Types of surgical operations

The following types of surgical operations are distinguished:

1. Emergency (urgent, emergency) - performed immediately according to vital indications. For example, in case of injury to the heart or large vessels, perforated gastric ulcer, strangulated hernia, asphyxia - if foreign body V Airways, perforated appendicitis, etc.

2. Urgent – ​​postponed for a short period of time to clarify the diagnosis and prepare the patient.

3. Planned – prescribed after a detailed examination of the patient and establishment of an accurate diagnosis. Examples: operations with chronic appendicitis, benign tumors. It is clear that planned operations pose less danger for the patient and less risk for the surgeon than emergency operations, which require quick orientation and extensive surgical experience.

4. Radical - completely eliminate the cause of the disease (pathological focus). Example - appendectomy, amputation of a limb due to gangrene, etc.

5. Palliative operations - do not eliminate the cause of the disease, but provide only temporary relief to the patient. Examples: fistula of the stomach or jejunum with inoperable cancer of the esophagus or stomach, decompressive craniotomy to reduce intracranial pressure, etc.

6. The operation of choice is the best operation that can be performed for a given disease and which gives the best treatment result at the current level of medical science. An example is a perforated stomach ulcer. The best operation today is resection from the stomach using one of the generally accepted methods.

7. Operations of extreme importance - are performed in relation to the conditions in which the surgeon works, and may depend on his qualifications, the equipment of the operating room, the patient’s condition, etc. Example - a perforated gastric ulcer - simple suturing of the stomach wall without eliminating the causes of the disease in a weakened patient or when the operation is performed by an inexperienced surgeon.

8. Operations can be single-stage, two-stage or multi-stage (one-, two- or multi-stage).

Most operations are carried out in one stage, during which all necessary measures are carried out to eliminate the cause of the disease - ϶ᴛᴏ one-stage operations. Two-stage operations are performed in cases where the patient’s health condition or the risk of complications does not allow the surgical intervention to be completed in one stage (for example, two-stage thoracoplasty, two-stage autopsy lung abscess). Two-stage operations are also used when it is extremely important to prepare the patient for long-term dysfunction of any organ after surgery. For example, in case of prostate adenoma, in cases of severe intoxication of the patient (uremia) or in the presence of cystitis, a suprapubic fistula is first placed on the bladder to divert urine, and after the inflammatory process is eliminated and the patient’s condition improves, the gland is removed.

Multi-stage operations are widely practiced in plastic and reconstructive surgery, when the formation or restoration of any damaged part of the body is carried out in several stages by moving a pedicle skin flap and transplanting other tissues. Operations are therapeutic and diagnostic. Therapeutic operations are performed to remove the source of the disease, diagnostic operations are performed to clarify the diagnosis (biopsy, trial laparotomy).

Combined (or simultaneous) operations are performed during one surgical intervention on two or more organs for various diseases. This concept should not be confused with the terms “extended” and “combined” operations.

Extended surgery is characterized by an increase in the volume of surgery for a disease of one organ due to the characteristics or stage of the pathological process. So, for example, metastases in a malignant tumor of the mammary gland affect not only the lymph nodes of the axillary region, but also the parasternal lymph nodes, leading to the extreme importance of performing an extended mastectomy, which consists in removing the mammary gland within healthy tissues not only with removal of axillary but also parasternal lymph nodes.

Combined operation is associated with the extreme importance of increasing the volume of surgical procedures for one disease that affects neighboring organs. For example, the spread of metastases from stomach cancer to the left lobe of the liver dictates the extreme importance of not only extirpation of the stomach, greater and lesser omentum, but also resection of the left lobe of the liver.

With the development of surgical technology, a number of special operations emerged:

Microsurgical operations are performed under magnification from 3 to 40 times using an operating microscope or magnifying glass, special microsurgical instruments and suture material with a thread diameter of 6/0 - 12/0. Microsurgical operations are widely used in ophthalmology, neurosurgery, angiosurgery, and traumatology.

Endoscopic operations are carried out using special devices - endoscopes. allowing to carry out various actions in hollow organs and cavities. Using endoscopes and television equipment, laparoscopic (cholecystectomy, appendectomy, etc.) and thoracoscopic (suturing of lung wounds) operations are performed.

Endovascular operations are intravascular interventions performed under X-ray control (dilatation of the narrowed part of the vessel, installation of steths, embolization).

The name of the surgical operation is made up of the name of the organ and the name of the surgical technique. The following terms are used:

Tomy - dissection of an organ, opening of its lumen (enterotomy, arthrotomy, esophagotomy, etc.);

An ostomy is the creation of an artificial connection between an organ cavity and external environment, ᴛ.ᴇ. fistula (tracheostomy, gastrostomy, etc.);

Ectomy – removal of an organ (appendectomy, gastrectomy, etc.);

extirpation - removal of an organ along with surrounding tissues or organs (extirpation of the uterus with appendages, extirpation of the rectum, etc.);

anastomosis - the imposition of an artificial anastomosis between hollow organs (gastroenteroanastomosis, enteroenteroanastomosis, etc.
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amputation - cutting off the peripheral part of a limb along the bone or peripheral part of an organ (amputation of the lower leg in the middle third, supravaginal amputation of the uterus, etc.);

resection – removal of part of an organ, ᴛ.ᴇ. excision (resection of a lobe of the lung, resection of the stomach, etc.);

plastic surgery – elimination of defects in an organ or tissue using biological or artificial materials (inguinal canal plastic surgery, thoracoplasty, etc.);

transplantation - transplantation of organs or tissues of one organism into another, or within one organism (kidney, heart, bone marrow etc.);

prosthetics – replacement of a pathologically altered organ or part thereof with artificial analogues (hip joint replacement with a metal prosthesis, femoral artery replacement with a Teflon tube, etc.)

Types of surgical operations - concept and types. Classification and features of the category “Types of surgical operations” 2017, 2018.

Before surgery you need to think through everything to the smallest detail and make a plan.

