The aim — to set clinical indications for radical surgery in patients with perforated duodenal ulcer (PDU) based on the peptic ulcer recurrence risk factors prediction after palliative open and laparoscopic surgeries.

Materials and methods. 181patients with PDU were included in prospective study. Laparoscopic palliative surgeries (perforation suturing) or conditionally radical operations (pyloroduodenal plastic) were performed in 92 patients, similar operations done by «open» method in 89 patients. The frequency of peptic ulcer recurrence was estimated in 2 years after surgery and ulcer recurrence risk factors were identified.

Results and discussion. Peptic ulcer recurrence risk factor was: ulcer anamnesis duration over 10 years, a conscious non-compliance to antiulcer therapy, heredity, Helicobacter pylori infection absence, alcohol abuse, expressed peri-ulcerous infiltration in 2.2 times accessed ulcer diameter, tolerance to proton pomp inhibitors. Patients with at least one of these risk factors belong to a high risk group. Two-year peptic ulcer recurrence frequency in such patients is higher (38.3 % versus 5.8 % in low-risk group patients) and does not depend on the surgical method (open or laparoscopic surgery). The most significant risk factors for ulcer are associated with the acid peptic factors and can be modified by radical organ preserving surgery.

Conclusions. Patients that belong to risk group (having at least one of risk factors) constitute 38.1 % of the patients with PDU. Twoyear ulcer recurrence frequency in high risk patients was significantly higher than in low-risk patient sand it does not depend on the surgical method.

Keywords: perforated ulcer, risk factors of peptic ulcer recurrence, highly selective vagotomy.

The aim — to determine the current status of most often used monopolar prostate transurethral resection, open trans-bladder prostatectomy and innovative transurethral procedures (minimally invasive surgery), including bipolar transurethral prostate resection (TUPR), potassium-titanyl-phosphate laser prostate vaporization and lithium three-borate laser vaporization (120 W), based on the functional results and complications associated with traditional and minimally invasive treatments analysis.

Materials and methods. The analysis included patients who underwent potassium — phosphate-tytanil vaporization (140 patients) and lithium three-borate laser prostate vaporization, 120 W (60 patients), monopolar (180 patients) and bipolar TURP (72 patients) and open trans-bladder adenomectomy (192 patient) performed for benign prostatic hyperplasia in clinics from May 2010 till May 2013.

Results and discussion. There was improvement in functional outcomes in the postoperative period according to International prostate symptoms scale (IPSS), life quality indicator’s rate, maximal urinary flow rate, residual urine volume. Noted the benefits absence of open prostatectomy and minimally invasive techniques compared with monopolar transurethral resection. Open prostatectomy has the advantage on improving postoperative IPSS scores compared with endoscopic techniques for large-sized prostatic hyperplasia. This is the only technique with a statistically significant (p = 0.005) advantage over monopolar transurethral resection for large-sized hyperplasia. Neither of operation had a statistically significant advantage over monopolar transurethral resection. However, open prostatectomy had a statistically significant advantage over the maximum urinary flow rate of PVP (80 W) for prostatic hyperplasia sizes more than 80 cm³.

Conclusions. Innovative laser technology (potassium-tytanil-phosphate and lithium three-borate vaporization) are highly effective and safe surgical methods, providing the most favorable conditions for the lower urinary tract restoration and provide functional indicators improvement.

Keywords: benign prostatic hyperplasia, photo selective prostate vaporization, transurethral resection, of biological tissues welding.

The aim — to study morphology of gastric ulcer marginal zone biopsies after acute bleeding in treatment process dynamic.

Materials and methods. Morphogenetic dynamic of gastric ulcers marginal zone in 40 patients with acute bleeding treated by proton pump inhibitors was analyzed. The degree of gastric mucosa alteration, density of leukocytes infiltration, angiogenesis (CD131), myofibroblasts reaction (α-SMA) and cells proliferation (Ki-67) were assessed during morphometric analysis.

Results and discussion. It was shown that proton pump inhibitors administration in complex treatment of patients with acute ulcer bleeding, not only affect the gastric glands secretory activity, but has also significant anti-inflammatory effect, border ulcer marginal zone secondary alteration. The angiogenesis and of epithelial cells proliferation stimulation were noted, however these effects were accompanied with gastric epithelial cells differentiation decrease and gastric mucosa lymphoid infiltration maintaining.

