Ambulatornaya Khirurgiya

Introduction . Telemedicine is a new form of communication between a doctor and a patient. Of interest is the expediency of its use in the postoperative observation of patients. Aim . To analyze the possibility of optimizing the postoperative management of patients who underwent outpatient surgical treatment of VVLE using telemedicine. Materials and methods . The study was performed in two stages on patients with VVLE. At the first stage, a comparative prospective, randomized study of the main and comparison groups (50 patients C2 according to CEAP) in the early postoperative period was conducted. In the main group, telemedicine was used, in the comparison group – face-to-face examinations in the polyclinic. The frequency of complications associated with surgery, the frequency of acute respiratory infections and the time spent on a follow-up examination were compared. At the second stage, in 876 cases of telemedicine use in the postoperative period, the frequency and structure of complications requiring conversion to face-to-face examination were studied. Results . Significant differences between the compared groups were revealed by the frequency of acute respiratory infections and the time spent by the patient on a follow-up examination. The reasons for conversion from telemedicine to face-to-face examination: copious wetting of the bandage with blood, swelling and severe pain of the operated limb, hyperthermia are rare. Discussion . Most of the complications and side effects associated with surgical intervention registered in the study have characteristic specific manifestations: complaints and appearance, which allows them to be diagnosed through telemedicine. Conclusion . The use of telemedicine optimizes the postoperative period in patients with VVLE: the risk of infection with acute respiratory infections is reduced, the time of the doctor and the patient is saved, while there is no negative effect on the frequency associated with surgery.

V. V. Davydenko

A. N. Galileeva

O. V. Genzik

O. S. Monaenkova

G. L. Khartakhoyeva

Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)

The use of telemedicine after outpatient surgical treatment of varicose veins of the lower extremities

下肢静脉曲张门诊手术治疗后远程医疗的应用

Introduction . There is a growing number of people over 60 years old and consequently a growing number of elderly and senile patients with varicose veins globally. These patients have involutive changes that occur in the body, and therefore they need a special and personalized approach to examination and treatment. Aim . Study and evaluate age-related and varicose disease-related structural changes in the inner lining of the large subcutaneous vein. Materials and methods . 135 fragments of the large subcutaneous vein were examined, 55 of which belonged to deceased people who had no venous disease, 80 operated patients with varicose veins. There are 4 age groups: young, middle, elderly and senile. Histological, morphometric and electron microscopic examination was performed. Results and discussions . The study showed that involutive changes are characterized by a decrease in the number of endothelial cells along the inner perimeter and their flattening, loosening and edema of the subendothelial stroma in persons over 75 years of age. In varicose veins, morphological changes progress with increasing patient age and disease duration. In young and middle-aged people with varicose veins, endotheliocytes flatten, protrude into the lumen of the vessel, collapse, areas of endothelial atrophy appear along the perimeter, signs of myoelastofibrosis appear, as indicated by an increase in the volume fraction of intima due to connective-woven structures. In patients over 60 years of age, endothelial desquamation is more evident in intimacy, the preserved cells are destructively changed, the volume fraction of intima significantly decreases, which corresponds to the signs of intima sclerosis. Conclusions . Under normal conditions in senile age, the volume fraction is significantly reduced compared to the middle age group (p &lt; 0.005). In case of varicose veins, structural changes, both qualitative and quantitative, progress against the background of involutive changes and disease duration, which aggravates endothelial dysfunction.

M. R. Kuznetsov

D. V. Matveev

I. A. Chekmareva

S. M. Chudhykh

Kh. A. Abduvosidov

Age-related and varicose disease-related structural changes in the inner lining of the large subcutaneous vein

大皮下静脉内壁年龄相关和静脉曲张疾病相关的结构变化

D. S. Zubkov

Paid healthcare services in surgery: new rules, old problems

手术中的付费医疗服务：新规旧患

Review authors consider the current possibilities of percutaneous laser coagulation for telangiectasias and reticular veins, which are the most common cosmetic defects of vascular genesis, occurring in more than 80% of women of different age groups. This vascular pathology constituting an aesthetic defect and causing local physical discomfort is one of the most common indications for phlebosclerosing therapy and percutaneous laser coagulation. The authors present the most effective and safe guidelines for percutaneous laser coagulation based on analyses of a large volume of specialized literature. Due to the use of state-of-the-art Nd:YAG lasers, percutaneous laser coagulation is increasingly used in patients with various types of intradermal vein lesions and, owing to high efficiency and safety, has advantages over compression sclerotherapy by several criteria. Nd:YAG lasers can be divided into long- and short-pulse ones according to their technical characteristics. Long-pulse lasers provide coagulation of the target vessel due to a single pulse with a high energy density (fluence), while short-pulse lasers, on the contrary, generate a series of pulses to the target vein with a running time of fractions of a millisecond, which ensures the conversion of hemoglobin into methemoglobin with a ten-fold increased ability to absorb laser energy and convert it to heat. As the duration of the pulses generated by the device is a priori shorter than the thermal relaxation time, the risk of burns to the skin and paravasal structures almost completely disappears. The authors provide clinical examples of the application of Aerolase Neo device that utilizes MicroPulse technology to confirm the effectiveness and safety of shortpulse Nd:YAG lasers.

