APPLICATION OF FUNCTIONALLY-SPARING SURGICAL INTERVENTIONS IN SURGERY OF LOCALLY-SPREAD COLORECTAL CANCER

O.I. KIT, D.S PETROV, N.V. SOLDATKINA, D.A. KARAGEZOV

Rostov Scientific and Research Oncology Institute, Rostov-on-Don, RUSSIA

Introduction. Locally-spread colorectal cancer, extending into urinary bladder, is one of the most difficult problems of modern oncology in connection with high percentage of disability of patients after radical operations. The aim of the study: to improve the results of treatment locally spread colorectal cancer, extending into the urinary bladder, by means functionally sparing surgery.

Materials and methods. Information about 17 patients with colorectal cancer, extending into the urinary bladder T4N1-3M0. 7 patients were at the age of 50. Histologically there was found adenocarcinoma. The 1^st group included 11 patients, who were performed subtotal resection of the urinary bladder with preservation of triangle of bladder, restoration of the volume of the urinary bladder by an isolated enteric reservoir was performed in addition to the colonic intervention . The 2^nd group - 15 patients, distinguished fir the lack of restoration of the volume of urinary bladder, and formation of a microcyst. No spread of the tumor beyond the visible boundaries of lesions of the bladder was determined morphologically, which allowed to perform functionally-sparing operations with the location of the tumors near triangle of the bladder.

The results of the study. Postoperative complications occurred in 2 patients of the 1^st group and 4 patients of the 2^nd group. All patients of the 1^st group held urine during at the daytime 3 months, at night - 6 months after surgery. The average volume velocity of urine evacuation is 20 ml/sec, the total volume of evacuation - 290 ml, time of evacuation - 14.5 sec, residual urine volume - 10 ml. In patients of the 2^nd group, urination was produced through epicystostomy. Indicator of the level of quality of life changed from “poor” before surgery in both groups, into “satisfactory” after 6 months (90% of patients in the 1^st group and 50% in the 2^nd group). During the observation (7 months - 1 year) in the 1 group no tumor progression was revealed, in the 2^nd group - 1 patient had remote metastases.

Conclusion. During the extension of the colorectal cancer into the urinary bladder, performance of functionally-sparing operations on the bladder with preservation of triangle bladder, and small bowel plastics even with the location of the tumor near the ureteral orifices, urethra is possible and promotes rehabilitation, improves quality of life, does not increase the frequency of progression.

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INFLIXIMAB AND AZATHIOPRINE RELATED SEVERE NEUTROPENIA AND THROMBOCYTOPENIA IN A CASE WITH CROHN’S DISEASE

AR.¹ KOKSAL, C.¹ ALKIM, E.¹ ALTINKAYA, MS.¹ BUGDACI, O.¹ OZDOGAN, S.¹ BOGA, H.² ALKIM, M.¹ SOKMEN

Sisli Etfal Training and Research Hospital, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, TURKEY

Background: The TNF-α antagonists are commonly used in the treatment of Crohn’s disease. Infliximab-related neutropenia is very rare; a few case reports were present. Bone marrow toxicity is a well-known side effect of purine analogues i.e. azathiopurine, but frequently mild and dose-dependent. We here present a patient with Crohn’s disease who experienced severe febrile neutropenia and thrombocytopenia during infliximab and azathiopurine combination therapy. Clinical Case: A 25-year-old female patient with Crohn’s disease was using azathioprine for a long time because of recurrent perianal and rectovaginal fistulae. Infliximab (5 mg/kg) was added to the treatment regime following post-operative recurrence of rectovaginal fistula. The patient presented with complaints of fatigue, fever and diarrhea 10 days after the third infliximab dose. Fever was 39ºC, WBC: 350/mm³, PMNs: 130/mm³, platelet: 34000/mm³ and Hb: 10.8 g/dl. She was hospitalized and both azathiopurine and infliximab were stopped. Neutropenia work-up did not reveal any other cause. Neutropenia was ameliorated with the use of granulocyte colony-stimulating factor. Two months later, treatment was restarted with infliximab alone upon leakage from the rectovaginal fistula with no hematologic toxicity. Her fistulae were healed under infliximab monotherapy.

Conclusions: This case was considered as a serious adverse effect of infliximab and azathioprine combination therapy. In conclusion, infliximab treatment in Crohn’s disease in combination with azathiopurine can cause serious myelosuppression. Patients under treatment with this combination should be closely monitored for hematologic complications.

TREATMENT OF UNFORMED ENTERIC FISTULAS

F.A. KUDJEVA, R.R. BAYRAMUKOV

Stavropol State Medical Academy, Stavropol, RUSSIA

Background:Unformed enteric fistulas (UEF) constitute a severe complication in various diseases and injuries of abdominal organs, requiring from a surgeon nonstandard actions, both in diagnostic and treatment points of view. Lethality in patients with UEF ranges between 60 – 90%.

Materials and methods of study: Clinical data are based on the material obtained during the examination and treatment of 196 patients c UEF, treated at the department of contaminated surgery of “SKKC STMA” SEI of Stavropol city. 97 patients with UEF constituted the control group, in the treatment of which there were used traditional “closed” methods. In 99 patients, constituting the main group, active surgical methods of treatment were applied.

Results and conclusion: In the course of active surgical tactics, diffuse inflammatory reaction subsides, granulations appear by average of 14^th day of treatment, and in within this term it is safe to insert sutures in the intestine. There were performed different types of operations for the removal of fistulas. The application of programmed sanations of the abdominal cavity in patients with of the main group helped to relieve peritonitis within 7 - 28 days, which made it possible to eliminate UEF at early stages - on the 1-12^th days after the relief of peritonitis. While considering the possible terms of elimination of UEF in patients of the control group, we noted, that in 21 (36.8%) cases fistulas were removed on the 16^th day, in 17 (29.8%) - on 14-15^th day and only in 3 (5, 3%) cases - on the 3^rd day. In case of high UEFs against the background of the relieving peritonitis there was indicated resection of a fistulabearing loop with the formation of discharging jejunostomy by the type of Midle, which reduces mortality from 56% to 33.3%. At low UEF against the background of peritonitis, with the purpose of elimination of its source, there was indicated resection of a fistulabearing loop with the formation of discharging ileostomy, which reduces mortality from 25.5% to 15.2%. The application of active surgical tactics in patients with UEF allowed to reduce mortality from 41.2% to 27.3%.

Date: 2014-12-28; view: 612