In most cases it is possible to operate different ways, but for each specific case the most appropriate one (modus operandi) is chosen. And for a specific method of surgical intervention, they select the method of fixing the animal, anesthesia, the necessary instruments, outline the features of the stages of the operation, and also take into account possible complications, methods for their prevention and elimination.

Any surgical operation consists of three successive stages:

1. Online access– in this part of the surgical operation, tissue is dissected and the affected organ or pathological focus is exposed. Access should always be rational, i.e. during its implementation, tissues, vessels, and nerves should be minimally injured, and the incision made should provide optimal conditions for viewing and manipulating the organ.

There is a rule for making cuts:

“The incision should be as large as necessary and as small as possible.”

• 1.1. Direct online access– carried out through the area that is closest to the pathological process. This is the most rational access.
• 1.2. Bypass access– performed through an area distant from the pathological focus, bypassing any organ.

2. Surgical procedure– in this part, surgical intervention is performed on an organ or pathological focus, which provides therapeutic effectiveness operational impact. The closer the relative position of tissues and organs, as well as their functions, are returned to normal, the higher the effectiveness of surgical treatment.

There is a rule for performing an operative procedure:

“The surgeon must operate anatomically and think physiologically.”

3. Final stage– in this part of the operation, the tissues are connected with sutures, the purulent cavity is drained, and a bandage is applied.

In some cases, the first 2 stages surgery cannot be differentiated (opening an abscess or fistula).

Previously, it was believed that surgical interventions on animals should always be subordinated to economic considerations (in contrast to humane surgery, where the issue of preserving the patient’s life is in the foreground). However, recently, this situation has changed dramatically due to the development of small animal surgery, where the life of the patient also always comes first. In the surgery of productive animals, an operation is considered successful when the economic value of the animal is preserved.

SURGERY(synonym: surgical intervention, surgical intervention) - bloody or bloodless medical or diagnostic event, carried out by means of physical (usually mechanical) influence on organs and tissues.

The history of the use of surgical operations began in ancient times (see Surgery). In the period before the new era, operations such as castration, amputation of limbs, and removal of stones from the bladder were already performed in Egypt, India, and Greece; in India they resorted to caesarean section and plastic reconstruction of the nose and ears. For a long time, progress in the development of surgical operations was hampered due to the lack of pain relief and methods of combating surgical infection. With the discovery of anesthesia (see), antiseptics (see), asepsis (see), the creation of modern surgical instruments (see), the development of microsurgery (see), the use of laser (see), ultrasound (see), cryosurgery (see) and other surgical operations have become possible on almost all organs of the human body.

Surgical operations are performed in a specially designed and equipped operating room (see Operating unit). In extreme conditions, life-saving surgical operations can be performed in a room temporarily converted into an operating room.

Surgical operations are performed by an operating team consisting of a surgeon, his assistant (one or more), an operating nurse (sisters), an anesthesiologist, an anesthetist, a doctor providing infusion therapy, and a nurse. If necessary, other specialists (pathophysiologist, radiologist, endoscopist, etc.) are included in the operating team. Sometimes, in order to reduce the operation time, it is performed simultaneously by two teams of surgeons (for example, during abdominoperineal extirpation of the rectum, one team operates in abdominal cavity, and the second - on the crotch). When an operation lasts many hours, for example, when replanting a limb, rotating teams of surgeons operate. Most often, during surgical operations on the abdominal organs, the surgeon takes a position to the right of the patient, during operations in the pelvic area - on the left, during amputation of a limb - on the side of the operated limb, during intrathoracic surgical operations - on the side of the operation. The first assistant usually takes a position opposite the surgeon, the second assistant next to the first assistant.

Surgical operations are performed using general and special surgical instruments (see Surgical instruments). General instruments are used in most operations - to separate tissues, stop bleeding, connect tissues, etc. Special instruments (bone, neurosurgical, microsurgical, etc.) are designed for corresponding operations. Many modern operations are performed using special devices - for example, a heart-lung machine (see Artificial circulation), devices for applying a mechanical suture (see Stapling machines), etc., as well as using an electric knife (see Electrosurgery), laser, ultrasound .

The names of surgical operations are often derived from Greek and Latin terms denoting an operative technique, for example, amputation (see) - cutting off a limb or part thereof, as well as removal of certain organs (uterus, mammary gland, penis); extirpation (see) - removal of an organ; resection (see) - removal of part of an organ. Some of these terms are involved in the formation of names of surgical operations consisting of several words (for example, uterine amputation, gastric extirpation). A number of term elements in Greek. origin, for example, ectomy - removal of an organ, ostomy - formation of an opening (ostium) on a hollow organ, tomia - dissection, etc., combined in one word with the name of the organ that is the object of the operation, indicate the nature of the operation (for example, appendectomy, tracheostomy, gastrostomy). There are names of operations based on the names of the surgeons who developed them, for example, Pirogov’s operation. Some names of surgical operations are preserved by tradition, although they do not reveal the essence of the operation, for example, cesarean section (see), or characterize it incorrectly, for example, lithotomy (see Lithotomy).

Surgical operations can be bloody or bloodless. Most surgical operations are bloody, in which the skin or mucous membrane is cut and through the surgical wound the surgeon penetrates deep into the patient’s body, into his cavities and organs. The scope of these operations and indications for them in modern times. surgical practice are very wide. Often, during one operation, intervention is performed on several vital organs, for example, on the brain and spinal cord, heart and lungs, stomach and liver, etc. The range of bloodless surgical operations is also expanding, including, along with traditional ones (reduction of dislocations, reposition of fragments during bone fractures, turning the fetus on its leg, applying forceps during obstetrics, etc.) they began to actively carry out therapeutic and diagnostic operations in the lumen of hollow organs without opening them. The latter include, in particular, stopping bleeding (see), taking biopsy material (see Biopsy), removal of polyps (see Polyp, polyposis), etc., carried out with the help of modern. endoscopes (see Endoscopy) from organs previously inaccessible for bloodless intervention, such as the stomach, duodenum, colon, bile ducts, etc.