V. Yu. Bogachev

H. P. Manjikian

O. A. Alukhanyan

Percutaneous laser coagulation of dilated intradermal veins: from theory to practice

经皮激光凝固扩张的真皮内静脉：从理论到实践

The article presents a series of clinical cases describing the successful use of the long-pulse neodymium laser in removing unaesthetic reticular veins and telangiectasia of various locations. The first two cases demonstrated reticular varicose veins of the lower limbs in female patients with a fear of injections, which were treated without compression garments and ecchymoses with excellent effect. The outcome of treatment was comparable with that of classical sclerotherapy. The third case showed a successful laser removal of large telangiectasias on the hands, which developed following the long-term use of injection narcotic drugs as part of trophovegetoneurosis. Such pathology is rare for medical practice and approaches to its treatment have not been developed. The fourth case showed large telangiectasias of the buccal and zygomatic regions A good effect after the use of a large diameter spot in that area was demonstrated. The fifth case demonstrated the treatment of the veins in the buccal region, including the vein curving over the mandibular angle. The outcome of the treatment allowed to evaluate not only the aesthetic effect of the procedure, but also the severity of side effects in that area. In the sixth case, the periorbital vein, which divides into two branches, was investigated. The treatment was successful despite the different structure of the vein wall and depth of occurrence. The seventh case demonstrated the removal of large temporal veins. The outcome of treatment was presented on the following day, reflecting the degree of visual discomfort in the early post-procedure period. The final outcome a month after treatment was also demonstrated. In conclusion, the eighth case demonstrated the effectiveness of the treatment of scattered small red telangiectasias on the face using a long-pulse neodymium laser.

M. A. Parikov

A. V. Patsyuk

S. S. Kulagina

E. V. Ozherelev

M. S. Agadzhanyan

M. V. Plotnikov

A. V. Maksimov

Sh. E. Orudzhev

K. O. Zhdanov

A. A. Sinitsyn

S. O. Perkov

Neodymium long-pulse laser as a monotherapy for unaesthetic vessels of various locations: a series of clinical observations

钕长脉冲激光作为各种位置非美学血管的单一疗法：一系列临床观察

Introduction. Due to the growing number of polyantibiotic-resistant strains of microorganisms, the issue of improving the tactics of local treatment of soft tissue wounds without the use of antibiotic therapy is gaining more and more urgency in surgery. Aim. To study the dependence of the antiseptic effect of chitosan-based wound dressings on the degree of their biodegradation and to evaluate the prospects for the use of such dressings for the treatment of purulent wounds. Materials and methods. The object of the study was wound dressings with incorporated antiseptic polyhexanide (PH) based on chitosan of two types: unstabilized (Ch-H-PH) and stabilized by cross-linking with glutaric aldehyde (Ch-H-GA-PH). The antimicrobial activity spectrum was investigated in vitro by disk-diffusion method using test cultures of Staphylococcus aureus and Escherichia coli . The directionality of biodegradation was studied by scanning electron microscopy. Results and discussion. Stabilized Ch-H-GA-PH samples had prolonged antimicrobial action due to longer biodegradation times (max – 36–48 h; p ≤ 0.05), while Ch-H-PH samples due to high hydrophilicity of the material biodegraded early and realized the full antimicrobial potential within 24 hours (max – 12 h; p ≤ 0.05). The obtained results correlated with the data provided in the foreign researchers’ publications on the investigation of the properties of biopolymer materials used as matrix carriers for drugs, and in terms of addressing the search for strategies to combat poly-antibiotic resistance in surgical practice. Conclusion. Application of wound dressing s of antiseptic type of action on the basis of chitosan with different parameters of biodegradation will allow to realize a programmed approach to treatment of purulent wounds of soft tissues in a personalized way depending on a specific clinical situation.

S. E. Gumenyuk

D. I. Ushmarov

O. Yu. Shokel

E. A. Aydinova

Ya. V. Belyakova

The prospects of application of antimicrobial biodegradable wound dressings for the treatment of purulent wounds

抗菌可降解伤口敷料在治疗化脓性伤口中的应用前景

In Russia, more than 70,000 new cases of breast cancer are registered annually. Vacuum aspiration biopsy (VAB) is a minimally invasive method for diagnosing the genesis of focal breast pathology, which is also used for therapeutic purposes for the complete removal of benign neoplasms. High efficiency and favorable clinical outcomes have allowed VAB to gain wide popularity in clinical practice, due to which the method has been widely developed. However, like any surgical intervention, the VAB procedure may be accompanied by complications, the main share of which are hemorrhagic. Generalization and systematization of information on the development of the VAB technique, prevalence and risk factors of complications, as well as methods of their prevention and timely elimination. Scientific publications cited in this literature review were selected from the Pubmed database of medical and biological publications (National Center for Biotechnology Information (NCBI), USA), the Clinical Key database (Elsevier Corporation, the Netherlands), Web of Science Citation Indexing Database (Clarivate, USA), Google Scholar (CIF), and the scientific electronic library elibrary.ru (Russia). The information presented in the article can become a theoretical basis for future research aimed at increasing safety, further development and improvement of the VAB technique.

