ФЛЕБОЛОГИЯ: НАСТОЯЩЕЕ И БУДУЩЕЕ Ю.С. Небылицин, А.А. НазарукУО «Витебский государственный ордена Дружбы народов медицинский университет», пр-т Фрунзе, 27, 210023, г. Витебск, Республика БеларусьНа сегодняшний день современная медицина поднялась на недосягаемый ранее уровень. Привычными стали малоинвазивные оперативные вмешательства с ис-пользованием эндоскопической аппаратуры и микрохирургия. В данной статье рас-крываются методы и подходы к лечению патологий вен в современной флебологии. Авторами проанализированы данные по эффективности радиочастотной аблации и эндовенозной лазерной коагуляции, антикоагулянтной и тромболитической терапии, селективному «катетерно-управляемому» тромболизису, чрескожой механической тромбэктомии и сонолизису, имплантации и кава-фильтров и многих других методов.Перспективным в развитии флебологии является предупреждение образования тромбов. Возможно, с этой целью будет применяться фармакологическое генное воз-действие и блокада некоторых патологических генов. При проведении антикоагу-лянтной терапии будут разрабатываться более эффективные и безопасные безинъ-екционные формы препаратов с предсказуемым действием. В лечении проксималь-ных тромбозов более активно будет внедряться агрессивная тактика, включающая эндоваскулярное лечение в сочетании с тромбэктомией. В лечении посттромботиче-ского синдрома перспективным является разработка и эндоваскулярная установка внутривенных клапанов. Важным также является дальнейшее проведение работ для оценки роли эндотелия кровеносных сосудов и использования мезенхимальных стволовых клеток в лечении хронических заболеваний вен. Today, modern medicine has risen to previously inaccessible level. Minimally invasive surgery with using endoscopic equipment and microsurgery became usual. This article describes the methods and approaches to the treatment of pathologies of the veins in modern phlebology. The authors analyzed the effectiveness of RFA and EVLA, anticoagulant and

The article presents data about the history of phlebology development in the period from XV to XX centuries – the key time of the establishment of medicine, the most important discoveries and breakthroughs. In the Middle ages the development of surgery, particularly in Europe, slowed considerably, due to the dominance of the Church and the introduction of various restrictions. However, the stagnation of the Middle ages gave way to the flowering of the Renaissance – a time of rapid development of art, science and technology. Gradually surgery were included in University education, and this marked the beginning of further improvement. XVII-XVIII centuries can be considered the time of completion of the empirical approach in surgery. In this period the development of phlebology has had a huge impact discoveries in physiology, histology, pathological anatomy and clinical medicine. A crucial period in medicine began XIX-XX centuries – asepsis and antisepsis, general and local anaesthesia, techniques of blood transfusion etc. was opened. The development of phlebology in this period was influenced by such scholars as Jerome Fabrizi, Ambroise Paré, Max Schede, Alexei Trojans, Friedrich Trendelenburg, Georg, Perthes, Albert Narath, William Wayne Babcock, Otto Wilhelm Madelung, Emil Theodor Kocher, etc. The article describes their contribution to the history of phlebology.

Objective. To study the implementation of medical recommendations regarding the use of compression therapy in patients with varicose veins of the lower extremities. Methods. A prospective comparative study, Patients Commitment to Compression Therapy (POMP), was conducted with the participation of phlebologist-surgeons who treat patients with chronic venous diseases in Minsk, Vitebsk, and Gomel. During 5 weeks each of the phlebologists included in the study patients with varicose veins who sought advice and needed compression therapy. 30-35 days after the consultation of the surgeon-phlebologist, an outsourcing call center conducted a telephone survey of patients in order to obtain information about the specifics of fulfilling medical recommendations. Results. The registration data base of the study contained individual data on 394 patients with varicose veins (C1-C6) who received recommendations to use compression therapy. After 30-35 days, 302 patients (aged 43, 18-84 (Me, IQR)) were available for telephone survey. There were 58 men (19.2%), 244 women (80.8%). Among them, class C1 was registered in 39 (12.9%), C2 - in 113 (37.4%), C3 - in 122 (40.4%), C4 - in 25 (8.3%), C5 - in 1 (0.3%), C6 - in 2 (0.7%) patients. It was found that 245 (81.5%) of the respondents either already had compression hosiery at the time of the consultation, or purchased it within 30 days. 228 (75.2%) respondents reported compliance with the recommendations. Patients who had already experience with compression therapy and patients with the history of venous thromboembolism showed higher commitment to compression therapy (p<0.001). There were no significant differences in the compliance of patients with different levels of education and professional characteristics. Conclusion. A high commitment of patients to compression therapy was established 1 month after receiving recommendations. To obtain more information about patient compliance, it is necessary to enlarge the follow-up period. What this paper adds In a prospective multicenter study a high commitment (75.2%) to compression therapy for patients with varicose veins was firstly defined 1 month after the recommendations made by a phlebologist to use it.

ИСТОРИЯ РАЗВИТИЯ ФЛЕБОЛОГИИ(Часть I) Ю.С. Небылицин, А.А. НазарукУО «Витебский государственный медицинский университет», пр-т Фрунзе, 27, 210023, г. Витебск, Республика БеларусьСтатья посвящена истории развития патологии венозной системы. Представ-лены важнейшие открытия древности, которые позволяют понять степень развития науки, изучающей венозную патологию на различных этапах истории, в различных древних цивилизациях. Приводится ряд исторических фактов, включающих исто-рию развития как хирургии, так и медицины в целом, в различных цивилизациях Древнего мира, которые были получены при изучении древних, античных медицин-ских трактатов и музейных экспонатов. Дана иллюстрация того, что в каждой от-дельной древней цивилизации способы борьбы с варикозной болезнью вен были аб-солютно уникальными и непохожими на методы, используемые народами других цивилизаций. Безусловно, по истечении времени некоторые взгляды были признаны ошибочными. В частности, длительное время лечение пациентов с венозной патоло-гией ограничивалось оказанием медицинской помощи при варикозном расширении и лечением трофических язв. Однако, с развитием медицины постепенно расширял-ся спектр оперативных вмешательств.Ключевые слова: история, флебология, древние цивилизации, варикозная болезнь, трофические язвы, лечение. _____________________________________________________________________________ HISTORY OF PHLEBOLOGY (Part I) Y.S. Nebylitsyn, A.A. NazarukVitebsk State Medical University, Frunze av., 27, 210023, Vitebsk, Republic of BelarusThe article is devoted to the history of the development of pathology of the venous system. It presents the most important ancient discoveries, which allow to understand the degree of development of science, the study of venous pathology at different stages of history in various ancient civilizations. It also provides a number of historical facts, including the history of development of surgery and medicine in general, in various civilizations of the ancient world, which were obtained in the study of ancient, ancient medical treatises and museum exhibits. Given is the illustration that in each ancient civilization ways of dealing with varicose veins were completely unique and different from methods used by people of other civilizations. Of course, with time, some views were rendered incorrect. In particular, for a long time the treatment of patients with venous pathology was limited to medical assistance for varicose and treatment of venous ulcers. However, the development of medicine has gradually extended the range of surgical interventions.