Intensive therapy in patients with scar strictures of the esophagus
The proposed medical tactics and intensive therapy of scar strictures of the esophagus we represent in this article. The causes of their occurrence: burns in the esophagus, surgical interventions on the esophagus, reflux esophagitis, and malignant genesis – esophageal cancer. A considerable part of patients with scar strictures of the esophagus is hospitalized at later stages of the stricture: with 4th and 5th degrees of obstruction. This leads to increasing of the number of exhausted patients and neglected cases, that contributes to increasing of levels of postoperative lethality and complications.
The sults of surgical treatment of 116 patients with esophageal strictures at the period of 2003–2017 were analyzed. We used a logistic regression method to determine the risk factors for postoperative complications. It was established that the risk increases significantly with the presence of technical difficulties during operation, diabetes mellitus, blood plasma albumin levels less than 25 g/l, complete obstruction of the esophagus. The proposed program of treatment of patients with scar strictures of the esophagus reliably reduces the risk of postoperative complications. The diagnostic algorithm, the program of treatment of patients with preoperative infusion therapy and parenteral nutrition with “all in one” system were applied in patients of the main group. Due to the treatment program and intensive therapy, the number of postoperative complications has decreased from 27,27% to 12,0%, and mortality – from 6,06% to 2,0%.
Boyko VV. Etapni operatyvni vtruchannia pry stenozuiuchykh zakhvoriuvanniakh stravokhodu (Staged surgical interventions for stenotic diseases of the esophagus). Kharkivska khirurhichna shkola. 2010;60(3):31–3. (In Ukrainian)
Zynherenko VB. “Vse v odnom” – ynnovatsyonnaia tekhnolohyia polnoho parenteralnoho pytanyia (“All in One” - an innovative technology of full parenteral nutrition). Medytsyna neotlozhnыkh sostoianyi. 2010;29(4):21–7. (In Russian)
Kachmar VM. Rozryvy stravokhodu, mediastynit – indyvidualnyi pidkhid u likuvanni (Gastric esophagus, mediastinitis - an individual approach to treatment). Shpytalna khirurhiia. 2016;1:116–7. (In Ukrainian)
Chernousov AF, Ruchkin DV, Chernousov FA, Kebedov MM. Opyt povtornoi ezofagoplastiki (The Experience of Re-Esophagoplasty). Chirurgiya. 2005;(5):14–9. (In Russian)
Movchan BB. Profilaktika nesostoiatelnosti shvov pishchevodno-organnykh anastomozov pri ezofagoplastike (Prevention of insolvency of seams of esophageal-organ anastomoses in esophagoplasty). Clinical surgery. 2005;11. (In Russian)
Savvi SA. Individualizirovannoe khirurgicheskoe lechenie iatrogennykh razryvov pishchevoda posle khimicheskikh ozhogov (Individualized surgical treatment of iatrogenic ruptures of the esophagus after chemical burns). Kharkivska khirurgchna shkola. 2006;1(20):73–4. (In Russian)
Rachmetov NR, Zhetimkarinov DS, Khrebtov VA. Khirurgicheskoe lechenie sochetannykh striktur pishchevoda i zheludka (Surgical treatment of combined strictures of the esophagus and stomach). Surgery. 2003;11:17–9. (In Russian)
Stoica AL, Bordos D, Miculit F, Pantea S, Vîşcu S, Oniţa M. [Benign esophageal strictures--outcomes of coloesophagoplasty in Surgical Clinic II Timişoara]. Chirurgia (Bucur). 2004 Nov-Dec;99(6):507-13.
Dantas RO, Mamede RC. Motility of the transverse colon used for esophageal replacement. J Clin Gastroenterol. 2002 Mar;34(3):225-8.
Ferguson DD. Evaluation and management of benign esophageal strictures. Dis Esophagus. 2005;18(6):359-64.
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