Depending on the goals, surgical operations are divided into therapeutic and diagnostic. Therapeutic surgical operations can be radical, when the disease is cured by removing the pathological focus or organ - for example, appendectomy (see), cholecystectomy (see), diverticulectomy, etc., and palliative, when complete cure of the disease is impossible and the operation is undertaken to alleviate suffering of the patient - for example, gastrostomy (see) for inoperable obstructive cancer of the esophagus, ileotransversostomy (see) for an inoperable tumor of the right half of the colon, etc. The radicality of the operation is often determined by the nature of the pathological process: with stenosis caused by a malignant tumor, the creation of a bypass anastomosis is palliative intervention, while in case of cicatricial stenosis such an operation, providing complete recovery, is radical. Diagnostic surgeries are performed to diagnose a disease; these include, in particular, laparoscopy (see Peritoneoscopy), laparotomy (see), laparocentesis (see), thoracoscopy (see), thoracotolya (see), etc. Diagnostic surgical operations are used only as a final diagnostic technique in cases when others diagnostic methods turned out to be insufficient. Often a diagnostic surgical operation turns into a therapeutic one and, conversely, a surgical operation begun with therapeutic purpose, can only result in clarification of the diagnosis (for example, if an inoperable tumor is discovered during surgery).

There are primary, secondary and repeated medical surgical operations. Primary are those surgical operations that are performed for the first time for a given disease (or injury). Secondary surgical operations are undertaken in connection with complications of the disease that appear after the primary operation performed on this occasion. For example, embolectomy (see Thrombectomy) for embolism of an artery of a limb is a primary operation, and amputation of a limb due to ischemic gangrene that occurred later (as a result of a former embolism) is secondary. A surgical operation undertaken in connection with an inadequately performed primary operation and its complications (bleeding, leakage of anastomotic sutures, anastomotic obstruction, etc.) is called a reoperation or reoperation.

Surgical operations can be performed in one, two or more stages. The vast majority of operations are one-step. Often, due to the general weakness of the patient and the severity of the surgical intervention, surgical operations are divided into two or more stages. For example, in case of sigmoid colon cancer, the first stage of the operation is the removal of the affected part of the intestine and the formation of a colostomy (see Colostomy), the second is the restoration of intestinal continuity, usually carried out in the long term. Sometimes the multi-stage nature is due to the nature of the operation itself; typical example Such a multi-stage surgical operation is skin grafting using the migrating stem method according to Filatov (see Skin grafting).

Depending on the duration of the operation and the severity of the surgical injury, so-called major and minor surgical operations are distinguished. Experience shows that such a division is very arbitrary and is not always justified, therefore, in modern practice, minor surgical operations include mainly those that can be performed on an outpatient basis.

Depending on the urgency, emergency, urgent and planned (non-urgent) surgical operations are distinguished. Emergency are those surgical operations that must be performed immediately, since delay even for a minimal period of time (sometimes for several minutes) can threaten the patient’s life and sharply worsens the prognosis (for example, bleeding, asphyxia, perforation of hollow abdominal organs, etc.). Urgent operations are those that cannot be postponed for a long time due to the progression of the disease (for example, for malignant tumors). Surgical operations are postponed in these cases only for the period of time minimally necessary to clarify the diagnosis and prepare the patient for surgery. Planned operations are surgical operations, the execution of which is not limited by time limits without harm to the patient.

Depending on the potential for infection of the wound with pathogenic microflora during surgery, surgical operations are divided into aseptic (or clean), non-aseptic and purulent. A surgical operation is considered aseptic if it is performed on a patient who does not have foci of infection and if during the operation there is no contact of the wound with the contents of the hollow organs (for example, during surgery for an uncomplicated hernia). Under these conditions, by strictly observing the rules of asepsis (see) and antisepsis (see) during surgical operations, bacterial contamination of the surgical wound is practically eliminated. During non-aseptic surgical operations (for example, during operations involving opening the lumen of the gastrointestinal tract), it is not possible to avoid infection of the surgical field, however, compliance with the rules of asepsis and antisepsis and the use of modern means of antibacterial prophylaxis prevent the development of wound infection (see). Purulent surgical operations are considered to be operations performed on an existing purulent focus (for example, opening an abscess, phlegmon, etc.); in these cases, infection of the surgical wound is inevitable.

With any surgical operation, there are potential dangers for the patient associated with anesthesia, bleeding (see), development of shock (see), wound infection, damage to vital tissues during surgery important organs, mental trauma etc. All these dangers increase in elderly and old age, in people with severe diseases of the cardiovascular and respiratory systems, liver and renal failure etc. The danger of a surgical operation also increases depending on the nature and severity of the pathological process for which it is being undertaken, and on its volume. The degree of possible danger to which the patient is exposed during surgery and anesthesia (see), as well as during the immediate postoperative period (see), is called operational risk. There are five degrees of operational risk: I - insignificant, II - moderate, III - relatively moderate, IV - significant, V - extreme. In case of stage V surgical risk (usually in elderly patients with profound functional and metabolic disorders and severe concomitant diseases), surgical operations are performed only for health reasons.

To reduce the degree of operational risk in modern surgical practice, a number of effective scientifically based measures are carried out. In this regard, great attention is paid to establishing indications and contraindications for surgical operations, guided by the fact that the danger of surgical operations should not exceed the danger of the disease itself. In the preoperative period (see), a preoperative conclusion is drawn up, which indicates clinical diagnosis(see), the need for surgical operations is justified, an execution plan is outlined, indicating the features of preoperative preparation and pain relief. The patient is carefully examined (see Examination of the patient) and prepared for surgery, taking measures to prevent and combat possible operational and postoperative complications (see Complications). In the arsenal of modern surgical practice there are many means for successful prevention and control of these complications (see Blood loss, Bleeding, Purulent infection, Controlled abacterial environment, Shock).

