Otchychenko V. Operations with primary anastomosis at surgical treatment of obstructive ileus of distal colon.

Object of the study: obstructive ileus (OI) of the distal colon with a tumour genesis. Purpose of the study: to improve the results of primary-restorative operations (PRO) in OI with the tumour genesis by increasing the reliability of interintestinal anastomosis and correction of regional blood flow disturbances. Methods of the investigation: clinical, laboratory, roentgenological and rheographic methods, a retrospective analysis of case histories of operated patients with processing of the research results using methods of variational statistics. Theoretical and practical results: the suggested tactics for surgical treatment of patients with OI of the distal colon makes it possible to objectify and broaden indications for making PRO. The devised technique of intestinal lavage and decompression contributes to a higher reliability of the anastomosis and a lower rate of postoperative complications and lethality. Novelty: for the first time, the state of the regional haemodynamics in the adducting and abducting portions of the anastomosed intestine during the operation and in the dynamics of the postoperative period in patients with OI of the colon was studied with help of tetrapolar intracavitary rheography. For the first time, microcirculation disturbances in the region of the anastomosed tissues were revealed; they manifested themselves with a reduced arterial inflow, a difficult venous outflow against a background of a spasm of the microcirculation vessels, more expressed in the suprastenosed portion of the colon. A dependence of microcirculation disturbances in the region of interintestinal anastomosis was found: a reduced arterial inflow and an increased peripheral resistance of the microcirculation vessels as the intra-abdominal pressure increased. On the basis of the obtained data, a method for increasing the reliability of interintestinal anastomosis during PRO in patients with OI of the colon was grounded; it includes the formation of an invaginated anastomosis on a tube, intraoperative and postoperative lavage, postoperative decompression of the colon and a prolonged epidural blockade. Degree of introduction: materials of the researches are used in the educational process at the Department of Oncology and Oncogynaecology of Kharkiv Medical Academy of Postgraduate Education. Sphere of application: medicine, surgery.