Цель работы — улучшить результаты хирургического лечения больных, оперированных по поводу заболеваний толстой кишки.

Материалы и методы. На основании анализа результатов выполнения 1378 операций по поводу заболеваний толстой кишки авторами установлены факторы риска и разработаны методы профилактики возникновения внутрибрюшных осложнений (интраоперационные повреждения органов брюшной полости и забрюшинного пространства, внутрибрюшное кровотечение, недостаточность швов межкишечного анастомоза, некроз низведенного кишечного трансплантата, послеоперационный перитонит, острая послеоперационная спаечная непроходимость кишечника).

Результаты и обсуждение. В ранний и поздний послеоперационный период внутрибрюшные осложнения, обусловленные выполнением операций на толстой кишке, возникли у 146 (10,6 %) больных. Среди осложнений преобладали физическая несостоятельность швов межкишечных анастомозов — у 32 (2,3 %) больных, в результате которой абсцесс брюшной полости возник у 8 (0,6 %) пациентов, воспалительный инфильтрат — у 19 (1,4 %) и распространенный перитонит — у 19 (1,4 %).

Выводы. Обязательным этапом подготовки к выполнению операций на толстой кишке должно быть целенаправленное прогнозирование послеоперационных внутрибрюшных осложнений, а также планирование и выполнение профилактических мероприятий, адекватных факторам риска возникновения осложнений. Использование разработанных методов прогнозирования развития внутрибрюшных осложнений и профилактических мероприятий при выполнении операций на толстой кишке способствовало уменьшению частоты возникновения осложнений до 5,2 %, послеоперационной летальности — до 0,7 %.

Keywords: прогнозирование, профилактика, факторы риска, внутрибрюшные осложнения, толстая кишка.

The aim – to improve the surgical treatment results in patients, operated for colon diseases.

Materials and methods. On the basis of 1378 operations for colon diseases data authors have developed risk factors stratification and prophylaxis methods for intra-abdominal complications: intraoperative abdominal organs and retroperitoneal damages, intra-abdominal bleeding, interintestinal anastomosis sutures insufficiency, descendent intestinal transplant necrosis, postoperative peritonitis, acute postoperative intestinal impassability.

Results and discussion. In early and late postoperative periods intra-abdominal complications after operations on colon were observed in 146 (10.6 %) patients. Physical interintestinal anastomosis sutures insufficiency was in 32 (2.3 %) patients, followed by abdominal abscess in 8 (0.6 %) patients, inflammatory infiltrate and widespread peritonitis in 19 (1.4 %) cases accordingly.

Conclusions. The necessary stage for colon operations preparation must be purposeful prognostication of postoperative intra-abdominal complications, and also planning and prophylactic measures, adequate to risk factors of their origin. The developed methods of intra-abdominal complications prognostication and prophylactic measures for colon operations were instrumental and allowed to decrease frequency complications to 5.2 %, and postoperative mortality to 0.7 %.

Keywords: prognostication, prophylaxis, risk factors, intra-abdominal complications, colon.

The aim — to reduce postoperative complications by anatomical and functional rectum reconstruction.

Materials and methods. Mathematical modulation of the bolus motor process to study the distal intestine wave contraction mechanism was used. In all 5 patients operative intervention with the anatomic rectal internal surface relief reconstruction by creation of duplication of transversal folds was done after basic stage implementation. After descending healthy part of colon bringing down, in the distance 4–5 cm from internal anal sphincter on lateral and medial surfaces, at the level of levator anus muscle interweaving in the longitudinal muscular layer of rectum, on a 1/3 diameter of bowel lay on, on three from every side, serous-muscular stitch, so that at their tightening two was formed meeting duplication transversal folds of rectum in depth in 1.5 cm. The next stage of reconstructive operative interference consisted in the distance-finding from the overhead edge of internal sphincter to the parietal peritoneum. Exactly at this level, after voiding of area of healthy bowel by similar appearance form the second pair of duplication transversal folds of rectum on a 1/3 diameter of bowel. At the level of symphysis projection, in area of sacral bend form the third pair of duplication transversal folds of rectum thus, that one lip was disposed on an anterio-lateral surface, and other lip is formed on 1 cm above of the first on a posterior – lateral surface.

