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Ключевые слова: перфоративная язва, фазы Лунного цикла. Key words: perforated ulcer, phase of the Lunar cycle.
UDK 616.34 - 007.431
I.A. Mirxodjaev, B.B. Muazzamov, Dz.S. Hikmatov, Sh.S. Ramazonova
PROPHYLAXIS OF THROMBOEMBOLIC COMPLICATIONS IN SURGERY OF HUGE HERNIAS10
Bukhara state medical institute after Abu Ali ibn Sina, Chair of Faculty and Hospital Surgery, Bukhara city, Republic of Uzbekistan
Topicality. Performance of operations of herniotomies at the larger and huge ventral hernias (VH) is interfaced by danger of development of thromboembolic complications (TEC) [3,4]. The operational trauma leads to activation of processes of hemo-coagulation, the level of factors of folding increases in blood. The lethality at this complication makes 0,8-10,0% [1,2,5,6,7].
Materials and methods. Objective of this research is studying of influence of operative measures with the use of network artificial prosthesis at larger and huge VHs on hemocoagulation which allows carrying out individualizedly prophylaxis of TEC.
Indexes of hemocoagulation are studied in dynamics of 1-3, 5-8, 10-14 and 15-21 days after operation at 35 patients older than 60 years and 28 ones - younger than 60. All results are processed statistically.
Results and discussion. The analysis of indexes of a coagulogram at control group of patients showed that in 1-3 days after operation there is a moderate tendency to hypercoagulation due to depressing of fibrinolytic activity of-264,04±10,27 min., at norm of 212±17 min. (PI <0,05), fibrinogen strengthening to 397±0,19 g/l, at norm of 2,72±0,2 g/l (Pi <0,01) and slight activation of a factor by XIII - 69,4±2,36 sec., at norm of 62±3,0 sec. (Р <0,05).
For 5-8 days of the postoperative period there are already apparent signs of nor-
10 И.А. Мирходжаев, Б.Б. Муаззамов, Ж.С. Хикматов, Sh.C. Рамазонова Профилактика тром-боэмболических осложнений в хирургии огромных грыж.
malization of coagulogram. The fibrinolysis becomes more active, concentration of fibrinogen and activity of fibrinosis decreases. Change of these indexes statistically is reliable.
By 10-14 days all indexes of coagulogram differ from norm a little.
At 68,5% of geriatric patients, since 1-3 days after herniotomy, strengthening processes of fibrillation due to decrease in level of fibrinolytic activity from 276±12,5 to 321±23 min. took place at norm of 212±17 min. (PI <0,01), fibrinogen strengthening with 3,6±0,21 to 4,9±0,5 g/l at norm of 2,72±0,2 g/l (Pi<0,01), some decrease in heparine activity with 13,3±2,5 to 10±2 sec. (PI<0,05). Picture of hypercoagulation is most expressed in an interval between 3 and 5th afternoon after operation and remains till 8 days. In this interval of the postoperative period progressive depressing of fibrinolysis about 373±23 min. against increase of concentration of fibrinogen to the maximal figures - 4,5±0,3 g/l (for the entire period after operation) and increases of fibrinous activity to 72±3 sec. (norm - 62±3 sec.) is noted.
For the purpose of prophylaxis of postoperative venous thrombosis and other TEC various physical (mechanical) and pharmacological tools are used recently. Venous stagnation prevents early activation of patients in the postoperative period with elastic compression of the bottom extremities. Among general measures which also can play a preventive role, it is necessary to mention: ensuring adequate hydration, use of a normvolemic hemodilution, use of most sparing equipment of an operative measure, treatment of respiratory and circulatory failure.
The pharmacological tools used for the purpose of prophylaxis of TEC are presented by:
- low-molecular dextrans (Reopoliglyukin, Reomakrodeks);
- dezagregants (generally Aspirinum);
- routine unfractionated heparin;
- low-molecular heparins (LMH): Kleksan, Fraksiparin;
For the purpose of improvement of results of herniotomies, specific and nonspecific measures of prophylaxis of TEC in to - and postoperative the periods were carried out taking into account the degree of possible risk of their developments (Table-1).
