Voloshyn S. Prophylaxis and treatment of the necrosis of the lowered intestine after sphincter-saving operations in patients with colorectal cancer

The object of the investigation is patients, suffering from colorectal cancer (CC), who have acquired necrosis of reduced intestine (NRI) during the post-operational period. The objective of the investigation is to improve the efficiency of treatment of patients with CC by means of prevention of NRI development and optimization of the tactics of correction of that complication, the prescribed methods include clinical methods, tool methods (endoscopic, X-ray application, ultrasonic), laboratory, and statistical methods; the novelty of investigation and its results lie in the fact that for the first time the influence of the fact of preservation of inner-wall arterial blood provision of the large intestine (LI) upon the level of crossing jejunoileal intestine in the distal direction by 20-40mm was investigated and it gave an opportunity of making reliable evaluation of sufficient blood provision to the LI transplant in case of presence of a pulsing flow of arterial blood from the foundations of ablated fat suspenders, located on one axis at the distance of 10-20mm from each other. For the first time the fact of possibility NRI development due to pressing and bending of the remains of RI from the side of the perineum was investigated. Proved for the first time was a possibility of reinsertion of a transplant from the perineum, and factors, affecting development of repeated stenosis of coloanal joint, particularly, not sufficient area of skin to be removed, development of ischemic changes inside pieces of skin during various kinds of plastic operations that presume skin cutting at sharp angles. It was proved that one of the factors worsening the lives of patients with NRI was application of a standard model of fecal receiving box. It was also revealed that that one of the major reasons that deteriorate the quality of lives of patients with NRI after operations was development of big post-operational ventral hernias, it leading to a necessity of application of repeated operational invasion and limitation of physical activity. A set of measures has been developed to reduce the rate of NRI. The tactic of treatment of NRI is optimized depending on the time it appeared and on the level of necrosis. The use of the developed tactics allowed reducing (p<0,05) the risk of postoperative complications of this category of patients in comparison with the previously used technique (the period from 1990 till 1999). Thanks to the use of the developed treatment tactics, there was twice decrease in postoperative mortality – from 12.5 ± 2.5 % to 6.2 ± 2.5 %. The use of 3-step prophylaxis of NRI with the simultaneous use of the worked out complex of preventive measures allowed reducing the risk of the necrosis development of the lowered intestine by 3.7 times. It was found that an excellent, good, satisfactory and relatively satisfactory of life quality of patients with rectal cancer with NRI while treatment with the worked out technique was noticed on 80.9 ± 4.2 % of patients (in the control group – 59.1 ± 4.0 % patients) (p <0.001). The results were implemented into practical work of Mariupol City Inter-district Dispensary CTPI, City Oncologic Dispensary of Kramatorsk; it was also implemented into the process of tuition of Donetsk National Medical University. The application branch is the process of treating and diagnosing at oncologic departments, tuition and pedagogical processes of departments of oncology of educational institutions.