Conclusions. Рroton pump inhibitors administration modulates inflammatory-regenerative processes and the mucousbicarbonate barrier state.

Keywords: acute ulcer bleeding, proton pump inhibitors, inflammation, healing.

The aim — to develop a comprehensive complex drug therapy of abdominal aortic aneurysms (AAA) according to the literature analysis and own research.

Materials and methods. The clinical data of 40 patients who underwent examination or treatment in the vascular surgery department were analyzed. The mean age was 69.47 ± 8.45 years. homocysteine blood levels and TNF-α has been studied. The basic instrumental methods include CT imaging of the aorta, coronary angiography. The morphological studies’ data of AAA wall was analyzed. According to the CT, maximum expansion of the abdominal aorta was 52.27 mm. Blood tests revealed the increase in TNF-α and homocysteine. The control group consisted of 11 patients who did not receive stabilizing treatment.

Results and discussion. According to CT, abdominal aorta maximum expansion was 52.27 mm. Blood tests revealed increasing levels of TNF-α and homocysteine. The AAA wall had expressed inflammation and tenderness. Infiltrates’ Cells expressed Cyclophilin A intensively. Based on own observations and literature analysis a medical (conservative and stabilizing) therapy was developed, designed to stabilize the aneurysms growth, including drugs that have a direct effect on the aneurysm pathogenesis.

Conclusions. The results of complex drug therapy show significant efficacy for the aneurysm growth stabilization.

Keywords: abdominal aortic aneurysm, stabilizing therapy, the aneurysm pathogenesis, cyclophilin A.

The aim — to study the anti-adhesive gel effect on abdominal adhesive process severity and pyo-inflammatory complications development after bowel resection together with anterior abdominal wall plastic using prolene mesh in experiment.

Materials and methods. 52 white Vistar rats were studied. Inflammatory and purulent complications were not registered in postoperative period. Rats were divided into 3 groups. Groups were not statistically differed by the ratio of males and females, place of bowel opening, anti-adhesive gel application during previous surgery and by abdominal adhesive process severity. Adhesiolysis and bowel anastomosis (previous) resection with formation of new one were performed during the first stage for all rats. Any other surgical manipulations were not performed in animals of group I (16 rats), abdominal cavity layers were sewn. Anterior abdominal wall sublay plastic using prolene mesh without anti-adhesive gel application was performed in animals of the second group (19 rats). Antiadhesive gel Mesogel application and further anterior abdominal wall sublay plastic were performed in animals of the third group. PML1 Prolene mesh used for anterior abdominal wall plastic. Re-laparotomy was performed during the second stage in 28 days. The prevalence and severity of adhesive process, pyo-inflammatory complications were estimated. All statistical calculations carried out using SPSS 13.0 for Windows.

Results and discussion. The spread and severity of adhesive process in abdominal cavity were statistically significant p = 0.001 and p = 0.032 respectively. The positive correlation between prolene mesh implantation and adhesive process was found (p = 0.489; p = 0.003). Similar relation to the adhesive process severity was not found (p = 0.062; p = 0.723). The spread of abdominal adhesive process in group 3 was statistically significant lower than in group 2 (p < 0.001) and severity — statistically significant lower than in groups 1 and 2 (p = 0.038 and 0.013 respectively). The strong correlation (p = 0.728; p < 0.001) was found between Mesogel application and spread of adhesive process in animals with anterior abdominal wall plastic. Pyo-inflammatory complications were observed in 11 (64.7 %) rats of group 3, which was significantly higher compared with group 2 : 6 (31.6 %) rats, p = 0.047 and group 1 : 4 (25.0 %) rats, p = 0.022. The complete mesh engraftment was registered in 9 (52.9 %) animals, which was significantly differed (p = 0.041) of group 2, in which complete mesh engraftment was observed in 17 (82.9 %) rats. The statistically significant positive correlation (p = 0.331; p = 0.048) was found between anti-adhesive gel application and increased frequency of pyo-inflammatory complications in rats after anterior abdominal wall plastic.

