Uglyar T. Optimization of surgical treatment in patients with bowel obstruction

The thesis is devoted to clarify the features of surgical treatment for patients with colonic obstruction, the development of intraoperative criteria for the diagnosis of condition of the colon, aimed at determining the feasibility of the primary radical and one-stage reconstruction surgery. There was found that in experimental colonic obstruction in the wall of the colon on 3-7 days, there are significant vascular disorders, degenerative and necrobiotic changes in the structural elements, infiltrative processes, that are characterized by a significant increase in the level of endothelial dysfunction, the relative amount of damaged epithelial cells and endothelial cells of small-caliber arteries (the average of 18.3 times). The complex assessment of endothelial dysfunction in patients with bowel obstruction was carried out by the number of desquamated endothelial cells in blood taken from cubital and afferent colonic loop veins. On this basis the intraoperative diagnostic criteria of condition of the colon were developed. The influence of endogenous intoxication on the frequency of postoperative complications and the endurance of hospital stay in patients, operated on colonic obstruction was proved. The indications for the primary radical and primary one-stage reconstruction surgery were formed.