Search

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62.5 ± 11.2 years. The complex approach was applied in treatment including medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

To present an experience of surgical treatment of hiatal hernia.An experience of more than thousand laparoscopic fundoplications in various modifications has been accumulated in the Clinic of Bashkir State Medical University for the period 2001-2016.An original device for intraoperative measurement of hiatal orifice is described. Hiatal orifice repair was indicated in case of its dimension over 3.5 cm. 310 patients underwent hiatal orifice repair including diaphragmocrurorrhaphy in 189 cases, hiatal orifice replacement by using of mesh implant in 121 cases. Simultaneous interventions were performed in 211 cases due to hiatal hernia combined with other abdominal diseases.Thus, selection of hiatal hernia patients for antireflux surgery should be clearly indicated according to clinical and instrumental data in the context of health care system reforming and widespread use of minimally invasive technologies. Laparoscopic operations for hiatal hernia are preferable and contribute to decrease of morbidity and improvement of outcomes.В клинике Башкирского государственного медицинского университета за 2001-2016 гг. накоплен опыт более тысячи лапароскопических фундопликаций в различных модификациях. Описано оригинальное устройство, позволяющее интраоперационно измерять диаметр пищеводного отверстия. Пластику пищеводного отверстия диафрагмы считали показанной при его расширении более 3,5 см. Диафрагмокрурорафия осуществлена в 189 наблюдениях, в 121 наблюдении выполнено протезирование пищеводного отверстия диафрагмы сетчатым имплантом, всего коррекция пищеводного отверстия произведена в 310 наблюдениях. При сочетании ГПОД с другими заболеваниями органов брюшной полости, требующими хирургической коррекции, в 211 наблюдениях выполнены симультанные вмешательства. Таким образом, в условиях реформирования системы здравоохранения, повсеместного внедрения и совершенствования минимально инвазивных технологий отбор больных на антирефлюксную операцию при ГПОД следует проводить по строгим показаниям, основанным на данных комплексного клинико-инструментального обследования. Лапароскопические операции при лечении больных ГПОД являются операциями выбора, способствуют уменьшению частоты осложнений, улучшению результатов лечения.

167 women were simultaneously operated on gynecological disease and the combined other surgical diseases. Novel methods of laparoscopic surgery, allowing to decrease intra- and postoperative complications were represented. Authors proved the efficacy and necessity of simultaneous operations.

Role ofimmunomodulating perforated atraumatic germicidal plasterin complex treatment of patients with suppurative diseases of soft tissues was analyzed. It is estimated that application ofimmunomodulating perforated atraumatic germicidal plasterallows normalizing of free radical peroxidation processes in the blood, increases tissue antioxidant activity compared with traditional methods of treatment.

Data of 258 patients with gastric polipi is analyzed. Endoscopic polypectomy with further microscopical analysis was performed in 218 patients. The method of preoperative submucosal drug injection is proposed. It allowed to decrease the number of postoperative bleedings and recurrences.

The authors present a clinico-statistical analysis of results of endoscopic polypectomy and dynamic observation of 258 patients with gastric polyps. The aim of the investigation was to determine a true histological diagnosis of gastric polyps using excisional biopsy. An endoscopic investigation has revealed 475 polyps in the stomach of 258 patients. Endoscopic polypectomy by the method of electroexcision and preliminary submucous administration of solutions was used for 218 polyps having the size more than 0.5 cm. Patients with formations located submucously and malignant tumors of the stomach (polypoid cancers included) were not investigated. Metaplastic and dysplastic alterations characteristic of adenomatous polyps were detected by the method of chromoscopy.

Reparative processes in calcaneal tendon after the use of new repair technique were studied in two animal series. In both groups the calcaneal tendon was incised to the half of its width. In control group no further manipulations were performed and in the experimental group the defect was covered with allotransplantate of dura mater (membrane stop). The control group demonstrated less active tendon reaction, whereas the experimental group demonstrated stimulation of reparation with the rapid change of inflammatory stages. The membrane stop serves as a modeling frame for new fibers of the regenerate. The obtained results permit recommending the membrane stop in treatment of hand hygromas for the cover of weak tendon areas.

Bile stones formation prognostification method, based on the chemical analysis of bile of patients with chronic cholecystitis, is developed. The method employs the phenomenon of chemiluminescense of the investigated bile in comparison with the model system. Hence, bile in chronic cholecystitis possess antioxidative qualities, whereas bile in chronic cholecystitis combined with cholelithiasis, is oversaturated with free radicals.

The authors propose a new method of surgical treatment of hiatal hernias by a laparoscopic method. The method was used in the clinic in 29 patients with good long-term results.

Surgical treatment of 298 patients with gastroesophageal reflux disease with both laparotomy and mini-invasive technologies is analyzed. New method of anti-reflux surgeries using synthetic implants is described. Short- and long-term results are analyzed. Advantage of laparoscopic procedures is demonstrated in long-term period. Excellent and good results were achieved at 82.3% patients.

The article presents results of surgical treatment of 48 patients with morbid obesity and concomitant metabolic disorders in the clinic of Faculty Surgery of the Bashkir state medical university. A new means of vertical gastroplasty is described allowing to prevent the early development of reflux-esophagatis and to reduce the number of postoperative complications. Stable reduction of the body mass was obtained in 7 patients with morbid obesity by using the method in the clinical practice.