Conclusions. The spread of adhesive process was statistically significantly higher in rats after bowel resection and anterior abdominal wall sublay plastic compared to animals without abdominal wall plastic. Anti-adhesive gel application significantly reduces the abdominal adhesive process spread and severity in rats with anterior abdominal wall sublay plastic after bowel resection. The number of pyoinflammatory complications and mesh non-engraftment was significantly increased in animals with anti-adhesive gel application after bowel resection and anterior abdominal wall plastic.

Keywords: adhesive process, anti-adhesive gel, prolen mesh.

The aim — to improve the surgical techniques and introduce the treatment options in the complicated and uncomplicated pharyngealesophageal diverticulum treatment.

Materials and methods. 54 patients with pharyngeal-esophageal diverticulum from 1988 to 2013 were treated in clinic. Men were 36, women — 18, aged from 24 to 87 years, on average — 54.3 years. Complicated course of the disease was observed in 64.8 % of patients. The diagnostic approaches to clarify the diverticulum character complications and to select the optimal treatment option are described.

Results and discussion. In the early postoperative period one (1.85 %) complication, in the later period — one (1.85 %) relapsed diverticulum was observed. Duration of surgery depend on the operation complexity and ranged from 30 to 220 minutes on average — 82 min. It was no lethal outcome.

Conclusions. Diagnostic of pharyngeal-esophageal diverticulum require special attention because they may have a complicated course. The diverticulum resection with split mucous and muscular layers stitching and the pharyngeal-esophageal muscle intersection allow obtaining the best results in the early and long periods. When the diverticulum complicated by pharyngeal-esophageal junction stenosis, diverticulum resection and stenosis segment reconstruction is the only possible intervention that allow curing combined esophagus and throat pathology.

Keywords: diverticulum, pharynx, esophagus, scar stenosis, esophagoplasty.

The aim — to study the effectiveness of the recurrent laryngeal nerve decompression during operations on the thyroid gland with initial neuropathic stenosis of the larynx and dysphonia syndrome.

Materials and methods. 23 patients with thyroid gland various diseases and unilateral vocal cord paralysis were examined prospectively. All patients underwent the combined operations: thyroidectomy and recurrent laryngeal nerve decompression. At the preoperative and postoperative stages the fibro-laryngoscopy, the maximum phonation time (MFT) study, spectral voice analysis by Praat program were performed. Self-study voice disorders and their impact on patient quality of life was carried out by B. Jacobson method (VHI-30).

Results and discussion. In all groups, a significantly improved aerodynamic performance and spectral voice analysis parameters, the spatial positioning of the vocal fold (VF), indicators of psychosocial disorders in the postoperative period were fixed. Decompression effectiveness to restore Ferrein's cord coordinated mobility in the group with extraorganic invasive thyroid tumors was 81.8 %, the MFT has increased from 12.7 ± 2.92 to 22.1 ± 1.94 s, VHI indicators declined from 47.4 ± 2.77 to 7.27 ± 1.26, in the group with recurrent laryngeal nerve ligature strangulation decompression efficiency was 42.8 %.

Conclusions. The recurrent laryngeal nerve decompression should be performed during the primary and repeated operations on the thyroid gland with original VF immobility, and in case of inability to perform or complete detection of anatomical nerve break — primary or delayed neurorrhaphy with one of the peripheral nerves.

Keywords: paralysis of the vocal folds, the recurrent laryngeal nerve decompression.

The aim — to improve thyroid surgery results by high-frequency welding coagulator application.

Materials and methods. The high-frequency welding coagulators ЕХВА-350МС and ЕКВ-З300 with 66 kHz and 440 kHz frequency wear applied in 130 patients in mono and bipolar regimen to create conditions for coagulations or cutting between forceps or clamps branches.

Results and discussion. The welding during operations was applied in 121 (93 %) patients to avoid bleeding. Bleeding different size vessels in 9 (7 %) patients were catch by the bipolar forceps and coagulated. Suture ligation was used only for wound closure. It allowed reducing operation time on 40 — 50 min especially its basic step duration.

Conclusions. High-frequency coagulation and soft tissues welding technologies application give opportunities to cancel suturing and numerous knotting, produce safe hemostasis, reduce basic stage surgery duration and improve thyroid surgery general results.