Immediately before the start of any surgical operation, the patient is placed on the operating table or given another position necessary for the operation, the surgical field is treated (see Operating field), and pain relief is performed (see). When performing an operation under general anesthesia, anesthesia is first applied, and then the patient is given the desired position on the operating table. The correct position of the patient on the operating table allows you to create maximum comfort for the surgeon, facilitate access to the pathological focus and help prevent complications associated with compression of vital organs and tissues (for example, radial nerve palsy due to compression of the shoulder). During the operation, the patient's position is changed if necessary, which is easily achieved thanks to modern technology. designs of operating tables (see). Surgeries on the thoracic and abdominal organs are usually performed with the patient in the supine position; on posterior mediastinum- on the stomach; kidneys - on the side, etc.

The course of the operation consists of providing prompt access, the use of surgical techniques and final manipulations. Operative access should provide an approach to the object of the operation and the ability to manipulate it with minimal damage to surrounding tissues. The dimensions of the surgical wound are characterized by the size of the angle formed by the lines that connect the extreme points of the incision with the deepest point of the surgical field (the angle of surgical action); As this angle increases, the morbidity of the surgical approach increases. When the angle of the surgical action decreases, manipulations in the depths of the surgical field become more difficult, which can lead to a sharp increase in the morbidity of the surgical procedure and the duration of the surgical operation. The correct choice of surgical access ensures the success of the operation. For each organ, there may be several surgical approaches, the choice of which depends on the nature and localization of the pathological process, the patient’s physique, etc.

Surgical admission is the decisive stage of the surgical operation. The surgical procedure can be simple (for example, removal of atheroma, opening of a superficial abscess) and extremely complex (for example, removal of an organ - stomach, lung; reconstructive operations on blood vessels and the heart, transplantation of organs and tissues, etc.).

Completion of the operation is the last stage of the surgical operation, which consists of restoring the normal relationships of organs and tissues (peritonization, layer-by-layer suturing of the wound, etc.) - In cases where there is no danger of developing a purulent process, the wound is sutured tightly or primary delayed sutures are applied (see. Primary seam). In other cases, secondary early or secondary late stitches(see Secondary suture)\ in some cases the wound is not sutured and they resort to drainage (see Drainage) and tamponade (see). The most effective drainage of large cavities with copious discharge from purulent wounds is achieved by mechanically removing the contents of the wound cavity by washing it or aspirating the discharge using various devices (see Aspiration drainage). Effective drainage is a combination of wound washing with vacuum aspiration.

After major operations, weakened patients in the first days of the postoperative period (see) may experience asphyxia (see) after anesthesia, shock (see), collapse (see), bleeding, etc. In this regard, such patients are transferred from the operating room to the ward intensive care, where they are constantly monitored (see Monitoring), treatment of identified complications and care (see Nursing care). They are transferred to a regular surgical department only after restoration of consciousness and stabilization of blood circulation and breathing. Used in the surgical department active methods treatment - getting up early, balanced diet, exercise physical therapy(see), etc., which contribute to the restoration of impaired functions in patients, the prevention possible complications and restoration of working capacity.

Features of surgical operations in certain pathological conditions. With a whole range of pathological conditions preparing patients for surgical operations, its technical execution and management of the postoperative period have their own characteristics.

For example, features malignant tumors(see) are rapid infiltrating growth, during which neighboring organs and tissues are destroyed, as well as the development of metastases, and the frequent occurrence of tumor relapse after its removal. The presence of a malignant tumor without metastases is an absolute indication for radical surgery, consisting of complete or partial excision of tissue or organ along with the tumor, surrounding tissue and regional lymph nodes. When the tumor process spreads to neighboring organs, but in the absence of signs of distant metastasis, a so-called combined surgical operation is performed, in which, together with resection (extirpation) of the affected organ and removal of regional lymph nodes, a neighboring organ is resected or removed (for example, gastric resection with removal of the spleen or resection of the transverse colon). If the tumor has spread significantly, they often resort to an extended surgical operation in which a wider resection (or extirpation) of the organs involved in the pathological process is performed and more distant ones are excised. The lymph nodes(for example, mastectomy with removal of tissue and lymph nodes of the anterior mediastinum). Contraindications to radical surgery are: tumor spread beyond the regional lymph nodes, presence distant metastases; germination or infiltration of neighboring vital organs by tumor cells, the resection or removal of which is incompatible with life; the presence of severe concomitant diseases. Achievements modern medicine made it possible to expand the indications for surgical operations for malignant neoplasms in elderly patients.

When performing radical surgery for malignant neoplasms the main requirements are resection of the organ within healthy tissue and prevention of dissemination of tumor cells - ablastic (prevention of injury to the tumor and surrounding tissues, lymph nodes and vessels, protection of the surgical field, frequent washing hands, changing tools, linen, etc.). A set of measures is also used aimed at destroying tumor cells in the wound (antiblastic), which is achieved by using the methods of electrosurgery (see), cryosurgery (see), as well as laser (see), etc. (see Tumors, operations) .

In modern clinical practice surgical treatment of many malignant tumors is combined with radiation therapy (see), chemotherapy (see), hormone therapy (see). This combination treatment for certain tumor locations provides best effect and has great prospects.

For diseases of the glands internal secretion(cm. Endocrine system) surgical operations consist of extirpation of the gland (for example, for a malignant tumor) or enucleation (for benign tumors), resection (for hyperplasia with hyperfunction; and can also be combined (for example, resection with enucleation). Denervation is used much less frequently (see. ), vascular ligation, gland transplantation (see Transplantation of organs and tissues).The most frequently and successfully performed operations are for thyrotoxic goiter (see Diffuse toxic goiter), parathyroid osteodystrophy (see), adrenal tumors (see) - adrenosteromas, corticosteromas, pheochromocytomas, etc. Diseases of the endocrine glands are accompanied by serious metabolic disorders and other body functions, which can enhance these disorders.Therefore, in such patients, preparation for surgical operations and their management in the postoperative period should be especially careful, which predetermines the need provide for timely correction of these changes.

