Профилактика несостоятельности тонкокишечного анастомоза в условиях перитонита (экспериментальное исследование)

Abstract

Background. The problem of development of postoperative complications after operations on the organs of the gastrointestinal tact is extremely important. Failure of intestinal suture, formed in the presence of peritonitis develops from 2.8 to 32 % of patients. Aim. To improve immediate outcomes in the formation of a small intestine anastomosis in conditions of purulent peritonitis. Materials and methods. We conducted immunohistochemical examination of biopsy specimens of the small intestine of 20 patients died of peritonitis and compared the area of the vascular bed in different types of intestinal wall section. The experimental operations were performed in 100 Wistar rats. On the background of established models of peritonitis we performed different variants of small bowel anastomosis, including one with the use of photodynamic therapy. On the 6th day after the surgery, animals were sacrificed, and histological examination of the anastomoses was conducted. Results. Suture strip in the section of the small intestine made at the angle of 60° is supplied substantially better than in the section made at the angle of 90°. The experiment confirmed that the suggested method of anastomosis showed the best results. Conclusion. When one forms the end-to-end anastomosis in the small intestine in conditions of purulent peritonitis, it is reasonable to cross the intestinal wall at the angle of 60° and to perform photodynamic therapy on the formed anastomosis.