The aim – to compare effectiveness of nitroimidazolum group drugs for combined nonhospital intraabdominal infection therapy and adverse reactions rate.
Materials and methods. The research was performed from 2007 till 2010 years. 98 patients 76 (77.6 %) female and 22 (22.4 %) male at age from 38 to 67 years were studied. 61 (63.5 %) patients had acute cholecystitis complicated with perivesical infiltrate, 37 (36.5 %) patients had intestinal obstruction of non-cancer etiology (adhesive, strangulated). Appropriate surgical procedures were performed to all the patients: laparoscopic cholecystectomy in 54 (88.5 %), opened cholecystectomy in 7 (21.5 %), viscerolysis for acute adhesive obstruction – in 27 (72.9 %), partial colon resection with anastomosis – in 8 (21.6 %), mesosigmoplication by Gagen–Thorn for dolichosigma volvulus – in 2 (5.5 %). Patients were divided into two groups. Patients in the first group received ceftriaxone 2 g i/m twice a day, 5 days and metronidazole 500 mg i/v 4 times a day during 5 days. Patients of the second group received ceftriaxone 2 g i/m twice a day during 5 days and ornidazole (Meratin, by Mili Healthcare Ltd.) 500 mg i/v twice a day during 5 days. Also they received standard infusion, detoxic and symptomatic treatment. Groups were representative.
Results and discussion. In both of the groups patients had good clinical and laboratory tests treatment results. There were no cases of peritonitis progressing. There were three cases of wound infection in two groups. General and local inflammatory reaction were arrested on (2.87 ± 0.11) days from the therapy onset. Postoperative wound infection (subcutaneous seroma 7 ml volume) was revealed in 3 patients (in 2 from 1st and in one from 2d group; р = 0.26).
Conclusions. Used combination of III generation cephalosporin and nitroimidazole group drugs is an effective method for combined therapy of nonhospital intraabdominals infection. Convenient mode of injections (twice a day) with low frequency of adverse reactions makes the priority of ornidazole in this combination.

Keywords: intraabdominal infections, antibiotic therapy, ornidazole.

In order to improve results of surgical treatment of patients with ventral hernias and related obesity in 33 patients during the surgery we used an original technique of surgical wound draping, which includes diaper fixation with two layers of subcutaneous kapron nodules sutures (after dissection of skin and subcutaneous tissue to the aponeurosis). Additionally we placed a large sterile gauze pad between the cavity of the wound and skin with subcutaneous fat, which goes beyond the edges of the wound, with subsequent fixation of diapers and gauze in the corners of the wound. This provides a more complete isolation the wound and facilitates the possibility of contaminated material replacing. The proposed methodology helped reduce the incidence of wound complications in the postoperative period, is convenient for use and affordable.

Keywords: prevention of postoperative complications, wound complications, ventral hernia, obesity.

The aim – to analyze different diagnostic and treatment regimens efficacy in subjects with juxtapapillary (JP) and postbulbar (PB) duodenal ulcers.
Materials and methods. The diagnostic and treatment results of 66 patients with JP and PB duodenal ulcers complicated by bleeding were analyzed. Patients were assigned to one of two groups: the control group consisted of 29 (43.9 %) subjects whereas the study group included 37 (56.1 %) subjects. In control group, a two-step diagnostic algorithm has been employed: the first step was the primary urgent esophagogastroduodenoscopy (EGD) using butt-end optics; the second step included colonoscopy with repeat EGD using butt-end optics. The test group investigation included an additional third step (three-step diagnostic algorithm) employing relaxation duodenography and EGD with splayed and lateral optics if indicated.
Results and discussion. The three-step diagnostic and treatment algorithm was more sensitive in detection of PB duodenal ulcers (97.3 %). Total sensitiveness of two-step diagnostic algorithm was 69.0 %, that is significantly less than in test group (p = 0.001). The frequency of relapse in patients with PB duodenal ulcers after the drug-promoted hemostasis (40.0 %) was significantly higher (c2 = 3.5; p = 0.05) than in patients after the endoscopic hemostasis (15.7 %).
Conclusions. Routine EGD using butt-end optics demonstrated a low sensitivity in detection of PB duodenal ulcers. An additional employment of relaxation duodenography and repeat target EGD with splayed and lateral significantly improve the method sensitiveness up to 97.3 % (p = 0.001). The frequency of relapse in patients with PB duodenal ulcers after the drug-promoted hemostasis is significantly higher than in patients after the endoscopic hemostasis (p = 0.05).

Keywords: duodenal ulcer, postbulbar ulcer, juxtapapillary ulcer, endoscopic diagnostic, bleeding ulcers, diagnostic and treatment algorithm.

