Merkulov A. Prophylactics of postoperative complications of resection of rectum.

This thesis relates to the problems of improving the surgical treatment of patients with volumetric nasogenesis of the rectum. The study is based on an analysis of the results in the survey of 120 patients with volumetric nerve formation of the rectum who were divided into 2 groups: the main group, comprising 59 patients and a comparison group, consisted of 61 patients. In the Main group of patients, the treatment included the use of techniques used in institute GU "IOUG named after V.T. Zaitseva of the National Academy of Sciences of Ukraine" techniques with formation of three ampulas in colonic reservoir. In the Comparison group, the treatment was performed according to the traditional method, with the anastomosis involving completed end to end without reservoir formation. Based on the main clinical indicators, including gender, age, history, etc., the patients of the groups were comparable, which indicated the representativeness of the groups and the studies conducted in them. It has been established that the main causes of unsatisfactory results of anterior rectal resection in the immediate postoperative period is due to the development of inconsistency of the anastomosis sutures caused by insufficient drainage from the anastomosed zone, as well as inadequate antibacterial therapy. It is proved that the optimal way of drainage of the anastomosed zone is the flow drainage "from two points", which provides a sufficient drainage function with insignificant material costs. The study of the viability of the intestinal wall in the experiment revealed characteristic changes occurring in it, depending on the values of the ratio of voltage drop at frequencies of 100 and 100 000 Hz, which can be used in clinical practice to determine the degree of impaired blood supply to the intestinal wall. A technique for resection of the rectum with the creation of a three ampular tank has been developed, which significantly improves bowel function after low rectal resection. The use of developed tactics for rectal resection reduced the number of complications in the immediate postoperative period from 19.7 to 10.2% and improved long-term results, increasing the overall adaptation of patients from 80,0 to 89,6%.