For blood diseases and lymphatic system surgical operations are often performed for thrombocytopenic purpura (see Thrombocytopenic purpura), congenital and acquired hemolytic anemia (see), for reticulosis (see), diseases of the lymphatic vessels (see), elephantiasis (see), etc. The most common operation is splepectomy (see), which is usually performed during the period of remission of the disease. Essential features of many blood diseases are the presence of severe hemorrhagic syndrome in patients and low resistance of the body to purulent infection, in connection with which any surgical operation for such diseases must be combined with blood transfusion (see) and its derivatives, hemocorrectors, the use of hemostatic and antibacterial agents, as well as immunotherapy (see).

In clinical practice, sometimes there is a need to perform surgical operations for urgent or emergency indications in patients suffering from hemophilia (see). Modern means of combating hemophilic bleeding make it possible to ensure the effectiveness and safety of surgery for this disease. The operation is usually performed in specialized medical institutions that have all the necessary transfusion agents (see) and antihemophilic drugs (antihemophilic plasma, antihemophilic globulin), after special preparation of the patient. During a surgical operation, blood is transfused in quantities necessary to replace surgical blood loss and replenish blood clotting factors (see Blood transfusion), and local hemostatic agents are used (hemostatic sponge, thrombin, etc.). In the postoperative period, daily monitoring of the state of the blood coagulation system with the introduction of the necessary antihemophilic drugs is mandatory. In case of pathology of the lymphatic vessels, to eliminate lymphostasis (see), lymphovenous anastomoses are applied using microsurgical techniques.

With combined radiation injuries (see Combined injuries), the features of the surgical operation are associated with radiation sickness (see). Surgery performed during the initial general reaction of radiation sickness can cause severe shock. In the latent period, with a visible wedge, well-being, which can last up to 2 or more weeks, the operation is the safest. This period should be used for surgical interventions in order to achieve healing of the postoperative wound by primary intention before the onset of pronounced wedge manifestations of radiation sickness. The surgical operation should be performed to the maximum extent possible in order to avoid repeated operations during the wedge period, manifestations of radiation sickness (for example, with combined lesions relative indications for amputation become absolute, since amputation at the height of radiation sickness is extremely dangerous for the affected person). If the wound becomes infected with RV, it is removed by radical surgery. surgical treatment wounds (see) under dosimetric control (see). Surgical operations in these cases are performed in a special operating room in compliance with the rules for personnel protection - safety glasses (see), suit, gloves, etc. After the operation, special treatment of operating room personnel is carried out, decontamination of surgical linen and instruments with careful dosimetric monitoring. During the height of clinical manifestations radiation sickness, the patient’s body’s resistance to infectious agents is sharply impaired; tissue regeneration processes are weakened, their bleeding is increased, as a result of which surgical wounds fester and bleed persistently. After surgical operations, the wounded affected by radiation sickness are given intensive antibacterial therapy, blood loss is replaced, and a set of other measures aimed at treating radiation sickness is used.

With the so-called surgical infection ( common name diseases and pathological processes of infectious origin, in which surgical treatment is crucial, for example, abscesses, phlegmon, wound infections, etc.), the indications for surgical operations increase. The presence of an unopened purulent focus can cause purulent intoxication (see) and the development of a general purulent infection (see Sepsis). IN complex treatment In patients with surgical infection, the leading role belongs to surgical intervention. Due to the decrease in the immuno-biological resistance of the body in such patients, secondary infection poses a great danger to them. Therefore, surgical operations for purulent diseases should be performed with careful observance of all rules of asepsis and antisepsis. These operations can be radical or palliative. In a radical surgical operation, the purulent-necrotic focus is removed completely within the healthy tissue; As a result, an aseptic wound is formed, which, under appropriate conditions (use of antibiotics, proteolytic enzymes, immune drugs, drainage, etc.), primary sutures can be applied, and if a tissue defect is formed, plastic closure of the defect can be performed (see Plastic surgery). Sometimes suturing and plastic surgery are postponed until the suppuration stops and the acute inflammatory process subsides, after which secondary sutures are applied. During palliative surgical operations (for example, opening an abscess), the main focus of inflammation remains in the tissues, however, opening and drainage of the purulent cavity creates conditions for reducing intoxication, subsiding the inflammatory process and accelerating the secondary healing of the postoperative wound. In practice modern surgery More and more wide application for purulent diseases, surgical operations are performed using a laser in combination with physical antiseptic methods (ultrasound, electrophoresis of various drugs) and other methods.

Methods for determining the amount of blood loss. During complex surgical operations, it is extremely important to control the amount of blood loss (see), which can vary from insignificant to 1.5 or more liters. Existing methods Estimates of surgical blood loss (as well as blood loss caused by other causes) are divided into direct and indirect. Direct methods include colorimetric, blood conductivity and gravimetric; to indirect - visual, method of assessment by wedge, signs, methods of measuring blood volume using indicators, “shock index”.

The colorimetric method is based on extracting blood from the material that has absorbed it, followed by determining the concentration of blood components and recalculating the lost volume. Blood is extracted from tampons in the so-called " washing machine“When an extracting substance and a certain volume of water are added, blood from the suction is collected here and the concentration of hemoglobin in the solution is determined using an optical densitometer. It is assumed that the concentration of hemoglobin in the blood is constant. Disadvantage of the method: the need to periodically replace the liquid in the apparatus, since the added volume affects the volume of the solvent.

The method for measuring blood electrical conductivity is based on data on the constancy of its value. The method is quite accurate if no electrolytes are added to the blood, but it requires special equipment.

The gravimetric method is based on weighing bloody swabs and napkins after surgery, and it is assumed that 1 ml of blood weighs 1 g. The advantage of the method is its simplicity. But it also has significant disadvantages: the loss of blood on sheets and gowns is not taken into account, the loss from evaporation of plasma from napkins, edges can reach 10% within 15 minutes if it is hot in the operating room. The value of the method is also reduced by the fact that non-standard tampons, napkins, etc. are often used. To obtain the value of true external blood loss, it is proposed to increase the data obtained by 25-30%, that is, take into account the amount of blood shed on the lining sheets, gowns and from evaporation. This method, while simultaneously taking into account the blood lost in suction and spent on various studies during major surgical interventions, especially during operations with artificial circulation, can produce an error of up to 45-50%.

