scholarly journals MODERN METHODS OF PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ESOPHAGO-ORGAN ANASTOMOSIS AT ESOPHAGOPLASTY

2020 ◽  
Vol 73 (8) ◽  
pp. 1696-1699
Author(s):  
Volodymyr O. Shaprynskyi ◽  
Yevhen V. Shaprynskyi ◽  
Mustafa Bassam Hussein ◽  
Oleg O. Vorovskyi ◽  
Yaroslav V. Karyi ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Diagnostic Algorithm ◽  
Main Group ◽  
Instrumental Method ◽  
Complication Risk ◽  
Esophageal Strictures ◽  
Bed Days

The aim: To improve the results of operative treatment of esophageal strictures by decreasing the rate of failure and stricture of cervical esophago-organ anastomoses. Materials and methods: There were 45 patients with post-burn corrosive gullet strictures, 17 patients with postoperative corrosive strictures, 10 patients with peptic strictures secondary to reflux-esophagitis, 42 patients with esophageal cancer strictures. The patients were divided into two groups: the comparison group – 55 persons and the main group – 59 persons. Patients of comparison group underwent surgical treatment of esophageal strictures according to classic protocols and standards. In the main group of patients we applied proposed diagnostic algorithm with prediction of complication risk and the designed method of esophago-organ anastomosis formation. Results: The results of operative treatment in patients with esophageal strictures showed the development of early postoperative complications in 59 individuals (51.75 %). In the postoperative period six patients died: four – in the comparison group and two – in the main group. Failure of cervical esophago-organ anastomosis and esophageal strictures occurred in 7 patients (11.86 %) of main group and 20 patients (36.36 %) of the comparison group (p<0.05). Conclusions: Application of method predicting the risk of complications of cervical anastomosis, treatment program and instrumental method of formation anastomosis resulted in reduced incidence of failure and strictures of esophago-organ anastomosis from 36.36 % to 11.86 % (p<0.05); decreased time of hospitalization - from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), postoperative period - from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality - from 7.27 % to 3.39 %.

scholarly journals The choice of surgical treatment method of patients with bacterial liver abscesses

2012 ◽  
Vol 93 (2) ◽  
pp. 265-269 ◽  
Author(s):  
A P Tolstikov
Keyword(s):  
Postoperative Complications ◽  
Ultrasound Guidance ◽  
Comparison Group ◽  
Average Duration ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Main Group ◽  
Early Postoperative Complications ◽  
Liver Abscesses ◽  
Bed Days

Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.

Experience of the usage of nabumetone in oncogynecologic patients

2017 ◽  
pp. 118-122
Author(s):  
S.M. Kartashov ◽  
◽  
E.M. Oleshko ◽  
Keyword(s):  
Antioxidant Activity ◽  
Postoperative Period ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Malonic Dialdehyde ◽  
Pain Syndrome ◽  
Main Group ◽  
Narcotic Analgesics ◽  
Diene Conjugates ◽  
Results Of Treatment

