Вплив неспроможності анастомозу на результати хірургічного лікування колоректального раку (огляд літератури)
DOI:
https://doi.org/10.30978/SU2019-2-92Ключові слова:
колоректальний рак, неспроможність анастомозу, чинники ризику, канцер‑специфічна виживаність, інтраопераційна діагностикаАнотація
Неспроможність анастомозу — одне з найсерйозніших ускладнень в абдомінальній хірургії. Це ускладнення є основною причиною смерті пацієнтів у хірургії колоректального раку. При цьому вирішення питання про методи профілактики неспроможності колоректального анастомозу є актуальним напрямком в сучасній онкоколопроктології. За різними даними, частота неспроможності анастомозу при раку товстого кишківника становить 3 — 7 %, при раку прямої кишки — 13 — 18 %, при цьому післяопераційна летальність варіює від 1до 27 %. Розкид даних щодо частоти неспроможності анастомозу та летальності внаслідок цього ускладнення можуть бути зумовлені різними чинниками, зокрема неоднорідністю груп пацієнтів, залучених у дослідження, відмінностями в хірургічній техніці й періопераційному веденні хворих, різним визначенням неспроможності анастомозу. Це ускладнення є незалежним предиктором погіршення загальної та канцер‑специфічної виживаності. Ризик розвитку неспроможності може бути зумовлений функціональним статусом хворого, характером захворювання, видом хірургічного втручання та іншими чинниками. Стратифікація пацієнтів за чинниками ризику розвитку неспроможності анастомозу дає змогу прогнозувати виникнення цього ускладнення і визначити оптимальну тактику лікування в конкретному випадку. Рання діагностика неспроможності анастомозу має вирішальне значення для успішного результату лікування та зниження показників летальності. Нині не існує загальновизнаних, стандартизованих і ефективних періопераційних чинників ризику розвитку цього ускладнення. Актуальним є пошук оптимальної тактики діагностики та лікування неспроможності анастомозу.
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