Despite the insigniϐicant prevalence, aneurysms of the splenicartery take a dominant share among all visceral aneurysms with a predominance of morbidity in women of childbearing age. Taking into account the mostly asymptomatic course and the high risk of mortality due to its rupture, timely diagnosis and correct treatment strategy remain extremely important. Questions regarding the choice of surgical treatment tactics for patients with this pathology remain debatable. The aim. Demonstration of a clinical case, improvement of diagnosis andsurgical treatment of patients with splenic artery aneurysms. Clinical case. Female patient G., 32 years old, with complaints of periodic pain in the left hypochondrium, signs of portal hypertension against the background of cavernous transformationof the portal vein, history of recurrent bleeding from the esophageal veins, hypersplenism admitted with a pre-diagnosed aneurysm of the splenic artery of giant dimensions (diameter 8x5 cm). The patient was qualified for open surgery and aneurysm resection with splenectomy and spleen autotransplantation by N. Roth. The postoperative period was complicated by the occurrence of reactive pancreatitis on day 7, which was successfully treated conservatively. In the future, the course was unremarkable. The remote follow-up lasted two years, and no recurrence of the aneurysm was detected. The performed immunogram showed normal results. Conclusion. The timely diagnosis makes it possible to establish the correct diagnosis, justify the treatment tactics and prevent fatal complications. Open surgical intervention in somecases remains the method of choice in the treatment of this pathology. Autotransplantation of the spleen has shown good long-term results and can be performed in patients of this category for the prevention of immunodeficiency states.

The aim — to evaluate the prevalence of postoperative wounds complications in patients after critical limb ischemia surgery and to study its structure and incidence rate depending on the complicated postoperative wound type.Materials and methods. The treatment results of 758 patients with occlusive and stenotic lesions of the aorto­iliac and femoral­popliteal arterial segments of lower extremities supervised in ambulatory were analyzed. 783 reconstructive surgeries were performed in the of Vascular Surgery department for the period from 2014 to 2016. The average age of the examined patients was 66.64 ± 0.65 years. The stages of soft tissue infection were determined according to the Szilagyi’s classification (1972).Results and discussion. Non­infectious postoperative wound complications were 5.4 %, lymphatic 12 (29.3 %) and ischemic 29 (70.7 %). Lymphatic complications manifested in lymphocele and among all postoperative complications was 6.8 %, ischemic — 16.5 %. Infectious postoperative wound complications among all patients was 17.81 %, among all surgical interventions was 17.24 %.Conclusions. The high incidence of postoperative wound complications (23.22 %) operated for critical lower limb ischemia requires improvement and development of new therapeutic and prophylactic techniques for follow­up care of such patients. Infectious complications cause numerous postoperative risks with lengthening of the wound healing duration and impair vascular reconstruction. The high rate of surgical site infection creates preconditions for special attention of vascular surgeons to infectious component in the postoperative wounds care.

Objective. Improvement the surgical management for cavoatrial tumor thrombosis due to renal cell carcinoma. Methods. The results of complex clinical, laboratory, instrumental examination, intraoperative observations and morphological studies were analyzed in 62 patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis, hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period 1993-2019. Surgical treatment included radical nephrectomy, thrombectomy from inferior vena cava and right atrium. Kaplan-Meier method was used to evaluate the long-term survival of patients. Results. The postoperative complications included: posthemorrhagic anemia - 22 (38,6%), acute renal failure - 15 (26,3%), pulmonary embolism - 4 (7,0%), acute liver failure - 3 (5,3%), phlebothrombosis - 3 (5,3%), pneumonia - 3 (5,3%), stroke - 2 (3,5%), wound сomplications - 5 (8,8%) cases. Perioperative mortality was 11,3%. The causes of death included: hemorrhagic shock - 4 (6,5%), pulmonary embolism - 3 (4,8%), stroke - 1 (1,6%) cases. Long-term survival indicators were evaluated among 53 patients. The median follow-up was 36,9±13,3 months. The cumulative 2-, 5-, and 10-year survival rates were 53,5%; 38,2% and 17,2%, in 32 patients without metastases - 58,7%; 43,1% and 18,5% respectively. There was no significant difference іin survival among patients with atrial and retrohepatic venous tumor thrombosis versus infrahepatic and cavarenal venous tumor thrombosis (p>0,05). Conclusion. The accurate preoperative assessment of the level of neoprocess involvement, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications make it possible to provide acceptable survival rates for patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis. What this paper adds The role of intraoperative blood reinfusion in the aspect of oncological safety in patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, was first determined. Based on the results of cytological examination of tumor contamination of blood sediment material from the operating field during the cavatomy and washed autoerythrocytes it has been established that intraoperative reinfusion can provide necessary ablastics and doesn’t pose an additional risk of tumor dissemination during radical nephrectomy and inferior vena cava thrombectomy. The use of combined mini-invasive approaches in the surgical treatment of supradiaphragmatic level of intracaval invasion due to renal cell carcinoma is proposed, which will reduce the volume, trauma and duration of surgery, as well as provide reliable pulmonary embolism prevention. For the first time in Ukraine the immediate and long-term results of surgical treatment of patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, during the last three decades were analyzed.

