ЦЕЛЬ. Проанализировать доступные за последние 5 лет исследования с последующей систематизацией основных групп факторов, приводящих к несостоятельности толстокишечных анастомозов после резекционных и реконструктивно-восстановительных операций. Анализ литературы проведен в медицинских базах PubMed, Medline, Cochrane Library, Web of Science. учитывая представленную большую выборку пациентов и количество оцениваемых факторов со статически значимой достоверностью, в литературный обзор вошли 22 рандомизированных исследования и метаанализа. Проанализированы и представлены контролируемые и неконтролируемые факторы, приводящие к несостоятельности толстокишечных анастомозов после реконструктивно-восстановительных и резекционных операций на разных этапах лечения данной категории пациентов. Частота развития несостоятельности межкишечных анастомозов, по данным изученной литературы, довольно высока. Оценка доказанных факторов и их нивелирование в дооперационном периоде позволит в большинстве случаев снизить риски и, как следствие, частоту несостоятельностей кишечных анастомозов, что значительно улучшит результаты лечения колопроктологических пациентов.
Radiation proctitis is a rare and significant complication of the combined therapy in patients with pelvic cancer. The choice of treatment of chronic radiation proctitis depends on the stage of disease and recurrent rectal bleeding. Comorbidity is cause to complicated proctitis. These clinical cases describe the choice and sequence of surgical interventions in order to achieve successful results in patients with chronic radiation proctitis.
Relevance. Liver abscesses remain one of the most urgent problems in abdominal surgery, reaching 2-3 cases per 100,000 people. A wide range of causes, the complexity of diagnosis and the imperfection of treatment methods reaching a high mortality, from 2 to 31% according to different authors. The abscesses developing as a complication in the postoperative period are the greatest difficulty in diagnosis and treatment. The advantage of minimally invasive technologies at the present stage of development of surgery is indisputable. However, the question remains of the indications for their use, phasing and technology of implementation.
Purpose of the study. On the clinical example, to show the possibility, logic and sequence of minimally invasive treatment in a patient with multiple liver abscesses.
Materials and methods. Presented a clinical case of minimally invasive treatment of postoperative complications in a patient receiving primary treatment for multiple primary cancer - cholangiocarcinoma and kidney cancer with the development of multiple liver abscesses of the ambiguous nature (cholangiogenic, pyogenic, traumatic, ischemic).
Result. In the presented clinical case are presented the possibilities of a staged, minimally invasive treatment of multiple liver abscesses
The article presents a clinical case of the staged treatment of a patient with a functioning colostomy and a segmental form of Hirschsprung's disease. Challenges in diagnosing and determining the tactics of reconstructive and restorative surgery in appropriate cases were demonstrated in absence of adequate medical documentation.
Minimally invasive percutaneous techniques, staged as part of the combined treatment of high stricture complications of the biliary tract, demonstrated high efficiency in the short term. On the other hand, the use of self-expanding nitinol stents as a definitive treatment for non-tumor stricture of the biliary tract in long-term life prognosis cannot be recommended as a routine intervention. The use of stents in these cases can only be justified in the absence of alternative treatment options, subject to frequent monitoring of the biliary tract.
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