No abstract

Morbid obesity is a distinct disorder which leads to metabolic disorders and to the development of many severe chronic diseases, therefore, the effective treatment of the disorder is an urgent problem of modern medicine. Currently, morbid obesity and the corresponding disorders are a growing problem associated with a significant risk of morbidity and mortality. The study was aimed to assess the morphological and functional changes in the stomach wall after gastroplication performed by the new method worked out in the Clinic of the Department of Surgical Diseases and New Technologies of the Bashkir State Medical University. Gastroplication was performed in 15 male rabbits of the Gray Giant breed aged 12–16 months weighting 3050–5380 g. The animals were withdrawn from the experiment 3, 6 and 12 months after surgery, followed by histological examination of the stomach wall plicated section. Changes in the mucous membrane and the muscle layer of the stomach wall after gastroplication were adaptive and associated with no severe morphological impairment. That made it possible to use the method in clinical practice in 15 patients with morbid obesity, 9 women and 6 men aged 42 ± 2.1. In most patients (13 people, 86.7%), a steady decrease in the body weight was achieved during the first 2–12 months. Long-term treatment results had been tracked during two years. It has been confirmed, that the new laparoscopic gastroplication technique does not lead to pathological changes in the stomach wall plicated section, therefore, the simple and cost-effective method may be used in clinical practice for treatment of patients with morbid obesity.

Morbidnoye ozhireniye - samostoyatel'noye zabolevaniye, vedushcheye k metabolicheskim narusheniyam i razvitiyu mnogikh khronicheskikh zabolevaniy, yego effektivnoye lecheniye yavlyayetsya aktual'noy problemoy sovremennoy meditsiny. Na segodnyashniy den' morbidnoye ozhireniye i svyazannyye s nim zabolevaniya vklyuchayut vse vozrastnyye problemy, svyazannyye so znachitel'nym riskom zabolevayemosti i smertnosti. Tsel'yu issledovaniya bylo izuchit' morfofunktsional'nyye izmeneniya v stenke zheludka posle vypolneniya gastroplikatsii v novom variante, razrabotannom na baze kafedry khirurgicheskikh bolezney i novykh tekhnologiy Bashkirskogo gosudarstvennogo meditsinskogo universiteta. Gastroplikatsiyu vypolnili 15 krolikam-samtsam porody «Seryy velikan» v vozraste 12–16 mesyatsev, vesivshim 3050–5380 g. Zhivotnykh vyvodili iz eksperimenta cherez 3, 6 i 12 mesyatsev s posleduyushchim gistologicheskim izucheniyem stenki plikirovannogo uchastka zheludka. Izmeneniya, proiskhodyashchiye v slizistoy obolochke i myshechnom sloye zheludka posle gastroplikatsii, nosili adaptivnyy kharakter i ne soprovozhdalis' ser'yeznymi morfologicheskimi narusheniyami. Eto mozhet byt' klinicheskaya praktika u 15 patsiyentov s morbidnym ozhireniyem, 9 zhenshchin i 6 muzhchin v vozraste 42 ± 2,1 let. V techeniye pervykh 2–12 mesyatsev udalos' dostich' stoykogo snizheniya massy tela v techeniye pervykh 2–12 mesyatsev. Otdalennyye rezul'taty lecheniya otslezhivali v techeniye dvukh let. Bylo ustanovleno, chto razrabotannaya metodika laparoskopicheskoy gastroplikatsii ne vyzyvayet patologicheskikh izmeneniy stenki zheludka v plikirovannoy yeye chasti, poetomu yeye mozhno primenyat' v klinicheskoy praktike lecheniya s morbidnym ozhireniyem kak tekhnicheski prostuyu i ekonomicheski effektivnuyu.

Значимость измерения пищеводного отверстия диафрагмы для выбора метода его коррекции в.С. занЕГа*, о.в. ГалИмов, а.м. авзалЕтдИнов, р.а. зИанГИров, в.о. Ханов ГБоу вПо «Башкирский государственный медицинский университет» минздрава россии, уфа, россия Грыжи пищеводного отверстия диафрагмы (ГПОД) встречаются в гастроэнтерологии достаточно часто. Пациенты с ГПОД обращаются, как правило, с жалобой на изжогу. Причиной ее появления в 70% случаев служит рефлюкс-эзофагит. Основными методами диагностики ГПОД являются фиброгастродуоденоскопия (ФГДС), рентгеноконтрастное исследование пищевода. также стоит отметить тракционную рентгенбаллонографию, для измерения размеров пищеводного отверстия диафрагмы (ПОД). Пациенты, прооперированные по поводу ГПОД, все чаще обращаются с жалобами на рецидив данного заболевания. В исследовании участвовали 497 пациентов, оперированных в Клинике башкирского государственного медицинского университета (КбГМу) в период с 2011 по 2015 г. по методике Nissen в различных модификациях. у пациентов, оперированных в 2011-2013 гг., не измеряли ПОД, а у пациентов, оперированных в 2014 и 2015 гг., проводилось измерение ПОД. В первом случае рецидивы данного заболевания были отмечены у 38 (13,5%) пациентов, а во втором случае рецидивы возникали заметно реже и отмечались у 15 (7%) оперированных пациентов. В настоящее время единой классификации ГПОД не существует. Нами предложена рабочая классификация ГПОД, основанная на размерах ПОД. Ключевые слова: классификация гПоД, измерение ПоД, рецидив гПоД в послеоперационном периоде. Role of hiatus size measurement for choice of surgical correction option v.S zanEGa, o.v. GalImov, a.m. avzalEtdInov, r.a. zIanGIrov, v.o. Khanov Bashkir State medical university, ministry of health of russian Federation, ufa, russia Patients with hiatal hernia (HH) occur in gastroenterology often enough. They approach, as a rule, with complaint of heartburn. The reason for its occurrence in 70 % of cases is reflux-esophagitis. The main diagnostic methods with HH are fibrogastroduodenoscopy (EGD) , esophageal radiopaque diagnostic. Also worth noting is that traction radioballonografy to measure the size of hiatal. Patients operated on for HH , increasingly complain about the relapse of the disease. In the research were involved 497 patients operated on in the Clinic of the Bashkir State Medical University (CBSMU) in the period from 2011 to 2015, according to Nissen procedure in various modifications. Patients operated during the period 2011-2013, has not been measured the hiatus, and patients operated on in 2014, 2015 were measured the hiatus. Relapses of the disease after surgical correction , were mentioned in the period 2011-2013 in 38 (13.5 %) patients, and in the period 2014-2015 these results have fallen considerably and were seen in 15 (7 %) of the operated patients. Currently, a single classification HH does not exist. We have proposed a working classification of HH based on the size of hiatus.

To determine the factors that ensure successful and complete implementation of the proposed simulation and tasks, a “boxed” simulator was taken to work out bimanual manipulations and work skills with a needle-holder and Lapsim simulator. A computer simulator allows with a high level of reliability to work out the stages of surgical interventions, use anatomical situations of various levels of complexity, work out orientation skill in two -dimensional space, master the use of a video camera, and getting used to the “lever effect”. Two training groups (16–18 students) performed the proposed simulation exercises and tasks within 2 weeks. For the current academic year, 38 groups passed this course. In general, the successful and complete implementation of the proposed simulation and tasks was carried out mainly by those students who were motivated to study this subject, that is, who chose professional specialization related to surgery.