Novosti
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Year 2014 Vol. 22 No 3
GENERAL AND SPECIAL SURGERY
V.I. DEMCHENKO, M.V. KUKOSH, D.L. KOLESNIKOV
THE PLANNED RELAPAROTOMY IN TREATMENT OF PATIENTS WITH MESENTERIC THROMBOSES
SBEE HPE “Nizhniy Novgorod State Medical Academy”
The Russian Federation
Objectives. To evaluate the effectiveness of the planned relaparotomy in the complex treatment of patients with mesenteric thromboses.
Methods. The treatment results of 107 (49 males, 58 females) patients with mesenteric thrombosis admitted to the “City Clinical Hospital N 7” of Nizhny Novgorod during the period from 2005 to 2011yrs. have been analyzed. There were 18 patients up to 60 years, older than 60 years – 89. 35 patients were not operated on due to multiple organ failure, the mortality rate – 100%. 72 patients have been operated on. Depending on treatment the patients were divided into two groups. In the first group (20 patients, 2005-2006 yrs.) the bowel resection with anastomosis creation was performed. In the second group (52 patients, 2007-2011 yrs.) the patients were subjected to the bowel resection with suturing of its ends hermetically (in case of doubt bounds lesion), planned relaparotomies with intestinal viability assessment and anastomosis creation, circadian administration of the anticoagulants and peridural anesthesia. The groups were comparable according to the main values. Assessment of the treatment results was conducted according to the mortality rate.
Results. In the first group 20 patients were operated on, 18 died (mortality – 90%). Three “relaparotomies on demand” were carried out, 2 patients died (mortality – 66,6%). In the second group 52 patients operated on, 32 of them died (mortality – 61,5%). 15 planned relaparotomies were performed, 6 patients died (mortality – 40%). It is established that the application of the delayed anastomosis in the complex treatment of mesenteric thromboses during the early planned relaparotomy is considered to be justified. The reduction of postoperative mortality rate from 90% to 61,5% and general mortality from 93% to 74,4% have been registered.
Conclusions. The conducted study confirmed the effectiveness of the planned relaparotomy assessing viability of bowel and anastomosis performance in the complex treatment of patients with mesenteric thromboses.
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603011, Rossiyskaya Federatsiya, g. Nizhniy Novgorod, ul. Oktyabrskoy revolyutsii, d. 66-a, GOU VPO «Nizhegorodskaya gosudarstvennaya meditsinskaya akademiya», kafedra fakultetskoy khirurgii,
Demchenko Vitaliy Ivanovich
Demchenko V.I. An assistant of the faculty therapy chair of SBEE HPE “Nizhniy Novgorod State Medical Academy”.
Kukosh M.V. MD, professor, a head of the faculty therapy chair of SBEE HPE “Nizhniy Novgorod State Medical Academy”.
Kolesnikov D.L. An assistant of the faculty therapy chair of SBEE HPE “Nizhniy Novgorod State Medical Academy”.
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