Delayed emergency surgery. Types of surgical operations. The effect of surgical operations on the patient's body. Classification of operations by purpose

The concept of “surgical operation” is a Greek expression adapted to the Russian language, which literally means “I do it with my hand.” From the time of ancient Greece Many years have passed, and today a surgical operation involves various effects on living tissue, during which the function of the entire organism is corrected. During the operation, tissues are separated, moved and reconnected.

Background

The first mention of surgical interventions dates back to the 6th century BC. e. Since the beginning of time, people have stopped bleeding, cared for wounds, and cut off crushed or gangrene limbs. Medical historians know that long before our era, healers of that time were able to perform craniotomy, immobilize broken bones and even... remove gallbladder.

In all textbooks on the history of medicine there is an ancient statement that in the arsenal of a doctor there is a knife, grass and a word. From ancient times to the present day, the knife - now its analogues, of course - has been in first place. Surgery is the most radical method of treatment, allowing a person to get rid of the disease forever. Surgery was developed more than others by Hippocrates, Galen and Celsus.

The best Russian surgeon was Nikolai Ivanovich Pirogov, whose tomb is carefully preserved in Vinnitsa. His former estate is still looked after free of charge by the relatives of those whom he treated and saved from death. Once upon a time, a great surgeon helped his neighbors without payment - and they still remember him. Pirogov removed the gall bladder in 40 seconds; his hands can be seen in the tomb - with long and thin fingers.

Pain relief or anesthesia

Any operation is primarily pain. To the pain living tissue reacts with spasm and deterioration of blood circulation, so relieving pain is the primary task during surgery. They reached us historical information about what our ancestors used for pain relief: plant decoctions containing narcotic substances, alcohol, marijuana, cold and vascular compression.

A breakthrough in surgery occurred in the mid-19th century when nitrous oxide was discovered, diethyl ether, and then chloroform. From that time on, it began to be used. A little later, surgeons paid attention to cocaine in the sense that this substance anesthetizes tissue locally. The use of cocaine can be considered the beginning of local - conduction and infiltration - anesthesia.

The discovery of muscle relaxants or substances that can immobilize muscles dates back to the middle of the last century. Since that time, anesthesiology has become a separate medical science and a specialty inextricably linked with surgery.

Modern surgery is a complex of techniques from various branches of medicine. We can say that this is a synthesis of knowledge accumulated by medicine.

Surgery: types of operations

There are classifications of operations according to the nature of the intervention, urgency and phasing.

The nature of the operation can be radical, symptomatic or palliative.

Radical surgery is complete elimination pathological process. A classic example is the removal of an inflamed appendix in acute appendicitis.

Symptomatic is the elimination of the most painful signs of the disease. For example, with rectal cancer, independent defecation is impossible, and the surgeon removes the healthy part of the rectum to the anterior abdominal wall. Depending on the general condition patient's tumor is removed at the same time or later. This type includes palliative ones, which also eliminate various complications.

Urgent and planned surgery

Sometimes the patient requires urgent surgery. Emergency operations are performed as quickly as possible; they are required to save lives. This is a tracheotomy or conicotomy to restore patency respiratory tract, cavities with life-threatening hemothorax and others.

Urgent surgery can be delayed for a maximum of 48 hours. Example - renal colic, stones in the ureter. If, despite conservative treatment, the patient fails to “give birth” to a stone, then it must be removed surgically.

A planned operation is performed when there are no other ways to improve health, and there is no direct threat to life. For example, such a surgical operation is the removal of an enlarged vein in chronic venous insufficiency. Removal of cysts and benign tumors is also planned.

Surgery: types of operations, stages of surgery

In addition to the above, depending on the type, the operation can be single- or multi-stage. Reconstruction of organs after burns or injuries, transplantation of a skin flap to eliminate tissue defects can take place in several stages.

Any operation is performed in 3 stages: execution surgical approach, prompt reception and exit. Access is the opening of a painful focus, dissection of tissue for approach. The technique is the actual removal or movement of tissue, and the exit is the stitching of all tissues layer by layer.

