Optimization of surgical treatment and prevention of development of acute adhesive small bowel obstruction
DOI:
https://doi.org/10.11603/2414-4533.2020.2.10760Keywords:
acute adhesive small intestinal obstruction, laser Doppler flowmetry, microcirculation, minimally invasive interventionsAbstract
The aim of the work: to improve the results of treatment of patients with acute adhesive small bowel obstruction by improving the therapeutic and diagnostic tactics and developing methods for the prevention of complications and recurrence of the disease.
Materials and Methods. The analysis of observation of 226 patients with acute intestinal obstruction was performed. 111 patients with acute adhesive small bowel obstruction were operated on. All patients were divided into control and main groups: the control group included 57 patients (31 patients wereoperated – laparotomically, 26 patients – laparoscopically); to the main – 54 (26 patients were operated laparotomically, 28 – laparoscopically).
Clinical studies were performed in three stages. To analyze the state of systemic microcirculation and mechanisms of regulation of microcirculatory flow, laser Doppler flowmetry was performed on a single-channel “LAKK-02” laser microcirculation analyzer. The examinations were performed before surgery, during surgery and for 3 days postoperatively. The survey evaluated baseline microcirculation and amplitude-frequency spectrum of blood flow oscillations.
Results and Discussion. During laser Doppler flowmetry, the nature of changes in perfusion and its regulation before surgery was dependent on the stage of the pathological process. Decreased shunting rates before surgery, impaired tissue filling, and decreased body temperature at the end of surgery indicate the possibility of developing complications in the postoperative period.
The use of minimally invasive technologies showed a decrease in microcirculation disturbance. The duration of surgery was reduced by half, the recovery of motor-evacuation function of the intestine came in the first day of the postoperative period, compared with the second–third days when using traditional technologies, the postoperative period decreased by 3.5 days.
The use of Defensal and Tsitoflavin in the treatment of patients with acute adhesive small bowel obstruction allowed to reduce the time of recovery of the motor-evacuation function of the intestine in the postoperative period, to reduce the number of complications and to reduce the stay of patients in the hospital by 1–2 days, and overtime, selected surgical technique.
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