Akútna mezenterická ischémia je ochorenie s pomerne nízkou incidenciou (0,02–0,9 % akútnych chirurgických hospitalizácií), ale veľmi vysokou mortalitou, ktorá bez včasnej revaskularizácie môže dosahovať až 100 %. Vzhľadom na vyššie uvedené, promptná, exaktná diagnostika a nasledujúca chirurgická intervencia je základným kameňom liečby a je nevyhnutná na zníženie vysokej úmrtnosti. Včasná revaskularizácia môže znížiť celkovú mortalitu až o 50 %. Liečba akútnej mezenterickej ischémie si vyžaduje spoluprácu gastrointestinálnych chirurgov, angiochirurgov a intervenčných rádiológov. Dôkladné klinické vyšetrenie, kontrastná počítačová tomografia realizovaná vo včasnom štádiu a súčasné možnosti intervenčnej rádiológie sú kľúčom k zlepšeniu výsledkov liečby akútnej mezenterickej ischémie. Touto prácou preto chceme oživiť vedomosti v problematike manažmentu akútnej mezenterickej ischémie a zosumarizovať najaktuálnejšie informácie o diagnostike a liečbe tohto ochorenia.
Acute mesenteric ischemia is a disease with a relatively low incidence (0,02–0,9% of acute surgical hospitalizations) but a very high mortality rate which can reach up to 100% without early revascularization. Given the above, prompt and accurate diagnosis and subsequent surgical intervention is the cornerstone of treatment and essential to reduce the high mortality rate. Early revascularization can reduce overall mortality by up to 50%. Treatment of acute mesenteric ischemia requires the cooperation of gastrointestinal surgeons, vascular surgeons and interventional radiologists. Thorough clinical examination, contrast computed tomography performed at the initial stage, and the current possibilities of interventional radiology are the keys to improving the results of treatment of acute mesenteric ischemia. The purpose of this paper is to refresh knowledge in the management of acute mesenteric ischemia and summarize the most up-to-date information on the diagnosis and treatment of this disease.
- MeSH
- akutní nemoc terapie MeSH
- časná diagnóza MeSH
- lidé MeSH
- mezenteriální ischemie * diagnóza patofyziologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019-October 2020. The mean age of patients was 61 years (lower-upper quartiles 54-69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower-upper quartiles 3.00-4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien-Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.
- MeSH
- anastomóza chirurgická MeSH
- drenáž MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta * chirurgie MeSH
- netěsnost anastomózy MeSH
- pilotní projekty MeSH
- rektum * chirurgie MeSH
- retrospektivní studie MeSH
- sliznice MeSH
- vakuum MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
