Method for surgical management of aseptic pancreonecrosis
SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.
EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.
3 dwg, 2 ex
The invention relates to surgery, in particular to methods of surgical treatment of aseptic necrotizing pancreatitis.
The known method of surgical treatment of aseptic necrotizing pancreatitis by the method of V. A. Kozlov - "abdominal pancreas" (V. S. Saveliev "Guide for emergency surgery of abdominal organs", Moscow, 1986, p. 367). The principle of operation is that after the mobilization of the pancreas behind her is a portion of the greater omentum on a vascular pedicle, which prevents the flow of fluid in the retroperitoneal space.
The disadvantage of this method is the risk of bleeding; the gland is transformed into a tight biological swab, this will disturb the blood supply to the gland, there is a risk of necrosis with subsequent infection.
Known as a "closed" method of surgical treatment of avascular pancreatic necrosis (see K. D. Toskin "Materials for the study of pancreatitis" synopsis of dissertation Dr. med. Sciences. M., 1968), taken as a prototype and which consists in the shelter of the pancreas all of the greater omentum.
The disadvantage of this method is that for shelter pancreas used the greater omentum without regard to its blood supply and lack of additional blood supply to the liver greater omentum, as violations� liver function in acute pancreatitis occurs in 39%, and hepatic failure with jaundice - in 27% (V. I. Filin Acute diseases and injuries of the pancreas", 1982, pp. 51-52). In addition, in this method, possible false-positive and false-negative results of diagnostic plots of the pancreas to be removed, as they are not defined.
The objective of the claimed invention is to improve the efficiency of surgical treatment of patients with aseptic pancreatic necrosis through the detection and removal of necrotic areas of the pancreas, improve the blood supply to the tissues of the pancreas and liver vessels omentum.
The problem is solved due to the fact that the segments of the pancreas will be removed, determined by the absence intraorganelle pulse. Dissect the greater omentum into 2 unequal parts - 1/3 on the left and 2/3 on the right to the base of the greater omentum. The left 1/3 of the greater omentum with the pulse amplitude of oscillations is not less than 3.0 mm in distal portion hem U-shaped seams to peripancreatic tissue, and the right 2/3 of the greater omentum with the amplitude of pulse oscillations is not less than 2.0 mm in the distal section is stitched to the right lobe of the liver the U-shaped seams.
The use of the claimed invention to detect and remove the necrotic areas of the pancreas, improve Cremona�proposal pancreas and liver due to the use of vessels omentum thereby to stop the progression of the disease and prevent infected pancreatic necrosis.
The inventive method is illustrated by drawings, which depict: Fig.1 - greater omentum is dissected into 2 unequal parts closer to the left edge; Fig.2 - 1/3 omental graft is fixed to the U-shaped seams to peripancreatic tissue; Fig.3 - 2/3 of the greater omentum is fixed to the right lobe of the liver the U-shaped seams.
The inventive method is implemented as follows: after sanation of abdominal cavity measured intraorganic the pulse of the pancreas (for example, by Z. M. Siegal (see Segal, Z. M. "the Phenomenon of vzaimoprevrascheny pulse and continuous intramural blood flow in arteries". Proceedings of the Academy of Sciences of the USSR, Moscow, 1982, pp. 795-799)) and is determined by the absence of a pulse of necrotic areas of the pancreas, the latter is removed, the cavity is drained.
Dissect the greater omentum to the base into 2 unequal parts closer to the left edge (Fig.1). Performed hemodynamic measurements in the greater omentum, identify sites with a better blood supply (on pulse 1/3 of the left edge of the greater omentum, the amplitude of pulse oscillations should be 3.0 mm or more; in 2/3 of the right edge of the greater omentum, the amplitude of pulse oscillations is not less than 2.0 mm). Cover 1/3 of the left edge of the greater omentum pancreas and fix e�about to peripancreatic tissue U-shaped sutures (Fig.2). The remaining 2/3 of the right edge of the greater omentum sutured to the right lobe of the liver is also U-shaped sutures (Fig.3).
Patient B., Diagnosis: hemorrhagic pancreatic necrosis aseptic, enzymatic peritonitis, alcoholic hepatitis.