Estimation of blood loss using visual observation, according to many researchers, is extremely unreliable and is always less than measured. Estimation of blood loss based on clinical signs is also not without inaccuracy. Basic Clinical signs(blood pressure, central venous pressure, pulse rate) are often not adequate to the degree of blood loss, especially in patients under anesthesia. The value of blood pressure does not reflect the degree of hypovolemia up to 20-30% of blood volume. Central venous pressure begins to decrease after a 10% decrease in blood volume. During prolonged traumatic operations leading to additional change physiological processes as a result of anesthesia, artificial ventilation lungs, the use of vasoactive substances, hypothermia, artificial circulation, etc., clinical tests of bleeding and hypovolemia are even less valuable.

With the introduction of volometron - a device for rapid automatic determination of blood volume - it became possible to quickly determine blood volume again at the stages of surgery. The method is most valuable for long-term traumatic surgical interventions, as well as for determining postoperative blood loss and assessing the degree of hypovolemia due to bleeding during various injuries. The use of one (plasma or cellular) indicator when measuring blood volume provides less reliable information about the true values ​​of blood volume compared to the simultaneous use of two indicators. As indicators, azo dye T-1824, albumin labeled with iodine isotopes, and red blood cells labeled with a chromium isotope are used. The recording equipment is a spectrophotometer, and for isotopes - special radiodiagnostic equipment.

For the purpose of approximate express diagnosis of the amount of blood loss, the definition of the “shock index” is used. It is the quotient of heart rate divided by systolic blood pressure. In adult patients before surgery, this figure is 0.54, with a postoperative decrease in blood volume by 10-20% - 0.78, with a decrease by 20-30% - 0.99, with a decrease by 30-40% - 1.11 , with a decrease of 40-50% - 1.38.

None of the considered methods for assessing blood loss is without drawbacks. All direct methods have two main drawbacks: with the help of these methods, only external bleeding is determined, they do not allow one to judge the loss of blood in soft tissues, in places of hemostasis; In addition, it is impossible to take into account the phenomena of blood deposition and sequestration.

When determining the amount of blood loss using one or more methods, it is necessary to simultaneously evaluate the volume of circulating blood in a given patient (see Blood circulation). This is due to the fact that the same absolute values ​​of blood loss in one patient may not have a noticeable effect on blood circulation, while in another patient with preoperative hypovolemia it may cause severe collapse and shock. To determine the volume of circulating blood, it is most advisable to be guided by the value of central venous pressure.

Bibliography: Akzhigito in G. N. Organization and work of a surgical hospital, M., 1979; G roses before in D. M. and Patsiora M. D. Surgery of diseases of the blood system, M., 1962; Elizarov with k and y S.I. and Kalashnikov R.N. Operative surgery and topographic anatomy, M., 1979; Cryosurgery, ed. E.I. Kandelya, M., 1974; Littmann I. et al. Operative surgery, trans. from Hungarian, Budapest, 1981; Malinovsky N.N. et al. Degree of operational risk (methodology clinical definition and practical significance), Surgery, N# 10, p. 32, 1973; O'Brien B. Microvascular reconstructive surgery, trans. from English, M., 1981; Peterson B.E. Oncology, M., 1980; Petrovsky B.V. and Krylov V.S. Microsurgery, M., 1976; Polyakov V. A. et al. Ultrasonic welding of bones and cutting of living biological tissues, M., 1973; Struchkov V.I. Purulent surgery, M., 1967; Struchkov V.I., Grigoryan A.V. and Gostishchev V.K. Purulent wound, M., 1975; Surgical care in clinics and outpatient clinics, ed. B. M. Khromova, JI., 1973; Yarmonenko S.P. Radiobiology of humans and animals, M., 1977; Abe M. a. Takahashi M. Interoperative radiotherapy, Int. J.radiat. Oncol., Biol., Physics, v. 7, p. 863, 1981; Berry R. E. Who is the surgeon? Amer. Surg., v. 47, p. 51.1981; BogdanT.Th. Evaluarea riscului operator global in chi-rurgie, Rev. Chir., Oncol., Radiol. (Buc.), y. 27, p. 181, 1978; Corriero W. P. Color coding of surgical instruments, Ab-dom. Surg., v. 20, p. 216, 1978; Frem-s t a d C. a. Welch J. S. Clean air bench, Use for sterile maintenance of unwrapped surgical instruments, Arch. Surg., v. 114, p. 798, 1979; Kanz E. DieNon-Infektion als hygieniches, Grundkon-zept der Unfallchirurgie, Unfallchirurgie, Bd 5, S. 1, 1979; Moore F. D. Lister Oration, 1979, Science and service, Ann.roy. Coll. Surg. Engl., v. 62, p. 7, 1980; Muller H. P. u. M a s s o w H. OPS-ein neues Operationsplanungssystem, Helv. chir. Acta, Bd. 45, S. 773, 1979; Payne N.S. a. o. Evaluation of the plasma scalpel for intracranial surgery, Surg. Neurol., v. 12, p. 247, 1979; Reggio M. a. o. Interventi chirurgici su pazienti portatori di radioattivita, Chir. ital., v. 30, p. 814, 1978; R u t k o w I. M. a. Z u i d e m a G. D. Unnecessary surgery, Surgery, v. 84, p. 671, 1978.V. I. Struchkov, E. V. Lutsevich;

G. M. Soloviev (methods for determining the amount of blood loss).

Choosing a clinic and a doctor is a question that every person faces when it comes to undergoing a planned surgical operation. In the minds of most patients who are faced with the need for surgical treatment for the first time, for any disease there is a certain method of surgical intervention that is used everywhere, and the quality of the operation depends on the hands and experience of the surgeon.

