Annotation. The MEDLINE/PubMed database was searched for all original articles published between 2011 and 2022 analyzing the incidence, prevalence, complications and surgical treatment of benign prostatic hyperplasia using laparoscopic prostatectomy (including retropubic interventions) and open retropubic prostatectomy to compare advantages and disadvantages of the both approaches. It was found that transperitoneal approach was used in 104 (12.4%) patients, extraperitoneal – 739 (87.6%). Complications of the I degree according to Clavien-Dindo inpatient period were observed in 4 (0.5%) patients; complications of the II degree – 10 (1.2%), complications of the IIIa degree – 5 (0.6%). Complications of the III, IV and V degrees were not identified, mortality was absent. Complications of the I degree according to Clavien-Dindo after discharge from the hospital (up to 90 days of observation) were discovered in 42 (5%) patients, complications of the II degree – in 13 (0.6%). Laparoscopic prostatectomies had a low percentage of intraoperative blood transfusions (1.2%), strictures of the urethra/bladder neck (0.35%) and fistula formation (0.12%). No wound infection was observed in any patient. Laparoscopic prostatectomies have the significant advantages over open prostatectomies, and therefore they should be more widely used in Ukraine.
Annotation. The aim of the study was to evaluate the immediate and long-term results of valvular prostatectomy and simultaneous peritoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia and assess the quality of life of patients. The article presents the treatment results of 152 patients with benign prostatic hyperplasia. All individuals were divided into two groups. The general group consisted of 32 (21.1%) patients with benign prostatic hyperplasia and inguinal hernia, who underwent one-stage retropubic prostatectomy and simultaneous preperitoneal hernia repair. The comparison group consisted of 120 (78.9%) patients with benign prostatic hyperplasia who underwent only a one-stage retropubic prostatectomy. Assessment of the life quality of patients after simultaneous preperitoneal inguinal hernia repair was performed according to the EuraHS - Quality of Life scale in 6 and 12 months after surgery. The obtained quantitative data were processed by the variation statistic methods with the calculation of t-Student criteria. The data were considered reliable at a significance level of 0.95 (p<0.05). The average age of men in the comparison group was 68.0±7.2 years, in the general group – 67.1±6.9 years; the average prostate volume in the comparison group was 94.4±42.3 cm3, in the general group – 91.2±32.6 cm3; 44 (36.7%) patients of the comparison group and 4 (12.5%) patients of the general group were admitted to the department urgently (due to acute urinary retention or chronic complete urinary retention). The inguinal hernia was found in all 32 patients of the general group, among them in 4 men – on both sides. The average time of ciliary prostatectomy in the general group and in the comparison group was the same (82.8±25.6 and 80.1±17.4 minutes). The simultaneous inguinal hernia repair on the one side lasted 55.0±17.4 minutes. Neurological complications in the general group were noted in 2 (6.25%) patients, in the comparison group – in 9 (7.5%); urological complications took place in 11 (34.2%) and 40 (33.3%), respectively. The average postoperative inpatient stay in the general group was 9.5±1.7; in the comparison group – 9.8±2.9. It was statistically better due to these periods after surgery when compared with preoperative life quality.
Вінницький національний медичний університет ім. М. І. Пирогова 1 Вінницька обласна клінічна лікарня ім. М. І. Пирогова 2 Лікування гнильної флегмони шиї, ускладненої медіастинітом, у хворого з гіпоергічною імунною відповіддю Мета роботи: описати правильний метод лікування пацієнтів із гнильною флегмоною шиї, ускладненою медіастинітом, на прикладі випадку успішного лікування хворого з ускладненим шийним некротизуючим фасціїтом та гіпоергічною імунною відповіддю. Гнильна флегмона шиї, ускладнена медіастинітом, -досить рідкісне захворювання з високим рівнем летальності (40-85 %). У статті представлено випадок успішного лікування хворого з ускладненим шийним некротизуючим фасціїтом та гіпоергічною імунною відповіддю на фоні ревматоїдного артриту, тривалий час лікованого глюкокортикостероїдами. Раннє хірургічне втру-чання з максимально широким розкриттям і наскрізним дренуванням всіх уражених клітковинних просторів з адекватною анти-бактеріальною терапією є єдиним правильним методом лікування таких пацієнтів.Ключовi слова: гнильна флегмона шиї; медіастиніт; цервікотомія.
Recently, a tracheostomy was considered the method of choice for provide ventilating of patients with deep neck phlegmons, but current trends recognize that tracheal intubation with bronchoscope is the most rational way of adequate breathing security in such patients. Objective - to investigate the peculiarities of features of adequate intu bating security in patients with odontogenic and tonsilogenic neck phlegmons. 70 patients with deep neck phlegmons of odontogenic 4(7 (67%)) and tonsilogenic origin - (23 (33%)) have been investigated. 47 (67%) suffered from descending mediastinitis. Tracheal intubation was performed using orotracheal laryngoscope, bronchoscope or through tracheostomy. 33 (47.1%) patients underwent orotra cheal intubation with a bronchoscope, 34 (48.6%) with a laryngoscope, and only in three cases (4.3%) tracheostomy was used. Bronchoscopic intubation was performed in 57.4% of patients with odontogenic phlegmons, and only in 26.1% cases of oropharyngeal spaces suppuration. The percentage of tracheostomies was the same in two groups of patients and showed 4.3%. Mortality rate was 12.9%. Thus, 57.4% of patients with odontogenic neck phlegmons need for bronchoscopic tracheal intubation, a tracheostomy is used extremely rarely (4.3%). Intubation with laryngoscope is possible in 70% of patients with tonsilogenic suppuration. Comparison of tracheal intubation in patients with deep neck phlegmons with and without descending mediastinitis is prospects for further research.
Проблема адекватного лікування гострого нагноєння клітковини шиї є однією з найбільш складних у хірургії. Актуальність даного питання обумовлена швидким розвитком таких ускладнень, як медіастиніт, сепсис, арозивні кровотечі, тромбоз шийних вен та ін. [1, 2]. Швидкому розвитку запального процесу на шиї сприяють її анатомічні особливості-наявність великої кількості фасцій, міжфасціальних просторів, рухливість органів шиї, присмоктуюча дія середостіння [3]. Серед причин виникнення флегмон цієї ділянки на перший план виходить орофарингеальна інфекція [4-6]. W. Yang et al. (2015) вивчили 130 хворих із глибокими шийними нагноєннями (deep neck infection), поміж яких фаринго-і тонзилогенні інфекції становили 24,4 %
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