The objectiveis to study the results of different methods of surgical treatment of patients with infected pancreonecrosis and to conduct a comparative analysis of minimally invasive and traditional surgical interventions.Material and methods.The results of treatment of 206 patients with infected pancreonecrosis were analyzed. In accordance with the used method of surgical treatment, the patients were divided into 2 groups: 105 (51.0%) patients with “traditional” open interventions were included in the first group (comparison), and 101 (49.0%) patients treated with various miniinvasive technologies, or a combination of minimally invasive and “open” interventions were included in the second group.Results.It was found that the mortality rate in the second group was less than in the first group by 12.8% (p<0.05).Conclusion.Minimally invasive surgical techniques are the method of choice for delimited pancreatogenic ulcers. The use of combined surgical interventions leads to a significant reduction of postoperative mortality and duration of inpatient treatment.
The objective is to analyze own clinical observations with the purpose of optimization of diagnostics and application of the adequate medical grant to patients with wounds of heart.Material and methods. The results of treatment of 268 patients with heart wounds operated in the clinic for the last 27 years were analyzed. The majority of patients 202 (75.4 %) had penetrating and through wounds to the heart, 66 (24.6 %) had non-penetrating injuries. The diagnosis was based on clinical symptoms, the results of electrocardiographic, echocardiographic and x-ray studies. The clinical picture depended on the nature of the wound – penetrating or non-penetrating. Videothoracoscopy helped to clarify the nature of the damage of the heart in vague diagnostic cases. In most patients, heart damage was recognized in a timely manner, a diagnostic error was committed in 18 (6.7 %) patients. In 59 (22.0 %) cases, myocardial wounds were stitched with P-shaped sutures, and in 209 (78.0 %) – with nodular sutures.Results. 240 (89.6 %) patients were discharged in satisfactory condition, 11 (4.1%) patients were transferred to the cardiology department for the follow-up treatment, 17 patients died with penetrating or through cardiac injury. The mortality rate was 6.4 %.Conclusion. Emergency surgery is the only effective method of treating heart injury. Long-term results of treatment were traced in 38 patients in terms of 1 year to 10 years. All patients had a clinical recovery.
Краевая клиническая больница скорой медицинской помощи, Барнаул 656038, Российская Федерация Цель исследования. Повышение эффективности комплексного лечения больных острым панкреатитом путем ослабления явлений тромбогеморрагического синдрома и уменьшения нарушений микроциркуляции с помощью криоплазменно-антиферментной терапии и коррекции протеиназно-ингибиторного дисбаланса в крови и в очаге поражения. Материал и методы. Проведен анализ результатов лечения 446 пациентов острым панкреатитом средней и тяжелой степени. 213 (47,8 %) пациентов составили основную группу, в комплексном лечении которых использовалась криоплазменно-антиферментная терапия и локальное введение ингибиторов протеолиза. 233 (52,2 %) больным, составивших группу сравнения, проводилось общепринятое лечение острого панкреатита. Результаты. Использованные патогенетические подходы в лечении больных острым панкреатитом позволило улучшить результаты лечения и снизить летальность с 21,5 % до 12,7 %. Заключение. Использование в комплексной терапии у больных острым тяжелым панкреатитом криоплазменно-антиферментного комплекса и локального введения ингибиторов протеиназ, позволяет улучшить исходы заболевания. Ключевые слова: панкреатит, панкреонекроз, деблокирование микроциркуляции, патогенетическое лечение, оперативное лечение, криоплазменноантиферментный комплекс, ингибиторы протеиназ. Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.
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