[Efficacy of prevention of recurrent laryngeal nerve injury in thyroid surgery]. / Effektivnost' profilaktiki povrezhdenii vozvratnogo gortannogo nerva pri operatsiyakh na shchitovidnoi zheleze.

OBJECTIVE: To evaluate the effectiveness of prevention of recurrent laryngeal nerve injury depending on thyroid gland lesion and extent of surgery. MATERIAL AND METHODS: There were 2412 thyroid surgeries between 2000 and 2020. Patients were divided into the main group (1689 patients) and the control group (729 patients). Patients with nodular thyroid gland lesions prevailed in both groups (987 (58.4%) and 415 (56.9%), respectively). All ones underwent atraumatic extrafascial desection and thyroid resection (ultrasonic scalpel). RESULTS. T: He upper laryngeal nerve injury occurred in 35 cases (1.4%). The number of surgeries with thyroid remnant preservation was significantly lower in the main group. The number of procedures with subtotal thyroid resection and thyroidectomy increased by 2.4 times (from 414 to 1010 operations, p<0.05). CONCLUSION: Improvement of surgical treatment of thyroid gland lesions consisting in new operative technique of recurrent laryngeal nerve isolation using ultrasonic scalpel reduces the incidence of recurrent laryngeal nerve injury from 2.3% to 1%. At the same time, the number of extended procedures in the main group significantly exceeded that in the control group (by 2.5 times).

[Combined operations on vessels and abdominal organs]. / Sochetannye operatsii na sosudakh i organakh bryushnoi polosti.

THE AIM OF THE STUDY: Is to describe the experience of combined operations and the expediency of choosing such a tactic for surgical treatment of patients with two or more surgical diseases. MATERIAL AND METHODS: The results of surgical treatment of 299 patients with vascular lesions in combination with other diseases requiring surgical treatment in 2014-2018 were analyzed. All operations were performed in the cardiovascular department of the GBUZ RKB on the basis of the Department of Hospital Surgery of the KBSU named after V.I. H.M. Berbekov. In the selected group, the proportion of patients of working age was 71%. Combined operations were performed in 151 patients, the remaining 148 people who underwent surgery for cardiovascular and surgical diseases were included in the comparison group. Among them, a combined operation was performed in 79 patients for vascular diseases and in 69 for other diseases. RESULTS: When analyzing the perioperative period in patients of the main and control groups, there was no significant difference in the parameters of simultaneous surgical interventions (duration of operations, volume of blood loss, the need to increase the dose of catecholamines in the operating and postoperative periods, the incidence of rhythm and conduction disturbances, the duration of artificial ventilation and stay in hospital). It was found that combined operations did not lead to an increase in the number of postoperative complications and an increase in mortality. At the same time, combined operations are possible even with a complex combination of various diseases. CONCLUSIONS: Combined operations are more justified than staged surgical treatment: 1) the patient is simultaneously cured of 2 or more surgical diseases; 2) the risk of repeated general anesthesia and its negative consequences is eliminated; 3) re-examination and preoperative preparation are excluded; 4) the frequency of progression and recurrence of diseases (infringement of a hernia, exacerbation of cholecystitis, etc.), repeated surgical interventions for concomitant diseases decreases; 5) a single access simplifies the surgical approach to the abdominal organs and is less traumatic; 6) the average time spent by the patient in the hospital, the terms of further rehabilitation and the period of incapacity for work are reduced; 7) combined surgical interventions are economically beneficial.

[Topographically oriented mobilization of the thyroid].

The analysis of clinical experience of the operative treatment of 600 patients with a thyroid pathology has allowed to develop technics of allocation of a return laryngeal nerve depending on the type of an anatomic structure of a gland. It gave the opportunities for the extrafascial removal of a share of a thyroid gland, the more accurate visualization and preservation of the parathyroid glands, located near the nerve and safe central lymphadenectomy.