ULTRASOUND DIAGNOSIS OF COMPLICATIONS IN THE EARLY POSTOPERATIVE PERIOD IN PATIENTS AFTER IMPOSITION OF COLON ANASTHOMOSIS
Purpose of the study. Investigate the possibility of using ultrasound in the early postoperative period to identify complications in patients after the imposition of colon anastomoses.
Methods. 183 patients who underwent surgery with the imposition of primary continuous two-line СA on the left parts of the colon were treated. With suspicion of anastomosis failure from this group examined 75 (40.9%) patients, which are divided into 2 groups, depending on the inability of СA: 1 group - 32 patients with recorded failure of СA - median age of patients - 65 (57; 75) years, group 2 (control) - 43 patients, without inability to anastomosis, (median age of patients - 63.5 (58.5; 70.5) years.
Results. The most reliable ultrasound signs of CA failure were the presence of gas outside the intestinal lumen, which was observed in 9 (28.1%) patients of group 1 on the 3rd day and 5 (15.6%) - on the 7th day after surgery, and also the presence of fluid formation in the area of CA in 6 (18.8%) and 12 (37.5%) patients, respectively. Both of these ultrasound signs were absent in patients of group 2. Restoration of intestinal peristalsis in the area of CA at its capacity was also significantly more frequent and earlier, which was found in 14 (32.5%) patients of group 2 on the 3rd and in 29 (67.4%) patients on the 7th day after surgery, respectively, while in the inability of СA this sign on the 3rd day, was not observed in patients of group 1, and on the 7th was registered only in 7 (21.9%; χ2 = 31.2; P < 0.05) patients. Thus, ultrasound signs of СA failure on day 3 were found in 15 (46.8%) patients of group 1, 8 (53.4%) of whom were treated conservatively, 7 (46.6%) patients required changes in treatment tactics. These patients underwent 2 relaparotomies for peritonitis, 3 removal of colostomy from the mini-access, 2 puncture drainage of fluid accumulation under ultrasound control. On the 7th day in 4 (53.1%) patients, 13 (76.5%) of whom were treated conservatively, 4 (23.5%) patients required changes in treatment tactics, respectively. These patients underwent 3 removal of colostomy from mini access, 1 puncture drainage of fluid accumulation under ultrasound control.
Conclusion. Early diagnosis of complications allowed to change the tactics and scope of intensive care to prevent further complications. Ultrasound patients in the early postoperative period allows to detect signs of failure of СA in 46.8% of patients on the 3rd day and is the basis for correction of treatment tactics in 46.6% of these patients and 53.1% of patients on the 7th day, which led to change the tactics of treatment in 23.5% of them, respectively. Timely diagnosis of early signs of anastomosis failure allows to predict the further course of the disease, which reduces the number of complications and the severity of their course.
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