The experience of the tread colostomy resection of the rectum in patients with colorectal cancer
Science Articles / / August 12, 2017
Yaik NA, Vasiliev SV, Avanesyan GR, EM AEState Medical University.Acad.Pavlov,
Chair of Surgical Diseases with the course of Coloproctology (Head. Department of. Acad. Of Medical Sciences prof. Yaitsky NA)
As an independent kind of surgery, ileostomy has more than 100-year history.In recent years, much attention is paid to the quality of life of cancer patients after undergoing radical surgery.Especially urgent this problem is presented in Coloproctology, where the frequency of colorectal cancer increases significantly.Due to the wide spread of circular staplers, allowing to carry out low resection of the rectum, has significantly increased the number of sfinkterosohranyayuschih operations.However, this type of surgery is associated with a number of complications, primarily generated by colorectal anastomosis.In this regard, relevant questions steel protective intestinal stomas.
Objective: To summarize the existing experience of protektivnoi ileostomy, and to prove the feasibility of using this
Materials and Methods: From 1997 to 2003, in the city center coloproctological operated patients with colorectal cancer who underwent a "low" anterior resection of the rectum with the hardware or manual imposition protektivnoi anastomosis and ileostomy for Tornbollu.
Indications for application ileostomy:
1) technical difficulties in mobilizing tumors of the rectum;
2) complexity in the formation of colorectal anastomosis;
3) formed colonic J -rezervuar;
4) the location of colorectal anastomosis below 5 cm from anokutannoy line;
5) positive test for tightness of the anastomosis;
6) severe concomitant diseases that may affect the viability of colorectal anastomosis.
ileostomy closure period is an average of 1 to 2 months, and depend on a number of factors: first of all, on the condition of colorectal anastomosis, presence paraileostomicheskih complications, the general condition of patients.In addition to general clinical examination methods are necessarily endoscopy anastomosis, rentgenoproktografiya using water-soluble contrast agent.
results.The failure of colorectal anastomosis occurred in 4 patients (5.0%) that did not require additional surgical interventions, taking into account the nature of the discharge ileostomy.They held conservative therapy: washing through retrorektalny drainage, micro enema, antibiotic therapy.Later in 2 patients who have had prior to the failure of the semicircle of colorectal anastomosis, there was his strictures.These patients before closing the ileostomy was performed probing anastomosis.
One patient (1.25%) for 7 days after primary surgery paraileostomichesky developed an abscess, cellulitis anterior abdominal wall, spilled purulent peritonitis.The patient is made relaparotomy, ileostomy reconstruction, rehabilitation and drainage of the abdominal cavity.In two cases (2.5%) was caused by the need arose relaparotomy mechanical intestinal obstruction due to twisting of the small bowel loops around the ileostomy.To eliminate this complication is made re-laparotomy, the elimination of bloat, ileostomy reconstruction and intubation of the small intestine.At the stage of admission to rekontruktivno-replacement surgery, 5 (6,3%) patients were identified during the inspection peristomalny dermatitis.
In 49 patients (89%) in the reduction of intestinal continuity due to the severity of scar adhesions, resection of the small intestine, the carrier ileostomy, with formation anastomosis " end-to-end" or "side-to-side."In other cases, the anastomosis was formed by 3/4 by Melnikov.Closure ileostomy stoma fringing produced through the incision, but in one case (1.8%) required to perform median laparotomy.Anastomotic leak was not.In 1 patient (1.8%) developed early adhesive intestinal obstruction, which required surgery - laparotomy and division of adhesions.In 3 patients (5.4%) in the early period after the closing of the ileostomy observed phenomenon of paresis of the intestines, which were stopped by conservative methods.operative wound suppuration occurred in 9 patients (16.4%).One patient (1.8%) with severe concomitant cardiovascular disease, long-existing chronic pyelonephritis, chronic renal failure II st., Died on the 6th day after the closing of the ileostomy, amid growing phenomena of renal insufficiency, intoxication, uremia.
1. Formation of protective ileostomy with "low" colorectal anastomosis reduces the risk of anastomotic leak and the severity of its clinical manifestations.
2. Significantly expands the possibility of primary restoration of colonic continuity, especially when using staplers.