[Lymphogenous metastasis and lymphadenectomy in stomach cancer].
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Biomedical subjects
Publications and source records attributed to E I Brekhov.
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The results of repeated operations on the large intestine, mainly reconstructive operations, are analysed. Surgical interventions with the performance of a triangular anastomosis, including that by a method modified by the authors, were carried out on 50 patients. The operative results, particularly those in the last group of patients, are very promising. The number of complications, such as suppuration of the postoperative wound and incompetence of the anastomosis sutures, reduced from 28.8% to 10%, which allows the method to be recommended for wide application in the clinic.
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Based on an analysis of the dynamic ultrasonic, biochemical and hormonal data on 550 patients operated on for cholelithiasis and comparison of preoperative and pathomorphological diagnoses, indications for surgical treatment of cholelithiasis patients in the stage of so-called "lithocarriership" were developed and a group at risk for cancer was identified as well. A comprehensive analysis of the clinical and instrumental data on 185 patients operated on for cholelithiasis, made in the long-term periods (from 1 to 3 years) after cholecystectomy indicates the efficacy of differentiated rehabilitation treatment, including elderly subjects and the necessity of early surgical treatment of cholelithiasis before there may develop irreversible alterations in the choledochus, liver and pancreas and in the gallbladder itself. Comparison of the dynamic ultrasonic data, liver and pancreas functions and factors such as sex, age, obesity and physical exercise makes it possible to predict the course of cholelithiasis to a certain degree of probability at the asymptomatic stage and to specify the policy of managing such patients under ambulatory conditions.
The authors treated destructive forms of acute pancreatitis for the first time by means of specific plasma sorption of proteinases with the use of a proteinase plasma sorbent which is an acid-stable proteinase inhibitor immobilized on sepharose (ASI-Sepharose). Specific plasma sorption of proteinases on ASI-Sepharose was applied to the treatment of 29 patients with various forms of acute destructive pancreatitis. At the end of specific plasma sorption procedure the activity of blood plasma proteolytic enzymes in the patients reduced by 60-75%, which was attended by marked improvement of the condition in most cases; aggravation of the patients' condition was not encountered. The mortality in this group was 20.7% and was due to complications occurring during the development of the main disease. The mortality rate among patients treated by specific proteinase plasma sorption is much lower than that recorded in the USSR for destructive forms of acute pancreatitis which ranges from 30 to 75%.
The authors suggest a new method for treating acute pancreatitis, which is based on the principles of an "opened abdomen" but combines practically all its advantages. The operation is called "dynamic omentopancreatostomy". This method was used in 1986-87 for the treatment of 13 patients, 7 of them had destructive pancreatitis with total and subtotal necrosis of the pancreas. Severe specific complications characteristic of acute pancreatitis occurred in all of the patients. Three patients died in the post-operative period. Most of the developing complications were easily arrested by means of this new operative method. It is concluded that seriously ill patients with omentopancreonecrosis may be treated successfully by the operation of "dynamic omentopancreatostomy".
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In examination of 57 patients with the use of a method of complex polarography, by oxygen and hydrogen, the increase in volumetrical rate of blood flow and oxygen tension in the purulent wounds treated by a defocused beam of the CO2 laser was established. This contributed to more favourable course of the wound process and accelerated healing. Complex polarography can be used as a diagnostic method in the purulent surgery.
The article discusses experience in surgical treatment of 480 patients with the most common diseases of the anorectal region (acute and chronic haemorrhoids, acute and chronic paraproctitis, polyps, chronic fissures of the anal canal) in which special laser tools were used. The carbonic acid laser Skalpel-1 with a wave length of 10.6 microns and power of 30 W was used as the source of laser radiation. Methods of operations with the use of these tools are described in detail. The advantages of laser instruments in the treatment of patients with the above listed diseases are shown on a rich clinical material.
The article deals with experimental studies in the choice of a plasma-forming gas and optimization of the operating regimen of a plasma surgical device to be used in surgical practice. On the basis of these studies, methods of operations on the liver were developed. Clinical experience in practical removal of a malignant tumor of the anterior abdominal wall with the use of a plasma device is discussed. The developed methods of hemostasis by means of a plasma flow of argon may be used in urology, thoracic surgery, gynecology, and military surgery.
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An effective method of plasma proteinases (trypsin, chymotrypsin. elastases) removal in dogs with acute pancreatitis has been suggested. The method is based on plasmasorption, using human urine acid-stable proteinase inhibitor immobilized on sepharose. The procedure of plasmasorption reduces proteinase levels in dogs with acute pancreatitis to 35-70%, with the animal life-span prolonged 8-fold.
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In experiments on rats, the state of microcirculation in purulent wounds that had been exposed to a defocussed beam from a CO2 laser is described and compared to that in similar but nonexposed wounds. The laser treatment was found to accelerate the normalization of blood supply to the wound walls; the stimulatory effect was maximal when the thermal damage to the tissues was minimal.
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