Morphological changes in the zone of plastic surgery with polypropylene graft were studied in experiment. Results of treatment of 195 patients with ventral hernias were analyzed. Study group consisted of 86 (44.1%) patients who underwent hernioplasty with subaponeurotic localization of the graft. Subaponeurotic hernioplasty was performed in 109 (55.9%) patients (control group). Algorithm of choice of plastic surgery's method in ventral hernia was developed with consideration of localization and size of hernia that permitted to reduce rate of early postoperative complications and to improve long-term results.

Results of surgical treatment of 310 patients with inguinal hernias were analyzed depending on hernioplasty method. Advantages of hernioplasty methods without tissues tension over traditional ones were demonstrated. Indications and contraindications of each method were determined. Algorithm of individual choice of surgery method for inguinal hernias has been developed.

Results of experimental hernioplasty with "Regeneration stimulator" in 38 dogs are presented. Reduction of postoperative period of abdominal wall reparation, stimulation of muscular-aponeurotic regeneration were revealed. Experience of surgical treatment of 49 patients with inguinal hernias is presented where surgical technique combined repair of anterior abdominal wall defect by different methods with intraoperative introduction of "Regeneration stimulator" in the zone of plastic reconstruction. There were no recurrences of hernias in the period from 1 to 3 years that permits to recommend wide use of this method.

The results of differential diagnosis of hemorrhage fever with renal syndrome and acute surgical diseases of abdominal organs in 1250 patients were analyzed. It was revealed that the course of the disease was similar to acute abdomen in 13.2% of them. The combination of fibrogastroduodenoscopy and diagnostic laparoscopy is optimal for differential diagnosis and permits to reveal typical symptoms of hemorrhage fever with renal syndrome.

Minimally invasive technologies were used in treatment of 89 patients with cholelithiasis complicated by mechanical jaundice and purulent cholangitis. Advantages of the two-stage operative treatment of such patients were shown. The first stage is decompression of the bile duct, the second stage is a radical operation either by laparoscopic or minilaparotomic methods. It allows to avoid extensive and traumatic operations and secures better immediate and long-term results of treatment.

Results of treatment of 89 patients with cholelithiasis complicated by obstructive jaundice and purulent cholangitis using the minimally invasive technologies are analyzed. The advantages of two-stages surgical treatment of these patients are demonstrated. The decompression of biliary tract are performed as the first stage, radical operations by laparoscopy or minilaparotomy--as the second stage. This method permits to refuse the large and traumatic operations and to improve significantly the nearest and long-term results of treatment.

An experience with treatment of 210 patients with hiatal hernias is summarized, 162 (77.1%) of them having a concomitant pathology of the abdominal cavity. Most frequently the hiatal hernias were associated with gastroduodenal ulcers (48.6%), chronic cholecystitis (18.1%), ventral hernias (5.7%). A new method of correction of hiatal hernias is described which prevents the development of complications resulting from an extreme narrowing of the hiatus. Good long-term results were obtained in 55.9% of the patients, satisfactory--in 34.3% unsatisfactory in 9.8% of the patients, results of the isolated correction of the hiatus being worse that those obtained after the combined operations. A conclusion is made that well-grounded simultaneous operations for hiatal hernias are followed by perfect medico-social and economic effects.

The problem of surgical management of gastric and duodenal ulcers associated with the hiatal esophageal hernias is reported. The authors have summed up the results of simultaneous surgical treatment of 97 patients. Good follow-up results were obtained in 69.2 percent of the patients, satisfactory in 26.9 percent and unsatisfactory in 3.9 percent of the patients. Of the 28 patients with reflux esophagitis who had previously undergone gastric resection, it was noted that nonresection of the associated hiatal hernia during the primary operation for ulcer disease decreased the effect of surgical treatment. A new method of surgical management of reflux esophagitis of the resected stomach is presented. The authors conclude that simultaneous operation for gastroduodenal ulcers associated with hiatal hernia is a promising area of surgical treatment and ensures high medical, social and economic efficiency.

The results of diagnosis and treatment of diseases of the stomach and intestine associated with diseases of the abdominal organs: hiatal hernia (97 cases), commissural disease of the peritoneum (31), calculous cholecystitis (28), abdominal wall hernia (22) are presented. In 34 patients, 3 and more diseases were revealed. Simultaneous operations were performed in 181 patients. At the long-term period, a good result was noted in 68.6%, a satisfactory one--in 25.5%, and unsatisfactory result--in 5.9%. The substantiated performance of simultaneous operations in patients of the given category is a perspective trend in surgery, it ensures the high medico-social and cost effectiveness of treatment.

The associated hiatal hernia, chronic cholecystitis and duodenal ulcer disease were diagnosed in 12 patients. Combined surgical operations were performed in 9 patients with a good long-term result.

In examination of 100 patients after operations on the abdominal organs, a high incidence of disorders in function of the esophagogastric junction was noted. Their timely diagnosis and rational correction are the urgent problem in the abdominal surgery.