Статья посвящена анализу особенности диагностики и хирургического лечения перфоративных дуоденальных язв у 510 больных. Предлагаются новые способы ушивания перфоративного отверстия с использованием лапароскопических технологий, которые были успешно применены у 83 пациентов-ушивание перфоративной язвы петлевым пломбирующим швом, оментопластика со съемной лигатурой. Определены точки введения троакаров, техника проведения оперативных вмешательств. Определены показания к различным видам лапароскопических методов ушивания перфоративных дуоденальных язв в зависимости от их размеров, расположения, сроков заболевания. Определены противопоказания к лапароскопическим вмешательствам при перфоративных дуоденальных язвах. Описано послеоперационное ведение больных, проанализированы послеоперационные результаты. Предложенные варианты лечения позволили значительно уменьшить болевую реакцию в раннем послеоперационном периоде, сократить сроки лечения в хирургическом стационаре в два раза и ускорить послеоперационную реабилитацию пациентов. Ключевые слова: перфоративная язва, методы ушивания, лапароскопия.
Aim. To analyze the current practice for the surgical treatment of destructive acute appendicitis complicated by typhlitis and periappendicular abscess. Methods. This study analyzed the treatment outcomes in 84 patients with acute destructive appendicitis aged 18 to 79 years who were treated in the Department of Surgery No. 2 of the City Clinical Hospital No. 7 of Kazan between 2016 and 2021 years. According to the method for completion of surgical intervention, patients were divided into 2 groups, similar in age, duration of the disease and morphological changes in the appendix. In the comparison group, 54 patients had the surgical intervention completed by gauze-glove drainage of the appendix bed. In 30 patients of the main group, the appendix stump and the adjacent intestinal wall was covered with a Tachocomb plate. Then the VAC system with the Vivano device and supplies from Hartmann Group (Germany) was connected. The statistical significance of the differences between the indicators was assessed by using the Student's t-test. Results. The analysis of the surgical techniques used showed that in the main group, postoperative wound complications decreased by 3 times (23.3% of patients, p=0.04), intra-abdominal fluid collections decreased by 2 times (6.7% of patients, p=0.02), the hospital lengths of stay decreased by 1.8 times (p=0.02) compared with the comparison group. Conclusion. The use of ligature appendectomy in combination with plastic closure of the appendix stump with a TachoComb and the technology of local vacuum-assisted laparostomy in patients with destructive appendicitis complicated by periappendicular abscess contributes to a 3-fold reduction in wound postoperative complications and reduces the hospital lengths of stay in this group of patients by 1.8 times.
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