Surgery: laparotomy, intraoperative hemodynamic control, necrectomy of the pancreas, pancreatoscopy, heptamethine, sanitation, drainage of the abdominal cavity.
During inspection of the abdominal cavity in the pelvis and in the subhepatic space is found to 500 ml of sero-hemorrhagic fluid. Last removed by suction apparatus. On the greater omentum places are stearic spots. Biliary tract, without features. The liver is enlarged, rather compact consistency. Revealed omental Bursa, pancreas severely swollen, thickened, dark cherry color all over. On the anterior surface of the pancreas detected foci of necrosis in the amount of 3 irregular shape: a 2.0×1.0 cm; a 3.0×2.0 cm; a 3.0×2.5 cm, the pulse Amplitude of oscillations in intact pancreatic tissue was 2.5 mm. the Amplitude of pulse oscillations of " no necrotic areas. Lesions removed method digitalise, cavity drained.
The greater omentum is longitudinally cut into two unequal flap closer to the left edge to the ground. When �hemodinamically study, 1/3 of the left edge of the greater omentum revealed the amplitude of pulse oscillations 4.5 mm and 2/3 of the right edge of the greater omentum - 2.5 mm. the Pancreas is covered by the left flap of the greater omentum; commit its U-shaped catgut sutures to peripancreatic tissue. The right 2/3 flap of the greater omentum sutured to the right lobe of the liver.
The postoperative period was uneventful. The patient is examined after 1 year, the condition is satisfactory, no complaints.Biochemical analyses of blood and urine without pathology.
Patient X., Diagnosis: Hemorrhagic pancreatic necrosis aseptic, enzymatic peritonitis, alcoholic hepatitis.
Surgery: laparotomy, intraoperative hemodynamic control, necrectomy of the pancreas, pancreatoscopy, heptamethine, sanitation, drainage of the abdominal cavity.
During inspection of the abdominal cavity in the pelvis and in subhepatic space up to 1500 ml of sero-hemorrhagic fluid. Last removed by suction apparatus. On the greater omentum places are stearic spots. Biliary tract, without features. The liver is enlarged, rather compact consistency with a yellowish color. Revealed omental Bursa. The pancreas is severely swollen, compacted, dark cherry color all over. On the anterior surface of the pancreas detected foci of necrosis in the amount of 4 irregular�Oh shape: a 1.5×1.0 cm; A 2.0×1.5 cm; 2,0×2.5 cm; a 2.0×2.0 cm, the pulse Amplitude of oscillations in intact pancreatic tissue was 3.0 mm. Intraorganic pulse no necrotic areas. Lesions removed method digitalise, cavity drained.
The greater omentum is longitudinally cut into two unequal flap to the base closer to the left edge. In the hemodynamic study, 1/3 of the left edge of the greater omentum revealed the amplitude of pulse oscillations 3.5 mm, and 2/3 of the right edge of the greater omentum - 2.0 mm. the Pancreas is covered by the left flap of the greater omentum; commit its U-shaped catgut sutures to peripancreatic tissue. The right 2/3 flap of the greater omentum sutured to the right lobe of the liver.
The postoperative period was uneventful. The patient is examined after 1 year, the condition is satisfactory, no complaints. Biochemical analyses of blood and urine without pathology.
Method of surgical treatment of aseptic necrotizing pancreatitis, including shelter pancreas gland on a vascular pedicle, wherein the detected portions of the pancreas with no intraorganelle pulse and remove them, to shelter the pancreas dissect the greater omentum into two parts, 1/3 on the left and 2/3 on the right to the base of the greater omentum and the detected portions with the amplitude of the pulse OSC�of lazy not less than 3,0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum, while in the left part distal portion hem U-shaped seams to peripancreatic tissue, and the right to distal portion is stitched to the right lobe of the liver.
FIELD: physics, computer engineering.