Keywords: thyroid surgery, hemostasis, electrocoagulation.

The aim — to increase the reconstructive surgery effectiveness in the extensive soft tissue defects restoration in the knee joint region.

Materials and methods. During the period from 2011 to 2013 7 patients for extensive skin and soft tissue defects in the knee region closure were treated in the clinic. The plasty with perforating posterior thigh flap on third deep femoral artery and popliteal perforating artery was done.

Results and discussion. In all cases, the wound defects have been eliminated and the patients discharged with recovery. All flaps survived, postoperative complications were not critical and have been removed. All pieces survived, postoperative complications were not critical and have been cured. Transposition flaps were similar in structure and color of the surrounding tissues, they did not change the the recipient area contours.

Conclusions. One-stage extensive soft tissue defects reconstruction in the knee region with posterior thigh perforator skin-muscle flap usage allows to improve the surgical treatment efficacy (the joint’s lost function and skin cover adequately restoration), significantly reducing the rehabilitation time and inpatients hospital costs, compared with the two-stages cross-plasty methods or micro-vascular anastomoses techniques.

Keywords: wounds, wound defects, plasty, propeller flaps, perforator flaps, island flaps, posterior thigh perforator flap.

The aim — to estimate the ultrasound debridement effectiveness for diabetic foot syndrome treatment depends on the lower limbs tissue ischemia degree.

Materials and methods. The research group (RG) consisted of 42 patients who received ultrasound debridement as a local treatment, control Group (CG) consisted of 27 patients with adequate drainage. Patients were classified according to PEDIS. For ultrasonic treatment, the Sonoca-180 device with the «hoof» sonotrode was used. Treatment was performed with an operating frequency of 25 kHz. Transcutaneous determination of partial pressure (ТсРО₂) in the lower extremity tissues was conducted by TCM-400 (Radiometrer, Denmark) according to standard methods. Digital camera and a specially — designed hardware-software complex «WoundVeiwer» was used for ulcer area measurement objectification. An absolute ulcer area and the relative healing rate (RHR) determined by the formula: RHR = (1 — S₁/S₀) · 100 %, where S₁ — area ulcer after treatment period, S₀ — the initial ulcers area were evaluated.

Results and discussion. When ТсРО₂ < 19 mmHg, the RHR in the RG was 11.15 ± 13.77 % in 4 weeks versus 8.83 ± 5.58 % in the CG (p > 0.05). An insignificant wound healing was achieved only as result of medicament revascularization. In 9 RG patients and 7 CG patients an amputation at the thigh or calf level the in 1 — 7 months after treatment was performed. When ТсРО₂ ranges from 20 to 29 mmHg the difference of RHR between the RG and the GC becomes statistically significant in 4 weeks (45.27 ± 11.35 % in RG vs 28.02 ± 8.80 % in CG, р < 0.01). There was any complications when using the device. In 11 of 17 RG patients (at 19 < ТсРО₂ < 30 mmHg) 50 % ulcers healing was observed within 4 weeks of treatment, compared to 1 of 12 patients in CG.

Conclusions. Using of ultrasound debridement significantly improves wound healing provided minimally sufficient blood supply. In cases of the initial ТсРО₂, less than 19 mmHg significant healing occurs only under conditions of parallel medical revascularization. With its inefficiency, healing was impossible.

Keywords: diabetic foot syndrome, ultrasonic debridement, wound healing, critical ischemia.

The aim — to improve the intensive care results in cardiac surgery with artificial blood circulation (ABC) by postoperative anticoagulant therapy (PAT) application.

Materials and methods. 36 patients (9 patients after mitral valve replacement, 8 — after aortic valve replacement, 3 patients after combine (mitral and aortic) valve replacement, 14 patients — after coronary artery bypass grafting, 2 patients — after left atrial myxoma resection) were observed. The PAT algorithm with bemiparin sodium (LMWH second generation): residual hypocoagulation after ABC control, anti-Xa factor activity and dynamic assessment until the target INR achievement was used for all patients.