The operation on each organ has its own characteristics. Thus, brain surgery most often requires craniotomy, because access to the brain substance requires first opening the bone plate.

At the stage of surgical exit, vessels, nerves, parts of hollow organs, muscles, fascia and skin are connected. All together makes up postoperative wound, requiring careful care until healing.

How to reduce trauma to the body?

This question worries surgeons of all times. There are operations that, in their traumatic nature, are comparable to the disease itself. The fact is that not every body is able to quickly and well cope with the damage received during surgical intervention. In the places of incisions, hernias, suppurations, and dense non-absorbable scars are formed, disrupting the functions of the organ. In addition, the sutures may come apart or bleeding from injured vessels may occur.

All these complications force surgeons to reduce the size of the incision to the minimum possible.

This is how a special branch of surgery appeared - microinvasive, when a small incision is made on the skin and muscles into which endoscopic equipment is inserted.

Endoscopic surgery

This is a special surgical operation. The types and stages in it are different. With this intervention, accurate diagnosis of the disease is extremely important.

The surgeon enters through a small incision or puncture and sees the organs and tissues located under the skin through a video camera placed on an endoscope. Manipulators or small instruments are also placed there: forceps, loops and clamps, with the help of which diseased areas of tissue or entire organs are removed.

They began to be widely used in the second half of the last century.

Bloodless surgery

This is a way of preserving the patient's own blood during surgical intervention. This method is most often used in cardiac surgery. During heart surgery, the patient's own blood is collected into an extracorporeal circuit, which maintains blood circulation throughout the body. After the operation is completed, the blood returns to its natural course.

Very difficult process such a surgical operation. The types of operations and its stages are determined by the specific state of the body. This approach avoids blood loss and the need to use donor blood. Such an intervention became possible at the intersection of surgery and transfusiology - the science of transfusion donated blood.

Someone else's blood is not only salvation, but also someone else's antibodies, viruses and other foreign components. Even the most careful preparation of donor blood does not always avoid negative consequences.

Vascular surgery

This branch of modern surgery has helped save many lives. Its principle is simple - restoration of blood circulation in problem vessels. With atherosclerosis, heart attacks or injuries, obstacles arise in the path of blood flow. This is fraught oxygen starvation and ultimately the death of cells and tissues consisting of them.

There are two ways to restore blood flow: installing a stent or shunt.

A stent is a metal frame that pushes the walls of a vessel apart and prevents spasm. The stent is installed when the vessel walls are well preserved. A stent is often installed in relatively young patients.

If the walls of blood vessels are affected by an atherosclerotic process or chronic inflammation, then it is no longer possible to move them apart. In this case, a bypass or shunt is created for the blood. To do this, they take part of the femoral vein and let blood flow through it, bypassing the unsuitable area.

Bypass surgery for beauty

This is the most famous surgical operation; photos of people who have undergone it appear on the pages of newspapers and magazines. It is used to treat obesity and type 2 diabetes. Both of these conditions are associated with chronic overeating. During the operation, a small ventricle is formed from the area of ​​the stomach bordering the esophagus, which can hold no more than 50 ml of food. Joins him small intestine. Duodenum and the following intestine continue to participate in the digestion of food, since this section is attached below.

After such an operation, the patient can eat little and loses up to 80% of his previous weight. Required special diet, enriched with protein and vitamins. For some, such an operation really changes their lives, but there are patients who manage to stretch the artificially formed ventricle almost to its previous size.

Surgical miracles

Modern technologies make it possible to perform real miracles. Every now and then there are reports in the news about unusual interventions that ended in success. So, just recently, Spanish surgeons from Malaga performed a brain operation on a patient, during which the patient played the saxophone.

French specialists have been performing facial tissue transplants since 2005. Following them, maxillofacial surgeons from all countries began to transplant skin and muscles to the face from other parts of the body, restoring the appearance lost after injuries and accidents.

They perform surgical interventions even... in the womb. Cases have been described when the fetus was removed from the uterine cavity, the tumor was removed, and the fetus was returned. Born at full term healthy child- the best award for a surgeon.

Science or art?