The aim – to estimate the combined antibacterial therapy efficacy in victims with traumatic illness and open or closed abdominal traumas.
Materials and methods. In traumatic shock unit of clinic in the period from January, 2005 till September, 2011 90 patients with traumatic illness were operated, from them 25 (27.8 %) were with the isolated closed abdominal trauma, 36 (40.0 %) – with open trauma (cut-stab wounds), 29 (32.2 %) – with combined thorax-abdominal trauma. Age of victims was from 19 till 65 years (middle age – (54.1 ± 17.7) years). 47 (52.2 %) patients for treatment and infectious complications prevention received a cefepime and amikacinum (Potentox by Venus Remedies Ltd., India) combination, others – standard intensive and antibacterial therapy.
Results and discussion. Operative treatment was made in all cases. After cefepime and amikacinum combination use the procalcitonin level has dropped in 1.3 times, and proportion neutrophils/lymphocytes – in 1.2 times in comparison by similar indexes in group of the patients receiving standard antibacterial therapy.
Conclusions. Cefepime and amikacinum combination application has shown high (80.8 %) efficacy in victims with traumatic illness at the open and closed abdominal traumas treatment. Cefepime and amikacinum are possible to be recommending in combination for complex intensive care in such patients.

Keywords: the traumatic illness, combined antibacterial therapy.

The aim – direct and remote results improvement of surgical treatment in patients with acute appendicitis, by surgical treatment technology upgrading.
Materials and methods. The surgical treatment results from 2006 till 200 in patients with destructive appendicitis forms were analyzed. In control group (112 patients) we performed standard surgical treatment (appendectomy with abdominal cavity drainage); in patients from study group together with standard treatment the probiotic with the Bacillus clausii spores suspension was prescribed.
Results and discussion. The dysbiosis in control group patients revealed in 50.8 % cases and in 9.5 % in study group after antibiotic therapy course. The probiotic therapy with Bacillus clausii spores suspension promotes accelerated colon motor-evacuation function restoration: colon peristaltic restoration period in study group patients was (24.1 ± 0.9) h, in control group- (63.2 ± 1.3)h, self-maintained defecation occurred in (37.2 ± 1.7) h in study group versus (78.6 ± 1.5) h in control group.
Conclusions. For acute appendicitis phlegmonous form complicated by serous-fibrinous peritonitis the antibiotic therapy should be conducted with cefepime and clindamycin, for gangrenous form – moxifloxacine. Combination of antibiotic therapy and probiotic therapy provides pathogenic microorganisms’ elimination and yeast-like Candida fungi from the intestines and provides early intestinal motor-evacuation function restoration in the postoperative period. Drainage of the pelvic cavity by modified method for appendicular peritonitis treatment is advocated.

Keywords: acute appendicitis, drainage of the pelvic cavity, probiotic, dysbiotic intestinal disorders, antibacterial therapy.

The aim – to increase lung resections efficiency in patients with tuberculosis on the basis of new post-resection hemithorax correction variants development.
Materials and methods. In the thoracic department, in a period from 2001 to 2010 134 patients were operated using single-stage lung resection with correcting interventions. The simultaneous thoracoplasty was used in 42 patients; pneumoperitoneum in 32 and 60 patients were operated by our developed method with pleurocollagenoplasty.
Results and discussion. Pleurocollagenoplasty application as a correcting post-resection hemithorax’s method allows reducing the level of postoperative complications in 14.6 times, fully removing remaining cavities, pleural empyema with bronchopleural fistulas, to decrease operation duration and hemorrhage volume in 1.4 time, middle hospital stay – in 1.7 time in comparison with correction of hemithorax by the thoracoplasty. In spite of biocollagen filling retraction on 31.3 % during one year after an operation, the correcting effect of pleurocollagenoplasty exceeds thoracoplasty in 1.2 times. The collagen used for biofilling is the stimulator of cellular proliferation and fibrillogenesis which being the basis of connecting tissue maturing.
Conclusions. The optimal method of post-resection hemithorax correction at the proximal lung resections is the pleurocollagenoplasty with the collagens plates biosealing that can reduce operation duration in 1.4 times, the number of postoperative complications in 1.4 times and can increase the clinic efficiency at 25.5 % in comparison with the thoracoplasty hemithorax correction. The collagen seal formation ends on 2 postoperative months that safely fixes lung in new position.

Keywords: lung resection, hemithorax correction, thoracoplasty, pleurocollagenoplasty, biofilling.

The aim – to study the offered recurrent inguinal hernia surgical treatment efficiency in elder and senile age patients
Materials and methods. The results of surgical treatment in 35 elderly and senile age patients from 2005 to 2011 with a recurrent inguinal hernia were analyzed. All patients were men aged from 61 to 85 years, mean age – 75.9 years. Study group included 19 (54.29 %) patients who underwent surgical hernioplasty with bioimplants Tutoplast by our proposed method. In the comparison group 16 (45.71 %) patients were included, which underwent hernioplasty with polypropylene implant according to the method after I. Lichtenstein and Prolen Hernia System (PHS).
Results and discussion. In basic group patients the good early results were achieved in 16 (84.2 %) cases, satisfactory – in 3 (15.8 %); in comparison group patients the in 10 (62.5 %) and in 6 (37.5 %) cases accordingly.
Conclusions. The choice of our hernioplasty technique with preoperative inspection and preparation promotes increasing of good early surgical treatment results in elder and senile age patients with inguinal hernia in basic group on 21.7 % in comparison with comparison group.

Keywords: implant, hernioplasty.

