Analiza hirurških metoda rešavanja crevne opstrukcije uzrokovane zloćudnim tumorima rektosigmoidnog dela debelog creva
Analysis of surgical procedures in the treatment of obstructive rectosigmoid cancer
Докторанд
Resanović, Vladimir R.Ментор
Krstić, SlobodanЧланови комисије
Karamarković, AleksandarŠijački, Ana
Mitrović, Mihajlo M.
Метаподаци
Приказ свих података о дисертацијиСажетак
Cilj rada: Odrediti adekvatnu metodu (Hartmann-ova procedura vs. bipolarna
kolostomija) za rešavanje crevne opstrukcije koja je prouzrokovana zloćudnim
tumorima rektosigmoidnog segmenta debelog creva. Pratiti pojavu hirurških i
nehirurških komplikacija, kao i potrebu za transfuzijom krvi i ishod lečenja.
Metoda rada: Studijom je obuhvaćeno ukupno 120 ispitanika, koji su operisani
dvema različitim tehnikama, metodom bipolarne kolostomije i Hartmann-ovom
procedurom. Svi ispitanici su randomizovani u četiri odgovarajuće grupe, shodno
godinama života i ASA skoru. Određivana je incidenca hirurških i nehirurških
komplikacija, kao i potreba za transfuzijom krvi i njena količina. Takođe, opserviran
je i ishod lečenja, odnosno praćen je intrahospitalni mortalitet (preživljavanje).
Rezultati: Ispitivanjem nije dobijena statistički značajna razlika u pojavi hirurških i
nehirurških komplikacija kod pacijenata operisanih dvema tehnikama. Takođe, nije
registrovana statistički značajna ra...zlika u preživljavanju u funkciji primenjene
hirurške strategije. U pogledu ishoda lečenja, konstatovano je da uticaj na mortalitet
ima pojava nehirurških komplikacija, kao i visoke vrednosti ASA skora. Hirurške
komplikacije takođe imaju uticaj na preživljavanje (intrahospitalni mortalitet).
zaključak koji se nameće je da su obe ove procedure dovoljno sigurne, sa gotovo
jednakim rezultatima lečenja i stopom komplikacija. Nijedna od ove dve metode se u
tom smislu ne nameće kao superiorna u odnosu na onu drugu. Međutim, u slučaju
značajne distenzije creva tehnički je primerenija metoda bipolarne kolostome.
Bipolarna kolostomija u odnosu na Hartmann-ovu proceduru ima prednost u činjenici
da je nakon kreiranja bipolarne kolostome rešen problem crevne distenzije i da se na
drugoj definitivnoj hirurškoj proceduri može imati bolji onkološki pristup. Mana je
svakako što je neophodna druga hirurška intervencija, za koju ne mogu biti
pripremljeni svi pacijenti u tako kratkom vremenskom roku, pa se kod takvih primena
Hartmann-ove procedure sa uklanjanjem tumora čini kao onkološki prihvatljivije
rešenje.
Objective: To determine the appropriate method (Hartmann's procedure vs. bipolar
colostomy) for the solution of bowel obstruction caused by malignant tumors of
rectosigmoid colon. Monitor the occurrence of surgical and nonsurgical
complications, and the need for blood transfusion and outcome.
Method of work: The study included 120 patients, who were operated on two different
techniques, using bipolar colostomy and Hartmann's procedure. All subjects were
randomized into four corresponding groups, according to age and ASA score. We
examined the incidence of surgical and nonsurgical complications, and the need for
blood transfusion and its quantity. Also, the outcome of treatment was monitored, as
well as intrahospital mortality ( the rate of cummulative survival).
Results: The study showed that there was no statistically significant difference in the
occurrence of surgical and nonsurgical complications in patients operated by two
techniques. Also, it didn’t find statistically... significant differences in survival as a
function of applied surgical strategy. In terms of outcome, it was concluded that there
is impact on mortality from emerging nonsurgical complications, as well as the high
value of the ASA score. Surgical complications also have an impact on survival
(hospital mortality). The conclusion that emerges is that both of these procedures are
safe enough, with almost equal treatment outcomes and complication rate. Neither of
these two methods is superior to the other. However, in the case of significant bowel
distension bipolar colostomy is technically more appropriate method. Bipolar
colostomy compared to Hartmann's procedure has the advantage in the fact that
creation of bipolar colostomy solved the problem of intestinal distension and on the
second definitive surgical procedure surgeon can have better access to oncology. The
downside is that second surgical procedure is necessary, and some patients can not be
ready for next procedure in such a short period of time. In cases like this, the
application of Hartmann's procedure with removal of the tumor seems like better
solution.