surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2019-9-3-171-176surgonco-411Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESИОХВ при формировании колоректальных анастомозов и С-реактивный белок как маркер развития инфекционных осложненийSSI Following Construction of Colorectal Anastomoses and C-Reactive Protein as Marker for Infectious Complicationshttps://orcid.org/0000-0002-4565-7861ГрушевскаяЕ. А.GrushevzkayaE. A.

Грушевская Екатерина Александровна — ассистент кафедры факультетской хирургии

Grushevzkaya Ekaterina Aleksandrovna — Assistant lecturer of the Department of Departmental Surgery

katlen@bk.ruМехтиевН. М.MekhtievN. M.

Мехтиев Намик Мурадович — д.м.н., профессор кафедры факультетской хирургии

Mekhtiev Namik Muradovich — Doctor of Medical Sciences, Professor of the Department of Departmental Surgery

https://orcid.org/0000-0002-5621-8266ГришинаЕ. Е.GrishinaE. E.

Гришина Елена Евгеньевна — к.м.н., доцент кафедры факультетской хирургии

Grishina Elena Evgen’evna — Candidate of Medical Sciences, Associate Professor of the Department of Departmental Surgery

https://orcid.org/0000-0002-6664-1308ТимербулатовМ. В.TimerbulatovM. V.

Тимербулатов Махмуд Вилевич — д.м.н., зав. кафедрой факультетской хирургии

Timerbulatov Makhmud Vilevich — Doctor of Medical Sciences, Professor, Head of the Department of Departmental Surgery

timerm@yandex.ruБашкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian Federation20192011201993171176Copyright © Грушевская Е.А., Мехтиев Н.М., Гришина Е.Е., Тимербулатов М.В., 20192019Грушевская Е.А., Мехтиев Н.М., Гришина Е.Е., Тимербулатов М.В.Grushevzkaya E.A., Mekhtiev N.M., Grishina E.E., Timerbulatov M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/411Введение

Введение. Инфекция области хирургического вмешательства (ИОХВ) достигает 30 % у пациентов после колоректальных операций. Особенностью инфекционных осложнений после колоректальных операций является превалирование глубоких форм ИОХВ, характеризующихся стертой клинической картиной и трудностями в своевременной диагностике. Актуальным является выявление наиболее раннего маркера развития инфекционных осложнений и его порогового значения.

Материалы и методы

Материалы и методы. Проведено проспективное исследование результатов резекции толстой кишки с формированием толстокишечных анастомозов у 135 больных. Пациенты были разделены на 2 группы, в зависимости от способа наложения анастомоза. Исследован уровень С-реактивного белка до операции и на 3, 5, 7-е сутки после операции.

Результаты и обсуждение

Результаты и обсуждение. ИОХВ выявлены у 32 пациентов (23,7 %). Сравнивая частоту обнаружения ИОХВ в  группах, получили статистически значимое различие в пользу механического анастомоза: 9 пациентов (15,2 %) против 23 пациентов (30,3 %), р = 0,0164. Выявлены статистически значимые отличия между уровнем СРБ у пациентов с ИОХВ и у пациентов без ИОХВ во все сроки послеоперационного периода. При уровне СРБ выше 100,5 мг/л (нижняя граница 0,95 доверительного интервала — ДИ) достоверно возрастает частота развития ИОХВ.

Заключение

Заключение. Механический анастомоз достоверно сокращает частоту развития ИОХВ в послеоперационном периоде на 15,1 %. Уровень СРБ выше 100,5 мг/л с третьих суток послеоперационного периода можно считать достоверным предиктором развития ИОХВ.

Introduction

Introduction. Surgical site infection (SSI) incidence amounts to as much as 30% in patients after colorectal surgeries. Infectious complications after colorectal surgeries are characterised by the prevalence of deep forms of SSI with an unclear clinical presentation and difficulties in a timely diagnosis. An important aspect here is finding the earliest marker of the developing infectious complications and establishing its threshold value.

Materials and methods

Materials and methods. This is a prospective study of outcomes of colon resection and construction of colon anastomoses in 135 patients. Patients were split in two groups depending on the method of anastomosis construction. The C-reactive protein level was recorded prior to surgery and on days 3, 5, and 7 postop.

Results and discussion

Results and discussion. SSI was diagnosed in 32 patients (23.7%). Comparing the SSI incidence in different groups the authors established a statistically significant difference in favour of mechanical anastomosis; 9 patients (15.2%) against 23  patients (30.3%), р=0,0164. Statistically significant differences in CRP levels have been established between patients with SSI and patients without SSI at all the times the samples were taken postop. At the level of CRP higher than 100.5 mg/l (0.95 confidence range lower limit) the incidence of SSI increases significantly.

Conclusion

Conclusion. Mechanical anastomosis conclusively reduces the incidence of SSI in the postop period by 15.1%. The CRP level of higher than 100.5 mg/l from day 3 postop can be considered a reliable predictor for the development of SSI.

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The authors declare that there are no conflicts of interest present.