The aim – to improve treatment results in patients with lymphedema of extremities by mini-invasive resection-drainage operations use and active after treatment.
Materials and methods. Analysis of examination and treatment results in 178 patients with extremities lymphedema from 2000 till 2010. Middle age of patients was (44.66 ± 18.09) years. Among the surveyed women were prevailed – 145 (81.46 %), men were 33 (18.54 %). A lymphedema stage defined according to clinical classification of lymphatic edemas by International Society of Lymphology (2003): in 19 (10.67 %) was I stage, in 105 (58.99 %) – II stage, in 54 (30.34 %) – III stage was taped. 126 patients were operated: in 18 resection operations with classical dermolipectomy and free dermal autografting after wound defect excising were made (control group), in 108 – the mini-invasive combined operations with lympho-venous anastomosis formation (LVA), an eiloid drainage and liposuction: in 22 – LVA applied, zonal dermolipectomy and open drainage operation; 48 – LVA applying and puncture drainage operation with eiloid drainages; 38 – liposuction, LVA and puncture drainage operation. In the postoperative period in 64 patients to whom mini-invasive operation was executed, venotonic (diosmine with a hesperidin, Detralex by Servier, France) in a complex of conservative treatment has been prescribed.
Results and discussion. In the remote postoperative period after lymphodrainage operations in patients good results were observed. In case of the particulate block of a lymphodrainage in patients with secondary lymphedema is recommended to use individual complex programs of treatment.
Conclusions. Minimal tissues traumatization after LVA applying in a combination with liposuction and adequate puncture drainage promotes an effective and nonperishable reduction of an extremity edema. Application of mini-invasive surgical interventions in complex treatment of extremities lymphedema is more effectively than traditional resection operations with classical dermolipectomy and free dermal autografting.

Keywords: extremities lymphedema, surgical treatment, diosmine with hesperidin.

The aim – to improve anesthesiology management quality and efficacy in patients with abdominal aorta aneurysms (АAA) by working out pathogenically evidenced differentiated perioperative therapy and rational anesthesia on the basis of intra – and postoperative infusion therapy optimization, hemodynamic, respiratory and metabolic disorders prophylaxis depending on a system complication certain risk.
Materials and methods. In the study basis are retro-and prospective analyses of anesthesiology management for surgical treatment in 1993–2010. 382 patients with various localization AAA (infrarenal, para-or juxtarenal) with open and endovascular methods use. Age of patients were from 30 till 78 years, middle age – (63.2 ± 7.2) years. Men there were 91.9 %. 355 (92.9 %) patients had infrarenal aneurysm, 27 (7.1 %) – supra – and juxtarenal. With urgent indications (acute aortal wall dissection and/or aneurysm rupture) 52 (13.6 %) patients were operated, for AAA rupture – 33 (8.6 %) patients. With traditional open procedure which provided AAA resection with the subsequent alloprosthetic 369 (96.6 %) patients were operated, with endovascular – 10 (2.6 %), in 3 (0.8 %) cases an abdominal cavity revision and a hemostasis were executed. Retrospective analysis of treatment results was done from 01.01.1993 till 31.12.2002 in 184 patients, complex inspection and treatment – in 198 patients, which were operated in the period from 01.01.2003 till 01.08.2010.
Results and discussion. To all patients with AAA operated by open procedure combined endotracheal narcosis was applied. The epidural anesthesia in retrospective group was used in 15 (8.2 %) patients, in basic group – in 156 (83.0 %). For arterial pressure changes correction during manipulations on an aorta in a basic group we used ventilation parameters changes – respiratory volume reduction to 4–5 ml/kg, respiration rate intensification till 23–26 in 1 minute and calcium channels inhibitor nifedipine infusion in a dose of 7.5–15 mkg/(kg·h). The factors which influenced on anesthesia protocol were: infusion therapy (colloidal solutions part increasing for fluid loss restoration and the prejudiced attitude to normovolumic hemodilutions), heart complications preventive maintenance and anesthesia carrying out in a «fast track» regimen
Conclusions. Hemodynamic disorders during aortal operations are expedient for correcting by lung controlled artificial ventilation parameters change in the course of an anesthesia and calcium channels antagonists introduction. The developed anesthesiology management protocol for operation and an intensive care in patients with AAA with extended epidural anesthesia and postoperative anesthesia application, heart complications perioperative preventive measures, protection of kidney, intestine, hemodynamic and hemostasis indexes correction, allowed to reduce a lethality from 17.4 to 8.5 % – in planned and with 79.3 to 43.5 % – in urgent surgery of AAA.

Keywords: an anesthesia, an intensive care, an abdominal aorta aneurysm, surgical treatment.

The aim – to define according to an angiography data the frequency of asymptomatic celiac trunk insufficiency (CTI) occurrence in potential liver donors and recipients a and to develop criteria of the hemodynamic changes caused by these pathology in hepatosplanchnic vascular system quantitative assessment.
Materials and methods. In the period from 2000 till 2010 angiography diagnostic in 158 potential recipients and 86 potential donors of a liver was executed. The research study included an angiography of a celiac trunk (celiacography) and top mesenteric arteries (mesentericography). All researches were carried out with transfemoral access by Cobra and Simmons catheters. We introduced from 30 to 60 ml of contrast medium into a lumen of arteries.
Results and discussion. Received angiography data of mesenteric-celiac indemnification have parted on four types according to which 4 CTI severity levels were secured. Such classification can become a basis for working out liver transplantation performance optimum tactics depending on revealed CTI severity.
Conclusions. Asymptomatic CTI timely diagnostics and coexisting hemodynamic changes assessment is one of significant factors for donor-recipient pair selection and liver transplantation optimum tactics definition.