It is difficult to answer this question unambiguously. A surgical operation is a fusion of knowledge, experience and personal qualities of the surgeon. One is afraid to take risks, the other does everything possible and impossible from the baggage that he currently has.

Last time Nobel Prize in surgery was awarded in 1912 to the Frenchman Alexis Carrel for his work on the vascular suture and Since then, for more than 100 years, surgical achievements have not received the interest of the Nobel Committee. However, every 5 years, technologies appear in surgery that radically improve its results. Thus, developing rapidly laser surgery allows for removal through tiny incisions intervertebral hernia, “evaporate” prostate adenoma, “solder” cysts thyroid gland. The absolute sterility of lasers and their ability to weld vessels give the surgeon the opportunity to treat many diseases.

Today, a real surgeon is called not by the number of awards and bonuses, but by the number of lives saved and healthy patients.

A surgical operation is a surgical intervention on human tissues and organs, which is performed for therapeutic or diagnostic purposes. In this case, a violation of their anatomical integrity inevitably occurs. Modern medicine offers many types of operations, including those with the most delicate effects and low risks of complications.

Types of surgical interventions

There are several classifications defining the types surgical operations. First of all, they are divided into therapeutic and diagnostic interventions. During the diagnostic process, the following manipulations can be performed:

There is a division of operations according to urgency:

1. In the first place is urgent or emergency surgery. More often we are talking about saving the patient’s life, since delay can lead to fatal outcome. Performed immediately upon admission of the patient to medical institution, no later than 4 hours.
2. Then there are urgent operations, which are prescribed for urgent conditions. Urgent operations are performed within 1-2 days.
3. There is delayed surgery when conservative treatment eliminates acute manifestation illnesses and doctors prescribe surgery for more late dates. This allows you to better prepare the patient for the upcoming manipulation.
4. Elective surgery is performed when the disease does not threaten the patient’s life.

In surgery, several methods of intervention are used: radical, in which the main disease process is eliminated, and palliative, also auxiliary, which is carried out to alleviate the patient’s condition. Symptomatic operations are carried out aimed at relieving one of the signs of the disease. The operational process can include either 1-2 stages or be multi-stage.

Modern medicine, including surgery, has made great strides forward, and today doctors have the opportunity to carry out sufficient complex operations. For example, combined interventions, when manipulations are simultaneously performed on two or more organs at once, relieving the patient of several ailments.

Often carried out combined operations, in which it is possible to perform a procedure on several organs, but the goal is to cure one disease. Surgical operations are divided according to the degree of possible contamination:

1. Clean (aseptic) intervention. They are performed as planned, without preliminary opening of the lumens.
2. Conditionally aseptic. The cavities are opened, but the contents do not penetrate into the resulting wound.
3. Conditionally infected. During manipulation, the contents of the intestine flow into other cavities and tissues, or we are talking about dissection of acutely inflamed tissues that do not contain purulent exudate.
4. Infected manipulations. Doctors know about the presence of purulent inflammation.

Preparatory activities

Any procedure requires mandatory preparation. Duration preparatory activities depends on many factors: the urgency of the operation, the severity of the condition, the presence of complications, etc. The anesthesiologist is obliged to advise the patient about the prescribed anesthesia, and the operating surgeon is obliged to advise the patient about the upcoming surgical intervention. All nuances must be clarified and recommendations given.

The patient should be examined by other specialized specialists who assess the state of his health and adjust the therapy, give advice on nutrition, lifestyle changes and other issues. To main page preoperative preparation The following tests and procedures are included:

• general urine and blood tests;
• electrocardiography;
• coagulogram (blood test for clotting).

Operating periods

There are several stages of surgical operations, each of which is important for the successful course of the entire event. The period from the moment the patient enters the operating room until he is removed from anesthesia is called intraoperative. It consists of several stages:

During surgical intervention, there is a team: a surgeon (if required, assistants), a nurse, an anesthesiologist, a nurse anesthetist, and a nurse. There are 3 operational stages:

1. Stage I - created quick access. A tissue incision is made, during which the doctor achieves convenient and minimally traumatic access.
2. Stage II - direct intervention is performed. The impact can be of a very different nature: trephination (a hole in bone tissue), incision (cut soft fabric), ectomy (part or all of an organ is removed), amputation (truncation of part of an organ), etc.
3. Stage III is the final stage. At this stage, the operating surgeon sutured the wound layer by layer. If diagnosed anaerobic infection, then this procedure is not carried out.

