Relevance. Gastroduodenal ulcer bleeding is one of the most complex problems of emergency abdominal surgery. An endoscopic hemostasis is a crucial importance during the treatment of patients with gastroduodenal bleeding. The using of biologically active draining sorbents in combination with local haemostatic drugs is a promising direction in the endoscopic hemostasis.Objective. The aim of the investigation is to improve the results of treatment of patients with acute ulcerative gastroduodenal hemorrhages by application of biologically active draining of sorbent Asepticob-A in combination with platelet-rich plasma for endoscopic hemostasis as an important component of complex therapy.Materials and methods. The study is based on the results of treatment of 112 patients with peptic ulcer bleeding. They were treated in the specialized city centre for the treatment of patients with gastrointestinal bleeding of Voronezh state hospital of emergency medical care №1. During the treatment of patients of the main group (n=57 persons) was used individual complex approach with the using of biologically active draining of sorbent of new generation – Asepticob-A and platelet-rich plasma in endoscopic treatment of bleeding complications of gastroduodenal ulcers. In the comparison group (n=55 persons) was used the well-known traditional methods of endoscopic hemostasis without the use of granular sorbents and platelet-rich plasma.Results and discussion. The effectiveness of treatment of patients with ulcerative gastroduodenal bleeding was assessed according to the criteria of reliability of hemostasis, assessment of dynamics of reparative processes in ulcerous defects, the frequency of recurrence of bleeding on the background of treatment using endoscopic techniques, prevention, emergency operations and mortality rate. The methods of treatment of gastroduodenal bleeding with the combined use of biologically active draining sorbents and platelet-rich plasma for the reliability of endoscopic haemostasis, that was developed and introduced into clinical practice, reduces the number of emergency operations in 2.6 times, mainly due to the reduction of recurrent bleeding and, as a consequence, leads to lower postoperative mortality.Conclusions. The use of biologically active draining of sorbent Asepticob-A and platelet-rich plasma in complex endoscopic treatment of patients with ulcerative gastroduodenal bleeding allows to reduce the frequency of recurrence of bleeding from 10.9% to 3.5% (3.1 times), to reduce the number of emergency surgical interventions at the height of bleeding from 9.1% to 3.5% (2.6 times), to reduce postoperative mortality from 5.45% to 1.75% (3.1 times) and reduce the duration of inpatient treatment from 9.0 to 6.0 days (p<0.05).
Purpose. Research of features of topography of the arcuate line of the rectus sheath. Materials and methods. There were studied 30 corpses of both sexes without signs of pathology of the anterior abdominal wall. During the autopsy of corpses, the muscular aponeurotic layer of the medial section of the anterior abdominal wall with fragments of the pubic bones, breast and costal arches was taken. On the prepared anatomical preparations was determined localization of the arcuate line of the rectus sheath in the midline relatively to the umbilical ring and the upper edge of the pubic symphysis. Results. In this studied autopsy material the arcuate line of the rectus sheath was more located below the umbilical ring (93%), by the way part of the upper third of the segment from the lower edge of the umbilical ring and the upper edge of the pubic symphysis (50%). In females, the arcuate line of the rectus sheath relative to the umbilical ring was located more lower (5,4±0,8 cm), compared to males (3,5±0,7 cm). Conclusion. The obtained data can be used in performing hernioplasty of variously localized hernias for the prevention of intra- incisional and incisional complications.
Актуальность. Гастродуоденальные кровотечения остаются одной из самых актуальных проблем современной неот-ложной хирургии. В лечении больных с желудочно-кишечными кровотечениями целесообразно максимально использоватьвозможность эндоскопического гемостаза. Перспективным, на взгляд авторов, является применение местных гемоста-тических средств и гидрофильных гранулированных сорбентов для эндоскопического лечения гастродуоденальных гемор-рагий.Цель. Улучшить результаты лечения больных с желудочно-кишечными кровотечениями путём оптимизации комплекснойтерапии и способов эндоскопического гемостаза.Материалы и методы. Исследование основано на результатах лечения 107 больных с острыми гастродуоденальнымикровотечениями, находившихся в городском специализированном центре желудочно-кишечных кровотечений БУЗ ВО«ВГКБСМП № 1» г. Воронежа. В основной группе (56 чел.) использовалась разработанная программа лечения, основаннаяна оптимизации комбинированного применения местных и системных гемостатических средств в сочетании с эндоско-пической пневмоинсуффляцией сорбентов. В группе сравнения (51 чел.) лечение проводилось в соответствии с установ-ленными инструкциями, отвечающими утвержденным стандартам оказания помощи больным с гастродуоденальнымикровотечениями.Результаты и их обсуждение. Результаты лечения оценивались по проценту окончательного гемостаза, частоте реци-дивов кровотечения, количеству экстренных оперативных вмешательств, летальных исходов.Выводы. Разработанная оптимизированная программа лечения с применением местных и системных гемостатическихсредств позволяет снизить частоту повторных кровотечений с 11,9% до 7,1% (в 1,7 раза), сократить число экстренныхопераций с 7,8% до 3,6% и уменьшить послеоперационную летальность с 3,9% до 1,8% (в 2 раза).Ключевые слова: язвенные желудочно-кишечные кровотечения, оптимизация лечения, местные и системные гемостати-ческие средства, гранулированные сорбенты, диовин, диотевин, новосэвен, ингибиторы фибринолиза.
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