A. V. Levanov

E. A. Marushchak

A. O. Sidorov

D. A. Nekrasov

M. V. Mnikhovich

S. V. Vetlitsyna

I. A. Shiripenko

P. A. Akhsanova

V. V. Smeianov

P. K. Katchieva

Vacuum aspiration biopsy: evolution of the method, prevention of hemorrhagic complications

真空吸引活检：方法的演变，出血并发症的预防

Introduction. The capacity to execute mini percutaneous nephrolithotomy (PCNL) as a day case procedure in the treatment on renal stones measuring between one and two centimetres is being assessed in this study. Mini-PCNL has been employed more and more in the treatment on renal stones with favourable results in terms on stone clearance and low morbidities. Aim. To find a reliable replacement for E.S.W.L. and R.I.R.S in treating small renal stones that is safe, efficient, and reliable with the shortest post-operative stay period. Materials and methods. Seventy patients underwent surgery for kidney stones that ranged in size from 1 to 2 cm and had densities greater than 1000 H.U. They were split into two groups: group B received mini-PCNL and group A received regular PCNL. Both procedures were carried out while the patients was in the prone position. In group A, we fragmented the material with an electrohydraulic lithotripter and removed the resulting fragments using forceps. In contrast, group B employed a 30 w Quanta Holmium laser in dusting mode (0.5 j and 15 Hz) with 550 um laser fibre and relied on our exit plan for the double-J stent implantation, which avoided the necessity for a nephrostomy tube. Results. Operation duration was significantly longer in mini-PCNL group (p &lt; 0.001). Intraoperative extravasation and its severity were non-significantly less frequent in mini-PCNL group (p &gt; 0.05). All patients operated with mini-PCNL underwent double j stent, while the other group included only two patients who necessitated double J insertion insertion, and the remaining 33 patients depended on the insertion on a nephrostomy tube together with a ureteric catheter. Conclusion: Mini-PCNL is a dependable day case method that is safe for treating tiny kidney stones. Larger sample size studies could be required to confirm mini-PCNL as a day case technique.

D. Mostafa

T. M. El-zayat

M. A. Omer

M. S. Salem

Evaluation of the safety and the reliability of day case mini-PCNL in treatment of renal stones 1 to 2 cm

日间手术微型经皮肾镜取石术治疗1至2厘米肾结石的安全性和可靠性评估

Healthcare-associated infections are the most common and relevant to all healthcare facilities of all types. Surgical site infections are the most frequently reported type of healthcare-associated infections. Surgical site infections are also one of the main causes of prolonged hospital stays, prolonged antibiotic therapy, unplanned re-hospitalizations, worsened long-term patient outcomes and the prescription of additional surgical interventions. At present, it is prevention that has been identified as the single most important strategy to combat surgical site infection. The proposed three-stage model combines perioperative interventions as well as interdisciplinary collaboration to continuously improve the quality of care. This approach includes preoperative, intraoperative, and postoperative prevention methods. Current preoperative strategies for the prevention of surgical site infections can significantly reduce the risk of developing this nosology; one important aspect of preoperative prophylaxis includes the identification, elimination, and/or correction of modifiable as well as non-modifiable risk factors. In addition, it is possible to identify intraoperative risk factors, of which the duration of surgical intervention is fundamentally important. Postoperative risk factors include hyperglycemia and diabetes mellitus, postoperative wound care and blood transfusion. Many effective ways of preventing surgical site infections have been developed, which include separate methods of preoperative, intraoperative and postoperative prophylaxis, however, only through the implementation of a comprehensive model that combines all perioperative measures, health care institutions will be able to effectively reduce the incidence of healthcare-associated infections and improve patient outcomes. Despite the fact that currently there is an active development of new methods of surgical site infections prophylaxis, the direct implementation of these technologies in the practical activity of specialists is of primary importance.

A. M. Morozov

A. N. Sergeev

V. M. Chervinets

J. V. Chervinets

O. N. Guskova

O. N. Skaryakina

E. N. Egorova

Methods of preventing surgical site infections

预防手术部位感染的方法

In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.

涉及主题	outpatient surgeryphlebologyproctologyorthopaedicsconservative treatment
出版信息	出版商: Remedium Group Ltd，出版周期: ，期刊类型: journal，开源期刊: 是
基本数据	创刊年份: 2021，原创研究文献占比: ，自引率:， Gold OA占比:
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Ambulatornaya Khirurgiya

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