Kondratiuk O. Optimization of surgical treatment tactics in patients with perforation of colon tumors

This dissertation is dedicated to the improvement of the immediate and distant results of treatment of the patients with colon perforations caused by various complications. Namely pericolonic abscesses and diverticula perforations in patients with colon diverticulosis disease. Furthermore, similar complications are accounted for in patients with foreign objects colon perforations. However, the predominant reason for perforations are malignant tumors of the colon, since the overall morbidity with colon cancer has increased significantly as of late decades. About 60 % of oncology patients are admitted to the non-specialized surgical departments due to the complications that require an urgent surgical intervention. Diagnostic and tactical error frequency in such circumstances vary between 63.2 to 94.9 % [12, 121, 122]. Major factors for unsatisfactory treatment results of complicated colon cancer are related to the general condition of the patient and limited time for accolading treatment tactics. Besides, it is necessary to eliminate the source of peritonitis and solve the issue as to the feasibility of one-stage or double-stage colon integrity renewal. It is important to select such type of primary surgery that would facilitate the upcoming restoration surgery. There is also a topical problem of the surgical rehabilitation of the patients following the radical surgery with unnatural anus. Methods that facilitate returning of the patients to active way of living and work, specifically surgical methods, are not enough developed. The trial was conducted in two stages and based on studying the results of surgical treatment of 124 patients with colon perforation at the ages from 26 to 80 years. First stage comprised analyzing the treatment results in 58 patients that were urgently admitted to the hospital with peritonitis symptoms. 41 (70.6 %) of these patients had colon tumor with dehermetized paracolonic abscess, and in 17 (29.3 %) patients the source of peritonitis was caused by a distant rupture of the caecum in turn caused by tumor obstruction of the left part of the colon. Surgeries applied were divided in two groups: primary anastomosis formation and unnatural anus shaping. Second stage of the trial comprised analyzing the results of reconstructive-restorative surgeries conducted on 66 patients. Of these, 39 (59 %) patients underwent surgery in this hospital, and 27 (40.9 %) underwent colostomy in other hospitals. Also highlighted among these are 44 patients (66.6 %) of the main group who underwent renewal of intestinal integrity taking into account an inflammation in the colon stump using the pre-surgery preparation technique improved by us (Ukraine patent # 129149) [52] with ensuing surgey. Comparison group included 22 (33.4 %) of the patients which underwent pre-surgery preparation without considering inflammatory changes in the colon stump, which was prepared by cleansing enemas. To evaluate the efficacy of the worked out treating techniques, the quality of life were studied by the specialized questionnaire GIQLI (Gastrointestinal Quality of Life Index). Clinical, laboratory, radiology, instrumental, bacteriology and statistics methods of investigation were used in the trial.