The aim of the study to improve the results of surgical treatment of patients with ventral hernias and concomitant abdominal pathology by optimizing the tactical and technical aspects of the simultaneous performance of simultaneous operations with the priority use of endovideosurgical technologies and tension-free plasty methods.
The object of the study were 331 patients with ventral hernias and concomitant simultaneous pathology of the abdominal organs, who were hospitalized in the surgical departments of the clinic of the Samarkand State Medical University for a period from 2012 to 2021.
The scientific novelty of the research is as follows: laparoscopic technologies were applied at certain stages of surgical intervention, which justified itself, since at the same time it allows to eliminate the hernia of the abdominal wall and the simultaneous pathology of the abdominal organs and correct it in a minimally invasive way; it was found that more than ½ (52.8%) of patients with ventral hernias have concomitant abdominal pathology that requires a one-time surgical correction, since the performance in a subsequent repeated operation levels out the results of hernioplasty; justified the use of laparoscopic technologies at certain stages of the operation, which allows correcting the simultaneous pathology of the abdominal cavity in a minimally invasive way with a significant removal of it from the hernial defect of the abdominal wall; the effectiveness of endovideosurgical technology for performing alloplasty in W1 and W2 hernias has been proven; the high information content of CT-hernioabdominometry has been proven, which makes it possible to identify defects in the topography of the anterior abdominal wall before surgery, determine the relative volume of the hernia to the volume of the abdominal cavity and choose the optimal method of hernioalloplasty; improved technical and tactical aspects of non-tension methods of hernioplasty for ventral hernias W3 and W4; the study of the dynamics of stress hormones proved that the implementation of the simultaneous stage of the operation does not significantly affect the degree of surgical aggression and thus justifies the expediency of a one-time correction of the combined pathology of the anterior abdominal wall and abdominal organs; optimization of tactical and technical aspects of one-time surgical correction of ventral hernia and combined abdominal pathology with the priority use of endovideosurgical technologies and tension-free alloplasty methods significantly improved the results of treatment.
The practical results of the study are as follows: According to the results of a scientific study to improve the diagnosis and surgical treatment of patients with ventral hernias and concomitant abdominal pathology: a methodological recommendation “Surgery of abdominal hernias and combined pathology of the anterior abdominal wall” was developed (certificate of the Ministry of Health 8н-р / 1080 dated October 7, 2022); a methodological recommendation "Surgical correction of combined abdominal pathology in ventral hernias" was developed (certificate of the Ministry of Health 8н-р / 1086 dated October 7, 2022). The proposed recommendations made it possible to optimize the choice of tactics for surgical treatment of patients with ventral hernias and concomitant surgical diseases of the abdominal organs; the obtained scientific results on improving the quality of diagnosis and surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs have been introduced into the practice of healthcare, in particular, in the departments of surgery of the Samarkand city medical association, the Samarkand regional multidisciplinary medical center, the multidisciplinary clinic of Samara State Medical University, Shakhrisabz city medical association, Surkhandarya regional diversified medical center, Jizzakh regional diversified medical center (certificate of the Ministry of Health 8н-д / 570 dated October 24, 2022). The introduction of the results of research on improving the tactical and technical aspects of the surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs substantiated the possibility of simultaneous performance of simultaneous operations in the combined pathology of the abdominal organs and the anterior abdominal wall, avoiding repeated operations after hernia alloplasty.
The structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, and a list of references. The volume of the main material is 153 pages.
Postoperative adhesion formation is the most common complication in general surgical practice with a frequency of more than 90% after abdominal surgery and up to 70% after thoracic surgery (Aysan E. et al. 2020, Banka R. et al. 2018). The frequency of relaparotomy and retorakotomy, according to various literature data, is estimated at 63% -97% (Bhatnagar R. et al. 2016, De Wilde RL et al. 2016). Repeated surgical procedures are more time-consuming and technically difficult, which, in turn, creates a potential risk of damage to vital structures. The paper analyzes the results of experimental and morphological studies, substantiates the effectiveness of the prevention of adhesion formation by using a domestic anti-adhesion agent in the form of a powder from cellulose derivatives. The biological safety of the new anti-adhesive coating has been determined under experimental conditions. 32 white outbred rats were used as experimental animals.
The article conducts research on the use of risk analysis methods to analyze tax risk and assess the results, studies foreign experience of risk analysis, formulates scientific and practical conclusions and recommendations for its application in our country.
В последние годы во всем мире регистрируется устойчивый рост числа больных, получающих лечение программным гемодиализом. Это связано с увеличением продолжительности жизни пациентов, большей доступностью гемодиализа и с пересмотром многих критериев, регламентирующих отбор больных для проведения программного гемодиализа . Одной из наиболее частых и трудных проблем, возникающих при лечении диализных больных, является коррекция фосфорно кальциевого обмена.
Согласно оценкам ВОЗ ежегодно от табакокурения гибнет более 8 миллионов человек. Чем раньше человек начинает курить, тем меньше вероятность, что он сможет отказаться от этой зависимости в зрелом возрасте, и тем более вероятно, что станет злостным курильщиком. Табакокурение сигнализирует о социальном неблагополучии студентов и повышает риск развития патологий сердечно-сосудистой, нервной, эндокринной, иммунной систем
Ушбу мақолада кичик бизнес субъектлари фаолиятининг инновацион фаоллигини ошириш, уни қўллаб-қувватлаш, инновацион фаоллигини оширишнинг истиқболли лойиҳаларини молиялаштириш механизмларини самарали ривожлантириш борасидаги муаммолар ва уларнинг ечимларига оид фикрлар келтирилган.
Foreign investment is the main tool for the
development of the economy and social life of developing ountries. Foreign investment serves as the basis for employment, introduction of new technologies, exchange of experience between companies, and increasing the level of competitiveness of production It should be noted that investing in developing countries is preferable not only for developing countries, but
also for foreign investors themselves to expand their production and sale of goods, as well as for business development in General. However, the economic and political instability of developing countries creates a risk for foreign investors and
hinders the development of the country's investment attractiveness. This article considers alternative mechanisms for resolving and / or preventing investment disputes between a foreign investor and a host state.
In the databases of evidence-based medicine, studies that study the effectiveness of taking vitamin-mineral complexes indicate a high risk of age-related macular degeneration (AMD) as a prevention (primary prevention). The purpose of the study was to evaluate the effectiveness of the use of lutein-zeaxanthin vitamin-mineral complex containing preparations in individuals with a high risk of AMD for the prevention of the disease. The material of the study was 98 individuals (196 eyes) from the 1st (main) group with the highest risk of developing AMD, who agreed to participate in the prevention of AMD and 90 individuals (180 eyes) from the 2nd (control) group, for various reasons refused to take the drug, but agreed to participate in condition monitoring. The follow-up period was 3 years. The results of the observation showed that in persons of the 1st group, there was a stability in the indices of visual acuity and field of vision, ophthalmoscopic and tomographic picture of the macular zone during the entire period of observation. Whereas in persons of the 2nd group by the 3rd year of observation, visual acuity worsened by 2.5 times, the total boundaries of the peripheral visual field narrowed by 47.10, relative and absolute scotomas appeared (p<0.05). The appearance of drusen was observed and in 8 eyes (4.44%) a diagnosis of age-related macular degeneration of the retina, early stage, was made. Conclusions. The proposed scheme of drug prevention of persons with the highest risk of developing AMD (Group 1) showed a significantly positive effect on the functional state of the retina, leads to a stable preservation of visual functions during 3 years of observation and prevents the occurrence of AMD in 100% of individuals.