ФГБОУ ВО «Воронежский государственный медицинский университет им. Н.Н. Бурденко», Российская ФедерацияЦель. Разработать способ прогнозирования количества межреберных нервов у латерального края апо-невротического влагалища прямой мышцы живота в околопупочной области передней брюшной стенки.Материал и методы. Исследовано 88 нефиксированных трупов лиц обоего пола без признаков па-тологии передней брюшной стенки: 45% трупов лиц мужского пола (средний возраст -53,8±11,9 года) и 55% -женского пола (51,9±13,2 года). Измерялись linea bicostalis (расстояние между нижними точками реберных дуг) и linea bispinalis (расстояние между передними верхними остями подвздошных костей). Определялось количество межреберных нервов в области латерального края апоневротического влагалища прямой мышцы живота на протяжении околопупочной области передней брюшной стенки.Результаты. Linea bicostalis в среднем составила 29,2±0,3 см, а linea bispinalis -28,2±0,2 см. В об-ласти латерального края апоневротического влагалища прямой мышцы живота на протяжении околопу-почной области передней брюшной стенки чаще всего наблюдалось 2 пары межреберных нервов (60% наблюдений), несколько реже -1 пара нервов (20%). В 11% к прямой мышце живота подходило 3 пары межреберных нервов, а в 2% случаев встретилось 4 пары нервов. В 7% отмечалось асимметричное количе-ство межреберных нервов. С использованием метода логистической регрессии был предложен способ про-гнозирования вероятности обнаружения 2 пар межреберных нервов в области латерального края апоневро-тического влагалища прямой мышцы живота на протяжении околопупочной области передней брюшной стенки: P(%)=100×(1/(1+e^(12,1+0,33×a1-0,76×a2))), где P -вероятность обнаружения 2 пар межреберных нервов, a1 -linea bispinalis, a2 -linea bicostalis.Заключение. Разработанный способ позволяет прогнозировать количество межреберных нервов у ла-терального края апоневротического влагалища прямой мышцы живота в околопупочной области передней брюшной стенки и может быть рекомендован для применения в клинической практике. Ключевые слова: передняя брюшная стенка, апоневротическое влагалище, прямая мышца, иннервация, межреберные нервы, пупочная грыжа, герниопластикаObjectives. To develop a method of prognostication of the number of intercostal nerves in the lateral edge of the aponeurotic sheath of the rectus abdominis muscle in the umbilical region of the anterior abdominal wall.Methods. The unfixed corpses (n= 88) of both sexes without pathology of the anterior abdominal wall were studied: 45% of male corpses (average age -53,8±11,9 years) and 55% -females (51,9±13,2 years). Linea bicostalis (the distance between the lower points of the costal arches) and linea bispinalis (the distance between the front upper iliac spines) were measured. The number of the intercostal nerves at the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region of the anterior abdominal wall was established.Results. Linea bicostalis on the average composed 29,2±0,3 cm and the linea bispinalis -28,2±0,2 cm. In the ar...
The aim of the study was to investigate the potential of Surgitamp hemostatic gauze and Molselect G-50 sorbent application in surgical hemostasis of simulated bleeding liver wounds in an in vivo experiment on laboratory animals. Materials and methods. The study included 30 laboratory animals: Chinchilla rabbits. Laboratory animals underwent median laparotomy under intravenous anesthesia (Zoletil 100 0.1 ml /kg, Xylavet 0.1 ml/kg), the right lobe of the liver was involved into the wound. At a 20 cm distance from the surface of the liver, a metal 92 g load in the form of a triangular prism was attached to the slider with the help of a thread. By operational readiness, the thread was burned, the prism fell vertically and hit the surface of the liver with a pointed end, this resulting in a simulated bleeding liver wound: a wound of the right lobe of the liver, linear in shape 3.0x0.7 cm, 0.6 cm deep, with uneven edges and active bleeding from the defect area. Hemostasis in the experimental group of animals (n=15) was carried out by covering the wound surface with a granular sorbent Molselect G-50, followed by tamponing the wound with a strip of hemostatic gauze Surgitamp. In the control group of animals (n=15) hemostasis was carried out by stitching a bleeding liver wound with a U-shaped suture with a PHA 3.0 thread until the edges of the wound converged. The effectiveness of hemostasis of the liver wounds was evaluated using the following parameters: the time of the final bleeding arrest, the volume of blood loss, the number of episodes of repeated bleeding. Results. Experimental studies have demonstrated that the surgical hemostasis technique with the hemostatic agent Surgitamp application combined with the granular sorbent Molselect G-50 allows for reliable hemostasis of simulated bleeding liver wounds, reducing the time of bleeding arrest from 461.0(420.0-501.0) sec to 280.0(264.0-308.0) sec (P=0.0001), simultaneously reducing the incidence of recurrent hemorrhages from 46.7% to 6.7% (P=0.035).
The Olympiad Student Surgical movement historically arose from the activities of student scientific societies at the surgical departments of medical universities and, foremost, departments of operative surgery with topographic anatomy. This is the first department where students are taught future surgical manual skills of a medical specialist. The history of the largest Moscow (All-Russian) Student Olympiad in surgery named after an academician M. I. Perelman, held under the authority of First Sechenov Moscow State Medical University, is more than 30 years. Olympiad Student Surgical movement at Voronezh N. N. Burdenko State Medical University appeared in 2008. A long and difficult path has been covered since then. The teams under the guidance of various lecturers and student leaders experienced ups and downs, repeatedly won victories in the qualifying stages of the All-Russian Olympiad and took prizes in the Finals of the All-Russian Olympiad. In 2015, the tradition of holding an intra-university student Olympiad in surgery was started. Since then, 6 intra-university Olympiads have already been held. This allows annually updating the staffing of the team and encouraging students to even better results. The Olympiad surgical movement has a great pedagogical and educational potential and, undoubtedly, is an important stage in training future medical specialists of a surgical profile.
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