[Fast track recovery protocols for extended pelvic surgery]. / Protokoly uskorennogo vyzdorovleniya pri rasshirenno-kombinirovannykh operatsiyakh na organakh malogo taza.

OBJECTIVE: To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice. MATERIAL AND METHODS: The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p=0.046), patients with recurrent (46.2% vs. 22.0%; p=0.009) and complicated tumors (26.9% vs. 11.9%; p=0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p=0.068). RESULTS: Surgery time was higher (319±125 min vs. 236±79 min, p<0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p=0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p=0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p=0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p=0.034) and local infectious complications (19.2% vs. 42.4%; p=0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p=0.89). CONCLUSION: FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

[Evaluation of functional potentials of microcirculation in patients with obliterating diseases of lower limb vessels]. / Otsenka funktsional'nykh vozmozhnostei mikrotsirkuliatsii u bol'nykh s obliteriruiushchimi zabolevaniiami sosudov nizhnikh konechnostei.

An analysis of the data of laser doppler fluorometry in 136 patients has shown that different obliterating diseases have different typical fluorometric features of changes in microcirculation. Results of the postischemic test are of greater informative value in the noninvasive assessment of the functional state of microcirculation. The significance of the functional tests was particularly increasing in critical ischemia of the lower extremities. The intraoperative determination of the muscle blood flow allowed performing the control of the lower extremity revascularization and determining the optimum level of amputation.

[Surgical treatment of patients with critical ischemia of the lower limbs of atherosclerotic etiology]. / Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskogo geneza.

The authors analyze the results of conservative and operative treatment of 546 patients. The results of operative treatment (reconstructive operations on the arteries, osteo-trepanation) were shown to be considerably better in cases of critical ischemia than those of conservative treatment (infusion therapy, hemodilution, plasmapheresis).