Objective: to study the effect of nabumetone in oncogynecologic patients in the postoperative period. Materials and methods. There were examined 98 patients of 40-78 years old, who were divided into two groups: the main group - 58 patients, of which 37 - patients with endometrial cancer I-III and 21 - with ovarian cancer of II-IV stage (FIGO); The comparison group included 40 patients (17 and 23 patients respectively). All patients underwent surgical treatment. In the postoperative period, were used NSAIDs - nabumeton. Before the operation and on the 10th day of the postoperative period, the following parameters were studied: a clinical blood test, TNF-a, ceruloplasmin, diene conjugates (DC), malonic dialdehyde (MDA), antioxidant activity (AOA). The content of TNF-a, in the blood serum was determined by radioimmunological, and DC, MDA, AOA by biochemical method. Results. Established: the content of the leukocyte formula before the start of treatment in the compared groups did not reveal any significant differences. After surgical intervention, both groups showed an increase in the absolute values of all leukocyte fractions. The level of ceruloplasmin in the patients of the comparison group increased significantly in the postoperative period, and in the main group the parameters of ceruloplasmin did not differ significantly. The level of TNF-a in the pre- and postoperative period in the compared groups did not differ. On the 10th day of the postoperative period, it significantly increased in the comparison group, and when nabumetone was used during the postoperative period, the level of TNF-a did not increase. The initial indicators characterizing the processes of LPO and AOA in both groups did not differ significantly. Assessing the dynamics of indicators before and after the operation, it was noted that in patients in the blood, the level of DC in both the baseline and in the comparison group increased. The use of nabumethon led to a slight increase in DC. The maintenance MDA in the postoperative period has increased in both groups, however it is unreliable in comparison with parameters before surgical intervention. In the comparison group, after the treatment, the antioxidant defense was reliably reduced. In the main group, the use of nabumetone contributed to a smaller decrease in AOA. The use of nabumeton allowed abandoning of narcotic analgesics in earlier periods of the postoperative period. Conclusion. Use of nabumeton in the postoperative period allows to reduce the pain syndrome, the number of inflammatory complications; contributes to the normalization of LPO processes, inhibits the inhibition of the antioxidant system, which contributes to the reduction of endogenous intoxication and improves the results of treatment of oncogynecologic patients. Key words: nabumeton, oncogynecologic patients, anti-inflammatory action, tumor necrosis factor, ceruloplasmin, diene conjugates, malanialdehyde, antioxidant activity.

scholarly journals LOCAL NODULAR PROCESSES AFTER BREAST CANCER SURGERY

2021 ◽  
Vol 11 (1) ◽  
pp. 73-74
Author(s):  
Dmitry Maksimov ◽  
Alexey Sergeev ◽  
Aleksandr Aseev ◽  
Maxim Korolenko ◽  
Alimjan Armasov ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Outcomes ◽  
Operative Treatment ◽  
Comparison Group ◽  
Radical Mastectomy ◽  
Radical Resection ◽  
Main Group ◽  
Breast Cancer Surgery ◽  
First Year ◽  
Significant Difference

The present study is based on treatment outcomes in 140 women who underwent operative treatment in the volume of oncoplastic radical resection (main group, n = 70) and Madden’s radical mastectomy (comparison group, n = 70) for 1st to 2nd stages of breast cancer. When examined during the first year after surgery, no progression (local and distant) of the disease was observed, both after oncoplastic radical resections and Madden’s radical mastectomy. Nodal processes in the surgical area were identified in 7.1% of patients in the main group and 10.0% in the comparison group. No significant difference was found between the groups. We noted that after oncoplastic radical resection, oleogranulomas were more common, whereas after Madden’s radical mastectomy — organized lymphoceles were observed more often.

scholarly journals THE POSSIBILITIES OF APPLICATION OF DECIMETER-WAVE THERAPY IN DESTRUCTIVE APPENDICITIS CHILDREN

2019 ◽  
Vol 23 (1) ◽  
pp. 4-8
Author(s):  
Ekaterina R. Soloveva ◽  
O. V. Karaseva ◽  
M. F. Vasileva ◽  
S. V. Petrichuk
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Comparison Group ◽  
Abdominal Ultrasound ◽  
Main Group ◽  
Inpatient Stay ◽  
Decimetric Wave ◽  
Insufficiency Syndrome ◽  
Common Laboratory ◽  
Inflammatory Effect

