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Biomedical subjects

V N Koshelev

Publications and source records attributed to V N Koshelev.

14 recordsLinked to original sources

[Use of laser scalpel in the surgical treatment of injuries of the liver].

An analysis of the 10-years clinical use of CO2-laser scalpel in surgery of traumas of the liver in 41 patients was performed. In 55 patients wounds of the liver were treated by the routine surgical method. Laser coagulation is especially effective for treatment of great area flat wounds. A pronounced hemo- and cholestatic effect of the defocused laser radiation was noted which allowed 3, 5 times more often performing the radical treatment of wounds of the liver. Lethality was reduced from 31% to 24%.

Adult

[Ways to decrease lethality in mechanical injuries to the liver].

An analysis of 135 observations of injuries of the liver and literature data of the recent 5 years (3931 cases) have shown that lethality resulting from trauma of the liver remains high and makes 20-78% of patients with closed injuries. Main causes of death of such patients are shock and blood loss. Optimization of the surgical treatment of injuries of the liver may be achieved by the introduction of reliable sources of hemostasis which are thought to be laser and plasma radiation, and by the development of effective methods of temporary hemostasis.

Cause of Death

[Complications and mortality in splenic trauma].

The analysis of complications and lethality in 97 patients with closed splenic trauma was carried out. The main causes of death of the injured were shock, concomitant injuries. The total postoperative lethality was 33%. Of the 60% of patients with associated injuries, 51.7% died. In injury to four and more organs, all the sufferers died. The incidence of postoperative complications was 22.7%. Most frequently (21.6%) the purulent septic complications which caused death in 7.2% of patients were noted. In preservation of a spleen, the incidence of such complications reduced 2.6-fold.

Humans

[Hyperbaric oxygenation in the treatment of bleeding gastroduodenal ulcers].

It is shown on the basis of analysis of the results of treatment of 179 patients that the use of hyperbaric oxygenation in the complex surgical management of ulcerative gastroduodenal bleeding reduced the number of postoperative complications by a factor of 3.3 and led to a decrease of mortality from 20 to 1%. The authors confirm the expedience of including hyperbaric oxygenation in the complex of therapeutic measures in patients with bleeding ulcers under conditions of accomplished hemostasis by conservative or surgical methods in one of three suggested variants: in preparation of the patients for operation in the postponed period; after operative interventions carried out at the peak of bleeding; before and after operations on patients with moderate and severe blood loss and concomitant diseases. The sessions should be conducted under pressure of 2 atm for 60 minutes.

Adult

[The use of the laser scalpel in surgery of the spleen].

The CO2 laser was used to arrest bleeding from traumatic wounds of the spleen in 24 patients. The success of laser coagulation was determined by the qualification of the surgeon who performed the operation and his skill in working with a laser scalpel. Comparative analysis of the intraoperative aspects and operative outcomes with those in 60 patients who underwent splenectomy (57) and suturation (3) showed the marked advantages of laser coagulation which allowed the spleen to be preserved in 63% of cases.

Adolescent

[Laser use in the prevention and treatment of suppurative-infectious complications in abdominal surgery].

From 1986, into the complex of treatment of 284 patients with inflammatory diseases of the abdominal organs, the irradiation by the helium-neon laser according to the scheme developed was included. There were no complications related to the use of a laser. Mean duration of treatment the patients in a hospital in circumscribed peritonitis reduced from 16.8 to 14.7 days, in diffuse peritonitis--from 35.1 to 27.4 days; the postoperative lethality reduced from 12 to 6%.

Abdomen

[The use of laser scalpel in the surgical treatment of cholecystitis].

A comparison of the results of 169 cholecystectomies with the use of a laser scalpel and 160--conventional methods was carried out. The CO2-laser was used for exposure of the gallbladder and coagulation of tissue of the liver in the region of its bed. Hemo- and cholestasis in all the cases was reliable, and due to this fact in 27% of the patients, the subhepatic recess was not drained. The incidence of complications after the elective cholecystectomy reduced by 11%, after the emergency one--by 9%, the lethality reduced considerably.

Cholecystectomy

[CO2 and YAG lasers in the surgery of traumatic lesions of the liver, spleen and kidney].

CO2 and YAG [correction of AIG] lasers were used in 86 patients with traumas of the liver, spleen, kidney. Methods of laser coagulation and indications for its use were developed and allowed to considerably reduce lethality in the surgery of closed injuries of the liver, to preserve the spleen in 46% of the patients, and to carry out treatment of kidney wounds with high quality. Laser coagulation is an effective method to arrest the parenchymal hemorrhage which results in substantially higher quality of the operations performed.

Evaluation Studies as Topic