USAGE OF HIGH-FREQUENCY ELECTRIC WELDING IN VASCULAR SURGERY

V.A. Chernyak K.K. Karpenko ³, D.Ye. Dubenko ², P.F. Muzichenko ²

^!Taras Shevchenko National University of Kyiv, Kyiv, Ukraine, 0689002428,

victorchernyak. ohta@gmail. com

²National Medical University named after O.O. Bohomolets,

³ National Military-Medical Clinical Centre of the Ministry of Defense of Ukraine

Annotation. Possibilities of high-frequency electric welding of living tissues for treatment of blood vessels are substantiated. An experimental research on human vessels described the physical and morphological effects of electric welding on tissues. The obtained data allowed to introduce technology and original medical devices into clinical practice.

Key words: electric welding, vessels, surgery, experiment.

Introduction. In Ukraine, the treatment of surgical diseases of vascular origin is relevant, given the independent statistics and treatment results [1-7]. The application of domestic latest technologies in this area, their improvement and development is a priority of modern medicine and science.

Aim. Research in the experiment and implement in clinical practice the technology of high-quality electric welding in the surgery of peripheral and main vessels.

Experimental studies. The features of high-frequency electric welding, its influence on the condition of the walls of the perforating veins and the surrounding biological tissues, and the subfascial space of the lower extremities were studied in the experiment. Thus, it is proved that a significant advantage of high- frequency electric welding over diathermy is the effect of strong adhesion of the vein walls at low temperatures (up to 110 degrees Celsius) without thrombosis and tissue carbonization. It is proved that the strength of the connection of tissues in the area of formation of the electric weld depends on the degree of homogenization of the tissues that form its substance. The main component of the substance of the electric weld, which gives it strength, are collagen fibers of the vein wall. In bipolar welding of biological tissues, heating is carried out due to the release of heat in an electrically conductive biological fluid, which is an electrolyte, when an electric current passes through it. It was found that the solids of biological tissues surrounding biological fluids or in them are not electrically conductive, are not heated by electric current, and, therefore, are always colder than liquids. As a result of these studies, it was found that from the line of electrode application to the peripheral parts of the vein layers, three zones of morphological changes are formed. Based on these studies, high-tech surgical devices and methods of their use based on the technology of electric welding of living tissues were created for clinical implementation.

Materials and methods. From 2012 to 2019 among 98 operated patients with the postthrombotic syndrome of the lower extremities (PTS) subfascial endoscopic dissection of perforating veins of the legs using high-quality electric welding was performed in 44 (45.0%).

Sowing from the area of the trophic ulcer is carried out repeatedly, and after surgical treatment adjusts depending on the flora and its sensitivity to antibacterial drugs. In order to prevent infectious drugs in the postoperative period used LEFLOCIN (levofloxacin) - an antibacterial drug with a broad spectrum of action, fluoroquinolone series with pronounced bacterial effects. In particularly severe cases the Ukrainian drug Grandazole was used - a combined antibacterial drug, which includes levofloxacin hemihydrate and ornidazole in vials intravenous of 100 and 200 ml. TIVOREL (4.2 g of arginine hydrochloride + 2.0 g of L-carnitine) was also used in this group. The drug was administered intravenously at a rate of 10 drops per minute, lasting the first 10­15 minutes, then the rate of administration can be increased to 30 drops per minute. The daily dose of the drug is 100 ml of the solution. The positive effect of arginine on vascular endothelium has already been proven [8,9]. In a complex of means of detoxification drugs of domestic production xylate, reosorbilakt, sorbilakt are applied.

The antiseptics of choice for ulcers were Dekasan and betadine, for skin treatment - Gorosten. For conduction anesthesia, preference was given to local anesthetics with rapid initial action and long-term surgical anesthesia. The most popular local anesthetic is domestic bupivacaine (Longocaine).

Results and discussion. The advantages of the implemented method of high-frequency electro-welded endoscopic subfascial dissection of perforating veins over other thermal (primarily coagulation) methods were revealed, namely: thermal damage to surrounding tissues, sensation of soot by patients in exhaled air, lack of smoke in the subfascial space, tissue carbonization, vascular burns, bleeding, etc.

Conclusions.

1. Clinical and experimental study of electric welding has shown its undeniable advantages in subfascial dissection of the perforating veins of the leg.
2. Usage of domestic instrumental and pharmaceutical developments has significantly improved the treatment process.

REFERENCES

1. Альбицкий, A.B. Лечение трофических язв венозной зтиологии с точки зрения доказательной медициньї / А.В. Альбицкий, В.Ю. Богачев, Е.В. Калинина // Ангиол. и сосуд. хирургия. - 2006. - Т. 12, №2. С. 137-144.
2. Богачев, В.Ю. Новьіе данньїе о хронической венозной недостаточности: от зпидемиологии к лечению / В.Ю. Богачев // Ангиол. и сосуд. хирургия. - 2002. - Т. 8, №2. - С. 119-126.
3. Богачев, В.Ю. Флебология сегодня и завтра. Обзор материалов 15- го всемирного конгресса флебологов (IUP) / В.Ю. Богачев // Ангиол. и сосуд. хирургия. - 2007. - Т. 13, №1. - С. 96-99.
4. Волкославская В.Н. Зкономические потери народного хозяйства Украиньї в связи с заболеваемостью венерическими и кожньши болезнями / В.Н. Волкославская // Журнал дерматологии и венерологии. - 1999. - № 1. - С. 22-24.
5. Игнатьев И.М. Варикозная болезнь. Современньїе аспектьі проблеми / И.М. Игнатьев, Р.А. Бредихин // Вестник хирургии. - 2004. - Т. 163, № 4. - С. 105-109.
6. Игнатьев И.М. Дуплексное сканирование в диагностике нарушений венозной гемодинамики при посттромботической болезни / И.М. Игнатьев, С.Ю. Ахунова, Р.А. Бредихин // Ангиология и сосудистая хирургия. - 2002, Т. 8. -№ 2. - С. 45-51.
7. Липницкий Е.М. Лечение трофических язв нижних конечностей/ Липницкий Е.М. //Медицина, 2001. - С. 160.
8. Fujita H, Yamabe H, Yokoyama M.Effect of L-arginine administration on myocardial thallium-201 perfusion during exercise in patients with angina pectoris and normal coronary angiograms. J Nucl Cardiol. 2000 Mar-Apr; 7(2): 180-4.
9. Sozykin AV, Noeva EA, Balakhonova TV, Pogorelova OA, Men'shikov MI. Effect of L-arginine on platelet aggregation, endothelial function adn exercise tolerance in patients with stable angina pectoris Ter.Arkh 2000.-72(8). - :24-7.