Keywords: celiacography, a mesentericography, liver transplantation.

The aim – to conduct a comparative analysis of intraoperative scleroobliteration (IOSO) and endovascular laser coagulation (EVLC) results in the lower extremities varicose disease (LEVD) treatment, to estimate the methods effectiveness and ability in different clinical situations.
Materials and methods. The treatment results in 234 patients with LEVD were analyzed. According to the aim, there were selected 2 groups of patients. The first group included 116 men and women in the age from 21 to 72 (the mean age 44 years) to whom the treatment was realized by IOSO. According to the international classification (CEAP) C2 was registered in 54 patients, C3 – in 37, C4 – in 19, C5 – in 6. The second group where EVLC was used included 118 men and women in the age from 27 to 74 years (mean age – 47 years). C2 was registered in 62 patients, C3 – in 31, C4 – in 20, C5 – in 5. IOSO and EVLC were used not as independent methods of treatment of LEVD, but as a step of a complex surgical intervention after the previous crosectomy, ligation and resection of incompetent perforating veins.
Results and discussion. In order to clear up advantages and disadvantages of the both methods we have conducted their comparison by criterions: painful syndrome expression in the early postoperative period, local tissue traumatic damage frequency and stage, postoperative complications frequency, staying in the hospital continuance, time of the working activity beginning after the operation, ultrasound data in the early and remote postoperative period, operation cosmetic result, frequency of the subcutaneous veins varicose dilatation relapse in the remote postoperative period. Determinant factors in indications choosing for IOSO or EVLC were functional phlebodynanic disorders features, venous system anatomic structure version, determined by the preoperative ultrasound investigation results and clinic form of disease. By our opinion ISSO and EVLC as complex surgical treatment stage has no significant advantages. Optimal combination of sclero- and laser methods, based on consideration of their advantages and disadvantages will allow getting better direct and remote results, than using only to one of them.
Conclusions. IOSC and EVLC is an effective technology in LEVD treatment and have no principal differences in long-term results. Complete fibrous transformation of sclerosed varices was achieved in 98.28 and 97.46 % of cases and positive cosmetic result was observed in 91.38 and 86.44 %, respectively. Basic criterions in optimal method choosing are anatomy-morphological characteristic of varicose veins and peculiarities of hemodynamic disorders which are defined only by preoperative ultrasound investigation.

Keywords: varicose disease, intraoperative scleroobliteration, endovascular laser coagulation.

The aim – to evaluate the possibilities of complex outpatient proctologic treatment and its opportunities both at the initial and at the final stages of chronic internal hemorrhoids treatment.
Materials and methods. 281 patients who were treated and undergone surgery for internal hemorrhoids (II stage) in an outpatient clinic were included into the study. In 79 (28.1 %) of them the ligation of hemorrhoidal nodes and in 202 (71.9 %) only hemorrhoidolysis procedure were performed.
Results and discussion. Unsatisfactory results or relapse of the internal hemorrhoids were diagnosed in 4 (5.1 %) patients, unsatisfactory functional results were noticed in 2 (2.5 %) patients (dysfunction of anal sphincter complex as a result of dystopia of rectal mucous and temporary anus paralysis after acute paraproctitis surgical treatment). In the early period after hemorrhoidolysis reduction in size of hemorrhoidal tissue straight after the procedure was noticed in 178 patients (88.1 %), cessation of bleeding – in 196 patients (97.5 %); disappearance of both discomfort and sense of foreign body in the rectum – in 154 (76.6 %) patients. Long-term results were considered good in 172 (85.6 %), satisfactory results were noticed in 29 (14.4 %) patients.
Conclusions. Outcomes of mini-invasive, out-patient treatment of internal hemorrhoids II stage can be defined as favorable on the whole, because good remote results in 75 (94.9 %) patients and good functional results in 77 (97.5 %) patients have been revealed after hemorrhoidal nodes ligation. Good and satisfactory remote results after hemorrhoidolysis have been revealed in 173 (85.6, %) and 29 (14.4 %) patients accordingly.

Keywords: chronic hemorrhoid, treatment, ligation of hemorrhoidal nodes, hemorrhoidolysis.

The aim – to determine the ciprofloxacin efficacy in the acute abdominal pathology purulent complications treatment.
Materials and methods. During the period from 2010 to 2011 on the basis of the surgical department 36 patients with acute abdominal pathology, which used ciprofloxacin for prophylactic or therapeutic purposes were under our supervision. Among them 14 patients were with acute calculous cholecystitis and 18 – with acute appendicitis. All patients with urgent indications were operated. In patients with a diagnosis of acute calculous cholecystitis we performed laparoscopic cholecystectomy, in patients with a diagnosis of acute appendicitis – open appendectomy. The use of ciprofloxacin began in the antibiotic prophylaxis mode. In 60 min. before surgery 200 mg (100 ml) of ciprofloxacin (Ciprolet by Dr. Reddy’s Laboratories Ltd., India) was administered intravenously. In case of only catarrhal changes in the operated organ intraoperative detection introduction of ciprofloxacin was continued for 24 hours in 200 mg (100 ml) dose by intravenously drop infusion twice a day. In case of destructive changes in operative organ intraoperative detection introduction of ciprofloxacin was continued until 4 days in 200 mg (100 ml) dose by intravenously drop infusion twice a day, with the subsequent conversion to its oral administration in the same doses for 7 days course.
Results and discussion. The ciprofloxacin use in patients with acute cholecystitis and acute appendicitis was highly effective in the septic complications prevention and treatment. There were no signs of peritonitis progression in all patients. Satisfactory postoperative course was associated with rapid endogenous intoxication indicators normalization rate. There was no significant difference at mean values of these parameters in patients receiving the drug for the intra-abdominal infections prevention or treatment already on the second day of the postoperative period.
Conclusions. The use of ciprofloxacin in patients with acute calculous cholecystitis and acute appendicitis provides a positive bacteriological effect and has a high clinical efficacy, suggesting the possibility of using it as one of the main drugs for ABP and ABT for these diseases.