Introduction. The article presents a comparative study of the postoperative period after laparoscopic appendectomy for destructive appendicitis in children with and without application of decimetric-wave therapy (DMWT). Material and methods. The study included 299 children aged from 3 to 17 years, the average age of children accounted for 10.7 ± 3.3 years. Patients were operated on for various forms of destructive appendicitis. The patients observed included 201 boys (67.3%) and 98 girls (32.7%), Destructive appendicitis (DA) was diagnosed in 129 (43.1%) children, appendicular peritonitis (AP) - in (56.9%). Patients of the main group received DMWT, starting from the 1st day after surgery. Patients in the comparison group did not receive physiotherapy. To assess the effectiveness of the use of UHF-therapy in the postoperative period, the following groups were taken into account: 1) intestinal insufficiency syndrome (ISS) and systemic inflammatory response syndrome (SSRS); 2) postoperative complications; 3) abdominal ultrasound data; 4) the dynamics of common laboratory indices 4) the duration of the inpatient stay. Results. In DA cases without peritonitis, ISS and SSRS in the main group were observed by 15.7 and 12.8 times less than in the comparison group, with the duration of ISS decreased by 2.13 times, SSRS by 3.3 times. In AP patients the frequency of ISS decreased by 1.68 times, SSRS - by 1.97 times. By the 5th day of the postoperative period in the main group, both in DA and AP cases, there was a significant increase in the incidence of patients with both leukocytes and lymphocytes count normal for the age, LII, CRP. The inpatient stay in the main group decreased by 1.0±0.7 days in DA patients, in AP cases - by 3.3±0.7 days. Conclusion. Evaluation of the postoperative period, as well as traditional laboratory indices, confirm the effectiveness of DMWTin the postoperative period in DA cases YES, in that the local and systemic anti-inflammatory effect is more pronounced in with AP patients.

scholarly journals "FAST-TRACK" IN SIMULTANEOUS OPERATIONS AGAINST THE BACKGROUND OF WIDESPREAD PERITONITIS

2018 ◽  
Vol 25 (5) ◽  
pp. 141-146
Author(s):  
V. Yu. Mykhaylichenko ◽  
O. Yu. Gerbali ◽  
U. I. Basnaev ◽  
N. E. Karakursakov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Fast Track ◽  
Comparison Group ◽  
Clinical Laboratory ◽  
Average Duration ◽  
Main Group ◽  
Simultaneous Operations ◽  
Duration Of Hospitalization ◽  
Recovery Program

Aim. This research was conducted to study the possibility and effectiveness of the "Fast-track" fast recovery program application when performing simultaneous operations against the background of widespread peritonitis.Materials and methods. In the course of the study were examined 66 patients, the ratio of woman/man was 45:21. The main group – 32 (48,5%) patients with the major disease of constricted postoperative hernia complicated by the widespread peritonitis and chronic calculous cholecystitis (a prospective analysis of surgical treatment). The comparison group – 34 (51,5%) patients with the identical pathology – the retrospective analysis of surgical treatment. The treatment of patients of the main group was supplemented with the application of the elements of the «Fast-track» program. Whereas, the treatment of patients of the comparison group was performed exclusively according to the standard scheme of the patient management with widespread peritonitis.Results. Clinical, laboratory and instrumental data indicate the positive effect of the "Fast-track" program on the process of rehabilitation of patients in the postoperative period. There was a significant acceleration in the recovery of motorevacuation function of the intestine in patients of the main group in relation to the comparison group and a smaller number of complications in the main group in relation to the comparison group against the background of the application of this technique. As a result, the average duration of hospitalization of patients from the comparison group was 10- 5 days (average 12±2,4 days). While the average duration of hospitalization of patients from the comparison group was 17-20 days (on average 18±1,2 days).Conclusion. The use of the "Fast-track" program in simultaneous operations does not increase the effectiveness of surgical treatment, thereby accelerating the process of rehabilitation of patients in the postoperative period. 

scholarly journals JUSTIFICATION OF THE EFFECTIVENESS OF THE USE OF DALMAXIN RECTAL SUPPOSITORIES (THIOTRIAZOLIN) IN THE COMPLEX TREATMENT OF ACUTE PARAPROCTITIS

2020 ◽  
pp. 54-62
Author(s):  
O. A. Viltsaniuk ◽  
M. V. Mazur
Keyword(s):  
Postoperative Period ◽  
Microbial Contamination ◽  
Comparison Group ◽  
Main Group ◽  
Symptomatic Therapy ◽  
Complex Treatment ◽  
Study Objective ◽  
Endogenous Intoxication ◽  
Hospitalization Period ◽  
Rectal Suppositories

