Классический подход к радикальному хирургическому лечению рака нижнеампулярного отдела прямой кишки предполагает выполнение операции брюшно-промежностной экстирпации прямой кишки, которая технически относительно легко выполнима, часто применяется в современных хирургических стационарах, однако приводит пациента к пожизненной инвалидности. Данное исследование ставит цель: продемонстрировать высокую степень радикальности и реабилитационный потенциал брюшно-анальной резекции прямой кишки при низкой злокачественной опухоли прямой кишки. В результате исследования установлено, что указанная операция в данном конкретном случае характеризуется высокой радикальностью, обеспечивает возможность полного восстановления трудоспособности в течение десяти месяцев послеоперационного периода. Ключевые слова: рак прямой кишки, нижнеампулярный отдел, хирургическое лечение рака, низкая резекция прямой кишки, радикальная операция при раке прямой кишки, трансверзостома, закрытие стомы, восстановление трудоспособности.
Objective. To develop a new way to enhance single-layer colonic anastomosis with oksitselanim tissue and to assess its effectiveness in comparison with anastomosis, reinforced by latex tissue adhesive (LTA). Material and methods. The study was performed on 48 white mongrel male rats. Both the groups underwent intersection of the colon with subsequent formation of anastomosis in an «end-to-end» single-row Pirogov-Mateshuk suture that in the control group was strengthened by latex tissue adhesive, and in the experimental group by oksitselanim tissue. The derivation of the experiment was carried out on 3, 7, 14, 30 days. Such parameters of blood as wbc, phagocytic index, phagocytic number, the level of circulating immune complexes, the activity of complement were studied. The swab was taken from the anastomosis zone for bacteriological examination. The presence of effusion, adhesions, abscess, anastomotic narrowing, expansion of the leading department were macroscopically evaluated. The mechanical strength of the anastomosis was determined by pneumohydropression method. The area of tanastomosis was taken for histological examination. Results. The comparison of the morphological patterns of the abdominal cavity, the results of microscopic and bacteriological study suggests a lower expression of local inflammatory changes and bacterial permeability of colonic anastomoses reinforced with «oksitselanim» tissue. The mechanical strength of anastomoses in the experimental group exceeds those in the control group. The comparative analysis of leukocyte counts, phagocytosis, levels of circulating immune complexes and complement activity suggests a more rapid and less intense non-specific inflammatory response in the experimental group. Conclusion. The «oksitselanim» preparation makes it possible to prevent quickly the development of infectious complications with minimal response of the body and provide better conditions for the tissue regeneration after the formation of intestinal anastomosis.
Полипы толстой кишки относятся к доброкачественным опухо левым образованиям, которые являются предраковыми заболеваниями. В большинстве случаев именно полипы толстой кишки, малигнизация которых занимает около 8-10 лет, приводят в последствии к развитию колоректального рака [1, 3]. Диагностическая трудность полипов толстой кишки заключается в том, что данное заболевание, зачастую, протекает бессимптомно [2. 3]. Очевидно, что снижение заболеваемости колоректальным раком обусловлено своевременным выявлением и удалением доброкачественных полипов. Поэтому исследование данной патологии актуально для современной медицины [1, 2, 3].
The article describes the observation of a clinical case of a combination of echinococcal lung and liver cysts in a patient born in 1961. Brief information is given on the features of etiology, pathogenesis, clinical features, differential diagnosis and treatment of this pathology, according to modern literature data. The study of the given clinical case indicates that multispiral computed tomography with contrast makes it possible to differentiate echinococcal cysts with a high degree of accuracy. The two-stage method of surgical treatment of combined lesions of echinococcal cysts of the lungs and liver by video-assisted resection of the lower lobe of the right lung and subsequent laparoscopic resection of the liver with an interval of three months during treatment with ambendazole is characterized by a high degree of radicalism and rehabilitation potential.
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