An important measure during the intraoperative period is asepsis. To prevent infection from entering the body, modern surgery includes the administration of antibiotics to the patient.

Possible negative consequences

Despite the fact that modern surgery is quite advanced high level, doctors often have to deal with a number of negative phenomena. The following complications may occur after surgery:

Doctors knowing the possibility postoperative complications, are attentive to preventive measures and in most cases prevent the development of dangerous conditions.

In addition, a patient admitted to planned surgery, everything definitely passes necessary examinations and undergoes a series of tests that give complete clinical picture his health: blood clotting, the functioning of the heart muscle, the condition of blood vessels, detect the presence various kinds diseases not related to the upcoming operation.

If diagnostics reveals any abnormalities and pathological conditions, then timely measures are taken to eliminate them. Of course, the risks of complications are higher during emergency and urgent operations, in which specialists do not have time to thoroughly diagnose the patient, because we are talking about saving lives.

Postoperative therapy

- another important period for the patient. Rehabilitation measures can pursue several goals:

Some patients believe that it is enough to eat well and get plenty of rest so that the body can recover after surgery. However, underestimate the importance rehabilitation measures not worth it, since their absence can nullify all the efforts of the surgeon.

If earlier in rehabilitation therapy the tactics of providing the patient with postoperative period complete peace, then today it has been proven that this method does not justify itself. It is important to properly organize rehabilitation, great attention is given to a positive psychological environment that does not allow patients to mope and fall into depression depressive state. If the process takes place at home, then the mandatory participation of family and friends is required so that the person strives for a speedy recovery.

Duration recovery period depends on the nature of the surgical intervention. For example, after spinal surgery, rehabilitation can take from 3 months to several years. And with extensive manipulations inside the peritoneum, a person will have to follow a number of rules for more than one year.

Recovery requires integrated approach, and the specialist can prescribe several procedures and measures:

Prepare: scissors, shaving machine, blades, soap, balls, napkins, water basins, towels, linen, antiseptics: alcohol, iodonate, rokkal; syringes and needles for them, Esmarch's mug, gastric and duodenal tubes, catheters, Janet's syringe.

Preparation for planned surgery.

Sequencing:

Direct preparation for the operation is carried out on the eve of the operation and on the day of the operation;

The night before:

1. warn the patient that the last meal should be no later than 17-18 hours;

2. cleansing enema;

3. hygienic bath or shower;

4. change of bed and underwear;

5. drug premedication as prescribed by an anesthesiologist.

On the morning of the operation:

1. thermometry;

2. cleansing enema before clean waters;

3. gastric lavage according to indications;

4. shaving surgical field dry method, wash warm water with soap;

5. treatment of the surgical field with ether or gasoline;

6. covering the surgical field with a sterile diaper;

7. premedication as prescribed by the anesthesiologist 30–40 minutes before surgery;

8. checking the oral cavity for removable dentures and removing them;

9. remove rings, watches, makeup, lenses;

10. empty bladder;

11. isolate the hair on the head under a cap;

12. transportation to the operating room lying on a gurney.

Preparing for emergency surgery.

Sequencing:

Skin examination hairy parts body, nails and treatment if necessary (wiping, washing);

Partial sanitization(rubbing, washing);

Dry shaving of the surgical field;

Fulfilling doctor's orders: tests, enemas, gastric lavage, premedication, etc.).

Treatment of the surgical field according to Filonchikov-Grossikh.

Indication: maintaining asepsis in the patient's surgical field.

Prepare: sterile dressing and tools: balls, forceps, tweezers, picks, sheets; sterile containers; antiseptics (iodonate, iodopyrone, 70% alcohol, degmin, degmicide, etc.); containers for waste material, containers with disinfectant solutions.