Despite the fact that medicine is a conservative science, modern surgical practice can offer a variety of approaches to treatment, and their use by a specific specialist is determined by the level of his qualifications, innovative approaches to treatment, and the use of certain techniques and technologies.

There's no doubt that traditional methods surgical treatment gives no less positive results than modern approaches, however, we should not forget that in addition to the operation itself, the patient awaits rehabilitation period, and the cosmetic effect after surgery can be of fundamental importance. Thus, the use of new technologies in surgery can reduce the patient’s recovery period from three to one week and leave a completely invisible pale scar instead of a clearly visible one up to 15 cm in size.

Clinic "First Surgery"

High-tech operations are the specialization of doctors at the First Surgery multidisciplinary clinic, which today provides medical care to patients in nine surgical areas: general surgery, plastic surgery, traumatology and orthopedics, vascular surgery, endocrine surgery, urology, gynecology, ENT surgery and oncology. The clinic's surgeons are well-known specialists in Moscow and Russia, doctors highest category, candidates and doctors of science, authors of scientific publications, developers of unique methods. Each operation is carried out taking into account the principles of efficiency, low trauma and safety for the patient, which together allows us to achieve the best results in the treatment of surgical pathologies.

Central reception of the clinic "First Surgery"

What operations does the First Surgery clinic perform?

Surgical treatment of all types of hernias (hernioplasty)

Operations are performed for umbilical, inguinal, femoral hernias and hernia of the white line of the abdomen. The main concern of patients who are candidates for hernia surgery is the high probability of its recurrence, which can reach 15%.

The most reliable method of surgical treatment of hernia is laparoscopic hernioplasty - this is endoscopic surgery, during which, under video control, an implant (synthetic material) is installed in the area of ​​the hernial orifice from the abdominal cavity. The advantage of this type of operation is the minimally expressed pain syndrome (since there is no tension of the tissues in the area of ​​​​the operation), an early rehabilitation period and a high cosmetic effect, since the operation is performed through several punctures of the abdominal wall measuring about 5-10 mm; as such, no incisions are made on the body . The period of hospital stay is usually no more than 1 day.

For operations on hernias, only original implants (mesh) from Paul Hartmann, Germany are used.

Removal of the thyroid gland (thyroidectomy)

This operation is usually performed when nodular formations are detected in thyroid gland. Unlike traditional techniques, surgery to remove thyroid gland at the First Surgery clinic it is performed in an open manner through a mini-access (incision no more than 3 cm), thereby leaving virtually no traces of the operation.

An incision is made in the front of the patient's neck through which all or part of the thyroid gland is separated from other tissues in the neck and removed. The wound is sutured with a cosmetic suture. If the thyroid gland is removed due to cancer developing in the area of ​​the operation, lymph nodes may also be removed. The total duration of the operation is from 1 to 2 hours. The period of hospital stay is usually no more than 1 day.

Operations for the surgical treatment of hernias and removal of the thyroid gland at the First Surgery clinic are performed by a surgeon of the highest category with more than 20 years of experience, Sergei Anatolyevich Shcherbakov.

An operation to remove the thyroid gland was performed by surgeon S.A. Shcherbakov.

Surgical treatment of varicose veins

It is carried out at the First Surgery clinic either in an open way (phlebectomy) by removing a vein through a mini-incision no larger than 1-2 cm, or using radiofrequency ablation (RFA) technology - the most modern, minimally invasive and minimally traumatic method of treating varicose veins. Radiofrequency ablation allows you to go home on your own within an hour after the manipulation.

The very principle of ablation is that instead of directly removing varicose veins, they are “sealed” without removal. Through a puncture of the skin, a special catheter is inserted into the vein, with the help of which the vein is sealed under radiofrequency influence, and the blood is redirected to healthy veins. The procedure is performed on an outpatient basis under local anesthesia. After undergoing the procedure, patients usually return to their normal lifestyle within a few days. Immediately after the RFA procedure, most patients are left with minimally noticeable scars, bruises or swelling, which completely disappear after 1-2 weeks, leaving no trace. The cord from the welded vein completely disappears within a month.

All operations on the veins, including the RFA procedure, at the First Surgery clinic are performed by a vascular surgeon of the highest category, candidate medical sciences, Alexander Alexandrovich Belkin.

Removal of the gallbladder (cholecystectomy)

A common type of surgery to treat cholecystitis.

The traditional method of cholecystectomy is an open abdominal operation, during which the gallbladder is excised and removed through an incision in the abdominal cavity.

The least traumatic method of performing the operation is laparoscopic cholecystectomy. Through several small (up to 5 mm) punctures of the abdominal wall, the surgeon installs trocars - tubes for inserting instruments for surgery and a video camera with a light into the abdominal cavity. To create space in the abdominal cavity for inspection and work, sterile carbon dioxide is injected into it, after which all abdominal organs become clearly visible on the monitor screen in the operating room. All incisions inside the abdominal cavity are made using an electrocoagulator, which simultaneously dissects and coagulates tissue (tissues and vessels are baked by the device, due to which the operation is carried out practically without blood). Gallbladder, separated from the liver, is removed from the abdominal cavity through a cosmetic puncture, after which the entire instrument is removed, sutures are applied to the punctures, and the operation is completed.

Thanks to the laparoscopic method of removing the gallbladder, in the postoperative period patients experience only minor pain on the first day after surgery. A few hours after surgery, the patient can move independently. Total time hospital stay from 1 to 3 days. A few months after the operation, the scars at the puncture site become almost invisible.

Rehabilitation after surgery

An important component of the recovery process and return to a traditional lifestyle, as well as a way to eliminate possible postoperative complications. The First Surgery Clinic offers its patients a course of magnetic therapy for more fast healing tissues, as well as eliminate cosmetic defects from surgery using laser resurfacing and introducing blockades with absorbable medications.

Intensive care ward of the First Surgery clinic

Clinic services

All surgical operations at the First Surgery clinic are carried out accompanied by nursing staff of the highest category with more than 15 years of experience and special training in resuscitation.