Summary. The problem of treatment of acute purulent paraproctitis is one of the most urgent problems of modern coloproctology. Study objective. To evaluate the effectiveness of the use of Dalmaxin rectal suppositories in the complex treatment of acute paraproctitis. Materials and methods. The effectiveness of use of Dalmaxin rectal suppositories was conducted in 62 patients with acute subcutaneous paraproctitis, assigned to two groups, a main group of 30 patients and a comparison group of 32 patients. All patients underwent radical surgery. Antimicrobial, detoxification and symptomatic therapy was prescribed postoperatively. Local treatment of purulent wounds was carried out using hydrophilic ointments depending on the phase of the wound process; the patients of the main group were additionally administered Dalmaxin rectal suppositories twice a day. The effectiveness of the treatment was evaluated by the severity of the swelling, the nature of the discharge from the wound, the level of microbial contamination, the wound cleansing period, the appearance of granulation tissue and epithelialization, and by cytological examination. Furthermore, general laboratory and biochemical studies were performed. Endogenous intoxication (EI) and its changes in the course of treatment were evaluated by the level of average-mass molecules, leukocyte intoxication index and hematological intoxication index. Statistical processing and comparison of the obtained data was performed using the STATISTICA® 5.5 integrated system (STATSOFT® Inc., USA), license A XX 910A374605FA. Results. The study showed that in patients with acute paraproctitis, the severity of the postoperative period is due to the severe intoxication and the development of a systemic inflammatory response syndrome that were observed in patients at the time of hospitalization. After surgical intervention, clinical and laboratory parameters did not normalize in the first five days of the postoperative period, and only starting from the fifth day, there was a gradual decrease in the level of EI and laboratory indicators, reaching the normal ones only at the time of discharge from the hospital. EI complicates the course of the postoperative period, primarily by weakening the level of humoral immunity and inhibiting the processes of reparative regeneration. When comparing the results of treatment of acute paraproctitis in patients using Dalmaxin rectal suppositories with traditional methods. The hospitalization period of the patients of the main group was also shorter than in the comparison group, and was (9.2 ± 0.5) and (11.9 ± 0.9) bed days, respectively. Conclusions. A comparative evaluation of the use of Dalmaxin in the complex treatment of acute purulent paraproctitis showed that the drug, due to its properties, significantly improves the course of the postoperative period, as evidenced by faster reduction of endogenous intoxication, reduction of microbial contamination and wound cleansing from necrotic tissues, faster granulation and epithelialization, as well as wound healing, thus helping to reduce the time of hospitalization.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

scholarly journals EVALUTION OF MAMMARY GLAND PROSTHESIS ROTATION PROPHILAXIS EFFECIENCY IN A THREE YEARS POSTOPERATIVE PERIOD

2019 ◽  
Vol 18 (4) ◽  
pp. 29-36
Author(s):  
O. I. Zakhartseva ◽  
Ya. M. Susak ◽  
L. Yu. Markulan
Keyword(s):  
Mammary Gland ◽  
Postoperative Period ◽  
Comparison Group ◽  
Main Group ◽  
Augmentation Mammoplasty ◽  
Lactation Period ◽  
Significant Difference ◽  
Group A ◽  
Clinically Significant ◽  
One Year