Sequencing:

1. Moisten a sterile ball generously in 5–7 ml of a 1% solution of iodonate (iodopyrone) using tweezers or forceps.

2. Give the tweezers (forceps) to the surgeon.

3. Perform extensive treatment of the patient’s surgical field.

4. Discard the tweezers (forceps) into a container for waste material.

5. Repeat the wide treatment of the surgical field twice more.

6. Cover the patient with sterile sheets with an incision in the surgical area.

7. Treat the skin in the incision area with an antiseptic once.

8. Treat the skin of the wound edges once before applying sutures.

9. Treat the skin in the area of ​​the sutures once.

Emergency surgery is not a planned procedure and is performed when the patient's life or health is in direct danger. Mostly emergency surgery performed by surgeons specializing in emergency medical care. Emergency surgery can be performed for many reasons, but most often it is necessary in emergency or critical cases of injury, cardiovascular problems, poisoning, traumatic brain injuries, as well as in pediatric medicine.

Purpose of urgent surgery

Most surgeries are elective and are performed after a diagnosis is made based on medical history and physical condition patient, taking into account differential research results and developing procedural strategies. In emergency surgery, the medical team, as well as the surgeon, may have less information about the patient than usual and work under very time-sensitive conditions to preserve the patient's life, avoid serious injury or systemic deterioration of the patient's condition, or to alleviate severe pain. Because of unique conditions in emergency surgery, urgent operations are usually performed using several surgeons specially trained in critical or life-threatening patient events.

Acute surgical emergencies include:

• invasive types of resuscitation for acute respiratory failure,
• thromboembolism pulmonary artery and pulmonary obstructions
• blunt and penetrating injuries to the head, chest, abdomen, mainly as a result of car accidents and gunshot wounds,
• burns,
• heart problems, including heart attacks, shock and arrhythmias,
• aneurysms,
• brain injuries and other neurological conditions,
• exacerbation of ulcers and peritonitis.

Subscribe to our YouTube channel !

Urgent surgery: description

Emergency surgery can be performed in any hospital setting. However, most emergency surgeries are performed in emergency rooms. The trauma center has special equipment, operating rooms, laboratories, anesthesiologists, X-ray and blood bank, medical staff intensive care and ward nurses.

Diagnosis and preparation for emergency surgery

Emergency surgery goes from resuscitation and stabilization of the patient's condition to preparation for emergency surgery, including postoperative and recovery procedures to quickly cope with a life-threatening situation for the patient. There is often little time or opportunity to extensively diagnose or gather information about a patient's illness. Decisions are made quickly and often without family members present.

Urgent surgery: normal results

Mortality rates are high for emergency operations. For example, a gap abdominal aorta leads to death in fifty percent of cases due to renal failure from shock or impaired blood supply. Untreated aneurysms are always fatal. Some gastrointestinal disorders, including bleeding in digestive tract, appendicitis and abdominal inflammation also require urgent surgery.

Pediatric surgery includes birth defects hearts. One in a hundred babies is born with a heart defect, which also requires surgical intervention.

Denial of responsibility: The information presented in this article about urgent surgeries is intended for the reader's information only. It is not intended to be a substitute for advice from a healthcare professional.

Preparation for an emergency operation is a very important stage, on which the degree of success of the event will depend. Before each surgical intervention, it is necessary to take into account the specifics of the operation and strictly adhere to the timing of the actions. And if this is an unscheduled procedure, prompt and high-quality preparation is needed.

- a whole range of measures that need to be taken quickly and urgently. They are aimed at making the patient's condition better. There are such options for operations:

• planned;
• urgent;
• emergency.

Planned surgery is carried out only if the patient has been examined in advance and the decision to undergo surgery was made long before. In addition, the patient conducts special examinations. At the same time, human life is not in danger and there is enough time for preparation.

If the operation is urgent, it means that specialists have several days left to organize the procedure.

Emergency is carried out urgently, so the opportunity to carry out diagnostic measures excluded.