Ìåòà. Ïîêðàùåííÿ ðåçóëüòàò³â õ³ðóð´³÷íîãî ë³êóâàííÿ ïóõëèííîãî òðîìáîçó íèaeíüî¿ ïîðîaeíèñòî¿ âåíè òà ïðàâîãî ïåðåäñåðäÿ ó õâîðèõ íà íèðêîâî-êë³òèííèé ðàê. Ìàòåð³àë ³ ìåòîäè. Ïðîàíàë³çîâàíî ðåçóëüòàòè êë³-í³÷íîãî îáñòåaeåííÿ, ëàáîðàòîðíèõ ïîêàçíèê³â, ³íñòðóìåíòàëüíèõ, ³íòðàîïåðàö³éíèõ ñïîñòåðåaeåíü òà ìîðôîëî´³÷íèõ äîñë³äaeåíü ó 83 õâîðèõ íà íèðêîâî-êë³òèííèé ðàê, óñêëàäíåíèé ïóõëèííèì âåíîçíèì òðîìáîçîì, ÿê³ ïåðåáóâàëè íà ñòàö³îíàðíîìó ë³êóâàí-í³ ó â³ää³ëåíí³ õ³ðó𴳿 ñóäèí Ëüâ³âñüêî¿ îáëàñíî¿ êë³-í³÷íî¿ ë³êàðí³ çà ïåð³îä ç 1993 ïî 2018 ðîêè. Äëÿ ïî-ð³âíÿëüíîãî àíàë³çó õâîðèõ ïîä³ëåíî íà äâ³ ãðóïè. Äî ïåðøî¿ ãðóïè, îñíîâíî¿, âêëþ÷èëè 61 õâîðîãî íà íèðêîâî-êë³òèííèé ðàê (39 ÷îëîâ³ê³â òà 20 ae³íîê, ñåðåä-í³ì â³êîì 58,1±2,7 ðîê³â; äâîº ä³òåé, â³êîì 5 òà 9 ðî-ê³â), óñêëàäíåíèé ïóõëèííèì òðîìáîçîì íèaeíüî¿ ïî-ðîaeíèñòî¿ âåíè òà ïðàâîãî ïåðåäñåðäÿ. Äî äðóãî¿ ãðóïè, êîíòðîëüíî¿, âêëþ÷èëè 22 õâîðèõ íà íèðêîâî-êë³òèííèé ðàê (19 ÷îëîâ³ê³â òà 3 ae³íîê, ñåðåäí³ì â³êîì 58,3±4,3 ðîêè), ó ÿêèõ ð³âåíü òðîìáîòè÷íî¿ ³íâà糿 áóâ îáìåaeåíèé íèðêîâîþ âåíîþ. Äëÿ îáñòåaeåííÿ õâîðèõ âèêîðèñòîâóâàëè ëàáîðàòîðí³ ìåòîäè äîñë³äaeåííÿ, à òàêîae ³íñòðóìåíòàëüí³: óëüòðàçâóêîâå äîñë³äaeåííÿ, ñï³ðàëüíó êîìï'þòåðíó ÷è ìà´í³òíî-ðåçîíàíñíó òîìî´ðàô³þ ç âíóòð³øíüîâåííèì êîíòðàñòíèì ï³äñèëåííÿì îð´àí³â ÷åðåâíî¿ ïîðîaeíèíè, ãðóäíî¿ êë³òêè, åêñêðåòîðíó óðî´ðàô³þ, Åõî-êàðä³î´ðàô³þ, âåíîêàâà-ðàô³þ çà ïîêàçàííÿìè. Äëÿ îö³íêè êóìóëÿòèâíîãî âèaeèâàííÿ õâîðèõ íà íèðêîâî-êë³òèííèé ðàê, óñêëàäíåíèé ïóõëèííèì âåíîçíèì òðîìáîçîì, âèêîðèñòîâóâàëè ìåòîä Êàïëàíà-Ìåéåðà. Ðåçóëüòàòè é îáãîâîðåííÿ. Îïåðàö³éíå ë³êóâàííÿ âêëþ÷àëî ïðîâåäåííÿ ðàäèêàëüíî¿ íåôðåêòî쳿 â êîì-á³íàö³¿ ç ìåòàòðîìáåêòî쳺þ ç íèaeíüî¿ ïîðîaeíèñ-òî¿ âåíè òà ïðàâîãî ïåðåäñåðäÿ. Çàñòîñóâàííÿ îáëàäíàííÿ "Cell-Saver Plus" äîçâîëèëî ñóòòºâî çìåíøèòè ïîòðåáó â äîíîðñüê³é êðîâ³. Íåçâàaeàþ÷è íà çíà÷íèé îá'ºì ³ òðàâìàòè÷í³ñòü õ³ðóð´³÷íèõ âòðó÷àíü ó õâîðèõ ïåðøî¿ ãðóïè, ðèçèê á³ëüøîñò³ ï³ñëÿîïåðà-ö³éíèõ óñêëàäíåíü íå ïåðåâàaeàâ â îáîõ ãðóïàõ. ³ä-äàëåí³ ðåçóëüòàòè îö³íþâàëè ñåðåä 76 ïàö³ºíò³â íà íèðêîâî-êë³òèííèé ðàê, óñêëàäíåíèé âåíîçíîþ ³íâà-糺þ-ó 55 õâîðèõ ïåðøî¿ òà 21 õâîðîãî äðóãî¿ ãðóï. Ñåðåäí³é ïåð³îä ñïîñòåðåaeåííÿ ñòàíîâèâ 53,2 ì³ñ. Ìåä³àíà âèaeèâàííÿ äëÿ õâîðèõ ïåðøî¿ ãðóïè ñêëàëà

Научная новизна статьиВпервые исследована бактериальная нагрузка ран при применении вакуум-ассистированной терапии у пациентов с сахарным диабетом и хроническими поверхностными ранами стопы с проявлениями легкойThe articles published under CC BY NC-ND license Цель. Определить бактериальную нагрузку ран при использовании вакуум-ассистированной терапии у пациентов с сахарным диабетом и хроническими ранами стопы.