Mammary gland prosthesis rotation (MGPR) after augmentation mammoplasty is a poorly studied complication of plastic surgery. The frequency of MGPR is not well known. There are indications that MGPR of 90○ , which is considered clinically significant, ranges from 0.9 % to 14 %. Preventing methods of MGPR are not developed enough. Aim: determination of the effectiveness of the upper pole reinforcement of «neo pocket» with prolen thread for the prevention of MGPR after primary augmentative mammoplasty (PAMP) in three years of postoperative period. Material and methods. The invectigation is performed on the basis of the Surgery Department No. 4 of Bogomolets NMU in the period from 2013 to 2018. A prospective, independent comparison of the primary augmentative mammaplasty results between three independent groups of patients was performed: two groups of comparison and one main groups. The first group of comparison (Group P1) included 94 patients who evaluated the results of augmentative mammaplasty one year after the operation, the second comparison group (Group P3) – 63 patients three years after this operation. The main group (group O) included 76 patients who had a prospective study after one (group O1) and then three years later (group O3) – 62 patients. In the comparison groups, the standard MGPR was performed, in the main group – according to the developed method. The patients did not differ statistically by age, body mass index (BMI), weight of prostheses, percentage of pregnant women and patients with lactation period. In all the cases, textured prostheses with high and medium profile were implanted. The majority of patients were operated with prostheses from 325-335 ml and 375 ml. The MGPR evaluation was carried out in accordance with the developed method using the ultrasound of the ESAOTE firmware model Technos Partner with a linear sensor with frequency of 12.5 MHz. Data analysis was performed using the IBM SPSS Statistics 22 statistical analysis packets. Results. One year after the operation in the P1 group, a slightly lower, but not reliable percentage of prosthesis rotation – 143 (76.1 %) against 103 (81.7 %) in the group P3, p=0.231, was diagnosed. At the same time, in the P1 group only 4 (4.3 %) women did not have the rotation of the prosthetics of both mammary gland (MG) and in the P3 group 2 women (3.2 %), p=0.001. Significant difference of the frequency of patients with clinically significant MGPR: 11 (11.7 %) patients in the P1 group versus 12 (19.0 %) in the P3 group (p = 0.202) and 13 (6.9 %) in the P1 group against 13 (10.3 %) of the prostheses in the group P3 (p=0.284). In patients in the main group, a small (30.9%) frequency of clinically insignificant MGPR was noticed after PAMP and it did not increase after the three years period (32.1%). In the P1 group, 143 (76.1 %) prostheses were diagnosed with rotation, in the group O1 – 46 (30.3 %), p = 0.001. At the same time, in the P1 group, only 4 (1.6 %) women didn`t have the rotation of the of both MG prostheses and in the group – 39 (51.3 %), p = 0.001, which indicates the effectiveness of the developed methodology. A similar trend was observed in the case of comparison of the three years results between the group P3 and the group O3. The absence of rotation of prostheses was diagnosed in 83 (66.9 %) O3 group and 26 (20.6 %) in the P group, and there was no clinically significant rotation of O3 patients versus group P where these patients were observed: 12 (19.0% ), p=0.001. Conclusion: the method of fixation of the submuscular «neo pocket» upper pole with prolen thread, provides stable protective effect of MGPR and gives a possibility to avoid a clinically significant rotation(more than 900) throughout three years after augmentative mammoplasty comparing with a traditional method – 11.7 %, patients in a year – 19 %, in three years after PAMP, р<0,01.

FEATURES OF DIAGNOSIS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION

2021 ◽  
pp. 33-38
Author(s):  
Б.В. Сигуа ◽  
В.П. Земляной ◽  
С.В. Петров ◽  
Д.Х. Каландарова ◽  
А. Л. Ефимов
Keyword(s):  
Small Bowel ◽  
Mortality Rate ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Comparison Group ◽  
Treatment Algorithm ◽  
Diagnostic Algorithm ◽  
Main Group ◽  
Diagnostic Methods ◽  
Adhesive Small Bowel Obstruction

