Aim. To estimate the economic efficiency of laser technology use in complex treatment of patients with benign anorectal diseases in a day ward or as an out-patients. Methods. «Mediola-Compact» semiconductor laser (manufactured by «Fotek» ldt, Belarus) was used to treat chronic hemorrhoids and chronic anal fissures. Interstitial submucosal tissue destruction device developed by authors (Republic of Belarus Patent for effective prototype №8755) was used, allowing to cause extensional destruction while inserted into the tissue. 297 surgical interventions were performed during 3 years, among them 157 patients underwent surgery while in a day ward, 140 - as an out-patients. Prevented indirect expenses like prevented admission fees, medical certificate compensations, prevented Gross Domestic Product reduction as a result of an average hospital stay reduction were assessed for economic efficiency calculation. Results. Total economic benefit of low-invasive interventions (as a reduction of expenses on admission fees and medical certificate compensations) for 3 years term in patients with anorectal diseases treated using the examined management and laser treatment methods was assessed as 140 250 US dollars. The overall economic efficiency on low-invasive laser technology is described with cost-effectiveness coefficient of 2.36, or 236%, compared to the conventional surgical treatment. Conclusion. Laser technology use in patients with benign anorectal diseases allows to significantly decrease the hospital stay using the day ward model, economic efficiency of the low-invasive laser technology as a complex treatment component in patients with chronic hemorrhoids and chronic anal fissures allows to cover the expenses for its introduction within 1 year.
We studied IR spectra of blood and cephalosporin antibiotics that are widely used in medical practice. We established the spectral regions that are suitable for determining their concentration in blood. It is shown using the antibiotic cephtriacson as an example that the IR spectroscopy method allows one to determine the concentrations of antibiotics in blood in the range of practical medical interest. We examined the possible transfer of antibiotics by blood erythrocytes.
Цель. Изучить результаты чрезраневой лазерной коагуляции абсцедирующей пилонидальной кисты, провести их сравнительную оценку с результатами традиционного метода санации абсцесса.Материалы и методы. В проспективное исследование отобрано 80 пациентов с абсцедирующими пилонидальными кистами, которые были слепо распределены на две группы (по 40 в каждой) методом простой рандомизации.Пациентам в группе А после вскрытия и дренирования абсцесса на 2-е сутки выполнена лазерная коагуляция полости абсцесса и кисты под местной анестезией. Пациентам группы В (контроль) также выполнялась санация абсцесса, но без лазерной операции. Группы были однородны по полу, возрасту, тяжести заболевания. Через 1 месяц, 1 год было выполнено ультразвуковое исследование крестцово-копчиковой области.Результаты и обсуждение. Средние сроки заживления ран оказались сопоставимы (p=0,8061, z=–0,2459 Mann – Whitney U-test). У 7,5% пациентов в группе В через месяц выявлен вторичный свищ, что позднее потребовало иссечения кисты. Применение лазерной коагуляции пилонидальной кисты достоверно не ухудшало состояние пациентов. Отсутствовали статистически значимые различия при сравнении групп по стационарному койко-дню (p=0,1586, z=1,4097), длительности нетрудоспособности (p=0,2092, z=1,2557 Mann – Whitney U-test). Выявлены преимущества группы А по частоте ремиссии заболевания через месяц и 1 год после начала лечения (Chi-square, p=0,0009, p=0,001). При морфометрии, эхоскопии через год наличие инфильтрата без жидкостных структур и воспаления в основной группе было выявлено в 5% наблюдений, в контрольной – в 22,5%.Заключение. Метод лазерной коагуляции полости абсцесса и пилонидальной кисты обладает преимуществом по сравнению с методом санации абсцесса по частоте ремиссии заболевания в контрольные сроки до 1 года. Существует необходимость дальнейших исследований, изучения отдаленных результатов и дискуссии по вопросу хирургической тактики. Purpose. To study the results of trans-wound laser coagulation of pilonidal sinus abscess, to perform its comparative assessment with the results of abscess incision.Materials and methods. 80 patients with pilonidal sinus abscess were selected for the study. They were blindly distributed into 2 groups (40 in each) by simple randomization.Patients in the group A were subjected to laser coagulation of abscess and sinus cavities under local anesthesia after abscess incision and drainage on the day 2. Group B (control) patients were also subjected to abscess incision, but without laser. The groups were homogeneous by sex, age, severity. In 1 month, 1 year, ultrasound examination of sacral area was performed.Results and discussion. The average wound healing terms were comparable (p=0.8061, z=–0.2459 Mann – Whitney U-test). 7.5% of patients in the group B had fistula in 1 month, which required excision. The use of laser did not significantly worsen patient’s condition. There were no statistically significant differences in the hospital term-stay comparison (p=0.1586, z=1.4097), disability duration (p=0.2092, z=1.2557 Mann – Whitney U-test). The advantages of the group A in the recovery rate in 1 month, 1 year after the start of treatment were revealed (Chi-square, p=0.0009, p=0.001). After ultrasound, the infiltration without liquid and inflammation in the group A were detected in 5% of patients, in the group B – 22.5%.Conclusion. The method of pilonidal sinus laser coagulation has an advantage over the method of abscess incision in terms of disease recovery rate in the control terms of 1 year. There is the need for further research, study of remote results, and discussion about surgical tactics.
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