[The use of endoprosthesis in treating tracheal and bronchial stenosis].
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Biomedical subjects
Publications and source records attributed to V V Grubnik.
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The results of treatment of 260 patients who were subjected to 485 endoscopic operations with laser and electrosurgical methods are described. Excellent and good results were obtained in 199 patients (76.6%). The results of treatment of 43 patients by means of temporary endobronchial occlusion showing its efficacy in pulmonary bleedings as well as in complex treatment of pneumo- and pyopneumothorax are presented. The therapeutic effect of the low intensity endobronchial laser therapy on complex prophylaxis and treatment of obstructive bronchitis after surgical intervention on the lungs and pleura as well as in complicated traumatic injuries of the chest is noted.
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The experience of the main bronchi endoprosthesis in treatment of 15 patients with the respiratory tract stenosis of tumoral genesis was analyzed. The endoprosthesis of original construction was proposed. An operation was done with the help of rigid bronchoscope after preliminary laser recanalization of the stenosed segment. The immediate and late follow-up results permit to recommend the method for palliative treatment of pulmonary cancer.
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The results of surgical treatment of 193 patients with chronic calculous cholecystitis were analyzed. In 89 of then the ordinary cholecystectomy (OC) was conducted, in 48--cholecystectomy through the minilaparotomy access (MC), in 56--laparoscopic cholecystectomy (LC). After OC conduction the incidence of postoperative complications was the greatest. After LC conduction the complications appeared in 5 patients, they started to stand up and walk on the second day, the majority of them were discharged from the hospital in 2 days. The hospital stay duration after LC conduction was (3.8 + 1.5) days on the average, while after MC and OC-(6.2 + 1.5) and (12.4 + 2.3) days accordingly. Essential advantage of LC over OC and MC was determined.
The results of treatment of 84 sufferers with a complicated thoracic trauma, using irradiation of the YAG-neodymium, argon, helium-neon and arsenide-gallium lasers, are presented. The techniques for the use of lasers for photocoagulation of defects of the lung and thoracic wall through a thoracoscope, endobronchial laser therapy and laser puncture is described. The expediency to use laser irradiation in the complex of treatment of a complicated thoracic trauma is shown.
Within a decade, the authors performed 484 thoracoscopies in patients with spontaneous pneumothorax, open and closed thoracic trauma, pleuritis, pleural empyema. High diagnostic possibilities of the method permitted to choose a rational therapeutic tactics. In 228 cases, different endothoracic interventions under the guidance of a thoracoscope were performed. With the use of thoracoscopy, diathermocoagulation, laser and ultrasound irradiation were performed, medical glue was introduced. This permitted in most cases to eliminate intrapleural injuries and achieve stable smoothing of a lung.
The results of conduction of operative interventions in 37 patients with alimentary-costitutional obesity are adduced. In 22 of them having the obesity of III-IV stages the small stomach 100-150 ml in volume was constructed puuling in it too tight with a synthetic ribbon. In 1-1.5 years after the operation patient loses 70-80% of excessive body mass, and severe metabolic disturbances never occur. In 15 patients cutaneo-subcutaneous aprons on the abdomen were excised. Intravascular blood irradiation with the help of helium-neon laser for the prophylaxis of early postoperative complications occurrence was conducted. The stimulating action of laserotherapy on the cell and humoral immunity groups, alike central and peripheral hemodynamics improvement, moderate hypocoagulating and analgetic effect, lowering of the purulent-septical and thromboembolic complications in 1.5-2 times was noted.
Results of treatment of 130 patients with diabetic gangrene, whom the lower limb amputation on various levels was conducted, are adduced. In 58 patients the surgical treatment together with combined use of laser was conducted: intravascular irradiation of blood, high-powered laser Application while amputation performance and after it--percutaneous irradiation of amputation stump. Laser use promotes the improvement of immediate results of treatment and decrease of its duration.
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The data on use of fibrin glue (FG) in 215 patients operated on the abdominal organs, employing laser surgical techniques, are presented. In 132 patients, the complicated forms of gastric and duodenal ulcer disease, in 25--gastric cancer, in 24--colonic tumors, in 26--injuries to the liver were revealed. Considerable reduction in incidence of early postoperative complications as compared with that in patients operated on with the use of conventional techniques was noted.
In acute inflammation of pilonidal sinus (PS), use of a laser scalpel permitted to reduce considerably the incidence of postoperative suppuration. Pain syndrome became less pronounced, or was absent, wound swelling disappeared at the early period. No differences in results of surgical treatment of uncomplicated PS at the stage of chronic inflammation in use of CO2-laser and conventional methods of treatment were noted. An original technique of operation for PS complicated by multiple fistulas, purulent leaks, pyodermia has been suggested. For plastic closure of a wound, the effect of laser photohydraulic preparation was used. Operated on was 31 patient, no disease recurrence was noted. Rough cicatricial deformity of the sacro-coccygeal region was absent.
Changes in the acid production and motility of a gastric stump in 108 patients after mediogastric pylorus-and-antrum preserving resection performed for ulcer disease of the stomach (72 patients) and duodenum (36) were studied. In most patients, 1-3 years later, a weak acid and moderate acid reaction was noted in the gastric body. Complete restoration of motor-evacuatory function of the stomach and duodenum occurred within 1 year.
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The authors have demonstrated in the experiment that under the influence of irradiation of the liver by means of a semiconductor laser with a wavelength of 890 nm, pronounced activation of its microsomal system occurs. The data obtained have become a basis for the development and introduction in the clinic in 96 patients of a technique of laser correction of hypercholesterolemia. A good therapeutic effect has been noted in all the patients.