Introduction. In this study, we analysed the results of applying various surgical methods in the combined treatment of inflammatory diseases of bones and joints.Materials and methods. The work was based on data from a multi-dimensional cohort study using non-concurrent (historical) control. A retrospective study included the analysis of medical records covering the period of 2009–2016 (1059 patients). A prospective study consisted in analysing the effectiveness of modern surgical methods in the combined treatment of inflammatory diseases of bones and joints in patients hospitalised to the Septic Surgery Department of the G.G. Kuvatov Republican Clinical Hospital (Ufa, Russia) in 2017–2018 (285 patients).Results and discussion. An analysis of the authors’ own data revealed that injuries (73.21%) and infectious complications after receiving surgery on bones and joints (15.03%) are the most common causes of osteomyelitis. In most cases, the following list of measures is optimal for diagnosing suspected osteomyelitis of various etiologies: X-ray, general clinical tests supplemented by the fistulography or CT of the affected area prior to surgery, as well as the examination of surgical material after surgery. The use of modern methods for surgical debridement and surgical repair of bone defects in the combined treatment of patients with chronic osteomyelitis can significantly reduce the relapse rate. It is recommended that patients with osteomyelitis be treated at large in-patient surgical facilities, which include a specialised department for the treatment of surgical infections and corresponding support services.Conclusion. Apparently, there is no one most optimal method for treating osteomyelitis. The optimal effect in the treatment of osteomyelitis is achieved through a personalised set of therapeutic measures using the following methods: laser vaporisation, negative-pressure wound therapy, ultrasonic cavitation in the focus of inflammation, as well as surgical repair of the post-trepanation bone defect or wound.
Rationale. Alveococcosis is a rare disease, its diagnosis and treatment depend on surgical techniques, equipment and clinical experience. The aim. To develop a diagnostic algorithm and compare the results of surgical treatment of patients with liver alveococcosis in different periods of time.Materials and methods. At the first stage, we carried out a retrospective analysis (1995–2007) of 33 patients with alveococcosis (a comparison group). At the second stage, a prospective clinical study (2008–2021) was performed on 39 patients (the main group). The number of patients was determined in accordance with the inclusion and exclusion criteria, and the study groups were comparable in age, sex, parasite localization (p > 0.05). For the names of operations, the WHO classification of alveococcosis was used.Results. In the main group, there is an increase in the applicability of: enzyme immunoassay; ultrasound and computed tomography; biopsy. Complications decreased by 2.7 times from 54.6 % in the comparison group to 20.6 % in the main group (χ2 = 8.97; df = 1; p = 0.003). The average duration of operations, as well as the average volume of blood loss in the comparison group and the main group were, respectively: with atypical resection – 220.4 and 180.2 min (p = 0.003), 640.1 and 480.0 ml (p = 0.005); with anatomical resection – 296.2 and 247.2 min (p = 0.002), 1450.2 and 1150.3 ml (p = 0.018); with cytoreductive resection – 230.2 and 200.1 min (p = 0.004), 860.3 and 670.4 ml (p = 0.001). There were 13 (39 %) cytoreductive resections in the comparison group, and 3 (8 %) in the main group (χ2 = 4.74; df = 1; p = 0.029).Conclusion. Timely diagnosis of alveococcosis leads to an increase in the number of radical resections, and modern surgical technologies and equipment can reduce the time of surgery, blood loss and the number of complications.
Background. Postoperative failure is a major cause of adverse outcomes in extensive liver resection. Post-resection liver failure requires intensive, including extracorporeal, care. Issues in correcting liver failure warrant novel approaches to prevent severe cases.Materials and methods. A retrospective analysis of 228 various-extent liver resections included minor (55.7 %), major (26.8 %) and extended (17.5 %) operations for malignant, benign and parasitic liver lesions. The post-resection liver failure rate has ben graded according to ISGLS.Results and discussion. Postoperative hepatic failure developed in 58 (25.4 %) cases, including 5 of 127 minor (3.9 %) resections, 18 major (29.5 %) and 35 of 40 extended resections (87.5 %). Mild class A liver failures were reported in 12.3 %, and severe classes B and C — in 9.2 % and 3.9 % cases, respectively.CT volumetry in place of the number of resected segments is suggested as a criterion to grade the expected post-resection residual liver, with >70 % defining a minor, 36–70 % — major and 25–35 % — extended expected residual liver.A two-staged extended hepatic resection approach is proposed to reduce postoperative liver failure, with vascular radiology-guided right portal vein embolisation (RPVE) or associating liver partition and portal vein ligation (ALPPS) at stage 1.A comparison of extended hepatic resection outcomes (n = 40) showed a significantly higher rate and severity of liver failure in single- vs. two-staged operations (p < 0.05).Conclusion. Liver failure is a leading cause of death in major and extended hepatic resection. Preoperative CT volumetry allows a more accurate volumetric control of expected post-resection residual liver. Two-staged extended hepatic resection can reliably reduce the rate and severity of postoperative liver failure.
Relevance. To evaluate the effectiveness of X-ray endovascular embolization of the portal vein branch in terms of preparation for extensive liver resections. Materials and methods. A retrospective analysis of 74 right-sided hemihepatectomies performed in one stage (classical, n = 54) or in two stages (X-ray endovascular embolization of the right portal vein followed by liver resection was performed, n = 20).Results. X-ray endovascular embolization of the right portal vein was accompanied by a significant increase in the planned liver remainder by an average of 37.3 %. This made it possible to reduce the volume of intraoperative blood loss, the incidence of postresection hepatic failure from 43.1 to 15.9 %, and postoperative mortality from 9.3 to 5.0 %.Conclusions. Preoperative X-ray endovascular embolization of the right portal vein leads to vicarious enlargement of the left lobe of the liver. This makes it possible to reliably reduce the incidence of post-resection hepatic failure after right-sided hemihepatectomy and, accordingly, reduce the frequency of deaths.
Introduction. Stomach perforations caused by ingested foreign bodies are extremely rare injuries in adults, accounting for less than 1% of all gastrointestinal perforations. The clinical picture is diverse and often presents a diagnostic problem. There are few publications reporting such cases in literature.Materials and methods. Using the example of a clinical case, this paper describes the clinical picture, diagnostic role of X-ray instruments and surgical tactics of diagnosing and treating a stomach perforation concealed by a foreign object, which occurred one week prior to admission. The patient V., 52 yo, was admitted to hospital on an emergency basis in the condition of moderate severity, complaining of abdominal pain for two days. The onset of the disease had no apparent reason. Similar pains had bothered the patient a week earlier the incident but were relieved without treatment.Results and discussion. On the basis of clinical and laboratory-instrumental data, acute pancreatitis was pre-diagnosed. Conservative drug therapy with positive dynamics was started. Two days later, computed tomography of the abdominal organs with intravenous bolus contrast was performed. According to the CT data, a foreign body in the abdominal cavity was identified, which rested on the liver at the level of the gallbladder, perforating the wall of the pyloric department of the stomach. Localized inflammatory effusion in the abdominal fat was observed. The patient was operated and discharged in satisfactory condition.Conclusion. Stomach perforations caused by small-sized foreign bodies are characterized by non-specific clinical manifestations. The use of radiation diagnostic methods facilitates the timely diagnosis and therapy choice in patients with stomach perforations caused by small-sized foreign bodies.
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