FORECASTING AND PREVENTIVE MAINTENANCE OF THE INCONSISTENCY OF SEAMS INTESTINAL ANASTOMOSIS AT PATIENTS WITH THE EMERGENCY AND URGENT RESECTION OF INTESTINES

E.K. AGAYEV

Azerbaijan Medical University, Baku, AZERBAIJAN

The inconsistency of seams intestinal anastomosis is one of terrible complications in abdominal surgeries. Frequency of this complication according to the literature makes 3,4-18,1%. There are various methods of forecasting and preventive maintenance of an inconsistency of seams intestinal anastomosis, however serious tendencies in reduction of frequency of the given complication at patients with an urgent and emergency resection of intestines is not observed. We had been spent clinical supervision at 332 patients (the basic group) and the retrospective analysis of results of treatment of 244 patients (comparison group) with an urgent resection of various segments of small and large intestines to the period with 1990 for 2008. At 235 (70,78 %) patients of the basic group and at 110 (45,1 %) patients of group of comparison operation has come to the end with imposing primary anastomosis.

For the purpose of forecasting of an inconsistency of seams intestinal anastomosis are spent intraoperative transillumination angiotensometry and pulsometerografy by M.Z.Sigal and Z.M.Sigal. The basic contra-indications to imposing primary anastomosis were fall maximum intramural arterial pressure below 60 mm hg and amplitude decrease pulse are free below 3 mm. For preventive maintenance of the given complication have been used nasointestional and transrectal intubation with carrying out intra - and postoperative decompression, sanitation and gastrointerosorbtion with polifepan, a lazero-magnetotherapy sutural strips ( by device of "Orion"). and also permanent intramesenteric blockade and lymphotropic therapy. For carrying out permanent intramesenteric blockade catheterization a root mesentery of small intestines catheter through which entered 0,5 % a solution novocain (7 ml/kg/day), with addition heparin (150 units/kg/ day), prozerin (0,03 mg/kg/day) and seftriakson (15 mg/kg/day).

At studying frequency of complications it was found out, that the inconsistency of seams intestinal anastomosis has arisen basically at patients with primary is thick- thick intestinal anastomosis, operated concerning acute intestinal impassability the genesis of tumors. From 110 patients of the basic group thin-thin intestinal anastomosis - 2 (1,8 %), 33 are ileocolic anastomosis - 1 (3,0 %), from 92 are thick- thick anastomosis - 5 (5,44 %) were observed inconsistencies of seams. In total it was observed 8 (3,4 %) cases of an inconsistency of seams at patients of the basic group. At patients of group of comparison from 59 it is thin- thin intestinal anastomosis including - 7 (11,9 %), from 21 thin- thick intestinal anastomosis are 4 (19,1 %) and from 30 thick-thick intestinal anastomosis are 6 (20,0 %) were observed inconsistencies of seams intestinal anastomosis. In total it was observed 17 (15,5 %) cases of an inconsistency of seams intestinal anastomosis at patients of group of comparison.

Thus, thanks to carrying out of the complex actions directed on forecasting and preventive maintenance of early postoperative complications, at patients of the basic group in comparison with comparison group, decrease in an inconsistency of seams intestinal anastomosis in 12,1 % was observed.

Date: 2014-12-28; view: 953