Results and discussion. It was no postoperative complications in clinical supervision. At late postoperative period investigation the signs of intestinal transit infringements in children were not observed, during the early postoperative period the incontinence phenomena was absent in children.

Conclusions. The offered pelvic rectoplasty method at cologenic constipations in children allows forming natural anatomic neorectum as transversal folds without additional section of bowel wall. Renewal of mucous neorectum anatomic relief is instrumental for the rectal functions inherent maintenance, including reservoir functions.

Keywords: constipations, peristaltic activity, pelvic rectoplasty.

The aim – to improve treatment results in patients with colorectal cancer by decreasing thromboembolic complications (TEC) frequency and anticoagulant and infusion therapies schemes optimisation.

Materials and methods. Research was done for period from 2003 to 2009. In a planned order 204 patients with colorectal cancer were operated: with ascending part cancer –37 (18.1 %), with descending part cancer – 81 (39.7 %), with rectal cancer – 86 (42.2 %). 139 (68.1 %) patients with local disease forms (Т3–Т4) were operated, in 95 (46.6 %) cases extended and combined operative interventions were executed. Men was 107 (52.6 %), women – 97 (47.4 %). Patients older than 60 years were 121 (59.5 %). 90 % of patients had high and very high TEC risk degree. Taking into account an initial patient’s status, dehydration degrees, TEC development risk and prospective operative volume, we used three anticoagulant schemes therapies along with adequate infusion therapy. In 1st group (68 patients) we applied low-molecular heparin (LMWH) – enoxaparin sodium («Klexan» by «Sanofi-Aventis»), in the form of a solution containing 2000 anti-Xa IU (20 mg), in preliminary filled syringes which was entered hypodermically by 1 time a day. In 2nd group (71 patients) we used following anticoagulant therapy scheme: 20 mg enoxaparin sodium hypodermically for 3 h before operation and through 6 h after operation in the first days subsequent of 7–10 days – 40 mg once a day in the morning. In 3rd group we used non fractioned heparin as anticoagulant (NFH): hypodermically entered 5000 IU, not earlier than through 8 h after operation 3 times a day. A therapy course was 7–10 days.

Results and discussion. The greatest quantity of complications during the postoperative period was noted in group with NFH use – 35.3 % versus 17.6 and 11.3 % in 1st and 2nd groups accordingly. The bleeding and pulmonary artery thromboembolic complications depended on a kind of entered anticoagulants and their dose. In cases of anti-platelets therapies combined with enoxaparin sodium in a dose of 20 mg/d in 1 (1.5 %) the postoperative hematoma had developed and in 1 (1.5 %) it was lethal. In enoxaparin in a dose of 40 mg/d group bleeding complications were observed in 3 (4.2 %) cases: in the form of insignificant wound hematomas (1 case) and postoperative wound extended bleeding (in 2 cases). TEC was observed in 1 (1.4 %) case in postoperative shin veins thrombophlebitis form, cured by conservative methods. In NFH group bleeding events in 6 (9.2 %) cases were more often observed. In one patient the internal bleeding followed by repeated operative intervention has developed in the postoperative period. A shin deep veins thrombophlebitis was observed in 2 (3.1 %) cases and in 1 (1.5 %) – massive PATE. NFH and anti-platelets combination has not caused bleeding complications has not worsened therapy currency.

Conclusions. Enoxaparin sodium use as LMWH in comparison with NFH is more an effective remedy of TEC prevention in patients with colorectal cancer. Combined application of enoxaparin sodium with the anti-platelets medications is effective for TEC prevention, not causing thus bleeding events frequency increasing. Inclusion in a complex infusion therapies LMWH in a combination with antiplatelets allows to correct rapidly hypovolemic and hypercoagulative abnormalities, to eliminate microcirculation disorders and to lower pyoinflammatory complications quantity in patients with colorectal cancer.

