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№1' 2020

SURGERY

International Medical Journal, Vol. 26., Iss. 1, 2020, P. 25−28.


DOI (https://doi.org/10.37436/2308-5274-2020-1-5)

CHOICE OF SURGERY TACTICS IN PATIENTS WITH HIGH RISK OF ANASTOMOTIC LEAK DEVELOPMENT


Tymchenko M. Ye.

State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine

Intestinal resection is one of the most common surgeries performed on urgent indications, the most difficult is the decision in favor of the formation of primary anastomosis in the case of primary infection of abdominal cavity, multiple defects of the intestinal wall, as well as the general serious condition of a patient. In order to improve the methods of diagnosis and prevention of post−surgery complications, as well as personification of surgical tactics of treatment in the patients undergoing anastomotic surgeries in intestine, the results of treatment of 96 patients were analyzed. The level of serum cryoglobulins was determined by the method of A. E. Kalovidoris with modifications. The results of surgical treatment were evaluated according to the classification of D. Dindo et al. (2004). The use of cryoglobulin levels before surgery can significantly affect surgical tactics: at a low degree it is possible to perform resection of a segment of small intestine with the formation of primary small intestinal anastomoses; at average − it is possible to perform small−intestinal anastomoses with unloading intestinal stoma or with the location of the anastomosis extraperitoneally (if possible) and decompression of the anastomosis with an incubation probe; at high − it is expedient to supplement performance of an anastomosis with a variant of an enterostomy or "delayed" anastomoses, at a severe general condition of patients it is expedient to form final small intestinal stoma. Determining the level of cryoglobulinemia as a marker of the prognosis of failure of the sutures of intestinal anastomoses and the use of differentiated surgical tactics depending on the level of this index contributes to a significant improvement in direct results of surgical treatment of the patients undergoing resection of small intestine segments. The proposed tactics virtually eliminate the implementation of multi−stage surgical interventions and helps to reduce the duration of treatment of patients, reduce the level of post−surgery complications and mortality.

Key words: cryoglobulinemia, surgical treatment, small intestine, anastomoses.


REFERENCES


1. Khіrurgіchne lіkuvannya khvorikh z urakhuvannyam prognozu perebіgu abdomіnal'nogo sepsisu / V. V. Boiko, І. A. Krivoruchko, M. S. Povelichenko, Yu. V. Іvanova // Kharkіvs'ka khіrurgіchna shkola. 2014. № 3 (66). S. 54−58.

2. Minnullin M. M., Abdul'yanov A. V., Nikolaev Ya. Yu. Khirurgicheskaya taktika pri rannei posleoperatsionnoi spaechnoi kishechnoi neprokhodimosti // Prakticheskaya meditsina. 2014. T. 2 (4). S. 77−81. doi: https://doi.org/10.25284/2519−2078.3(72).2015.84590

3. Sukhodolya A. I., Nazarchuk S. A., Dmitriєv D. V. Obґruntuvannya zastosuvannya ksenodermoimplantativ dlya profilaktiki nespromozhnosti kishechnikh shviv ta anastomoziv v onkokhvorikh u kritichnomu stani // Bіl', znebolyuvannya і іntensivna terapіya. 2015. № 3. S. 44−51.

4. Profіlaktika nespromozhnostі tovstokishkovikh anastomozіv pri obturatsіinіi neprokhіdnostі / M. M. Militsya, І. M. Angelovs'kii, M. D. Postolenko, V. V. Coldusova // Shpital'na khіrurgіya. Zhurnal іmenі L. Ya. Koval'chuka. 2016. № 4. S. 11−13. doi: https://doi.org/10.11603/2414−4533.2016.4.7176

5. Ks'onz І. V., Kharchenko D. A., Ks'ondz V. І. Krіoadaptatsіya segmentіv kishki pri nakladannі anastomozu u khvorikh z kishkovoyu neprokhіdnіstyu pukhlinnogo genezu // Svіt meditsini ta bіologії. 2019. № 2 (68). S. 79−82. doi: https://doi.org/10.26724/2079−8334−2019−2−68−82−85

6. Issledovanie neirokhimicheskikh aspektov obmena mediatornykh aminokislot u bol'nykh kolorektal'nym rakom / S. V. Perepadya i dr. // Problemi ekologії ta meditsini. 2010. № 1−2. S. 25−27.

7. Survival and Prognostic Factors in Mixed Cryoglobulinemia: Data from 246 Cases / C. Mazzaro et al. // Diseases. 2018. Vol. 3, № 6 (2). doi: https://doi.org/10.3390/diseases6020035

8. Desbois A. C., Cacoub P., Saadoun D. Cryoglobulinemia: An update in 2019 // Joint Bone Spine. 2019. № 86 (6). R. 707−713. doi: https://doi.org/10.1016/j.jbspin.2019.01.016

9. Lesson from an intriguing case of cryoglobulinemia / M. Barone et al. // World J. Gastroenterol. 2013. Vol. 14, № 19 (2). R. 304−306. doi: https://doi.org/10.3748/wjg.v19.i2.304

10. Ferri C. Mixed cryoglobulinemia // Orphanet. J. Rare Dis. 2008 № 16. R. 3−25. doi: https://doi.org/10.1186/1750−1172−3−25

11. Dindo D., Demartines N., Clavien P. A. Classification of Surgical Complications. A New Proposal with Evaluationin a Cohort of 6336 Patients and Results of a Survey // Ann. Surg. 2004. Vol. 244. P. 931−937.

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