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Introduction

Research urgency. The word "varicose" occurs from a Latin word "varix, varicis" - "inflation". The first mentions of treatment of varicose illness meet in drevneegipetskih papyruses (about 3 thousand years ago) [17, 99, 118].

Varicose illness of the bottom extremities (VBNK) is the most widespread pathology of vascular system. V.S.Savelyev (1999) notices, that the epidemiological situation concerning chronic diseases of veins in Russia does not concede to universal indicators. So, 35 million citizens of Russia suffer various forms of chronic venous insufficiency. Annual gain VBNK makes about 2,5 % in this connection the given illness is recognised, as public illness [88, 94, 124, 167].

Disease begins in a youth, is characterised by a chronic progressing current and at the age of 40-50 years patients often have the serious complications sharply reducing working capacity up to its proof loss [46-48, 80, 134, 207]. According to V.S.Savelyev and co-workers. (2001 38 % of invalids of the third group and 10 % - the second are made by people with complications VBNK.

The data cited above convincingly show, that treatment of varicose illness is a problem social which decision has the important state value. A variety of clinical implications of varicose process complicates working out of preventive actions and methods of treatment of this disease.

The most important etiological factors of development VBNK are: a genetic predisposition - hardly proceeding forms HVN are bound to an is autosomal-dominant mode of inheritance; a dysplasia of a connecting tissue of a vascular wall; a sex - women are ill in 1,5-2 times more often, to it promote
Labours and hormonal disturbances; excess weight; long static loads and a small motor performance. [14, 68, 70, 92, 104, 124, 155].

Inspection of patients with HVN was based earlier on physical inspection, functional assays, a radiopaque phlebography. Now, with development of new methods of inspection, on the first place there were safe and informative ultrasonic methods: ultrasonic dopplerografija and duplex scanning. The radiopaque phlebography is carried out under strict indications [38, 61,79, 144].

Now in the literature distinguish three degrees HVN. The third degree is characterised by the expressed trophic disorders of tissues of anticnemions and presence of the trophic ulcer which conducting causes various opinions in clinicians. However, despite contradiction of judgements, one is conclusive - in the absence of contraindications, the venous trophic ulcer is the indication to the operative treatment, referred on liquidation of a principal cause of its development - a venous hypertensia [98, 99, 120]. According to Chong T.W, et al. (2005) trophic ulcers meet at 2 % of able-bodied population, and at 4-5 % of persons of advanced age. They appear against disturbance of a venous circulation in the bottom extremities, is as consequence long existing varicose illness or the thrombophlebites accompanied, as a rule, by a venous hypertensia [86,138,177].

Surgical treatment of trophic ulcers is referred on discontinuing of ways of dump of additional volumes of blood to what conduct insolvent venous valves [3, 189].

Variants of surgical treatment of varicose illness depend on gravity of disease. The uniform approach does not exist, and the question remains disputable.

In easier cases, namely, at an incompetence

Other valve apply the combined treatment: crossing of the big hypodermic vein in a place of its confluence of a femoral vein (Troyanov-Tredenlenburga operation or krossektomija), with the subsequent carrying out of compression sclerotherapy [28, 82-85, 90-95, etc.] . In the most serious cases, at the expressed trophic disorders of tissues and a trophic ulcer, after krossektomii it is carried out stripping on Bebkokku, then through small cuts or by means of endoscopic technics delete with legirovaniem varicose conglomerates and perforantnye veins [41, 60, 155], or make their hypodermic crossing by special hooks [81]. Till now in many clinics operations Lintona and Kokketa are carried out. Many operative measures are travmatichnymi, nekosmetichnymi, give rather big number of complications and relapses. In some cases patients refuse operative treatment only that extensive cicatrixes standing do not wish to have. Therefore, not only it is necessary to consider radicalism, but also cosmetic result as the important criterion at an estimation of efficiency of any operation.