Keywords: colorectal cancer, thromboembolism prevention, anti-platelets, enoxaparin sodium.

The aim – to improve the varicose disease treatment results by using the worked up individual approach, which is based on clinical data, color duplex angioultrasonography (CDAS) and functional interoperating analyses of recurrence in patients who entered clinic.

Materials and methods. We have analyzed the examination and treatment results in two patients groups: I group consisted of 1124 patients with different forms of the varicose disease (С2–С5) and also 316 patients with reticular varicose and teleangioectasia (С1), II group consisted of 468 patients with recurrence (С2–С5) after surgical treatment performed 3 months – 5 years ago. Examination of the patients included anamnesis, clinical data and CDAS, which made the anatomical picture of primary and secondary varicose.

Results and discussion. The result of the study is the conformation of modern conception about removing only the incompetent segments of the great saphenous vein while performing the operation. Varicose tributaries may be removed from separate incisions or sclerotised. In case of this the ultrasound valuation of pathological venous reflux wide spreading in distal way becomes very important.

Conclusions. CDAS is the basic method of examination of the patients with varicose disease when choosing the strategy and tactic of treatment due to minimizing an operating trauma. Treatment of patients with the different clinical-anatomic forms of varicose disease must be pathogeneticaly grounded. Great (small) saphenous vein resection was performed in 68.95 % patients. It is necessary to leave unchanged segments of veins with functionally capable valves. Crossectomy is the obligatory attribute of operation in patients with reflux on the sapheno-femoral junction (was executed in 69 % operated patients regardless of future operation type). Intervention on perforate veins is needed in the case of presence of reflux and was observed in 92 % patients. Treatment of patients with varicose disease must be complex with using of surgical methods, including innovative technologies and also compression sclerotherapy.

Keywords: varicose disease, great saphenous vein, surgical treatment.

The aim – is surgical treatment technique development of incision ventral hernias (IVH) and umbilical hernias (UH) with cosmetic effect operations preservation by navel forming (NF).

Materials and methods. In the article the results of treatment of the 85 patients with incision ventral and umbilical hernias during 2007–2009 were analysed. In these patients a new method of NF was used. Patients were divided into two groups. 42 patients in first (main) group were operated using the method of navel forming, and 43 patients in second (comparative) – using the classic methods without forming navel. All patients have passed traditional preoperative examination, and when it was necessary – preoperative preparation. Group by age, gender, type of ratio and duration pathology were comparable. UH had 15 (17.6 %) patients, paraumbilical – 6 (7.1 %), postoperative ventral – 64 (75.3 %).

Results and discussion. The main point of new method consists in forming additional cutaneous-subcutaneous rags in the projection of future NF at the time of hernia repairing. After hernioplasty, the cutaneous rags were fixed to aponeurosis following an umbilical pit forming which did not distinguish from natural one. Postoperative course and wound healing in the patients did not distinguish from control group of patients. Restore the natural look of the abdomen with NF does not significantly affect the duration of the operation: in the main group (105.4 ± 4.5) min., under comparison – (98.2 ± 16.3) min. (p > 0.05). The duration of stay in hospital in the main group was on average – (7.1 ± 1.1) days, and in comparative – (6.9 ± 1.2) days (p > 0.05). Post-operative healing wounds and the duration of post-operative patients groups were not reliably (p > 0.05).

Conclusions. Surgical treatment of POVH (postoperative ventral hernias) and navel hernias, using adequate plastic of hernia defect or using the alotransplantant, must provide the preservation of natural form of the ventral, using the preservation or navel forming method. Worked out operations of hernioplasty methods on creating of artificial navel provide the cosmetic effect, simple and available, what causes the reasonability of it’s using in treatment of this kind of hernias.

Keywords: postoperative incisional ventral and umbilical hernias, hernioplasty, navel forming.

The aim – to investigate the severity and type of bacterial contamination of women tissues, which have been got in the course of surgical excision of geleoms, and consequent formation of periimplantar fibrose capsule contracture.

