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dc.contributor.authorКравченко, Сергій Павлович-
dc.contributor.authorКравченко, Сергей Павлович-
dc.contributor.authorKravchenko, S. P.-
dc.identifier.citationКравченко С. П. Спосіб оптимізації хірургічного лікування хворих з хронічною анальною тріщиною / С. П. Кравченко // Вісник проблем біології і медицини. – 2015. – Вип. 4, Т. 2 (125) . – С. 266–269.uk_UA
dc.identifier.otherУДК 616.352-001.4-002.2-089-
dc.description.abstractЗапропоновано спосіб оперативного лікування хронічної анальної тріщини, який передбачає за допомогою апарата радіохвильової хірургії (інструмент – електрод-петля, режим – різання-коагуляція) економне видалення анальної тріщини з гіпергрануляціями. За допомогою апарата радіохвильової хірургії виконується коагуляція дна рани, завдяки чому коагулюються поверхневі шари м’язів анального жому, що призводить до ослаблення тонусу останнього. Пластику ранової поверхні клаптем слизової – не проводимо. Даний спосіб, у порівнянні з відомими, виявив такі переваги, як: зменшення травматизації тканин (не накладаються шви), підвищення швидкості загоєння рани, відсутність гнійно-некротичних ускладнень рани, відсутність явищ інконтиненції; Предложен способ оперативного лечения хронической анальной трещины, предусматриваю- щий с помощью аппарата радиоволновой хирургии (инструмент – электрод-петля, режим – резонно-коагуляция) экономное удаление анальной трещины с гипергрануляциями. С помощью аппарата радиоволновой хирургии выполняется коагуляция дна раны, благодаря чему коагулируются поверхностные слои мышц анального жома, что приводит к ослаблению тонуса последнего. Данный способ, по сравнению с известными, выявил следующие преимущества: уменьшение травматизации тканей (не налагаются швы), повышение скорости заживления раны, отсутствие гнойно-некротических осложнений раны, отсутствие явлений анальной инконтененции; Treatment of patients with chronic anal fissure has a long history. This is due to the fact that the proportion of anal fissures among diseases of the colon is 11-15% and the incidence ranges from 20 to 23 people per 1 Open adults [2]. In healthcare, this issue has great social significance, since the fissures are affected mainly persons young and middle age, that is the most workable of the population. The high prevalence of the disease and the urgency of the problem led to a large number of different treatments. Yes, W. P. Mazier counted 32 combinations of surgical treatment of anal fissures. Not in all cases, these methods have pathogenetic basis, which explains the high frequency of adverse outcomes. Despite the progress in understanding the pathogenesis of anal fissure, establishing a significant role in this process spasm of internal sphincter and ischemia anodermy results of treatment of anal fissures still can not be considered satisfactory [3,6]. Conservative treatments, including the most advanced products for medicinal internal sphincter relaxation, only slightly higher than placebo performance [1,4]. The frequency of relapses during the first year after treatment, can reach 33% [2,7,9]. The reasons for such a high rate of relapse is the development of tolerance to organic nitrates action [8,9] and stored in the anal canal scar and inflammatory changes such as patrol mound, hypertrophied anal papilla, cracks scar edges [3,8]. Therefore, the main treatment of chronic anal fissure is surgery. Among them, the «gold standard» is excision of anal fissure combined with lateral subcutaneous sfinkterotomia. Despite compelling evidence advantages over lateral subcutaneous sfinkterotomia devulsion anal sphincter and back sfinkterotomia [7], in the long term after surgery recurrence rate can reach 11.7%, and the incidence of anal incontinence – 35.1%. Attempts to improve outcomes led to a large number of modifications of this operation, when the length of the proximal edge sfinkterotomia limited to anal fissure. The use of these techniques has reduced the incidence of anal incontinence to about 10%. But even perfect technique would not be sfinkterotomia performance, it is surgery, which leads to irreversible damage to apparatus for close the rectum with all the ensuing consequences. Objective: to improve the outcomes of patients with chronic anal fissure. Materials and methods. The research is based on studying the results of treatment 33 patients with chronic anal fissures for the period from 2014 to 2015 Patients were divided into 2 groups. The first group (18 patients) included patients operated on by traditional techniques: excision of anal fissure dosage of sfinkterotomia in place mucosal defect. Surgery was performed in a hospital under spinal anesthesia. Patsyentam second, the main group (15 patients) performed an operation on its own technique on an outpatient basis under local anesthesia in the volume excision of anal fissure using radio wave surgery device. The advantages of the proposed method is that due to the physical properties of radio waves practically not injured underlying tissues, while the removal of tissues is their coagulation, reduced blood loss, sterilizing effect of high temperature prevents the development of inflammatory complications, achieved the effect of anesthesia (achieved concomitant coagulation nerve endings in wound). Description methods. In terms of local anesthetic 0.5% solution lonhokayin perianal areas, adrectal fiber and anal canal, using radio wave surgery device (tool – electrode-loop mode – cutting-coagulation) economically removed from hypergranulation anal fissure. Using device radio wave surgery performed coagulation bottom of the wound, so coagulation superficial layers of the muscles of the anal sphincter, leading to a weakening tone latter. Plastic wound surface mucosa graft – no wires.Results and discussion. Evaluation of clinical results conducted on the duration and intensity of postoperative pain, time and nature of the exudation, the presence of inflammatory complexities, the presence or absence of relapse of chronic anal fissure. In two (main) group in the early postoperative period (within 1-2 days) 86% of patients have noted a rapid reduction of pain in the anus (in 1 group – 62%). This most celebrated of them moderate perianal swelling with a tendency to eliminate (3-4 day). This group observed significantly less pronounced wound exudation, which was of serohemorrhagic nature. In 1 group in 10.7% of patients experienced purulent exudate character that was treated as a festering wound treatment needed correction with the longer recovery periods. In group 2 inflammatory complications were observed. Terms after operation wound healing in group 2 patients were lower by an average of 2-4 days. Galway phenomena partial incontinence or gases in group 1 patients in the postoperative period observed in 3.9% of cases, patients 2 (the main group) – was observed. The average length of stay of patients in one hospital was 11 days. Patients treated with outpatient group 2, indicating that significant economic benefits of the proposed treatment. Conclusions. 1. The advantage of the proposed method is that due to the physical properties of radio waves, practically subordinate injured tissue. Due to this, more controllable depth exposure to the fibers of the anal sphincter. 2. Simultaneously with the removal of tissues is their coagulation, reduced blood loss, high temperature sterilizing action prevents the development of inflammatory complications of anesthesia effect is reached (achieved coagulation concomitant nerve endings in the wound). 3. The phenomena or partial incontinence Galway gases in group 1 patients in the postoperative period observed in 3.9% of cases, patients 2 (the main group) – was observed. 4. This method can effectively treat patients with chronic anal fissures outpatient basis.uk_UA
dc.publisherВищий державний навчальний заклад України "Українська медична стоматологічна академія".uk_UA
dc.subjectхронічна анальна тріщинаuk_UA
dc.subjectрадіохвильова хірургіяuk_UA
dc.subjectхроническая анальная трещинаuk_UA
dc.subjectрадиоволновая хирургияuk_UA
dc.subjectchronic anal fissureuk_UA
dc.subjectradiowave surgeryuk_UA
dc.titleСпосіб оптимізації хірургічного лікування хворих з хронічною анальною тріщиноюuk_UA
dc.title.alternativeСпособ оптимизации хирургического лечения больных с хронической анальной трещинойuk_UA
dc.title.alternativeOptimization of surgical method treatment chronic anal fissureuk_UA
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