In this aspect the electrosurgical method applied in our country since 1960, combines high radicalism with good cosmetic effect. The given technique is known in the literature under the name endovazalnaja coagulation of hypodermic veins [25]. For thermal energy delivery, for endovazalnoj coagulations of veins, the special catheters which are warmed up under the influence of radio-waves of certain frequency (radio-frequency coagulation) or flexible laser light guides (laser coagulation) or electrodes (electrocoagulation) [9, 138, 169, 183,204] use.

Till now exist raznorechivye, and at times and inconsistent opinions in definition of indications and contraindications to a method endovazalnoj electrocoagulations. So, the technics of coagulation of veins is insufficiently developed, questions of preventive maintenance of complications are a little studied.

Estimation of results of treatment by pore are based on insufficient quantity of clinical observations. Possibilities of the given technique in treatment of complicated forms VBNK are not established definitively. At the same time the big frequency of complicated forms VBNK with presence of venous ulcers do studying of this question rather actual. The presented work is devoted it.

Research objective of the present work is improvement of results of surgical treatment of patients with the complicated forms of varicose illness of the bottom extremities.

For achievement of this purpose following problems have been put:

Research problems

1. To spend a comparative estimation of modern surgical techniques of treatment of varicose illness of the bottom extremities (VBNK).

2. To develop an advanced surgical technique endovazalnoj electrocoagulations with hypodermic crossing of veins at treatment of complicated forms VBNK and to estimate its efficiency.

3. To offer optimum tactics of postoperative conducting sick of the complicated forms VBNK, referred on preventive maintenance of complications and relapses.

4. To study the nearest and remote results of treatment sick of complicated forms VBNK by the given surgical technique.

5. To optimise indications to application endovazalnoj electrocoagulations with hypodermic crossing of veins.

Scientific novelty of work

For the first time treatment of complicated forms VBNK by an advanced surgical technique endovazalnoj electrocoagulations with hypodermic crossing of veins by a needle with the demountable handle is spent.

The technique is idle time in performance, malotravmatichnoj, not causing the big hemorrhage, a radical technique providing good cosmetic effect.

For the first time excision varicose dilated and kommunikantnyh veins in the field of an ulcer and trophic disorders of tissues without drawing of dermal cuts that improves results of surgical treatment of complicated forms VBNK, even at patients with a serious accompanying pathology is offered.

Risk factors of development of complicated forms VBNK are defined and for the first time indications to a choice of pathogenetically focused treatment are developed. High efficiency, radicalism and kosmetichnost techniques endovazalnoj is proved an electrocoagulation with hypodermic crossing of veins in treatment of complicated forms VBNK.

The practical importance of work

The new concept on treatment of complicated forms VBNK is developed at a single-step lesion of both pools of the hypodermic veins, allowing considerably to reduce travmatichnost an operative measure and to dilate indications to its application for a serious contingent of patients with a number of accompanying diseases.

On enough considerable quantity of own clinical observations of surgical treatment of complicated forms VBNK the high cosmetic effect of a technique endovazalnoj is proved an electrocoagulation with hypodermic crossing of veins.

The special needle with the demountable handle for hypodermic crossing varicose and perforantnyh the veins, considerably raising kosmetichnost is offered phlebectomy operation, not in injury of its radicalism.

Accurate references on performance autodermoplastiki are given at surgical treatment of complicated forms VBNK, in the presence of various on the size and character of ulcers.

Frequency of relapses in the remote terms of operation, thanks to technique improvement endovazalnoj electrocoagulations with hypodermic crossing of veins is considerably reduced.