Keywords: antibiotic prophylaxis, antibiotic therapy, acute calculous cholecystitis, acute appendicitis, ciprofloxacin, Ciprolet.

The aim – to determine the influence of breast reconstruction on the life quality in breast cancer patients with MOS SF-36 questionnaire.
Materials and methods. 216 women (mean age 43.67 ± 1.33) answered to the questions of SF-36 questionnaire. We divided responders into three groups: in the first group there were women without any breast pathology, in the second group were involved patients with mastectomy and without reconstruction, and in the third group patients with mastectomy and immediate breast reconstruction were included.
Results and discussion. While comparing three groups, we found out, that mastectomy actually worsens the quality of life (all parameters) in comparison with the healthy women (p < 0.05), but simultaneous breast reconstruction allows achieving life quality level almost as those in healthy women.
Conclusions. Immediate breast reconstructive options improve quality of life of the breast cancer patients almost to the level of those in healthy women.

Keywords: quality of life, breast cancer, mastectomy, immediate breast reconstruction.

The aim – to summarize experience of combined ostheosynthesis method application and to estimate the treatment results in victims with radial distal epimetaphysis (DEMR) fractures.
Materials and methods. The operative treatment results analysis in 16 patients with distal radius intraarticular fractures was carried out in a period from 2008 to 2010 in the orthopedic-traumatology center. Men were 4 (25 %), women – 12 (75 %). The mean age of victims was 41.3 years (from 39 to 67). There were 23В2–3 (18.75 %), 23В3–7 (43.75 %), 23С1–3 (18.75 %), 23С2–2 (12.5 %), 23С3–1 (6.25 %) DEMR fractures according to АО/ASIF classification. The concomitant closed soft tissues damages were also classified by АО: IС1 – 2 (12.5 %), IС2 – 4 (25 %), IC3 – 6 (37.5 %), IC4 – 4 (25 %). Intraarticular DEMR fractures fixed with such ostheosynthesis combined methods: extralocal ostheosynthesis with external fixation apparatus external fixation – in 6 (37.5 %) cases and ostheosynthesis with plates and wires – in 10 (62.5 %).
Results and discussion. In the early postoperative period there were no complications in any patient. The estimation of remote treatment results was conducted in terms from 12 months to 3 years in all 16 patients. X-ray control was conducted in all patients in 6 weeks, 3, 6, 9, 12 months. After one year fragment’s reposition was estimated as 0 points by Knirk–Jupiter scale (0–1 mm) – in 4 (25 %) cases, 1 point (1–2 mm) – 9 (56.25 %) cases, 2 points (1–3 mm) – 3 (18.75 %) cases. Bending-unbending limitation was revealed in 2 (12.5 %) patients, the ulnar bending limitation in radiocarpal joint in 1 (6.25 %) patients. Pain syndrome after Stewart scale was absent – in 12 (75 %), at high activity presented in 3 (18.75 %), at low activity – in 1 (6.25 %).
Conclusions. Combined ostheosynthesis is the method of choice in victims with intraarticular DEMR fractures and advanced concomitant soft tissues damages, at impossibility of small size DEMR fragments fixation only by one fixing mean, and also for victims with advanced concomitant pathology, when open stable functional ostheosynthesis is impossible to execute because of the life threatening general status. That allowed receiving in 81.25 % patients’ excellent and good treatment results.

Keywords: radial distal epimetaphysis fracture, combined ostheosynthesis, external fixing, plate.

Portal hypertension – one of the principal reasons for esophagogastric life-threatening bleeding. Extrahepatic occlusion of janitrix and its inflows – second, after a hepatocirrhosis, reason for portal hypertension syndrome. A basic treatment task in patients with portal hypertension is bleeding from gullet varicose veins prevention. The mesenteric-portal by-passing operation demonstrates radical correction possibility of prehepatic portal hypertension form after thrombosis, occlusion of janitrix. Case of the mesenteric-portal by-passing done in patient with a diagnosed portal vein thrombosis on the stage of renewal, portal hypertension and varicose vein of gullet is 3–4 degrees is described in the article. Renewal of portal blood flow registers in an early and remote postoperative period, with reduction of gullet varicose veins.

Keywords: thrombosis of portal vein, portal hypertension, varicose veins of gullet, operative treatment.