Each type of surgical intervention consists of certain stages, one of which is preparing the patient for the process. Missing or incorrectly implementing this step will result in a poor result (poor quality output).

The main feature of this operation is the lack of time to fully prepare the patient. The decision that a patient needs surgery is made very quickly, and doctors have no right to hesitate, as this can even lead to the death of a person.

resort to urgent help necessary in a number of cases. Among them we can highlight following problems with health:

• trauma (for example, broken limb);
• acute forms of diseases (for example, strangulated hernia);
• other complications;
• if a foreign object is detected in the patient’s body.

The preparation process is determined by vital indications for each specific case. The main requirement is the minimum time that will be spent on the operation. Doctors have a maximum of 2 hours that can be spent preparing for emergency surgery. In certain cases, this only takes 1 minute while the patient is taken to the operating room, but these cases are very rare.

Based on the recommendations of the surgeon, the planned preparatory measures may be adjusted. Most often, the anesthesiologist gives direct instructions. In each specific case, it is possible to reduce the amount of certain manipulations.

Preoperative preparation of the patient

Preoperative preparation of the patient for emergency surgery may include various events, the goal of which is to successfully help a person and stabilize his condition. Designed for this special algorithm, according to which it is necessary to act in most cases.

The first step is data collection (brief anamnesis). It is very important to obtain information about the nature of the illness (injury, etc.). If possible, you should interview either the patient himself or his friends. Next, a person is examined, which consists of the following stages:

• auscultation;
• percussion;
• palpation.

It is almost mandatory to take general analysis blood and urine. For emergency surgery, information about your blood type and Rh factor is required. In certain cases there may be separate indications. Based on them, a decision is made on the need to carry out additional research. It's about about ultrasound, fluoroscopy, fibrogastroduodenoscopy. The latest event is aimed at organ research digestive system. The need for it arises when a certain pathology of the gastrointestinal tract is identified.

If the case is not very complicated and there is still time, it is recommended to take the following measures:

• conduct a coagulogram, it allows you to obtain information about blood clotting;
• blood test for total protein;
• determination of blood glucose.

Types of sanitization

Sanitary treatment of the patient is required element, without which the operation cannot be started. Since time is limited, all activities are minimized. The first event is taking off clothes. If on the body open wound, then you need to make sure that no items of clothing remain in it. All contamination is removed with sterile objects.

Processing activities should not be omitted, as this is dangerous to human health. If the contamination remains, there is a high probability that rotting processes will begin. Due to the fact that time is limited, all procedures are simplified to the maximum extent. Indeed, in some cases, the patient can count for minutes.

On the skin where the operation will be performed, hair should be removed, while the skin should remain dry. If there is an open wound on the site, then the complex of preparatory measures expands. It is imperative to apply a special sterile cloth to the wound. The skin should be treated using special means(medical gasoline). Also need help medical alcohol. When shaving hair, do not touch the wound.

In preparation for surgical event the wound area is treated with iodine solution. Moreover, it is being implemented this measure twice. The first time after shaving and treating the area with alcohol. Second time before surgery.

In some cases, doctors may insist on removing additional items from the patient's body, such as piercings. Since such elements can interfere with the normal operation. In certain cases, you will need to use a special device (electrocoagulator). In this case, metal products placed on the site can serve as a hindrance. Therefore, rings and chains should be removed. If you leave these products on the body, after surgery, burns may appear in these areas.

Women should definitely remove makeup from their face. This is due to the fact that urgent surgery requires an objective assessment of the condition from the doctor. skin and color change. Concealer and other concealers will hide any changes. Therefore, you need to cleanse your face of any cosmetics. In addition, during surgery, doctors must evaluate the patient's cyanosis (gas exchange). Therefore, facial skin color is the main indicator of a person’s condition.

The preparatory process that precedes emergency surgery takes a minimum amount of time. Moreover, any delay can lead to negative processes. Therefore, it is very important that the event in question is carried out by real specialists who cope with the task as efficiently as possible. Fast and coordinated work medical specialists who will carry out the entire complex necessary procedures according to the instructions, regardless of external circumstances, - almost 30% of the success of the operation.