Groma V. Clinical and anatomical study of surgical tactics in patients with acute disturbances of blood flow in the basins of mesenteric vessels.

The thesis is devoted to the development and scientific concepts justification choice of surgical tactics in patients with acute disturbances of blood flow in the basins of mesenteric vessels, based on clinical and anatomical features of mesenteric channel and to improve treatment outcomes by using mainly known improved and developed new minimally invasive, conservative and surgical methods. The thesis is a comprehensive clinical and experimental research. The work provides a new direction in solving the problem of the choice of surgical tactics and complex treatment of patients with acute disturbances of blood flow in the basins of mesenteric vessels. In the model of acute ischemia in the experiment established the basic pathogenesis and nature of the acute ischemic bowel, ischemic disorder transition in necrobiotic depending on the cause and duration of ischemic factor. The clinical part of the study performed a retrospective and prospective analysis of case histories of 473 patients with acute disturbances of blood flow in the basins of mesenteric vessels from 1997 to 2011 in a study, a new clinical and anatomically-based approach to the surgical treatment of choice in patients with this disease, algorithms conservative measures and surgical interventions of the predominant use of minimally invasive "second-look" interventions, allowing the study group compared with the comparison group interventions to reduce the frequency exploratory from 30.7% to 4.1%, lower postoperative mortality from 64.5% to 37.0% and 66.2% of the total to 37.6%, reduce the incidence of complications of 3.2%.