«Risks and Сhances» of Development of Adverse Events at Treatment of Enteric Fistula

Abstract

Relevance. The basis of a solution of the problem of treatment of enteric fistula is made by the termination of current of contents on the formed pathological course. For this purpose use sandostatin or its analogs which efficiency needs objectification and statistical justification.
 Purpose: to define possibilities of a method of mathematical modeling of risk and weighing of chances at assessment of emergence of an adverse event during a disease depending on a way of treatment of enteric fistula.
 Materials and methods. Results of treatment of 65 patients with enteric fistula who were in a surgical department of hospital of N.A. Semashko of Yaroslavl during the period from 1988 to 2017 are analyzed. At treatment of 41 patients we adhered to traditional tactics. Sandostatin was included in a complex of therapeutic measures at 24 people. For identification of predictive value of clinical symptomatology, clinical laboratory indicators of blood, urine and haemo biochemical parameters carried out the statistical analysis according to Friedman of 352 options 112 of the estimated variables. At the same time assessment procedure of risk and weighing of chances of emergence of such events, adverse events as need of an operative measure for elimination of fistula (the first model) and a lethal outcome (the second model) is realized.
 Results. On each of three investigation phases from 27 to 55 determined parameters indicating a high probability of the fact that against the background of use of traditional medical measures carrying out operation with the purpose of treatment of fistula is required are revealed. The quantity of the indicators connected with use of an octreotide at the first two investigation phases was minimum, and by 28 their days did not become at all that testified to high performance of the used means excluding need in a surgical grant during the entire period of observation. At the second statistical model in the conditions of traditional tactics throughout all research the number of parameters was notable higher. Meant it that the practiced complex of treatment of an intestinal fistula was ineffective. When using an octreotide total number of the integrated signs at the first and second investigation phases was minimum, and to the third stage of observation of similar parameters did not become at all that indicated high performance of treatment of enteric fistula, excepting the predicted risk of a lethal outcome.
 Conclusion. The technique of statistical modeling allows to reveal well-being of medical process concerning enteric fistula. The mathematical analysis which is carried out at the same time gives the chance to define significantly changing variables. Unlike traditional tactics at early operational stages of an octreotide chances of development of adverse events decrease, and need of surgical intervention is completely leveled later and the probability of a lethal outcome decreases that correlates with clinical effectiveness of the practiced measures (reduction of lethality by 2.5 times).