Materials and methods. General clinician, instrumental, ultrasound, mammography, MRI, surgical treatment – excision of geleoms, mammoplastics (endoprosthesis), hystological, bacteriological and statistical.

Results and discussion. 154 patients suffered from complications induced by polyacrylamid gel (PAAG) mammoplastics have been operated on. Bacterial analysis of perigeleom tissues revealed the presence of bacterium in 84 (63.2 %) cases of the obvious absence of septic inflammation along with 100 % presence in those women who demonstrated acute inflammation. Aerobic infection was identified in 79.6 % and 71.4 % cases correspondently. In 27 patients out from 65 women whom textured implants have been successfully implanted after excision of geleoms demonstrated the development of fibrose capsule contracture. All of them demonstrated the presence of bacterial bodies with the prevalence of staphylococcal infection, which was identified two times more frequently in comparison with those women who did not suffered from fibrose capsule contracture. The pronounced fibrose capsule formation along with the mononuclear infiltration was seen in cases of bacterial contamination of tissues.

Conclusions. Bacterial contamination with aerobic bacterii plays an important role in the formation of complications, induced with PAAG, which was administered for contural mammoplastics. The development of fibrose capsule contracture is connected with the presence of staphylococcal bacterial contamination.

Keywords: mammoplastics, polyacrylamid gel, fibrose capsule contracture, bacterial infection.

The aim – to evaluate the patient’s body self-esteem after the trunk cosmetic defects surgical correction.

Materials and methods. Seventy eight patients aged 20 to 72 years (mean age 41.2 ± 1.41 years) have been included into this study. Among them there were 71 females and 7 males. Abdominoplasty combined with liposuction (LS) have been performed in 40 patients, LS of the trunk – in 17 and LS with correction of the musculoaponeurotic layer laxity with umbilical approach – in 21 patients. At the same time 9 females underwent mammary augmentation. Patients completed Multidimensional Body Self-Relations Questionnaire (MBSRQ) one day before surgery, 6 and 12 months after surgery. Statistical analysis was conducted on each of 10 subscales. Overall results were presented as a mean of all subscales. Anthropometric measurements have been performed; information about early postoperative complications and aesthetic defects was also collected.

Results and discussion. Analysis revealed statistically significant improvement of the self-esteem on the Appearance Evaluation, Fitness Evaluation, Body-Areas Satisfaction and Self-Classified Weight Subscales at six-month postoperative visit. The results of Self-Classified Weight subscale correlated with body mass index (BMI). The negative correlation was found between changes of BMI and Appearance Evaluation Subscale results in 47 overweight patients. One year after the operation Fitness Evaluation Subscale results revealed statistically significant improvement of the feelings of physical health. The other subscales did not demonstrate essential changes. Seventy six respondents reported improvement of their self-esteem of the mid torso 6 months after the surgery. Postoperative complications were met at 14.1 % of operated patients. They did not essentially influence the overall self-attitude of the patients to their bodies.

Conclusions. Cosmetic body surgery cardinally improves patient’s self-esteem, first of all, – self-image perception. Small aesthetic defects of the operations and not severe early postoperative complications don’t worsen the self-esteem. Surgical correction of the trunk cosmetic defects creates psycho-emotional and physiological conditions for improvement of physical activity and, in a year term after the operation – health self-evaluation.

Keywords: abdominoplasty, liposuction, complications of the cosmetic surgery, body image self attitude.

The aim – to improve the treatment results in patients with pancreatic pseudocysts by introduction and investigation of possibilities for application of laparoscopic operations.