Results and discussion. At the 1st stage after APTT level determination the hypocoagulation in 9 (25.0 %) patients, hypercoagulation in 21 patients (58.4 %) was observed. At the 2nd stage the antiXa-factor activity level assessment showed that in 32 patients (88.9 %) this level was sufficient after bemiparin 3500 ME once daily administration, 4 patients (11.1 %) had need to increase the dose to 6000 ME once daily. At the 3rd stage dose adjustment to 6000 ME required in 13.9 % of cases. The LMWH therapy canceling occurred in 122.4 ± 13.1 h after 2.5 target INR achieving by phenindione.

Conclusions. The postoperative anticoagulant therapy with bemiparin application in cardio surgical patients operated with artificial blood circulation showed high efficiency (no thromboembolic complications in postoperative period) and safety (severe bleeding complications were observed in the 1 patient). PAT allows personalizing the indications for initiation of therapy with anticoagulants and differentially using it on every stage. Determined the validity of markers to monitor the effectiveness and safety SPAT at each stage.

Keywords: postoperative anticoagulant therapy, cardiac surgery, anti Xa-factor activity, bemiparin.

The aim — to analyze the complex treatment results for venous leg ulcers inpatients with disaggregate thrombocytopathy.

Materials and methods. The prospective study included 40 patients in whom disaggregate thrombocytopathy (DT) was diagnosed. All patients had lower limbs trophic ulcers of the venous etiology in alteration phase. The average venous ulcers duration was 4.3 ± 1.5 years. The total area of ulcer surface ranged from 35 to 155 cm². Thrombocytopathy was verified by anamnestic questionnaire screening profiles for hemorrhagic syndrome and hemostatic system study. According to severe hemorrhagic manifestations in patients was used nonspecific hemostatic therapy. Patients were divided into two groups. In 1st group (20 patients) for ulcer treatment regardless of the wound healing process stage the antibacterial drug tyrothricin (Tirozur) in the gel and powder form was used, in 2rd group (20 patients) for venous ulcers local treatment the ointment dressings (Laevomekolum, Oflokain, miramistin, metiluratsil) depending on the wound healing phase was applied. The lower limbs ulcer treatment in both groups was completed by Thiersch autodermoplasty after preparation.

Results and discussion. On the nonspecific hemostatic therapy background in 38 patients with DT during venous ulcers topical treatment, no hemorrhagic complications have been recorded. After treatment I group patients had a significant microbial elimination, II group this indicators have not reached a safe value. During tyrothricin treatment the wounds purification have been observed on 6— 7th day, the appearance of granulation tissue and marginal epithelialization — on 12 — 14th day. Purulent — necrotic masses purification and wound bottom tissue granulation allowed to perform Thiersch autodermoplasty successfully. In II group, the ulcer healing (granulation and epithelialization) ulcers occurred on 4 — 6 days later.

Conclusions. In the leg venous ulcers treatment in patients with DT the non-specific hemostatic therapy is obligatory to prevent bleeding complications during treatment and in order to adequately prepare to trophic ulcer autodermoplasty. In the complex treatment scheme for trophic ulcers in order to accelerate the ulcer necrotic masses purification, stimulate granulation and prevent post-traumatic eczema on DT background the antibacterial drug tyrothricin in gel and powder is advocated.

Keywords: disaggregate thrombocytopathy, trophic ulcers, tyrothricin.

Separate questions of the inoperable malignant bowel obstruction treatment for extensive (inoperable) malignant tumors (malignant bowel impassability (MBI)) are considered in the review. Despite that the MBI is observed in 5 — 51 % of patients with advanced ovarian carcinoma and in 10 — 28 % with gastrointestinal tract cancer, and the average life duration from 30 till 90 days since the first symptoms, in our country such patients usually get a medical care not in a specialized cancer institutions (refused medical aid because cancer incurability), but at the surgical and therapeutic in-patient departments. Approaches to the MBI treatment are ambiguous and require an individual approach based not only on medical but and on ethic and human principals of the patients’ care at the end of life. Questions of the infusion volume choice, nutrition, endoscopic and palliative surgical procedures are highlighted. In order to decide whether to eliminate the symptoms by surgery, an individual way of treatment, clear understanding of the operation aims and an expected patient’s life duration are required.