The above-mentioned measures of prophylaxis allowed us to reduce degree of risk of TEC to minimum. However, in our supervision 1 patient in the postoperative period had a complication - thrombophlebitis of the surface veins of a shin, conservative treatment with convalescence in 5 days after complex therapy.
ТаЬ1е-1
The scheme of prophylaxis of TEC at larger and huge ventral hernias
Risk degree Way of prophylaxis
The low 1 . Elastic compression of the bottom extremities in to - and postoperative periods; 2 . Application of preparations of antiagregantny action before and after operation - Curantylum 0.25gr. on Itab. 3 times a day, Glyutaminovaya acid 0.25gr. on 1 tab. 3 times a day; 3 . Early activization of patients
The moderate The same as 1-3 items. 4 . Use of dextrans - Reopoliglyukin's infusions 400,0 in days in to - and the postoperative periods. 5 . LMH - Kleksan 20 mg.a day hypodermic or Fraksiparin 0.3 in days hypodermic or the Heparin of 5000 units of 2-3 times a day, hypodermic
The high 6 . LMH -Kleksan 40 mg. a day hypodermic or Fraksiparin 0.3-0.6 a day hypodermic or Heparin of 5000-7500 units 2-3 times a day, hypodermic 7 . The same 1-4 under umbilicus 8 . Methods of acceleration of venous blood-groove.
Conclusions. Thus, the well-timed assessment of a condition of hemocoagulation at patients with larger and huge ventral hernias in pre - and postoperative period, and also targeted correction of the revealed changes promotes sharp reduction of throm-boembolic complications.
Literature
1. Дибиров М.Д., Газимагомедов Г.Р., Бекмирзаев Ш.Ш., Саидова П.М. Профилактика и лечение тромбоэмболии легочной артерии в многопрофильной больнице скорой медициской помощи // Врач скорой помощи. - 2011. № 11. -С. 65-69.
2. Дибиров М.Д., Газимагомедов Г.Р., Саидова П.М., Бекмирзаев Ш.Ш., Ка-кубава М.Р. Специфическая и неспецифическая профилактика венозных тромбозов и тромбоэмболий при хирургической патологии у лиц пожилого и старческого возраста // Материалы II съезда хирургов Южного Федерального Окру-
га. Пятигорск 2009. - С.232.
3. Егиев В.Н. Ненатяжная герниопластика. - М.: Медпрактика, 2002. - 120 с.
4. Жебровский В.В., Мохамед Том Эльбашир. Хирургия грыж живота и эвентераций. - Симферополь: Бизнес-Информ, 2002. 440 с.
5. Лубянский В.Г. и др. Патогенез и профилактика венозных тромбоэмболических осложнений при больших вентральных грыжах // Хирургия. 2008. № 1. С. 30—32.
6. Савельев В.С., Кириенко А.И. - Хирургические болезни, I том. Москва, 2006 г. 608 с.
7. Цверов И.А. - Автореферат: Выбор метода абдоминопластики и коррекция нарушений гемокоагуляции в хирургии послеоперационных вентральных грыж. Новогород 2011.
8. Lubianskií VG, Kolobova OI, Onoshkin VV, Kostina IuP. Pathogenesis and prophylaxis of venous thromboembolic complications at large ventral hernias. Khirurgiia (Mosk). 2008;(1):30-2.
УДК 616.31(07)
Нагайко А.Е., Холод Р.А
ПРИМЕНЕНИЕ МАТЕРИАЛА НА ОСНОВЕ КОРАЛЛА ДЛЯ ПЛАСТИКИ КОСТНЫХ ДЕФЕКТОВ
Областная Ленинградская областная клиническая больница, Санкт-Петербург; Военно-медицинская академия имени С.М. Кирова,
Санкт-Петербург, Россия
В практической челюстно-лицевой хирургии и стоматологии сохраняется актуальность устранения больших послеоперационных дефектов челюстей, которые возникают после удаления опухолей, одонтогенных кист, а также секвестров. Для этих целей используется много отечественных и зарубежных оптимизаторов репаративного остеогенеза.
С целью повышения эффективности хирургического лечения стоматологических заболеваний, сопровождающихся образованием больших дефектов челюстей, не нарушающих непрерывность нижней челюсти, предложен способ, основанный на использовании отечественного материала, изготавливаемого на