24-hour duty and monitoring of patients after operations is carried out by an anesthesiologist-resuscitator of the highest category. All data on the condition of each patient in real time is sent to the central console of the anesthesiologist, from which he can track the slightest changes and immediately take action. necessary measures to stabilize the condition of a postoperative patient.

Throughout his stay at First Surgery, the patient feels attentive and sensitive to his health on the part of the entire clinic staff. After the operation and until complete recovery, patients undergo all necessary treatment, examinations and dressings from their attending physician, and no additional costs are required for this - everything is included in the cost of the operation.

More about the clinic

You can learn more about the peculiarities of the clinic’s work by looking at the section on the website - 12 reasons to contact the First Surgery clinic.

The clinic is located in the North-Western Administrative District of Moscow at the address: st. Shchukinskaya, 2. If you have any questions, you can contact the clinic’s reception by phone +7 495 276-00-15 or leave a request on the website www.1surgery.ru

Please note that there are currently special offers available for General Surgery surgeries.

Surgical operations. Types of operations. Stages of surgical operations. Legal basis for the operation.

Surgery– mechanical (traumatic) effect on tissues and organs for therapeutic or diagnostic purposes.

In modern surgery, normal surgical intervention is ensured by adequate anesthesia.

Classification of surgical operations.

Diagnostic:

biopsies (excisional, incisional, puncture);

punctures (abdominal, pleural, articular, spinal, etc.);

endoscopic examinations (laparoscopy, thoracoscopy, arthroscopy);

angiography and cardiac catheterization;

diagnostic (exploratory) laparotomy and thoracotomy (used last).

Medicinal.

According to the urgency of execution - 1) urgent or emergency, 2) urgent or urgent and 3) planned operations.

Emergency - immediately or in the first two hours after hospitalization of the patient and diagnosis (stopping bleeding, tracheostomy; thromboembolectomy; acute appendicitis, perforation of an ulcer, strangulated hernia, intestinal obstruction).

Urgent - in the first days after hospitalization, because later, a state of inoperability may occur (malignant neoplasms, external intestinal fistulas, severe congenital defects, heart defects).

Planned - performed at any time convenient for the patient and the availability of hospital conditions, while preparation for the operation can last for several weeks.

Radical, palliative, symptomatic. Radical (incision for abscess, appendectomy, gastric resection, ligation of patent ductus arteriosus, etc.). Palliative operations do not eliminate the cause of the disease, but alleviate the patient’s condition. Symptomatic operations are aimed at eliminating a specific symptom.

Stages of implementation - one-stage, two- and multi-stage. One-stage (appendectomy, resection of a lung lobe, heart valve replacement); two-stage (for example, a colostomy before radical surgery for an intestinal tumor). Multi-stage operations (plastic, etc.).

Combined, combined operations. Combined operations are those performed simultaneously on two or more organs for two or more diseases. Combined operations are operations performed on two or more organs to treat one disease.

According to the degree of potential contamination:

1) aseptic; 2) conditionally aseptic (for example, hernia repair); 3) conditionally infected (for example, operations on the colon); 4) primary infected (peritonitis).

Stages of the operation – surgical access, surgical technique, restoration of tissue integrity.

Operative access - intended to expose the affected organ and provide conditions for performing an operative procedure. The exception is endoscopic and endovascular interventions.

Requirements for online access:

Access must be wide enough to provide comfortable working conditions;

Gentle and cosmetically adequate.

Surgical procedure is the main stage of the operation, during which the planned impact is carried out.

Types of surgical procedures:

Elimination or delimitation of the pathological focus;

Organ removal /ectomy/;

Removal of part of an organ /resection/;

Reconstructive and restorative manipulations.

Completion of the operation is the restoration of the integrity of tissues damaged during surgical access.

Cosmetic and functional effects, healing time, and the risk of complications (bleeding, hematomas, eventration, hernias) largely depend on this stage.

Options for completing operations:

Cosmetic suture of the wound;

Layer-by-layer suturing of the wound tightly;

Application of subtotal sutures;

Total sutures;

Use of quick release devices;

Leaving the wound open /laparostomy/;

Solving the issue of drainage;

Solving the issue of leaving tampons.

At the end of the operation, as soon as the patient crosses the border of the operating room, the postoperative period begins.

Legal basis for the operation.

Constitution of the Russian Federation;

“Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” dated July 22, 1993.

Article 41 of the Constitution of the Russian Federation provides the basic guarantees of the state to citizens in the field of healthcare. Main types identified medical care, which citizens can receive in the compulsory health insurance system, i.e. for free.

In the voluntary health insurance system, citizens of the Russian Federation can receive specialized medical care in medical institutions of federal significance.

In the document “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”:

Article 30 establishes the fundamental rights of the patient;

Article 58 reflects the duties of the attending physician;

Article 61 is devoted to medical confidentiality;

Article 32 guarantees the patient’s right to voluntary (written) informed consent to medical intervention;

Article 33 states the patient's right to refuse intervention.

Information consent is a legal confirmation of the patient’s consent to diagnostic procedures, treatment, including surgery, and pain relief. According to this article of the law, every person has the right to choose methods of diagnosis and treatment.

Based on Russian legislation, the patient has the right to receive copies of medical documents reflecting the state of his health and the treatment being carried out.

The legislation also provides for the patient's right to conduct a medical examination to provide him with medical care. The main documents on the basis of which such an examination is carried out are the patient’s outpatient card, which reflects the patient’s treatment in the clinic, and the medical history, which records all the studies carried out and the treatment of the patient while he is in the hospital, as well as the outcomes of the disease.

In recent years, there has been an increase in the number of complaints and claims from patients in the provision of medical care. Responsibility of medical workers for improper treatment can be civil, criminal, administrative and disciplinary. If the doctor’s mistake is proven, the patient may receive financial compensation for the damage incurred, and the doctor may bear financial responsibility, including criminal punishment.

Based on this, the doctor must carefully prepare medical documentation, since it is the main evidentiary document in the event of legal conflicts between the patient or his relatives and medical workers.