Clinical case of diagnostics and surgical treatment of giant paraovarian cyst, which was twisted 720 degrees upon its pedicle in teenager-girl, is described. Medial middle-lower laparotomy, a cystectomy of right ovary, appendectomy were performed. Antibiotic therapy was done during 8 days. The patient was discharged from hospital in satisfactory condition on 14th day.

Keywords: giant paraovarial cyst, teenager-girl.

The case of strangulated umbilical hernia, tuboovarian purulent tumor and purulent obstructive pyelonephritis successful one-stage surgical treatment is discribed. Patient M., 51 years old, female, was hospitalized with emergency to the urology unit. The patient was examined clinically and laboratory, instrumentally. Cystoscopy was done; right urethra and bladder were catheterized. Patient was examined by a gynecologist. In 3 hours after admission in the hospital the patient developed umbilical hernia strangulation clinical signs. The patient was examined by a surgeon, and with diagnosis «umbilical hernia strangulated» was transferred to general surgery unit for urgent surgical procedure. In 5 hours after hospitalization was performed operation: herniotomy, right-sided adnexectomy hernioplasty by Schampioner method. The abdominal cavity was drained with 4 tubes through the contrapertures. The postoperative period passed without complications. The patient has received antibiotics during 10 days, proton pump blockers, low molecular weight heparins, analgesics. The drainage tubes were removed on the 3-d and 5-th days. The urethra catheter was removed on the 8-th day, and there were no urination disorders after. The postoperative wound healed with initial tension, sutures were removed on the 10-th day. The patient was discharged from hospital in satisfactory status for out-patient treatment in local polyclinic. In 2 months the patient was examined by a gynecologist, an urologist and a surgeon. There were no complains on examination time. laboratory tests of blood and urine were performed, as well as ultrasound examination of abdominal cavity and pelvis. No disorders were found. The case of strangulated umbilical hernia, tuboovarian purulent tumor and purulent obstructive pyelonephritis successful treatment is an example of several urgent diseases combination in clinical practice. For the successful treatment it is desirable to eliminate them simultaneously.

Keywords: simultaneous urgent surgical operations, combined urgent abdominal diseases.

Portal hypertension – one of the principal reasons for esophagogastric life-threatening bleeding. Extrahepatic occlusion of janitrix and its inflows – second, after a hepatocirrhosis, reason for portal hypertension syndrome. A basic treatment task in patients with portal hypertension is bleeding from gullet varicose veins prevention. The mesenteric-portal by-passing operation demonstrates radical correction possibility of prehepatic portal hypertension form after thrombosis, occlusion of janitrix. Case of the mesenteric-portal by-passing done in patient with a diagnosed portal vein thrombosis on the stage of renewal, portal hypertension and varicose vein of gullet is 3–4 degrees is described in the article. Renewal of portal blood flow registers in an early and remote postoperative period, with reduction of gullet varicose veins.

Keywords: thrombosis of portal vein, portal hypertension, varicose veins of gullet, operative treatment.

Портальная гипертензия — одна из основных причин пищеводно-желудочных кровотечений, угрожающих жизни пациента. Внепеченочная окклюзия воротной вены и ее притоков — вторая по частоте (после цирроза печени) причина синдрома портальной гипертензии. Основная задача лечения больных с портальной гипертензией — предотвращение кровотечений из варикозно расширенных вен пищевода. Операция мезентерико-портального шунтирования демонстрирует возможность радикальной коррекции допеченочной формы портальной гипертензии при тромбозе, окклюзии воротной вены. В статье описано проведение мезентерико-портального шунтирования у пациентки с тромбозом портальной вены в стадии реканализации, с портальной гипертензией, варикозным расширением вен пищевода III—IV степени. В ранний и отдаленный послеоперационный период отмечено восстановление портального кровотока с редукцией варикозного расширения вен пищевода.

Keywords: тромбоз портальной вены, портальная гипертензия, варикозно-расширенные вены пищевода, оперативное лечение.