Materials and methods.We investigated the treatment results in 102 patients with pancreatic pseudocysts, operated from 2005 to 2008. Study group comprised of 9 patients with pancreatic pseudocysts, where laparoscopic interventions were planned, and control group comprised of 93 patients, operated with traditional techniques. Men were 64, women – 38. Middle age of patients has made 43.3 ± 1.2 years (from 21 till 78 years). Among 102 patients pseudocysts were found out in 87 patients, 15 patients were operated for the various reasons before pseudocysts wall formation. In 5 patients laparoscopic cystoenteroanasthamosis with the gut which have been switched off by Roux was executed. For laparoscopic stage 4 ports (1–12 mm, 1–10 mm and 2–5 mm) in standard points were used. In 4 cases operative intervention was done with manual assistance for safe operative intervention at development technique stage. Cystoenteroanasthamosis was formed by device method with a following seam of a residual aperture. Interintestinal anastomosis was formed in all cases by open way through manual assistance port or slightly increasing of anterior abdominal wall cut in port place on laparoscopic stage. In 4 patients anastomosis was done ahead transversal colon after disclosing gastroenteral ligament, in 1 anastomosis patient anastomosis was executed through mesocolon. At 1 patient with spleen hilum cyst and iatrogenic trauma danger the conversion was executed. The basic interventions in patients from control group were cystoenteral and cystopancreatoenteral stoma which have been executed in 59 patients. In 19 patients cyst drainage was done, in 8 patients – with ultrasonography control. Pseudocysts punctures with ultrasonography control was used in 8 patients, in 7 patients endoscopic cystogasrostomy was executed.

Results and discussion. Operation time in the main group lasted from 110 to 280 minutes, in the sub-group of laparoscopic cystoenterostomy – from 210 to 280 minutes. Blood loss in all cases was minimum. Early postoperative complications were found in 3 (3.2 %) patients of the control group. The level of postoperative complications in both groups differs insignificantly. At follow-up from 6 to 18 months we did not observe the recurrence of the disease in both groups with internal drainage procedures.

Conclusions. Methods of laparoscopic operations in patients with pancreatic pseudocysts are effective and their usage is justified. Relative contraindications for the laparoscopic operation could be the presence of the adhesions in upper abdominal region, and atypical location pseudocysts (retropancreatic or in the spleen hilum).

Keywords: pancreatic pseudocysts, cystoenterostomy, laparoscopy.

The aim – to determine causes of delayed graft function in kidney transplant recipients.

Materials and methods. The retrospective analysis of donor’s, recipient’s and transplantation’s variables influence on the 1st posttransplant week course was conducted on the data from cadaver kidney recipients transplanted in our centre between 1998 and 2008 years. During this period, several protocols of immunosuppression (IS) were used: group 1 (cyclosporine A (CsA) + steroids (S) + azathioprine); group 2 (CsA + S + mycophenolate mofetyl (MMF)); group 3 (CsA + S + MMF + monoclonal antibodies to interleukin-2 receptor, as induction therapy).

Results and discussion. Delayed graft function frequency did not change significantly from gr.1 to gr.2 and gr.3: 28.9 % vs. 18.2 % vs. 21.4 %. However, biopsy-proven acute rejection frequency during first week was dramatically changed: 56.6 % vs. 36.4 % vs. 9.5 %. Similarly with IS changes, the use of kidneys from non-heart-beating donors (NHBD) (100 % vs. 42 % vs. 13.8 %) were reduced. Nevertheless, frequency of stroke as a cause of donor death (11.5 % vs. 11.1 % vs. 37.2 %), duration of pretransplant dialysis (12 (8—21) vs. 23 (12—33) vs. 27 (10—46) months) were increased.

Conclusions. In spite of reducing acute rejection frequency due to IS strengthening; minimization of NHBD use, the frequency of delayed graft function remains constant. This can be explained by increasing influence of such antigen-independent factors, as stroke as a cause of donor death and duration of dialysis treatment.

Keywords: kidney transplantation, delayed graft function, acute rejection, immunosuppressive regimens, donor’s and recipient’s state.

The aim – to determine preferential localization and incidence frequency of intramuscular hematomas in the patients with hemophilia A and B.

Materials and methods. 76 patients with hemophilia and muscles bleeding in Surgical Hematology and Hemostasiology Department were subjected to examination within the period from 2006 to 2008. 65 patients from them were with hemophilia A and 11 persons with hemophilia B. We used clinical, laboratory study methods of hemostasis system and beam methods of examination (ultrasound, computer tomography, MRI). The patient’s age was from 15 to 60 years. The most severe disease form was diagnosed in 44 (67.7 %) patients with hemophilia A and intramuscular bleeding manifestation, 14 (21.5 %) from them had moderate degree of severity and 7 (10.8 %) represented a mild case; in 7 (63.6 %) patients with hemophilia B was diagnosed a severe disease form and in 4 (36.4 %) patients – mild case.