SUBSTANCE: group of inventions relates to ergatic systems and can be used to correct the functional status of a human operator. The method includes evaluating the status of a human operator. The status indicator used is the heart rate. Limiting values of the range of a good status ChSSmin and ChSSmax are set for each human operator. When the heart rate exceeds the limiting values, the energy stimuli used are light pulses and binaural action, the frequency f of which is set in accordance with a given expression. An apparatus for correcting the functional status of a human operator is used. The apparatus comprises a central control unit connected to a storage unit, a stimulus generating unit and an analysis unit. The stimulus generating unit is connected to a stimulation unit. The output of the analysis unit is connected to the central control unit. The apparatus additionally includes a unit for measuring and processing an electrical cardio signal and a heart rate determining unit. The output of the unit for measuring and processing an electrical cardio signal is connected to the input of the heart rate determining unit, the output of which is connected to the analysis unit.
EFFECT: group of inventions improves the efficiency of correcting the status of a human operator, prevents excessive fatigue of the human operator quickly and in advance, reduces emotional and psychological stress, raises the level of activity of the body owing to a method of determining the status of the human operator, using the heart rate ChSS as an indicator of the status, the effect of light stimuli and binaural action.
2 cl, 2 dwg, 1 tbl
SUBSTANCE: clinical, X-ray and echocardiographic examinations are performed in a premature infant on the third day of life. Gestation age, Apgar score, infant's reflexes, states of the muscular system, skin, oedemas, moist rale, increased pulmonary vascularity on the X-ray pattern, as well as echocardiographic values of final diastolic size, left atrium and right ventricle per one kilogram of infant's body weight are assessed, and a prognostic coefficient is determined by mathematical formula. If the prognostic coefficient is 10 points and more, the high risk of long persistence of a haemodynamically significant form of the open arterial duct in the premature infants is predicted; the prognostic coefficient falling within the range of 0 to 9 points shows the low risk of long persistence of the haemodynamically significant form of the open arterial duct.
EFFECT: method enables predicting the non-invasive prediction of the high risk of long persistence of the haemodynamically significant form of the open arterial duct in the premature infants on the third day of life, and specifying the further therapeutic approach to the infant and the absolute indications for persistent foetal communication correction.
2 tbl, 2 ex
SUBSTANCE: invention refers to medicine, namely to cardiosurgery. The bypass blood flow is assessed with assisting artificial circulation and clamped aorta. After a distal anastomosis is created, the bypass is connected to a heart and lung apparatus by means of an intravenous infusion system. Each anastomosis is assessed successively.
EFFECT: method enables the intraoperative assessment of the blood flow in the bypasses and the inspection of the dysfunctional anastomosis before unclamping the aorta and applying cardioplegic solution additionally.
SUBSTANCE: group of inventions relates to medical diagnostics. Method of determining degree of vessel narrowing contains stages at which obtained are: sequence of first pressure measurements P1 and sequence of respective first rate measurements U1 in first location inside vessel, sequence of second pressure measurements P2 and sequence of respective second rate measurements U2 in second location inside vessel. Wave rate c in fluid medium is determined for each location depending on square of pressure change divided by square of respective rate change. For first location change of direct pressure is determined depending on the sum of pressure change and rate change. For second location change of direct pressure is determined depending on the sum of pressure change and rate change. Reserve of separated direct flow, representing drop of pressure through target area is determined, with said drop of pressure indicating degree of local narrowing or compression of vessel between said first location and second location. Device for determining degree of vessel narrowing is described.
EFFECT: inventions provide measurement of localised flow restriction.
14 cl, 6 dwg
SUBSTANCE: patient with premature atrial contraction (PAC) undergoes ECG study. A signal-averaged ECG is recorded. The method involves measuring the length of a filtered push-pull (FiP-P) wave of the signal-averaged ECG (ms), P wave dispersion determined as a difference of maximum and minimum P wave lengths while recording 12 leads of the standard ECG (Pd) (ms), a linear deviation (A), B that is the number of premature atrial contractions per hour, a risk index of developing atrial fibrillations (RIDAF) by an original formula. If the RIDAF is less than 0.5, the high risk of atrial fibrillation is predicted for 1-3 months; the RIDAF from 0.5 to 1.5 stands for the moderate risk during 3 months to 1 year, whereas the RIDAF of more than 1.5 shows the low risk for more than 1 year from the first examination of the patient suffering from premature atrial contraction.
EFFECT: method enables increasing the determination accuracy of the risk of atrial fibrillation following the first examination and correcting the therapy.