Цель работы — сравнить результаты интраоперационной склерооблитерации (ИОСО) и эндовазальной лазерной коагуляции (ЭВЛК) при лечении варикозной болезни нижних конечностей, оценить эффективность и возможности методов в разных клинических ситуациях.
Материалы и методы. Проанализированы результаты лечения 234 больных с варикозной болезнью нижних конечностей. В соответствии с целью исследования выделили две группы больных. В первую группу, в которой лечение осуществляли с применением ИОСО, включили 116 мужчин и женщин в возрасте от 21 года до 72 лет (средний возраст — 44 года). Согласно международной классификации (СЕАР) С2 выявили у 54 больных, С3 — у 37, С4 — у 19, С5 — у 6. Вторую группу, в которой использовали ЭВЛК, составили 118 мужчин и женщин в возрасте от 27 до 74 лет (средний возраст — 47 лет). С2 выявили у 62 больных, С3 — у 31, С4 — у 20, С5 — у 5. ИОСО и ЭВЛО применяли не как самостоятельные методы лечения варикозной болезни нижних конечностей, а как этапы комбинированного хирургического вмешательства после предварительной кроссэктомии, перевязки и пересечения недостаточных перфорантных вен.
Результаты и обсуждение. Для выяснения достоинств и недостатков обоих методов провели их сравнение по выраженности болевого синдрома в ближайший послеоперационный период; частоте и степени травматического повреждения окружающих тканей; частоте послеоперационных осложнений; продолжительности пребывания в стационаре, срокам начала трудовой деятельности после операции; ультразвуковым данным в ближайший и отдаленный послеоперационный период; косметическим результатам вмешательства; частоте рецидива варикозного расширения подкожных вен. Основными критериями при выборе показаний к ИОСО или ЭВЛК были особенности флебогемодинамических нарушений, вариант анатомического строения венозной системы, установленный по результатам дооперационного ультразвукового исследования, а также клиническая форма заболевания. По нашему мнению, ИОСО и ЭВЛК как этап комбинированного хирургического лечения варикозной болезни не имеют принципиальных преимуществ. Оптимальная комбинация склеро- и лазерооблитерирующих методов с учетом их преимуществ и недостатков позволит получить лучшие результаты, чем использование этих методов по отдельности.
Выводы. Интраоперационная склерооблитерация и эндовазальная лазерная коагуляция являются эффективными технологиями в лечении варикозной болезни нижних конечностей и не имеют принципиальных различий в отдаленных результатах лечения. Полную фиброзную трансформацию склерозированных варикозных вен удалось достичь у 98,28 и 97,46 % случаев, а положительный косметический результат отмечен у 91,38 и 86,44 % пациентов соответственно. Основными критериями выбора оптимальной технологии являются анатомо-морфологические характеристики варикозно расширенных вен и особенности гемодинамических нарушений, которые определяют только по результатам дооперационного ультразвукового исследования.

Keywords: варикозная болезнь, интраоперационная склерооблитерация, эндовазальная лазерная коагуляция.

Цель работы — оценить возможности комплексной амбулаторной проктологической помощи при использовании ее как на стартовом, так и на завершающем этапе лечения геморроидальной болезни.
Материалы и методы. В исследование включены пациенты (n = 281), пролеченные и прооперированные амбулаторно по поводу геморроидальной болезни второй стадии. У 79 (28,1 %) больных выполнено лигирование геморроидальных узлов, у 202 (71,9 %) — геморолиз изолированно.
Результаты и обсуждение. Неудовлетворительные результаты или рецидив геморроидальной болезни в отдаленный период после лигирования зафиксированы у 4 (5,1 %) пациентов, неудовлетворительные функциональные результаты — у 2 (2,5 %): нарушение работы замыкательного аппарата прямой кишки вследствие дистопии слизистой оболочки прямой кишки и временный паралич ануса после оперативного лечения острого парапроктита. В ранний период после геморолиза уменьшение объема геморроидальной ткани сразу после процедуры наблюдали у 178 (88,1 %) больных, остановку кровотечения — у 196 (97,5 %), ликвидацию дискомфорта и ощущения инородного тела в прямой кишке — у 154 (76,6 %). Поздние результаты оценены нами как хорошие у 172 (85,6 %) пациентов, удовлетворительные — у 29 (14,4 %).
Выводы. Результаты миниинвазивного амбулаторного лечения геморроидальной болезни второй стадии в целом можно оценить как благоприятные — у 75 (94,9 %) и у 77 (97,5 %) пациентов наблюдали соответственно хорошие отдаленные и хорошие функциональные результаты лечения после процедуры лигирования геморроидальных узлов. Хорошие и удовлетворительные отдаленные результаты после процедуры геморолиза зафиксированы у 173 (85,6, %) и 29 (14,4 %) пациентов соответственно.

Keywords: хронический геморрой, лечение, лигирование геморроидальных узлов, геморолиз.

Цель работы — определить эффективность ципрофлоксацина в лечении гнойных осложнений острой абдоминальной патологии.
Материалы и методы. В период с 2010 по 2011 г. на базе хирургического отделения Александровской клинической больницы г. Киева под нашим наблюдением находились 36 больных с острой абдоминальной патологией, которым был назначен ципрофлоксацин с профилактической или лечебной целью. Среди них было 14 больных с острым калькулезным холециститом и 18 — с острым аппендицитом. Все больные оперированы по неотложным показаниям в ургентном порядке. Больным с диагнозом «острый калькулезный холецистит» выполняли лапароскопическую холецистэктомию, с диагнозом «острый аппендицит» — открытую аппендэктомию. Применение ципрофлоксацина начинали в режиме антибиотикопрофилактики. За 60 мин до начала оперативного вмешательства внутривенно капельно вводили 200 мг (100 мл) ципрофлоксацина («Ципролет», производства «Д-р Редди’с Лабораторис Лтд.», Индия). При интраоперационном выявлении лишь катаральных изменений оперируемого органа введение ципрофлоксацина продолжали еще 24 ч в дозе 200 мг (100 мл) внутривенно капельно дважды в сутки. При интраоперационном выявлении деструктивных изменений оперируемого органа введение ципрофлоксацина продолжали до 4 суток в дозе 200 мг (100 мл) внутривенно капельно дважды в сутки, с последующим переходом на его пероральное применение в той же дозе, длительность курса — 7 суток.
Результаты и обсуждение. Применение ципрофлоксацина у больных с острым холециститом и острым аппендицитом оказалось высокоэффективным в профилактике и лечении гнойно-септических осложнений. Не выявлены признаки прогрессирования перитонита. Удовлетворительное послеоперационное течение ассоциировалось с быстрой нормализацией показателей, свидетельствующих об эндогенной интоксикации. Уже на вторые сутки послеоперационного периода не выявлено достоверных различий в средних значениях исследуемых показателей у больных, получавших препарат в целях профилактики или лечения интраабдоминальных инфекций.
Выводы. Применение ципрофлоксацина у больных с острым калькулезным холециститом и острым аппендицитом обеспечивает положительный бактериологический эффект и имеет высокую клиническую эффективность, что свидетельствует о возможности использования его как одного из основных препаратов антибиотикопрофилактики и антибиотикотерапии при этих заболеваниях.

