Обґрунтування нових жорстколігатурних швів при лапароскопічних операціях (експериментальне дослідження)

Ключевые слова: лапароскопические операции, новые жестколигатурные швы, эффективность, объективизация оценки.

ANNOTATION

Ziemann Uwe. The Basis for Modernrigid Ligature Stitches in Laparoscopic Operations (Tentative). - Manuscript.

Dissertation for the Degree of Candidate in Sciences (Medicine). Speciality: 14.01.03 - Surgery. - The Gusak V.K. Institute of Urgent and Restorative Surgery, AMS, Ukraine, Donetsk, 2006.

The work deals with the topical problem of enhancing efficacy of laparoscopic operations (stomach resections, cholecystectomy, adnexhysterectomy and sterilization) employing new technologies, modern rigid ligature stitches, new apparatuses and instruments with its approbation. A technique of the above operations has been developed and tested on 10 human cadavers and 50 dogs. The developed operations were used in surgical treatment of 6 bears having various lesions of the extrahepatic biliary tract and the stomach, in laparoscopic adnexhysterectomy (31 dogs), ovariectomy (1 dog and 1 orang-outang), in dressing the uterine tube (12 baboons, 1 orang-outang, 3 bears) at the Leipzig Zoo (FRG). The animals conditions, the traumatic rate of the operation and healing processes in the suture areas were evaluated by means of clinical, biochemical (serous activity of aspartateaminotransferase /AsAT/, alanineaminotransferase /AlAT/, gamma-glutamyltransepeptidase /GGTP/, alkaline phosphatase); spectrophotometric (the content of mid-molecular peptides /MMP/; anatomic (preparation, measuring the diameter and length of vessels, the number of branches); histologic, angiographic, morphometric, biophysic and statistic methods.

Modern titanic staples of new suturing apparatus (Endo GIA Universal) traumatize tissues minimally, they are biologically inert and do not have drainage properties. The reaction to their presence results in a slight cellular infiltration and development of collagenic fibres on the side of tissue compression. A tender cicatrix is formed in the line of the organs connection. Disengagement and migration of the staples is not followed by tissue distruction. A healing process proceeds without marked circulatory disturbance, the absence of perisutural inflammation foci in the presence of good adaptation of the tissue of the compared organs. The titanic sutures, even without being protected by seromuscular ligatures, are able to provide with a reliable hermeticity and sufficient durability. The developed complex method of quantitative evaluation of the traumatic rate on the basis of biochemical indices (AlAT, AsAT, GGTP, alkaline phosphotase, MMP), the state of vasculo-neurocellular interrelations in the tissues objectively appreciates the efficacy of operations and points out a lesser trauma and shorter terms of normalization in case of laparoscopic interferences.

The suggested techniques utilizing rigid ligature sutures and new surgical technologies (video-laparoscopic technique, the apparatuses LigaSure AtlasTM , Endo GIA Universal) twice shorten the time of interference and period of treatment, ensure reliability, decrease by 53,6 % the traumatic rate, reduce twice the number of postoperative complications and can be recommended to be put into practice.

Key words: laparoscopic operations, new rigid ligature sutures, efficacy, objectivization of estimation.

СПИСОК УМОВНИХ СКОРОЧЕНЬ

АсАТ - аспартатамінотрансфераза.

АлАТ - аланінамінотрансфераза.

ГГТП - гамма-глутамілтранспептідаза.

СМП - середньомолекулярні пептиди.

ОЩС - об?ємна щільність судин.

СНВ - судинно-нейроклітинні взаємовідношення.

МНС - міжм?язове нервове сплетення.

СНМ - судинно-нейроклітинні мікрокомплекси.

Vcv - об?ємна щільність мікросудин гангліїв.

Dc - діаметр мікросудин.

Lcуд - питома довжина мікросудин.

Vkv - об?ємна щільність нейронів гангліїв.

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