Цель исследования-описание клинической анатомии IV сегмента печени и определение ее значения в хирургии, а также комплексного подхода в лечении злокачественных новообразований этой локализации. Ключевые слова: хирургическая анатомия, сегмент S IV печени, злокачественные новообразования печени, хирургическое леч ение.
Nowadays, adhesive small bowel obstruction (ASBO) is a disease characterized by the stable increase in the number of patients, a significant level of postoperative complications, and a high risk of disability and death. The objective of the article was the research and analysis of relevant data of video laparoscopic treatment of patients with ASBO and possible postoperative complications. A small percentage of complications in clinical centers with a large flow of patients of this profile and rapid postoperative recovery of patients promote the active introduction of laparoscopic adhesiolysis in practical medicine. The analysis of foreign and domestic literature showed that the faithful adherence of indications for application of the technique for resolving intestinal obstruction and restoring passage through the gastrointestinal tract allows to achieve better results and avoid iatrogenic and infectious complications. Thus, laparoscopic treatment can and should be the operation of choice only in a carefully selected group of patients (the first manifestation of ASBO, the absence of pronounced ischemic changes in the intestinal wall and (or) the predicted presence of a small number of peritoneal adhesions), in all other cases, the use of laparotomy is indicated. Currently, there is a clear trend towards an increasing recognition and use of laparoscopy in surgical practice. It is becoming the preferred choice in clinical centers with extensive experience in the treatment of patients with ASBO due to an insignificant percentage of complications and a rapid postoperative recovery.
The objective: to determine the quality of knowledges about the Helsinki Declaration on Patient Safety among Russian anesthesiologists and intensivists and how widely its vision and standards have been adopted in clinical practice.Subjects and Methods. The study design involved the creation of 44-item online and offline questionnaire. The questions were divided into three blocks: personal information, data on hospitals where respondents work, and questions about implementation of the Helsinki protocol in their practice. Some of the questions required open answers. Persons with higher medical education who have completed residency and/or internship in anesthesiology and resuscitation and are working in this field in the Russian Federation were invited to participate in the survey.Results. 140 (21.5%) respondents answered all the question of the questionnaire. Of those surveyed, 76.4% were familiar with the Helsinki Declaration on Patient Safety, but only 17.1% felt they had sufficient knowledge of the concept. 43.6% of the respondents apply the Helsinki Declaration on Patient Safety to their clinical practice, while 49.3% of the respondents had difficulty answering whether they follow the Declaration in their work or not. The study showed a satisfactory level of compliance with mandatory standards for monitoring in the perioperative period but all the EBA-recommended standards are applied in only 23% of the hospitals. 26.4% of the respondents use the Safe Surgery Checklist prepared by the World Health Organization. 58.6% of the respondents use the reporting/notification system for adverse events or critical conditions in the perioperative period.Conclusion. The survey has shown that many of the surveyed anesthesiologists and intensivists have good knowledge of the Helsinki Declaration on Patient Safety and successfully apply it to their clinical practice but some doctors do it unconsciously, not understanding what standards they follow. Organization of additional educational programs could help physicians to improve their knowledge and raise their awareness in order to provide safer patient care. We also suggest introduction of unified checklists and national reporting systems for adverse events or critical conditions in the perioperative period.
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