Substantive provisions taken out on protection

1. The advanced surgical technique «Endovazalnaja an electrocoagulation hypodermic crossing of veins» - malotravmatichnoe, and allowing to reach the radical intervention accompanied by the minimum hemorrhage of high cosmetic results at treatment of complicated forms VBNK. The technique is highly effective and allows to achieve appreciable depression of complications and disease relapses;

2. The technique endovazalnoj electrocoagulations with hypodermic crossing of veins by a needle with the demountable handle is an economic intervention, does not demand application of expensive equipment, considerably reduces terms of stay of patients with complicated forms VBNK in a hospital

Dissertation approbation. Dissertation substantive provisions are reported:

• - on the International surgical congress «New technologies in surgery» (on October, 05th 2005, Rostov-on-Don.),

• - on 16 international conferences of the Russian society angiologov and vascular surgeons (on November, 21-23st 2005, Moscow),

• - at the All-Russia congress flebologov (May 2006, Moscow),

• - approbation of materials of the dissertation is spent at joint scientific conference of employees of chair of surgery FUV MONIKI both units of surgery of vessels and ischemic heart disease MONIKI on March, 12th 2008г.

Publications. On a dissertation theme it is published: four printing works, 3 patents of the Russian Federation for inventions are received:

1. Endovazalnaja an electrocoagulation with hypodermic crossing varicose and perforantnyh veins. And Materials International
The surgical congress «New technologies in surgery». - Rostov-on - to Don - on October, 05th 2005г. - With. 23. (V.J.Korchagina, J.I.Sedov).

2. Endovazalnaja an electrocoagulation in treatment of chronic venous insufficiency 3-4степени. Both an angiologia and vascular surgery - the appendix - №2. Materials 16 international conferences of the Russian society angiologov and vascular surgeons. - Moscow. - on November, 21-23st 2005г.-With. 174. (V.J.Korchagina, J.I.Sedov).

3. Operative treatment of varicose illness of the bottom extremities in system of a small hypodermic vein in the presence of trophic ulcers. And the Almanac of clinical medicine. - Moscow. - 2006. - t. VIII, ч.5. - With. 13-21. (V.J.Korchagina, J.I.Sedov).

4. A method of hypodermic crossing of varicose veins in out-patient conditions,//Theses of reports of VI conference of association flebologov Russia. - Moscow. - on May, 23-25rd 2006. - С.17. (V.J.Korchagina, J.I.Sedov).

5. A way of surgical treatment of varicose illness of the bottom extremities.//the Patent of the Russian Federation № 2281039 date of a priority 27.12.2004. The bulletin № 22.2006.-CH. №3. - С.606. (V.J.Korchagina, J.I.Sedov).

6. The device for surgical treatment of varicose illness bottom konechnostej.//the Patent of the Russian Federation № 3381042 date of a priority 27.12.2004. The bulletin № 22.2006. - CH ³ 3. - С.607. (V.J.Korchagina, J.I.Sedov).

7. A way of treatment of varicose expanded veins of the bottom extremities.//the Patent of the Russian Federation №2316273 date of a priority 05.04.2006. The bulletin № 4.2008.

- CH ». - With. 475. (V.J.Korchagina, J.I.Sedov, P.O.Kazanchjan)

Volume and dissertation structure. ‘

Work is stated on 140 pages of the text, includes 37 tables and is illustrated by 18 drawings.

The dissertation consists of introduction, heads, the conclusion, conclusions, practical references and the index of the literature which includes 224 sources from them: 121 domestic and 103 foreign.

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A source: KORCHAGINA VALENTINA JUREVNA. ENDOVAZALNAJA the ELECTROCOAGULATION With HYPODERMIC CROSSING of VEINS In TREATMENT of the COMPLICATED FORMS of VARICOSE ILLNESS of the BOTTOM EXTREMITIES. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2008. 2008

More on topic Introduction:

  1. in introduction
  2. INTRODUCTION
  3. INTRODUCTION
  4. 10.1. Introduction
  5. INTRODUCTION
  6. approbation and introduction of results.
  7. Introduction
  8. Introduction
  9. INTRODUCTION
  10. INTRODUCTION
  11. Introduction
  12. Introduction
  13. INTRODUCTION
  14. Instead of Introduction …
  15. PRACTICAL INTRODUCTION OF RESULTS OF WORK
  16. 5. Attention strengthening to questions of legal introduction.
  17. Introduction
  18. Introduction
  19. Introduction
  20. Introduction