Keywords: антибиотикопрофилактика, антибиотикотерапия, острый калькулезный холецистит, острый аппендицит, ципрофлоксацин, «Ципролет».

Цель работы — изучить влияние одномоментных реконструктивно-пластических операций на качество жизни больных, перенесших радикальное лечение по поводу рака молочной железы.
Материалы и методы. На вопросы SF-36 ответили 216 женщин (средний возраст (43,67 ± 1,33) года). Респондентов распределили на три группы: в первую вошли женщины без патологии молочной железы, во вторую — пациентки, перенесшие мастэктомию, но без реконструкции молочной железы, в третью — больные, перенесшие мастэктомию и одномоментную реконструкцию молочной железы.
Результаты и обсуждение. При сравнении трех групп выявлено, что мастэктомия ухудшает качество жизни по всем показателям по сравнению с группой здоровых женщин (p < 0,05), однако при сочетании мастэктомии с одномоментной реконструкцией молочной железы достигается качество жизни, сопоставимое с качеством жизни здоровых.
Выводы. Одномоментные с мастэктомией реконструктивно-пластические операции улучшают качество жизни пациентов практически до уровня показателей здоровых.

Keywords: качество жизни, рак молочной железы, мастэктомия, одномоментная реконструкция молочной железы.

Цель работы — обобщить опыт применения метода комбинированного остеосинтеза и оценить результаты лечения пострадавших с переломами дистального эпиметафиза лучевой кости (ДЭМЛК).
Материалы и методы. Проанализированы результаты лечения 16 больных с закрытыми внутрисуставными переломами ДЭМЛК, которым в период с 2008 по 2010 г. проведено оперативное лечение в ортопедо-травматологическом центре Киевской областной клинической больницы. Мужчин было 4 (25 %), женщин — 12 (75 %). Средний возраст пострадавших — 41,3 года (от 39 до 67 лет). Выявлены такие переломы ДЭМЛК по классификации АО: 23В2 — 3 (18,75 %), 23В3 — 7 (43,75 %), 23С1 — 3 (18,75 %), 23С2 — 2 (12,5 %), 23С3 — 1 (6,25 %). Сопутствующие закрытые повреждения мягких тканей также классифицировали по АО: IС1 — 2 (12,5 %), IС2 — 4 (25 %), IC3 — 6 (37,5 %), IC4 — 4 (25 %). Использованы такие комбинации методов остеосинтеза внутрисуставных переломов ДЭМЛК: внеочаговый остеосинтез аппаратом внешней фиксации со спицами — в 6 (37,5 %) случаях и остеосинтез пластинами со спицами — в 10 (62,5 %).
Результаты и обсуждение. В ранний послеоперационный период осложнений не наблюдали ни у одного больного. Оценку отдаленных результатов лечения проводили в сроки от 12 мес до 3 лет у всех больных. Рентгенконтроль всем больным проводили через 6 нед, 3, 6, 9, 12 мес. Через 1 год репозиция обломков по шкале Knirk—Jupiter была оценена как 0 баллов (0—1 мм) — в 4 (25 %) случаях, как 1 балл (1—2 мм) — в 9 (56,25 %), как 2 балла (1—3 мм) — в 3 (18,75 %). Ограничение сгибания-разгибания наблюдали у 2 (12,5 %) больных, ограничение ульнарного сгибания в лучезапястном суставе — у 1 (6,25 %). Болевой синдром, оцененный по шкале Stewart, отсутствовал у 12 (75 %) пациентов, имел место при большой активности — у 3 (18,75 %), при незначительной активности — у 1 (6,25 %).
Выводы. Комбинированный остеосинтез у пострадавших с внутрисуставными переломами дистального эпиметафиза лучевой кости является методом выбора при тяжелых сопутствующих повреждениях мягких тканей, при невозможности фиксации малых фрагментов дистального эпиметафиза лучевой кости только одним средством фиксации, а также у пострадавших с тяжелой сопутствующей патологией, когда открытый стабильно функциональный остеосинтез невозможно выполнить из-за тяжелого общего состояния больного. Это позволило получить у 81,25 % больных отличные и хорошие результаты лечения.

Keywords: перелом дистального эпиметафиза лучевой кости, комбинированный остеосинтез, аппарат внешней фиксации, пластина.

Описан клинический случай диагностики и хирургического лечения гигантской параовариальной кисты яичника с перекрутом на 720° у девочки-подростка. Проведены средне-нижняя срединная лапаротомия, удаление кисты правого яичника, аппендэктомия. Антибиотикотерапию осуществляли в течение 8 сут. Пациентка выписана в удовлетворительном состоянии на 14-е сутки.

Keywords: параовариальная киста яичника, девочки-подростки.