Спаечная тонкокишечная непроходимость является часто встречающейся патологией с тенденцией к нарастанию, характеризуется сложным патогенетическим течением, с высоким процентным соотношением осложнений и летальных исходов. Среди форм кишечной непроходимости, обусловленных механическим препятствием, острая тонкокишечная непроходимость составляет 64,3-80 % с летальностью 5,1-8,4 % в структуре ургентных заболеваний. Сложность ранней диагностики наряду со стертой клинической картиной, тяжелым течением на отягощенном фоне у лиц пожилого и старческого возраста ведет к поиску новых оптимизированных лечебнодиагностических протоколов. Цель исследования - изучение характера течения спаечной тонкокишечной непроходимости у лиц пожилого и старческого возраста, установление информативности различных методов диагностики, определение показаний к выбору оптимального срока и метода лечения. Проведен сравнительный анализ по результатам лечения 191 пациента 60-90 лет и старше, получавших лечение в хирургических отделениях Елизаветинской больницы (Санкт-Петербург) в период 2016-2019 гг. Все пациенты были разделены на две группы: основную составили 106 пациентов (2018-2019 гг.), группу сравнения - 85 пациентов (2016-2017 гг.). Для всех пациентов основной группы использован усовершенствованный лечебно-диагностический алгоритм с применением оригинальной балльно-оценочной шкалы, который позволил оптимизировать диагностику и улучшить результаты лечения. Пациенты группы сравнения были обследованы в соответствии со стандартными протоколами, оперативное лечение осуществляли исключительно традиционными методами. Применение предложенного лечебно-диагностического алгоритма позволило увеличить вероятность консервативного разрешения острой спаечной тонкокишечной непроходимости с 20 % (17) до 33 % (35), снизить частоту послеоперационных осложнений с 60,2 % (41) до 25,3 % (18), р<0,01, а уровень летальности - с 23,5 % (16) до 7 % (5), р<0,05. Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80 % with a mortality rate of 5,1 to 8,4 % in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20 % (17) to 33 % (35) and to reduce the incidence of postoperative complications from 60,2 % (41) to 25,3 % (18), p<0,01, and the mortality rate from 23,5 % (16) to 7 % (5), p<0,05.

scholarly journals PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS OF INTESTINAL SURGERY USING IMMUNOMODULATING THERAPY

2020 ◽  
pp. 37-45
Author(s):  
M. Tymchenko
Keyword(s):  
Small Intestine ◽  
Postoperative Complications ◽  
Lipoic Acid ◽  
Comparison Group ◽  
Intestinal Anastomosis ◽  
Interleukin 2 ◽  
Postoperative Mortality ◽  
Main Group ◽  
Immunomodulating Therapy ◽  
Results Of Treatment

Summary. The aim of the study is to develop a method of immunocorrection, which improves the results of treatment of patients with developed peritonitis against the background of the small intestine anastomosis leakege by stopping the cascade of SIRS and MOF. Materials and methods. The work was clinical in nature, was performed in the clinic of the SI «ZIGUS NAMSU» in the period from 2016 to 2019. We examined 58 patients with various diseases of the abdominal organs complicated by peritonitis, in which sections of the small intestine were resected. The Comparison Group included patients who received traditional therapy, patients of the Main Group, the complex of drug therapy included recombinant interleukin-2, galavit and α-lipoic acid. The results of surgical treatment were evaluated according to the classification of D. Dindo, N. Demartinesta, P.-A. Clavien (2004). Statistical analysis was removed from the Statistica 6.0 software (StatSoft, Inc. 2001) and SPSS 7.5 on Apple PC. Results and Discussion. Thus, the results of the use of a comprehensive immunomodulation scheme using IL-2, galavit and α-lipoic acid in the complex treatment of patients with widespread peritonitis against the background of intestinal anastomosis failure suggest that the developed scheme has a targeted immunoregulatory effect and prevents the excess production of inflammatory mediators in the early postoperative the period of the disease, helps to eliminate the cytokine imbalance and prevents the development of secondary immune deficiency. A comparative analysis of the incidence of complications revealed that in patients of the Main Group the average number of complications per patient was 0.53, while in the Comparison Group this indicator was 1.36. Conclusions. The use of a combination of IL-2, galavit and α-lipoic acid in the complex of treatment of common peritonitis helps to reduce the level of systemic and local postoperative complications, as well as the level of postoperative mortality.

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