence of ion exchange and saturation with iron transferrin on the background of increasing endotoxicosis, depending on the severity of the clinical course of acute small bowel obstruction and peritonitis. Materials and methods. The research was carried out at the SI «ZIGUS NAMSU» and was based on the analysis of laboratory data of 63 patients with a failure of small intestinal anastomoses who in the future needed one of the options of resections of the segments of the small intestine, which were treated in the clinic from 2016 to 2019. All patients were divided into 3 groups according to the degree of physical severity of the condition on the APACHE II scale. The study was conducted in two stages: the first stage examined the content of zinc, copper and iron ions in the serum of all patients studied, the second stage of the study in patients evaluated the objective indicators of endogenous intoxication on the basis of leukocyte index of intoxication, index of content molecular weight, malonic aldehyde and diene conjugates in serum and iron levels in whole blood, as well as its serum. Results and Discussion. The study of Fe2+, Zn2+, Cu2+ metabolism in the serum of all patients with inflammatory phenomena of the peritoneum on the background of anastomosis failure revealed significant changes. In the clinical group of patients with small bowel anastomosis, the level of zinc upon admission to the hospital was significantly increased. In the second stage, we conducted a study on the detection of an increase in serum iron content, endogenous intoxication and a decrease in transferrin iron saturation depending on the clinical course of the disease in patients with acute intestinal obstruction and peritonitis and the degree of contamination of the small intestine. The results shown in study indicate that in the studied patients, depending on the severity of the disease there is a progressive decrease in the content of iron in whole blood, along with an increase in its serum level against the background of a significant decrease in iron saturation and increase in objective indicators of endogenous intoxication. Conclusions. On the basis of the results of the research, we can conclude that the increase of serum iron content with simultaneous decrease of transferrin iron saturation in the studied patients on the background of intensification of endotoxicosis depending on the severity of the condition, considering it as a factor of increasing the aggressiveness of bacterial resistance and flora correlates with the severity of the clinical course, according to which appropriate adequate additional corrective therapy is performed in complex surgery. treatment of patients with a small bowel anastomosis.