Материал и методы. Объектом исследования были пациенты с сахарным диабетом, у которых имелись хронические поверхностные (кожа, подкожная клетчатка) раны стопы с проявлениями легкой инфекции согласно классификации для определения наличия и тяжести инфекции IWGDF/IDSA. Критериями исключения были следующие: онкопатология, тяжелая сопутствующая патология, поражения костно-суставного аппарата. Пациенты лечились амбулаторно и не получали системную антибиотикотерапию. Проводилась терапия ран отрицательным давлением -125 mm Hg в постоянном режиме. Первый этап работы выполнялся для определения уровня бактериальной нагрузки ран до и после 3 суток вакуум-ассистированной терапии (группа из 10 пациентов). Вторая группа (10 пациентов) была отобрана для определения динамики изменений бактериальной нагрузки ран после каждых 24 часов вакуум-ассистированной терапии, наблюдение проводилось на протяжении 96 часов экспозиции повязки. Уровень бактериальной нагрузки контролировали по изменениям показателя колониеобразующих единиц в грамме ткани (КОЕ/г) биопсийного материала из ран.Результаты. Средняя бактериальная нагрузка ран у пациентов первой группы после 3 суток терапии составляла 8,11±1,27 lg КОЕ/г, что на 31,9% превышало исходный уровень (р<0,05). При исследовании материала из ран пациентов второй группы установлено увеличение средней бактериальной нагрузки ран через 24, 48, 72 и 96 часов после начала терапии, на 10,8%, 16,4%, 38,9% и 58,6% соответственно (р<0,05).Заключение. Использование вакуум-ассистированной терапии у пациентов с сахарным диабетом и хроническими ранами стопы с проявлениями инфекции не обеспечивает необходимого контроля уровня бактериальной нагрузки, поэтому метод необходимо применять в комплексе с системной антибиотикотерапией.Ключевые слова: вакуум-ассистированная терапия, диабет, рана, бактериальная нагрузка, инфекция Objective. To determine the bacterial load of wounds at the application of vacuum-assisted therapy for patients with diabetes mellitus and chronic foot ulcers.Methods. The object of the research was patients with diabetes mellitus with chronic superficial (skin, subcutaneous tissues) wounds of the foot with the signs of mild infection according to the classification for determination of presence and severity of infection of IWGDF/IDSA. Oncopathology, heavy concomitant pathology and lesions of the osteoarticular apparatus were the criteria of exception. Patients were treated as out-patients and did not get system antibiotic therapy. Therapy of wounds was conducted by negative pressure -125 mm Hg in the continuous mode. The first stage of work was conducted to find out the level of the bact...