3 tbl, 4 ex
SUBSTANCE: method involves determining a period of time from the onset of symptoms to establishing a diagnosis (t); a functional class is rated at the time of establishing the diagnosis (FCinit); a cardiac output is calculated at the time of establishing the diagnosis (CO); an acute pharmacological test (APT) coefficient (X) is calculated as follows: (APT-)=0, (APT+)=1, (APT++)=2. A risk of the unfavourable clinical outcome in the patients suffering from idiopathic pulmonary hypertension (H) is calculated by an original formula. If the value H ≤0.35, a low risk is stated; H=0.36-0.55 shows a moderate risk, whereas H≥0.56 is a sign of a high risk of the unfavourable clinical outcome.
EFFECT: method enables the high-reliability detection of the unfavourable clinical outcome in the patients with idiopathic pulmonary hypertension, the determination of rates of the disease progression for the purpose of prescribing an adequate therapy.
SUBSTANCE: group of inventions relates to medical equipment. A cuff contains a chamber for the application of pressure to the area of measurement; a screwable element for displacement of a chamber (161) for a flowing medium to the area of measurement, and a chamber-like covering element, which includes the chamber of the flowing medium and the screwable element and is configured in the form of a tape, wrapped around the area of measurement. The screwable element has a curved shape, which follows the direction, in which the screwable element is wrapped around the area of measurement, and has two curvilinear regions and a rectilinear connecting region, which connects the said curvilinear regions in the section in the points of bending, in which the radius of the screwable element curvature changes. The connecting region is located inside the curve, formed by the extension of the curvilinear regions. The central position between the first point of bending in the section and the second point of bending in the section is superposed on the central position of the chamber for the flowing medium in the direction, in which the chamber for the flowing medium is wrapped around the area of measurement. Versions of implementation of the device for pressure measurement and an additional version of the cuff are disclosed.
EFFECT: group of inventions makes it possible to reduce the measurement error due to the reduction of errors of the chamber volume change.
6 cl, 15 dwg
SUBSTANCE: invention refers to medicine, namely to occupational medicine, and can be used for specifying the indications for the instant correction of the psychophysiological states. A cardiointervalogram is recorded before and after professional activity. A range of RR interval lengths (MxDMnbefore, MxDMnafter), a square root of a total difference of a sequence of RR intervals (RMSSDbefore, RMSSDafter) and a mode amplitude of RR interval lengths (AMobefore, AMoafter) are determined. Differentiation functions G1 and G2 are calculated. If G1 is less than G2, the individuals being tested are considered to be in need of the instant correction of their psychophysiological states. Otherwise, it is stated that the individuals being tested are not in need of the instant correction of their psychophysiological states.
EFFECT: examining the individual before and after the occupational activity, using the cardiointervalography findings and specifying the most significant criteria for the psychophysiological states assessment make the method increase the responsiveness to the process of detection if there are any individual-specific indications for the instant correction of the psychophysiological states.
SUBSTANCE: assessing a risk of recurrent atrial fibrillation (AF) is ensured by determining the patient's age in years (A), the time following radio frequency ablation in months (B), postoperative inpatient recurrent atrial fibrillation (C), the degree of the aortic valve insufficiency (D), the left atrial diameter in mm (E), anti-arrhythmic therapy conducted (F) with F=l if the anti-arrhythmic therapy involves amiodarone, and F=2 if the anti-arrhythmic therapy with sotalol is conducted, the degree of the mitral valve insufficiency (J), the number of reference ablation points (I); the number of radio frequency applications (G); the radio frequency ablation type (H) with H=2 accompanying RF labyrinth, and H=3 with the radio frequency ablation of pulmonary vein basins and ganglia plexuses. The derived values are used to calculate the risk (R) of atrial fibrillation by three formulas. The highest of the three derived R values is further determined. If the highest R value has been derived by the first formula, the recurrent atrial fibrillation following the radio frequency ablation may not be predicted. The highest R value produced by the second formula enables predicting the recurrent atrial fibrillation to come during 6 months following the radio frequency ablation.The highest R value taken from the third formula shows that the recurrent atrial fibrillation is predicted to come during more than 6 months following the radio frequency ablation.
