Казанский государственный медицинский университет, г. Казань, Россия; Республиканский клинический онкологический диспансер, г. Казань, Россия; Казанская государственная медицинская академия, г. Казань, Россия РефератЦентральная температура тела человека служит важнейшим показателем, мониторируемым в клинической практике анестезиологии и интенсивной терапии. Современные анестетики влияют на процессы регуляции центральной температуры и приводят к её снижению в периоперационном периоде. Непреднамеренная интра-операционная гипотермия сопровождает многие операции, проводимые под общей и регионарной анестезией. Она значительно увеличивает риск кардиальных и инфекционных послеоперационных осложнений, на её фоне возрастают послеоперационная кровопотеря и потребность в гемотрансфузии. Пациенты в условиях гипотер-мии медленнее просыпаются, их пробуждение чаще сопровождается мышечной дрожью. Периоперационная гипотермия приводит к увеличению сроков госпитализации и внутрибольничной летальности. В связи с этим предотвращение непреднамеренной периоперационной гипотермии -важная часть анестезиологического обе-спечения больного во всех областях хирургии. Поддержание нормотермии во время операции служит важной составляющей всех программ ранней послеоперационной активизации больных. Ключевые слова: гипотермия, периоперативное согревание, температура. Human body central temperature is an important monitored value for anesthesiology and intensive care practice. Present anesthetic agents influence on the central temperature regulation and lead to its decrease in the perioperative period. Inadvertent perioperative hypothermia accompanies various surgeries with general and regional anaesthesia. It considerably increases the risk of cardiac and infectious postoperative complications, and against its background blood loss and necessity for blood transfusions also increase. Patients with hypothermia wake up slower and the postoperative shivering may often occur. Perioperative hypothermia increases the length of hospital stay and the nosocomial mortality. In this regard, prevention of inadvertent perioperative hypothermia is an important part of anaesthesia assistance in all fields of surgery. Maintenance of normal temperature during the surgery is an important component of all programs of patient's early postoperative activation. Prevention and management of inadvertent perioparatve hypothermia
Gastric stump cancer is a carcinoma which forms no earlier than 5years after surgery for benign disease. The incidence ranges from 2.4 to 5% among patients with stomach cancer. Previous operations lead to the emergence of an adhesive process in the abdominal cavity, changes in the anatomy and topography of the abdominal organs, as well as the development of new ways of lymph outflow. These factors lead to the re-surgery becomes technically more complicated and requires high professional training from the surgeon. Of particular surgical interest is the issue of restoration of the digestive tract, which directly depends on the nature and volume of the previous surgery. In this paper, the authors describe cases of surgical treatment of gastric stump cancer in two patients, who had previously undergone pancreaticoduodenectomy.
Primary multiple neoplasms (polyneoplasia) are among the interesting and insufficiently studied fields of oncology. The term polyneoplasia is usually used for two or more malignant neoplasms in a single patient, which occur synchronously or metachronously. Over the last decade, an increase of primary multiple tumors prevalence has been observed. In 2015 39 195 new cases of primary multiple tumors were registered in Russia and comprised 6.7% of all incident malignant neoplasms. Primary multiple metachronous and primary multiple synchronous tumors with two neoplasms development are observed most often, with three more rarely, and with four or more very rarely. In average, 0.1% of a total number of oncologic patients have at least three malignant neoplasms. Primary multiple tumors of gastrointestinal tract are observed most often. The current article presents a clinical case of four synchronous tumors in a single patient localized in major duodenal papilla, sigmoid, transverse colon and lung.
The article contains description of such serious pathology in emergency surgery as bowel infarction caused by acute mesenteric ischemia in two patients with colorectal cancer admitted to Tatarstan regional clinical cancer center. Patients were admitted for emergency indications with the clinic of an acute abdomen. Both patients underwent an emergency surgery of laparotomy, enterectomy with colon resection and anastomosis. Both patients had satisfactory immediate postoperative results. One patient died 8 months later due to the progression of the underlying disease, the second one is alive to the present day with a satisfactory quality of life and the only complain of frequent loose bowel movements. Most patients with acute mesenteric ischemia are operated on with trial diagnostic laparotomy, and mortality rate for this pathology reaches 90% or more. The presented clinical cases familiarize physicians with an opportunity of successful surgical treatment of patients with acute mesenteric ischemia combined with colon cancer and demonstate expediency and need for surgical interventions with extensive colon resection.
Total mesorectal excision with low anterior resection has significantly improved the long-term outcomes of surgical treatment for rectal cancer, decreasing the local recurrence rate and increasing survival. However, total mesorectal excision is becoming one of the main factors for the development of colorectal anastomosis leakage, the rate of which reaches 20% in these operations. To minimize the complications associated with the inconsistency of the colorectal anastomotic suture, preventive intestinal stoma is formed when performing low anterior resections. That significantly worsen the quality of life of patients, their elimination requires re-hospitalization, and surgical interventions are accompanied by a high incidence of postoperative complications, reaching a rate of 20%, which has a significant impact on the cost of treatment for this category of patients. Transanal drainage is an alternative to the formation of preventive intestinal stoma and is devoid of its shortcomings. This literature review is devoted to an analysis of the effectiveness of transanal drainage in low anterior rectal resection. Until recently, transanal drainage has not yet gained popularity among surgeons due to the lack of evidence of its safety and effectiveness, and many studies are retrospective, including small samples. The review considered single-center, multicenter, randomized trials and a meta-analysis of the use of transanal drainage. Transanal drainage is an effective method for preventing the inconsistency of colorectal anastomotic suture, it is safe, and it surpasses the preventive intestinal stoma in a number of indicators.
Intussusception is one of the varieties of mixed (strangulation and obturation) mechanical intestinal obstruction. It arises as a result of the introduction of the adducting segment of the intestine into the abducting one. Gastroduodenal intussusception is an extremely rare type of high intestinal obstruction. It most often occurs after surgery on the stomach and much less often in non-operated patients. Intussusception of the jejunum into the stomach can occur soon after surgery, but most often, this complication occurs 515 years after the intervention. This paper describes a case of retrograde intussusception that arose 9 years after the Billroth II gastric resection with Braun anastomosis. This clinical case acquaints specialists with the possibility to encounter this pathology in clinical practice and demonstrates the appropriateness of differential diagnostics in cases with similar clinical symptoms.
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