Dushik L. Splenectomy in hematologic patients using physical methods of dissection and coagulation (experimental clinical research).

The dissertation focuses on reducing the risk of intra and postoperative complications, as well as providing hemostasis when performing splenectomy in hematological patients using USS. The aim - to improve the results of surgical treatment of patients with disorders of the blood system based on a comprehensive study of the characteristics of electrosurgical and ultrasonic effects on tissues for dissection and coagulation. The study consisted of experimental and clinical parts. Experimental work included acute and chronic experiments on 168 laboratory mature rats - males Vister line, weighing 200-250g. In I - (primary) group included animals that splenectomy and spleen resection performed ultrasonic scalpel (USS), II - (control) group included animals in which as intraoperative dissector used electrocoagulation (EC). In acute experiments evaluated the quality of the dissection, the presence of hemostasis through dissection, coagulating ability of devices, the length of the zone of destruction. In chronic experiments studied the dynamics of reparative processes. The clinical part of the work performed on the basis of complex clinical laboratory and instrumental examination of 97 patients with various diseases of the blood system, which required splenectomy. Depending on the intraoperative dissector to mobilize the spleen with splenectomy, patients were divided into 2 groups on the same principle as in the experiment. Zone of lateral necrosis after ultrasound dissection of 2.5 - 4 times lower than after the application of high-frequency alternators. Dissection and coagulation using ultrasonic energy is characterized by a purely local effect and reliable hemostasis. Comparing the duration of surgery in the performance of splenectomy revealed reduction of spent time to 30-40 minutes in patients where used LSE. It has been observed reduction in intraoperative blood loss in patients where used LSE for 100-120ml and reduce postoperative complications from 8.8% to 2.5%. Splenectomy helps restore normal immune reactivity, which is most pronounced after LSE. Investigation of quality of life in the remote postoperative period showed that 88.2% of patients after LSE assessed their health as good or excellent, only 11.8% as satisfactory, and in patients after undergoing traditional splenectomy 76.7% of patients evaluated condition their health as good or excellent, 23.3% - as satisfactory.