EFFECT: method enables predicting the risk of the recurrent atrial fibrillation following the radio frequency ablation in the patients, pre-selecting a set of medical products necessary for the anti-arrhythmic and anti-coagulant treatment of the patient, pre-specifying a follow-up visit schedule and additional functional diagnostic techniques and considering if the repeated radio frequency ablation is required.
SUBSTANCE: invention refers to medical equipment. An electronic sphygmomanometer comprises a cuff, an inflation and pressure release unit for the cuff pressure adjustment, two pressure sensors, two generation circuits generating a rectangular signal at a pressure-dependent frequency, a generation circuit adjustment circuit ensuring passing an output signal from one of the above generation circuits, and a control circuit for generating an input rectangular signal from the circuit adjustment circuit and for calculating blood pressure at a rectangular signal frequency. The pressure sensors are connected to the cuff and matched with the generation circuits. The adjustment circuit is configured as a common one for the above generation circuits. The control circuit switches between the generation circuits by producing a signal of switching to one of the generation circuits. The control circuit generates the first signal of switching to the first generation circuit and determines the first cuff pressure dependent on the first rectangular signal frequency. The control circuit generates the second signal of switching to the second generation circuit and determines the second cuff pressure dependent on the second rectangular signal frequency. The control circuit detects if there is a failure of the above pressure sensors as shown by the first and second cuff pressure difference.
EFFECT: invention is expected to increase the measured blood pressure reliability when using more than one sensor.
4 cl, 9 dwg
SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.
EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.
SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.
EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.
12 cl, 25 dwg
SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.
EFFECT: method enables increasing the antibacterial effect.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in myringoplasty, for repairing partially lost anatomic structures, such as tympanic membrane. The surgery is performed with local or general anaesthesia. A tympanic membrane defect is closed with a thinned prepared alloplant in the form of an allogeneic cartilage plate. Before implanting, the alloplant is fragmented up to 0.2-0.3 mm thick and 0.8-0.9 cm in diameter that is followed by placing the plate into a bottle with a fixing fluid. The final stage of the operation involves placing the alloplant on the edges of the tympanic membrane defect. The cartilage plate is supposed to be more by 1.0-1.5 mm in size with the plate edges to be ovelapped with the acoustic meatus skin. The acoustic meatus is packed.
EFFECT: method provides the reliable fixation of the alloplant, preventing its postoperative dislocation and retraction, audiological characteristics of the alloplant as close to the characteristics of the normal tympanic membrane as possible, the absence of implant rejection and pronounced immune response, proteolytic enzyme stability, necessary rigidity of the cartilage plate, reduced length of the intervention, the absence of a cosmetic auricle defect.
SUBSTANCE: surgical management of colon cancer is required in low colonic obstruction. A midline laparotomy and abdominal organs inspection is followed by colon mobilisation. A colonic segment with a tumour is resected. The segmented intestine is decompressed with an electric suction machine. The rectal stump is stitched with a stapling apparatus. A superposed segment of the segmented intestine is mobilised to be brought down. A tunnel is formed behind the rectal stump from the side of the anus as close as possible to the oral end of the stump. A hole is formed along the posterior wall with an electric knife and used to bring down the mobilised segmented intestine by means of a guide. The intestine is fixed to the hole borders with four stitches. The excessive intestine is brought out through the anus and fixed to the perineal skin. A dioxidine solution is administered into the abdominal cavity. The rectal stump is daily washed with antiseptic solutions until the excessive brought out intestine is dissected away on the 10-14th day.
EFFECT: method enables applying the primary stitch-free colorectal anastomosis, requires no rehabilitation stage of treating colon cancer by the natural formation of the anastomosis and prevention of its leakage; it also reduces the length of disability and improves the patient's quality of life.