Results and discussion. Following localization of intramuscular hematomas was identified in patients with hemophilia A: with severe disease form – in 48 cases (37.1 %) – adductors and quadriceps thigh muscles, in 23 cases (17.7 %) – forearm flexors, in 13 cases (9.7 %) – gluteus, in 11 cases (8.1 %) – triceps calf muscle, in 11 cases (8.1 %) – head and neck muscles, in 8 cases (6.4 %) – iliopsoas muscle, in 8 cases (6.4 %) – dorsal muscles, in 6 cases (4.8 %) – biceps arm muscles, in 2 cases (1.6 %) – greater pectoral muscle; with moderate severity: in 13 cases (57.2 %) – adductors and quadriceps thigh muscles, in 3 cases (14.3 %) – triceps calf muscle, in 3 cases (14.3 %) – dorsal muscles, in 2 cases (7.1 %) – iliopsoas muscle, in 2 cases (7.1 %) – head and neck muscles; with light severity: in 3 cases (30 %) – triceps calf muscle, in 3 cases (30 %) – gluteus, in 2 cases (20 %) – adductors and quadriceps thigh muscles, in 1 case (10 %) – iliopsoas muscle, in 1 case (10 %) – dorsal muscles. Results of examination of patients with hemophilia B: with severe disease form: in 6 cases (27.3 %) – forearm flexors, in 5 cases (22.8 %) – adductors and quadriceps thigh muscles, in 5 cases (22.8 %) – iliopsoas muscle, in 3 cases (13.6 %) – gluteus, in 1 case (4.5 %) – triceps calf muscle, in 1 case (4.5 %) – biceps arm muscles and in 1 case (4.5 %) — head and neck muscles; with light severity – single cases of bleeding into triceps calf muscle, thigh abductor muscle, forearm flexor and dorsal muscles. According to our data 1.66 intramuscular hemorrhages were stated on the average per year per patient with severe hemophilia A form, with moderate severity – 1.39, with light severity – 1.08; with severe hemophilia B form – on the aveage per patient – 1.81 intramuscular hematomas, and with light severity – 1.0. We drawn attention to the fact that within the period of study the same patients several times were admitted to the hospital with intramuscular hematomas in different groups of muscles.

Conclusions. Most frequent intramuscular hemorrhages were observed in the patients with severe form of hemophilia in following groups of muscles: medial and anterior groups of thigh muscles, posterior groups of shin muscles, anterior groups of forearm muscles and iliopsoas muscles. 1.66 intramuscular hemorrhages were stated on the average per year per patient with severe hemophilia A form, with moderate severity – 1.39, with light severity – 1.08; 1.81 intramuscular hematomas were stated with severe hemophilia B form per patient on the average, and with light severity – 1.0. The frequency of incidence of intramuscular hematomas in the patients with hemophilia changes depending on the factor VIII or IX deficiency level.

Keywords: hemorrhage, hemophilia, intramuscular hematoma.

The aim – to research collateral arteries of lower extremities in patients with chronic occlusive diseases.

Materials and methods. We examined 56 cut off lower extremities (macro- and microscopic status of main arteries and its branches).

Results and discussions. Patients with diabetes and hypertension had long arteriosclerotic stenosis and occlusions of main arteries (walls – uniform thick and dense, channel – blocked). External diameter was 3–4 mm, internal – less than 1 mm. Branches had alterations 2–5 sm from branching place. There was occluded of 70–90 % of channel. Patients without diabetes and hypertension had local alterations of main arteries. Main legs arteries were narrowed on 30–90 %. Length of occlusive part was – 1–7 sm. Branches had alterations only 1–2 mm from branching place. Collaterals arteries were soft, elastic, without stenosis and occlusions By microscopic patients with diabetes and hypertension had thicken of all walls layers, intimae hyperplasia, circular occlusion of channel, fibrosis of adventitia in main legs arteries. Alterations in branches were similar. Patients without diabetes and hypertension had atherosclerosis of main legs arteries. Branches were fewer alterations: walls were thickening due to moderate growth of connective tissue, in branching place – small fibrosis alterations. Channel was not occluded. Patients with diabetes had vessels walls fibrosis and occlusive channel in legs muscles arteries.

