Вивчено вміст TNF-α, IL-2, IL-8 в крові у 162 хворих з гнійними ранами. Встановлений позитивний зв'язок між концентрацією прозапальних цитокінів та об'ємом і площею ран, виявлено зниження рівня цитокінів при хронізації загоєння. Застосування озонобаротерапії у комплексному лікуванні хворих сприяло поліпшенню результатів лікування та нормалізації рівня цитокінів при хронізації ранового процесу Ключові слова: гнійні рани кінцівок, озонобаротерапія, бактеріофаг, хірургічнелікування Foundation. One of the mechanisms of ozone effect is its impact on immune state of organism. The work is devoted to study of peculiarities of the state of proinflammatory cytokines at the complex treatment of patients with festering diseases and wounds of limbs. Materials and methods. It was examined and treated 162 patients with festering diseases and wounds of limbs. In the main group 87 patients underwent treatment with ozonebaro-and ozonetherapy, and in the group of comparison 75 patients were treated according to accepted standards. It was studied the content of proinflammatory cytokines TNFα, Il-2, Il-8 in the blood of patients with festering wounds in both groups depending on the volume and area of wounds in the dynamics of treatment. Results. Studying the group of comparison it was established a positive connection between the concentration of TNFα, Il-2, Il-8 and the volume and area of the wound process. It was revealed that hyperactivity of organism that led to the "necrotic" script of development of an alternative phase of the wound process was one of the causes of large necrosis. At chronization of the wound process the level of cytokines decreased on the 15 day comparing with patients with a smooth clinical course that indicated the decrease of reactivity of organism. The offered medical and diagnostic algorithm of the treatment patients using ozone-and ozonebarotherapy favored an improvement of the results of treatment and fastened the healing of wounds. In analysis of the level of cytokines in patients of the main group it was revealed that at the high levels of proinflammatory cytokines the use of the offered methods of treatment favor the decrease of its level and at chronization (with the low level of cytokines) its concentration increases. So the use of ozonebaro-and ozonetherapy leads to normalization of immune response and diminishes the probability of chronization of the wound process. Conclusions. The study of the level of proinflammatory cytokines allows evaluate the clinical course of the wound process objectively, to reveal the tendency to its chronization. The use of ozonebaro and ozonetherapy leads to normalization of immune response at the too high or too low levels of IL-2, IL-8, TNF and diminishes the probability of chronization of the wound process. The data received during the research indicate an efficiency of the offered methods of treatment
Summary. The most formidable early postoperative complications of Lewis esophagogastroplasty (EGP) is the failure of esophagogastroanastomosis (EGA), and in the late period — stricture of EGA, in some patients there are functional disorders. The aim of the study. Assess the treatment of complications of EGP using minimally invasive methods. Materials and methods: The results of 150 operations for cancer of the middle and upper thoracic esophagus with the imposition of high EGA were analyzed (65 used cervical EGP). X-ray endoscopic techniques are used to treat patients with complications. The functional results of EGP using esophageal manometry and pHZ monitoring were also evaluated. Results and discussion. When applying EGA on the neck was significantly higher incidence of failure of the anastomotic sutures, which was associated with impaired blood supply with increasing length of the graft. Surgical tactics in case of failure of the EGA on the neck was to open and drain the deep space of the neck, conducting a transnasal tube for feeding into the stomach — there were no fatalities. Surgical tactics in case of failure of intrapleural EGA, which took place in 4 cases, consisted of drainage of the empyema cavity and conducting a transnasal tube for nutrition in the initial parts of the small intestine under X-ray video surveillance. In the treatment of failure of intrathoracic anastomoses there was 1 fatal case. At strictures of EGA which took place at 24 patients, performed balloon dilatations under X-ray video control. In 2 patients with the phenomena of pylorospasm performed balloon dilatation of the pyloric pulp under X-ray video control. In general, patients who underwent EGP showed good and satisfactory functional results, but in some patients there were functional disorders that were transient in nature. Conclusions: The use of clinically developed methods of esophagogastroplasty can reduce the number of failures and strictures of anastomoses. At insufficiency and strictures of an esophagogastroanastomosis, and also at a hypertonia of pyloric pulp X-ray endoscopic methods are highly effective and low-traumatic.
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