результати лікування 356 пацієнтів з гострим асептичним некротичним панкреатитом віком від 21 до 82 років. Встановлено, що найчастішим ускладненням гострого асептичного некротичного панкреатиту є парапанкреатичний інфільтрат, який виявлений практично у всіх хворих. Доведено, що диференційований підхід до показань, термінів виконання, вибору способу і об'єму хірургічного втручання при гострому асептичному некротичному панкреатиті дозволив знизити післяопераційну летальність до 3,9%. При гострих асептичних парапанкреатичних рідинних скупченнях летальність становила 2,9%: при ГАРС-СС-1,3%, при ГАРС-ЗК-8,2%. У цілому при гострих асептичних парапанкреатичних рідинних скупченнях у 91,7% пацієнтів вдалося уникнути розвитку гнійних ускладнень. Ключові слова: гострий асептичний некротичний панкреатит, хірургічна тактика.

No abstract

Техника «LOZENGE» при одноэтапной реконструкции молочной железы

The article presents current literature data of domestic and foreign authors on the main problems of endoscopic diagnostics and complex approach to treatment of gallstone disease complicated by pathology of the extrahepatic biliary tract. Efficiency of one-stage and two-stage methods of surgical treatment of cholelithiasis and the possibility of their practical application are considered. Complex approach for minimally invasive bile duct interventions with cholecystoccholedocholitiase, which can be conditionally divided into laparoscopic, mini-access, endoscopic by duodenoscope, cholangioscopy, ultrasound-controlled biliary intervention, is analyzed. Methods of diagnostic testing that can be divided into preoperative and intraoperative, non-invasive and invasive used in patients with cholecystoccholedocholitiase, namely fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, percutaneous-transhepatic cholangiography, diagnostic laparoscopy, intraoperative cholangiography, intraoperative ultrasound, angiography. New concepts of providing surgical care to patients with this pathology are presented, which include one-stage performance of cholecystectomy with priority use of intraoperative antegrade endoscopic papillosphincterotomy, and retrograde litho-extraction under duodenoscope control, in comparison with the two-stage tactics of correction of cholelithiasis with pathology of extrahepatic biliary tract, when the first stage includes its decompression, rehabilitation, and the second — cholecystectomy. Statistical data of complications arising during diagnostic and therapeutic manipulations in patients with cholelithiasis complicated by pathology of the extrahepatic biliary tract are presented. Number of cases of postoperative mortality depending on the severity of complications of cholelithiasis is also considered.

The aim: Is to determine the main causes of adverse outcomes of the patients’ treatment with acute ulcerative gastroduodenal bleeding and to develop preventive measures to improve the quality of the patients’ treatment with this pathology. Materials and methods: A retrospective analysis of the treatment results of 1323 patients with bleeding of ulcerative etiology has been carried out. There are 375 patients with gastric ulcer (28.3%) and 948 patients (71.7%) with duodenal ulcer among them. The patients’ age ranged from 15 to 93 years old. Concomitant pathology was observed in 623 (47.1%) patients, the most common of which were coronary heart disease, chronic non-specific lung diseases and cerebrovascular diseases. Mild severity of blood loss was detected in 404 (30.5%) patients, moderate severity 693 (52.5%), severe 145 (10.9%) and extremely severe 81 (6.1%). Overall mortality was 5.9%, postoperative mortality 6.3%, the mortality in conservative treatment only 6.1%. Results: The main cause of the patients’ mortality with acute ulcerative gastroduodenal bleeding was decompensated hemorrhagic shock which developed at the prehospital stage in 45.3% and as a result of bleeding recurrence during treatment 44.2% of the patients. Inadequate drug therapy increases the risk of bleeding recurrence from 15.8 to 32.7%. The use of proton pump blockers and the combination of bolus and prolonged use of proton pump blockers allow to reduce the risk of bleeding recurrence by half (up to 6.8%). Conclusions: Endoscopic hemostasis in combination with the injection method with diathermocoagulation or thermal coagulation can be considered as full-fledged, and when performing endoscopic monitoring the preference should be given to coagulation methods of diathermo- and hydrodietermocoagulation.