1 ex, 2 dwg
SUBSTANCE: axial line of two enclosing incisions is marked by connecting the centres of outer mouths of fistula sequentially from up to down by a wavy line. That is followed by making two wavy enclosing incisions parallel with the axis: right and left at 20 mm from the axial line. The left incision starts 15 mm above the proximal outer mouth of fistula, and ends 15 mm below the distal outer mouth of fistula, whereas the right incision starts at the level of the proximal outer mouth of fistula and ends at the level of the distal outer mouth of fistula. Thereafter, RPF is excised in the radial direction. Two L-sutures relaxation incisions are made. The upper relaxation incision originates from the point at the beginning of the right enclosing incision and extended to the point at the beginning of the left enclosing incision and 20 mm further, turned at a right angle 25 mm upwards, and an upper triangular adipocutaneous flap is formed. The lower relaxation incision originates from the point at the end of the left enclosing incision and extended to the point at the end of the right enclosing incision and 20 mm further, turned at a right angle 25 mm downwards, and a lower triangular adipocutaneous flap is formed. That is followed by closing a wound defect by adipocutaneous repair by shifting the formed upper and lower triangular adipocutaneous flaps onto the wound defect and fixing them with interrupted sutures. The lower edge of the upper adipocutaneous flap is fixed to the right enclosing incision, and its upper edge - to the left enclosing incision. The lower edge of the lower adipocutaneous flap is fixed to the left enclosing incision, and its upper edge - to the right enclosing incision; thereafter, the wavy s are closed.
EFFECT: more effective surgical management of recurrent pilonidal fistulas, reduced number of complications and recurrences and improved aesthetic effect of the operation.
SUBSTANCE: own finger artery, dorsal vein and own finger nerve of the fifth finger are cut and bandaged. A common finger artery of the transplant is sutured with own finger artery of the third finger stump. The dorsal vein of the transplant is sutured with the dorsal vein of the stump. Own finger nerve of the transplant is sutured with own finger nerve of the stump.
EFFECT: method improves results of treatment due to the correspondence of dimensions of the transplanted finger vessels to the dimensions of the vessels of the recipient area.
SUBSTANCE: tumour is removed by a laryngectomy within the boundaries of health tissue together with an underlying part of a thyroid cartilage. The upper and lower parts of the thyroid cartilage not involved into the tumour process are presented on the involved side in the form of horizontal plates 6.0-8.0 mm wide. A skin flap is cut out on the neck 0.4 cm more than the width of the created larynx defect, while its length is supposed to be equal to the one of the defect. The skin flap is thrown over the preserved fragments of the thyroid cartilage. That provides restoring the removed part of the larynx. The flap is anchored with single sutures to the intact mucosa of the preserved parts of the larynx along the perimeter of the defect. A lumen of the newly formed larynx is packed. A laryngostoma and a tracheostoma is formed. A tracheostomic tube No. 5-6 is inserted into the tracheostoma. A dressing is applied.
EFFECT: method provides performing the functionally conservative surgery, preserving the natural respiratory and vocal functions, reducing postoperative inflammatory complications, preventing a laryngeal lumen stenosis and rehabilitating its functions, reducing a rate of intraoperative injuries and a length of staying in hospital, improving the patient's quality of life, making it possible to start a radiation therapy by preserving the intact upper and lower parts of the thyroid cartilage and repairing a laryngeal side wall with the thrown-over skin flap cut out on the neck.
4 dwg, 1 ex
SUBSTANCE: oesophagus is separated. Oesophageal wall injuries are detected. A through drain tube with perforations is delivered through the defects in the oesophageal walls. One through drain tube is delivered through two oesophageal defects simultaneously. The drain tube holes are placed in the oesophageal lumen. The oesophageal defects are closed up to the drain tube. The tube is delivered through pedicle grafts pre-excised of proper tissues. The above grafts are used to fasten suture lines on the oesophagus. The drain tube - through counter apertures.
EFFECT: method for transoesophageal through drainage reduces the length of treatment by adequate sanitation of a mediastinal septum and oesophageal defect and conditions for their independent healing.
SUBSTANCE: kidney is approached. It is mobilised. An involved segment of the kidney is dissected away by means of laser light. When dissecting the involved segment away, the vascular blood flow of the renal pedicle is preserved. The involved segment is dissected away by focused continuous laser light at wave length 970 nm. The light power for excising a renal capsule makes 25-35 Wt. The light power for excising a renal cortex makes 40-45 Wt. The light power for excising a renal cortex makes 55-60 Wt. The surgical area is drained. The incisional wound is closed.
EFFECT: method enables avoiding the intraoperative renal parenchyma ischemia, provides minimum injuries of the renal parenchyma, reliable homeostasis ensured by the differentiated mode of laser exposure taking into account a type of transected renal tissue.
4 cl, 3 ex
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg