Тезисы пироговской конференции 2007

FRAXEL: A NEW APPROACH

TO TREATMENT OF SCARS AND SKIN PIGMENTATION

V.Buydenok, E.Buydenok, I.Sechenov University of California

Department of Surgery

The project’s advisor – MD, PhD prof. N.Tankovich

The department’s chairperson – MD, PhD prof. S.Nelson

Fractional photothermolysis is a new concept in laser applications in which the laser treatment results in the placement of numerous microscopic zones of thermal damage, leaving the majority of the skin tissue intact. The remaining untreated skin serves as a reservoir for healing. Histologic finds prove the presence of CD34+ and CD38cells, which are of an undifferentiated form; i.e. pluripotential stem cells. The purpose of the study was to examine a new laser in treatment of scars and melasma. 20 patients with melasma and 10 with different scars underwent treatment with Fraxel. 60% in the first group and 50% in the second were assessed to have 75-100% clearing. 20% in each group - 50-75% skin improvement. The rest – 25-50%. There were no no-responders. Side effects were limited to sunburn-like erythema, which lasted 1-3 days. Rarely, at high densities, the patients had small linear abrasions each about 2 to 3 X 8 to 16mm, which healed uneventfully. The advantages: patients do not have open wounds, and, as such, downtime is minimized. Second, anatomic areas that would generally be highly prone to complications of scarring with traditional resurfacing lasers, such as the neck, chest, and hands, can be safely treated. Third, potential complications associated with open wounds, such as infection and hyperor hypopigmentation, are minimized. Fourth, one can potentially treat deeper dermal pathology.

EVALUATION OF ECHINOCOCCUS HEPATIC DISEASE

J.Delev, D.Despotovski

St. Cyril and Methodius University

Department of Digestive Surgery

The department’s chairperson – MD, PhD M.Panovski

The project’s advisor – ass., MD G.Begovic

Goal: Evaluation of Echinococus hepatic disease on Clinic of Digestive surgery in the period of 5 years. In our work we made examination and assessment of all the cases with Echinococcus Hepatic Disease at our Clinic within the period from 2001 to 2005 year. We fully examined: sex, age, diagnosis methods, treatment, duration of hospitalization, complications and outcome. In that period we had total of 201 cases from which 110 were female and 91 male. The most common age was 15 to 25 years, with 46 cases. The main diagnostical methods were MRI, CT, Echotomography, Cholangiography, detection of specific IgG antibodies with ELISA and Biopsy. The most usedoperativemethodwas:Extirpatiocystaecumreductio pericystae ad maximum cum omentoplicatio; Evacuatio cystae cum omentopexio; – Sectio Papadimitriou, with 147 cases, 7 case were treated conservative only with Albendazole for further preparations decreasing risk and improving operative result. The rest of the cases were treated depending on early, intraoperative or late complications with: Resectio hepatis atipica, cholecystectomia, haemostasis and biliostasis, drainage abscessus subphrenicus, evacuatio bilomatis bilomae, fistula biliocutanea solved with conservative treatment mostly. Cases that ended with exitus lethalis were 3. Summary: we can conclude that this disease is still present in our country with relatively big percentage. But, the outcome results from complete treatment are completely satisfied and encouraging.And we have to continue working on prevention on one side and postoperative rehabilitation on the other.

ASSOCIATION BETWEEN TUMOUR BUDDING AND CD44 EXPRESSION REPRESENTS A USEFUL MARKER FOR PREDICTION OF LYMPH NODE METASTASES IN COLORECTAL ADENOCARCINOMA

D.V.Janevska

St. Cyril and Methodius University

Department of Digestive Surgery

The department’s chairperson – MD, PhD M.Panovski

The project’s advisors – MD, PhD L.Spasevska, MD, PhD V.Janevski

Goal: to evaluate the association between tumour budding and CD44 expression in correlation with histopathological parametersandlymphnodesmetastases.Methods:surgically resected specimens from 39 pT2 or pT3 colorectal adenocarcinomas were studied. The presence of tumour buddingwasexaminedaccordingtoMoradoni’scriteria.An isolated single cancer cell and a cluster of fewer than five cells at the invasive margin were counted under light microscopy within a microscopic field of x250. ImmunostainingforCD44wasperformedusingavidin-biotin peroxidase technique. The associations between tumour budding,CD44expression,histopathologicalparametersand lymphnodesmetastaseswereexaminedstatistically.Results: budding was observed in 79,2% of the colorectal adenocarcinoma and was significantly correlated with the histopathological parameters, such as extramural spread, infiltrativegrowthpattern,extramuralvenousinvasionand numberoflymphnodemetastases(p<0,05).CD44positive cancers had a greater number of budding foci than other categories(63%).Theassociationbetweentumourbudding andCD44expressionwashighlysignificant(p<0,001).74% of cancers with lymph node metastases showed CD44 expression.Therewashighlysignificantcorrelationbetween CD44 expression and lymph nodes metastases (p<0,001). Conclusions:tumourbuddingandCD44expressionmaybe usefulinidentificationofhigh-riskpatientsforlymphnode metastases.

SURGICAL TREATMENT

OF COMPLICATIONS OF GASTRIC ULCER V.Joksimovic, M.Gjeorgjievski

St. Cyril and Methodius University

Department of Abdominal Surgery

The department’s chairperson – prof. V.Janevski The project’s advisor – ass. G.Begovic

Aims: this study shows an importancy of surgical treatment of complication of gastric ulcer. Matherial and methods: The three chief methods of endoscopic therapy are: 1) thermal contact methods (heater probe, multipolar electrocoagulation), in which the bleeding vessel is compressed with a probe, which then heats the tissues, re-suiting in coagulation; 2) injection of

the bleeding site with dilute epinephrine; 3) The endoscopic approach to lesions with an adherent clot but no active bleeding is the topic of much ongoing research. Currently, the most common approach is to attempt to displace the clot. The rate of further bleeding in patients with active bleeding or nonbleeding visible vessels is reduced by about 50% with endoscopic therapy. However, in about 20% of such patients, bleeding persists. Results: in a hypothetical cohort of 1,000 patients presenting to ED with signs of UGI bleeding, published data indicates that 610 will have a gastric/duodenal ulcer. Of these, 220 patients (36%) will have an ulcer amenable to endoscopic treatment. These 220 patients are ones in which IVPPI has proven benefit such that 40 rebleeds would be prevented compared with the same number of patients who would receive standard endoscopic treatment alone. In the base case scenario, we found that administering IVPPI to all patients would result in savings of a) $790 US b) $122 Can per patient treated. The strategies are cost saving even at the lower end of the 95% confidence interval. By using more accurate patient information provided by RUGBE data we have further validated our previous models. Conclusions: based on our analysis, the early administration of empiric IVPPI in all patients presenting to the ER with signs and symptoms of UGI hemorrhage is cost saving when compared to endoscopic therapy alone.

SURGERY OF ESOPHAGEAL

CANCER – THE CHALLENGE

TO ANTI-NEOPLASTIC TREATMENT K.Knut, M.Pawlak, M.Borys, P.Kuzminski Medical University of Gdansk Department of Surgical Oncology

The department’s chairperson – prof., PhD, MD A.Kopacz

The project’s advisor – MD K.Drucis

Cancer of the esophagus is the neoplasm of the gastrointestinal tract with the poorest prognosis. The diagnosis is common established late (advanced stadium); therefore performing of the resection is questionable. To the study 118 patients with squamous cellesophagealcancerhospitalizedintheyears1980–2001 were surveyed and analyzed, retrospectively. In all cases potentially curative resection was performed. 16 women (13,55%) and 102 men (86,44%) were included (median age 56,3 years, range 38–73). Analyzed agents were: demographic data, resection type (R0 vs. R1 and R2), margins of surgical resection, localization and size of tumor, complication rate (anastomosis leakage) and TNM status. Particularly important were presence of metastatic local lymph nodes and type of resection as factors determining local recurrence and local failure rate. Median survival

of the group was 10.4 months. Demographic data, malnutrition, localization of the tumor and postsurgical complications have no influence on overall survival. Advancement of disease (p=.05), tumor size (p=.04) and positive margin of resection (p=.05) revealed importance for survival rate. Type of resection (23,7% of patients R0, 76,3% of patients R1 or R2) reached the strongest correlation to the time of survival (p=.001), and as the only one influences local failure rate (p=.05). The median survival time after resection remains poor. The diagnosis at the time of local metastasing cancer causes the R0 resection unable to perform, what provides insufficient efficiency of surgical treatment. The introducing of diagnostic tools, including radiological tests with the new-generation radioisotopes and molecular screening tests should be considered.

CELIOSCOPIC ANTIREFLUX PROCEDURES IN TREATMENT OF HIATAL HERNIA D.Rotaru

State Medical and Pharmaceutical University “Nicolae Testemitanu”

Endoscopy and laparoscopic surgery clinic The department’s chairperson – A.Ghereg The project’s advisor – A.Ghereg

During the past decade, the development of miniinvasive surgery has determined resurgence in popularity of the antireflux surgery. The purpose of this study is to examine indications, preoperative evaluation, surgical techniques, and outcomes after mini-invasive surgery. Materials and Methods: In the Endoscopy and Laparoscopic Surgery Clinic of the SMPhU –N. Testemitanu – between February 1998 and April 2006 were operated 30 patients with hiatal hernia (HH)(16 men and 14 women) with the middle age 45,7±1,8 (p<0,05) with the age between 25 and 64, from which 9 patients were diagnosed with HH of I-st degree, 19 patients with HH of II-nd degree and 2 with 3rd degree. The indication for surgery was failure of long-term medical therapy. All patients had endoscopic and X-Ray monitoring The signs and symptoms characteristic for the pathology were present in all cases: heart-burn, eructations, dysphagia, regurgitation, abdominal discomfort and thoracic pain. All patients underwent antireflux procedures

– in 60% – 18 patients was applied Nissen procedure, in 27% – 8 patients Door procedure, 10% – 3 patients Toupet procedure and 3% – 1 patient – Watson procedure. Conclusions: Laparoscopic Nissen fundoplication has emerged as the most widely accepted procedure for HH patients with normal esophageal motility. Partial fundoplication (e.g., Toupet fundoplication) is also considered to decrease the possibility of

postoperative dysphagia. Laparoscopic approach decreases intraoperative morbidity and excludes intraoperative complications. Laparoscopic approach combines the optimal operative results with the reduction of postoperative period and cost, leading to an increase in the comfort of the patient and subsequently to social benefit.

OPERATIVE MANAGEMENT OF SCAPHOID BONE FRACTURE AS A TREATMENT

OF CHOICE VERSUS OPERATIVE TREATMENT AS A SECONDARY MEASURE M.Siuda, M.Karlinski, L.Nagraba, T.Mitek Medical University of Warsaw

Clinic of Orthopedy and Rehabilitation

The department’s chairperson – prof., MD, PhD J.Deszczynski

The project’s advisor – MD R.Cyranowski

Goal. The aim of the study was to evaluate and compare operative management of scaphoid bone fracture as a treatment of choice versus operative treatment as a secondary measure. Results. The research was conducted in WSzZ Hospital, Kielce and involved group of n=40 (38 males, 2 females; aged 17–50) patients. The selection criteria were: scaphoid bone fracture, age =>17 and application of surgical treatment. All available patients’records and operative book entries were retrospectively analysed.To assess the type of fracture, three different scales based on radiographic images (Modified Herbert staging, Russe classification, and simple anatomic classification) were applied. In examined group the primary operative procedure and operative procedure secondary to conservative treatment of scaphoid fractures, was performed respectively in 18 and 22 cases.X-ray in three different projections (PA, lateral and oblique) was routinely taken. In the majority of primary operative procedures a simple pressure screw was applied with a good intraoperative result. Right hand was more often involved in a secondary operation. There was no statistically significant difference in duration of the operation as well as in the type of surgical approach. In the secondary operative procedure additional resection of the scaphoid was performed in a number of cases, while none in the primary one. Similar distribution was observed in the self graft application. The number of primary surgical operations in scaphoid bone fracture as well as a secondary treatment for complicated synosthosis appeared to be similar. Therefore, it might be reasonable either to improve the sensitivity of diagnostic procedures or to extend indications for primary surgical treatment that is applied in clinical practice.

SENTINEL LYMPH NODE DISSECTION IN BREAST CANCER – EVALUATION OF THE IDENTIFICATION TECHNIQUE K.Wierzba, J Glich, D.Maliszewski

Medical University of Gdansk Department of Surgical Oncology

The department’s chairperson – prof., PhD, MD A.Kopacz

The project’s advisor – MD K.Drucis

Sentinel lymph node dissection (SLND) has become a standard procedure in breast cancer threatment providing safe and accurate staging of the nodal status with less morbidity in comparison to traditional axillary lymph node dissection. Sentinel lymph node (SLN) can be identified with blue dye technique or combined technique (blue dye and radioisotope). Study was performed in 90 (89 women and 1 man) patients with early breast cancer (T1N0M0 and T2N0M0) divided into two groups. Group I had SLNB with blue dye technique, group II with combined technique. In both group marker or markers were injected intradermaly in the border line between skin and areola in the line connecting tumor and areola. Radical surgery was performed in all patients. As a radioactive tracer Nanocis labeled with Tc99m was used. As a SLN was diagnosed a blue-stained lymph node or/and a lymph node with increased radioactivity (confirmed with gamma-probe used intraoperatively). SLN was identified in 87 patients. In 3 cases no SLN was identified. We evaluated with Fiher exact test and Spearman rang test: BMI, tumor grade, TNM status, histological diagnosis, technique of SLND. The sensitivity of SLNB in Group I was 95,5% in Group II 97,7%. There was no significant difference in SLN identification between both groups (p=0,5). The only significant factor for the SLN identification was nodal status (number of positive lymph nodes; p<0,001). No false positive results of SLND were noted in both groups (described as metastases-free SLN with positive non-SLN nodes). Conclusion: both methods of SLND performed by an experienced team result with accurate nodal staging of the axilla in breast cancer.

ASSESSMENT OF KNOWLEDGE

AND INFLUENCE OF SCREENING TESTS ON PATIENTS WITH COLORECTAL CANCER P.Wozniacki, M.Borys, K.Knut, M.Pawlak Medical University of Gdansk

Department of Surgical Oncology

The department’s chairperson – prof., PhD, MD A.Kopacz

The project’s advisor – MD K.Drucis

The study is performed to estimate the knowledge about screening tests and its influence on patients undergoing surgical treatment. 32 patients with

diagnosed colorectal cancer treated in Surgical Oncology Clinic were enrolled in the prospective study. The group consisted of 9 women (28.12%) and 23 men (71.87%). Median age was 68years (range 28 – 88). Clinical data were obtained from medical documentation and own questionnaire. 4 patients have screening tests performed (12.5%). Risk factors (colitis ulcerosa, FAP and patient who fulfill Amsterdam II criteria) were established in 3 patients. One patient (had colonoscopy as a screening examination without risk factors present. 3 patients (9.37%) were aware of screening. 13 patients (40,62%) were aware how to detect colorectal cancer and 8 patients (25%) knew how to prevent colorectal cancer disease. Median time from the onset of symptoms to the treatment was 6.5 months (2–60 months). The analysis of patients age revealed that it is a significant factor, when screening is performed (p= 0,02), colonoscopy is performed (p=0,02), and when genetic test are performed (p=0,03). Elderly patients have increased weight loss (p=0,01). History of colorectal cancer in family is significant factor in younger patients (p=0,03). Age and gender is not a significant factor for time of operation and onset of symptoms (p>0,05). In the group of patients with colorectal cancer the knowledge about screening is very low. Younger patients were more aware of screening especially with the colorectal cancer in the family. In elderly patients colorectal cancer is detect later, when to primary symptoms accompany weight loss and according to low localization of the tumor it leads to intensification of symptoms of subileus.

DEPENDENCE BETWEEN HISTOLOGICAL TYPE OF BREAST CANCER AND NUMBER OF METASTATIC LYMPH NODES INCLUDING SENTINEL LYMPH NODE K.Zyzynska, J.Glich, E.Wojciechowska, H.Grabowski

Medical University of Gdansk Department of Surgical Oncology

The department’s chairperson – prof., PhD, MD A.Kopacz

The project’s advisor – MD K.Drucis

The aim of the study was to evaluate the correlation between histological type of breast cancer and number of metastatic lymph nodes among patients with breast cancer treated in Department of Surgical Oncology Medical Academy in Gdańsk, Poland. 240 patients operated from 2004 to 2006 because of breast cancer with additional sentinel lymph node dissection were enrolled in the study. The cases were classified for histological type of cancer and number of metastatic lymph nodes. Among 240 patients there were 238 women and 2 men. 63,3% of all patients suffered from ductal carcinoma, 16,4% patients from

операции как у донора, так и у реципиента, демонстрируют, что аномалии сосудов не являются противопоказанием к АлТП.

ФУНКЦИОНАЛЬНЫЕ ИЗМЕНЕНИЯ ЛОР-ОРГАНОВ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2 ТИПА О.В.Алехно

Белорусский государственный медицинский университет Кафедра болезней уха, горла, носа

Зав. кафедрой – к.м.н. доц. А.Ч.Буцель Научный руководитель – к.м.н. доц. А.Ч.Буцель

Цель работы – выявление характерных поражений ЛОР-органов при сахарном диабете (СД). Задачи: изучить основные ЛОР-ослож0- нения СД в зависимости от длительности заболевания, уровня гликемии и соматического статуса пациентов. Материалы и методы: обследованы 14 пациентов в возрасте от 24 до 68 лет, страдающих СД 2 типа, среди которых было 6 женщин и 8 мужчин. Из них 5 пациентов поступили с носовым кровотечением (35,71%), 2 – с острым гнойным фронтитом (14,29%),1 – с рожей ушной раковины (7,14%), 1 – с острым средним отитом, осложнившимся мастоидитом (7,14%), 3 – с обострением хронического гнойного эпитимпанита (21,43%), 2 – с искривлением носовой перегородки (14,29%). Два пациента получали инсулин, 12 – таблетированные сахароснижающие препараты. Глюкоза крови находилась в пределах 5,0–7,8 ммоль/л. Всем больным проводились ph-метрия носовой слизи с использованием индикаторной лакмусовой бумаги (для контроля обследовалась группа добровольцев из 10 человек, не имеющих патологии ЛОР-органов), исследование слуха шепотной и разговорной речью, камертональные пробы, пороговая тональная аудиометрия. Результаты: 1. Наблюдалось повышение вязкости и снижение уровня ph носовой слизи до 6,0–6,5 по сравнению с контрольной группой (ph=7,5–8,0), причем у пациентов, получающих инсулин, отмечались наиболее низкие значения ph, несмотря на поддержание концентрации глюкозы на допустимом уровне. 2. При исследовании слуха обнаружена тугоухость различной степени у 8 пациентов (57,14%), причем у 4 из них – односторонняя, по кондуктивному типу, у 3 – двусторонняя, по сенсоневральному типу, у 1 – односторонняя смешанная тугоухость. Выводы: пациенты с сахарным диабетом нуждаются в наблюдении оториноларинголога и контроле гликемии для более раннего предотвращения, выявления и коррекции осложнений.

К ВОПРОСУ КРОВОСНАБЖЕНИЯ ПЕРЕГОРОДОК СЕРДЦА В.И.Алиев, И.Н.Ширинкин ГОУ ВПО «Пермская государственная

медицинская академия им. акад. Е.А.Вагнера Росздрава» Кафедра оперативной хирургии

и топографической анатомии Зав. кафедрой – проф. И.А.Баландина

Научный руководитель – проф. А.А.Лопанов

Хирургическое лечение врожденных дефектов перегородок сердца нуждается в детальных и достоверных анатомических сведениях о кровоснабжении сердца и его отдельных оперируемых зон. Особое значение приобретает детальное знание внутриорганного распределения сосудов в этих отделах при патологии. Кровоснабжение перегородок изучено на 210 препаратах сердца лиц различных возрастных групп. Использовали рентгеноконтрастную вазографию, бихромную инъекцию сосудов с последующей коррозией, просветление и гистотопографические срезы. Исследования показали, что условия кровоснабжения перегородок предсердий и желудочков неоднозначны. Передний верхний отдел межпредсердной перегородки кровоснабжают 2–3 длинные отдельные артериальные ветви магистрального типа, отходящие от правой венечной артерии. К нижним отделам перегородки идут 4–6 коротких артериальных ветвей. Сосуды в межпредсердной перегородке расположены по периметру овальной ямки. У новорожденных и детей артериолы и капилляры проходят и распределяются в мышечном слое перегородки относительно равномерно в количестве 10–14 в поле зрения. У взрослых артерии диаметром 150–200 микрон в сопровождении вен идут преимущественно в полях жировой клетчатки в количестве 3–6 в поле зрения. Артериальная сеть межжелудочковой перегородки обильнее. Артерии диаметром 200–250 микрон в количестве 15– 20 входят в передние и задние отделы перегородки и делятся в е¸ слоях на ветви 2– 4 порядков. Наиболее крупные ветви проходят

âсрединном слое. Сосудистые сети различных мышечных слоев межжелудочкой перегородки непосредственно переходят друг

âдруга и многочисленными анастомозами соединяются с сетями эндокарда. Дренирующие и выносящие вены межжелудочковой перегородки располагаются в лестничном порядке в передних и задних ее отделах.

димефосфона в кратчайшие сроки способствует устранению субъективных и объективных признаков заболевания.

КЛИНИКО-ЛАБОРАТОРНЫЕ КРИТЕРИИ ЭФФЕКТИВНОСТИ ЛЕЧЕБНОГО ПЛАЗМАФЕРЕЗА У ДЕТЕЙ С ОСТРОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ М.Бекмухаметов, У.Холматов Самаркандский медицинский институт Кафедра анестезиологии и реаниматологии Зав. кафедрой – д.м.н. проф. А.У.Рахимов Научный руководитель – И.Л.Шарипов

Лечение больных с острой почечной недостаточностью (ОПН) оста¸тся актуальной проблемой: показатели летальности при этой патологии остаются высокими (от 50 до 70%). Сообщается об успешном применении в педиатрии плазмафереза (ПФ). Проведен анализ результатов обследования и лечения 43 детей (от 3 до 14 лет) с ОПН (22 мальчика, 21 девочка). Определялись показатели КЩР крови, ФСП ПФ (методом прерывистого центрифугирования). В течение 15 минут, скорость – 2000 об/мин. Процедуру проводили

âрежиме от 2 до 4 сеансов 1–2 сут. Программа интенсивной терапии ОПН включала в себя гемодилюцию, форсированный диурез и плазмаферез. При поступлении состояние больных тяжелое, сохраненное сознание, бледность кожных покровов, выраженное явление эксикоза и резкое снижение диуреза. Проведена стимуляция диуреза с одновременной дезинтоксикационной терапией (10 мг/кг лазикса), выделилось 100–150 мл мочи, макрогематурия и протеинурия (1,2 г/л). К терапии был подключен ПФ, за процедуру было удалено от 100 до 200 (25–30%) ОЦП, объем возмещался реополиглюкином, 10% глюкоза, одногруппная нативная плазма, 4% раствор натрия гидрокарбоната 4 мл/кг. Клинический эффект после проведении ПФ наблюдался уже

âпроцессе процедуры. Отмечалось улучшение самочувствия больных, уменьшение диспепсических явлений, снижение возбудимости и возрастание диуреза. В последующие сутки наступила полиурическая стадия ОПН. Снизилась концентрация азота на 14%, мочевины на 12,2%, креатинина в среднем на 21% и калия в крови на 5,2%. Также улучшились показатели КЩР и периферической крови. Таким образом, применение ПФ с целью экстренной детоксикации организма дало возможность в короткий срок перевести олигоурическуюстадиюОПНвполиурическуюспоследующим полным восстановлением функции почек.

ПРИМЕНЕНИЕ МОДИФИЦИРОВАННОГО ЭЛЕКТРОДА ДЛЯ ЭЛЕКТРОКОАГУЛЯЦИЯ ГЕМОРРОИДАЛЬНЫХ УЗЛОВ АППАРАТОМ WD-II

Р.Р.Булатов, Д.В.Губко ГОУ ВПО «Башкирский государственный

медицинский университет Росздрава» Кафедра хирургических болезней и новых технологий Зав. кафедрой – д.м.н. проф. О.В.Галимов

Научный руководитель – д.м.н. проф. О.В.Галимов

Цель – улучшение результатов амбулаторного лечения геморроя. В исследование включено 160 больных геморроем, пролеченных методом биполярной диатермии. В возрасте от 20 до 70 лет. Контрольную группу составили 85 пациентов, пролеченных с использованием обычного электрода. Половозрастной состав контрольной группы идентичен основной. С целью улучшения результатов лечения больных геморроем методом биполярной электрокоагуляции нами предложен модифицированный электрод для аппарата WD-II. Разработанный на базе имеющегося стандартного электрода модифицированный электрод. Суть нововведения заключается в том, что на расстоянии 0,5 см от заостренных концов электрода между ними напаивается кусочек проволоки толщиной 1мм, который соединяет оба конца электрода. Кроме того, для удобства при проведении процедуры дистальная треть электрода загибается под углом 10î. Применение данной конструкции дает возможность коагулировать ножку узла не только в продольном, но и (за счет новой детали), в поперечном направлении, что позволяет более эффективно провести обработку ножки с проходящим в ней питающим сосудом. После проведенного лечения все больные отмечали улучшение. Хорошие результаты были отмечены у 73% пациентов, удовлетворительные – у 14,5%. Осложнения (тромбоз, отек геморроидальных узлов, кровотечение) отмечены у 5 больных. Рецидивы отмечены у 4 больных: у 2 в сроки 2–3 месяца после коагуляции возникли явления тромбофлебита геморроидальных узлов, у 2 больных в эти же сроки возобновилось выпадение геморроидальных узлов, которое прекратилось после повторного курса лечения. Вывод: применение модифицированного электрода для биполярной диатермии является эффективным и достаточно простым методом лечения геморроя и может с успехом использоваться в амбулаторной практике врачей-колопроктологов.