Conclusions. Sclerotic alterations and collaterals arteries occlusion in lower extremities appeared later and less intensive, than in main arteries (maximum – 1–2 mm from branching place) in patients with chronic ischemia. Peculiarity of diabetics and hypertensions collaterals alteration was long stenosis and branches occlusion.

Keywords: lower extremities’ arteries, chronics occlusive disease, collateral arteries.

The aim – the operative treatment results analysis in patients with closed diaphyseal shin bones fractures by traditional and small invasive ostheosynthesis

Materials and methods. The operative treatment results analysis of 161 patients with 165 closed shin bones diaphyseal fractures was carried out. The patient’s mean age was 36.6 years, men were – 121 (75.15 %), women – 40 (24.85 %). There were 42А1 – 20 cases, 42А2 – 17, 42А3 – 21, 42В1 – 24, 42В2 – 32, 42В3 – 12, 42С1 – 14, 42С2 – 18, 42С3 – 7 closed tibial fractures according to АО/ASIF classification. The definitive fixation methods for tibial fractures were used: plates in 139 (84.25 %) cases, 8 of which were carried out small invasive plate ostheosynthesis; locking intramedullary nails in 19 (11.5 %), external fixators in 7 (4.25 %).

Results and discussions. The estimation of treatment results lasted from 6 months to 5 years after operative treatment. The mean term of fracture healing after traditional ostheosynthesis was 4.4 months, while after minimal invasive plate ostheosynthesis and intramedullary nails – 3.5 months, after external fixators — 5.5 months.

Conclusions. The use of small invasive methods of extra- and intramedullary ostheosynthesis in the treatment of shin bones diaphyseal fractures allows saving maximally vascularisation of bone in the fracture site, as follows in reduction of term of uncomplicated consolidation in 20.4 % and 36.4 % in comparison with traditional ostheosynthesis and external fixation accordingly. There were 6.5 % of early complications and 4.3 % delayed complications in use of traditional osteosynthesis by plates and external fixators, while there were no complications in use of small invasive ostheosynthesis, minimal traumatizing of tissues.

Keywords: shin bones diaphyseal fractures, traditional osteosynthesis, small invasive ostheosynthesis.

One of most significant venous thromboembolism risk factors is surgical intervention, especially orthopaedic operations, operations on main veins or extended general surgical operations. In the article a short international randomized studies review concerning of efficiency and safety correlation for direct Ха factor inhibitor, rivaroxaban, application, in surgical patients for the of thromboembolic complications prophylaxis. Rivaroxaban is a promising alternative to the traditional anticoagulants for prevention and treatment of venous thromboembolic disease treatment in surgical patients' not only orthopaedic type and can be appointed in a stable dose without permanent control of hemopexis indexes.

Keywords: venous thromboembolic disease, Ха factor inhibitor, rivaroxaban, surgical treatment.

Epidemiology, diagnostics and various methods treatment efficiency for lower extremities superficial veins thrombosis, the disease relapses and thromboembolism prevention were given in literatures review.

Keywords: lower extremities superficial veins thrombosis, epidemiology, diagnostics, treatment.

In this work is represented world literature analysis data concerning radical surgical treatment in patients with solid benign liver lesions using laparoscopic technologies, there are represented advantages and lacks of this method, there are formulated basic indications to implementation of laparoscopic liver resection at solid benign lesions. There are evaluated various accesses at its implementation, there are represented some technical aspects of implementation of this operation, hemo- and bile stasis, possible complications of operation and methods of its prophylaxis.

Keywords: solid benign liver lesions, laparoscopic liver resection.