Keywords: bowel impassability, malignant tumors, surgery.

The analysis of evidence-based medicine data concerning conservative treatment for patients with peripheral occlusive disease in the stage of intermittent claudication was done. The numerous studies data advocates the cilostazol pathogenetic advisability for these patients treatment is presented. Multicenter randomized placebo-controlled trials results indicate the cilostazol clinical and economic benefits above pentoxifyllin and other vasoactive drugs in the treatment for patients with intermittent claudication manifestations. Extensive evidence base concerning safety of long-term cilostazol appointment is approachable.

Keywords: cilostazol, intermittent claudication, treatment, evidence-based medicine.

Modern understanding of the gastrointestinal tract periodic motor activity features depending on age-related changes in innervation and smooth muscle contractility, which lie at the diseases origin, such as duodenogastric reflux disease, colitis, irritable bowel syndrome, gastroesophageal reflux disease, enteropathy, constipation, and possible ways of pharmacological correction are highlighted in article.

Keywords: age-related changes, the gastrointestinal tract, motor function, smooth muscle, nerve plexus.

The history of the lymphatic system anatomy and physiology study, malignant tumors lymphogenous metastasis features, lymphadenectomy techniques are highlighted in article.

Keywords: lymphadenectomy, malignancy, history.

A case of combined removal of retro-peritoneal fibrosarcoma and inferior vena cava prosthetic replacement with good clinical (work ability is fully restored, ECOG = 0) and oncological (disease-free survival rates at the control check-up examination after 20 months) results.

Keywords: inferior vena cava, retro-peritoneal fibrosarcoma, prosthetic replacement of major vessel.

The aim — to study the efficacy of low-frequency ultrasonic cavitation in the complex treatment of purulent-necrotic wounds in patients with diabetes mellitus and severe lower limbs ischemia.

Materials and methods. The treatment results in 15 patients with diabetes and purulent-necrotic wounds and severe lower limbs ischemia were analyzed. Therapeutic complex involved purulent-necrotic local surgical debridement with low-frequency ultrasonic cavitation system.

Results and discussion. Developed therapeutic algorithm application allowed to achieve wound healing in all 15 patients, and to avoid amputation.

Conclusions. Early low-frequency ultrasonic cavitation application in purulent-necrotic wounds surgical treatment is an effective method in complex treatment and infectious complications prevention in diabetic patients with purulent-necrotic wounds and severe lower limbs ischemia.

Keywords: diabetes mellitus, purulent-necrotic wound, diagnosis, treatment, low-frequency ultrasound cavitation.

Цель работы — усовершенствовать хирургическую технику и внедрить новые варианты операций для лечения осложненного и неосложненного глоточно-пищеводного дивертикула.

Материалы и методы. В клинике в период с 1988 по 2013 г. пролечено 54 пациента с глоточно-пищеводным дивертикулом.

Мужчин было 36, женщин — 18, возраст — от 24 до 87 лет, в среднем — 54,3 года. Осложненное течение заболевания зафиксировано у 64,8 % больных. Описаны диагностические подходы, позволяющие уточнить состояние дивертикула, характер осложнения и выбрать оптимальный вариант лечения.

Результаты и обсуждение. В ранний послеоперационный период наблюдали 1 (1,85 %) осложнение, в отдаленные сроки — 1 (1,85 %) рецидив дивертикула. Продолжительность хирургического вмешательства зависела от сложности операции и составляла от 30 до 220 мин, в среднем — 82 мин. Летальных исходов не было.

Выводы. Диагностика глоточно-пищеводных дивертикулов требует особой тщательности, так как они могут иметь осложненное течение. Удаление дивертикула с раздельным прошиванием слизистого и мышечного слоев его устья и пересечением перстневидно-глоточной мышцы позволяет получить наилучшие результаты в ближайший и отдаленный период. При дивертикуле, осложненном рубцовым стенозом глоточно-пищеводного перехода, удаление дивертикула и реконструкция стенозированного сегмента — единственно возможное вмешательство, позволяющее устранить одномоментно сложную комбинированную патологию пищевода и глотки.

Keywords: дивертикул, глотка, пищевод, рубцовый стеноз, эзофагопластика.