Tratamentului ileusului intestinal aderential acut in chirurgia de urgenta
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BERLIBA, Sergiu, GHIDIRIM, Gheorghe, LESCOV, Vitalie, GHEORGHIŢA, Vadim, VLAD, Ion, MIRCIU, Oleg. Tratamentului ileusului intestinal aderential acut in chirurgia de urgenta . In: Chirurgia (București, Romania), 2022, vol. 117, supl. nr. 1, pp. 27-28. ISSN 1221-9118.
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Chirurgia (București, Romania)
Volumul 117, Supliment nr. 1 / 2022 / ISSN 1221-9118

Tratamentului ileusului intestinal aderential acut in chirurgia de urgenta

Treatment of acute aderential intestinal ileus in emergency surgery


Pag. 27-28

Berliba Sergiu12, Ghidirim Gheorghe12, Lescov Vitalie12, Gheorghiţa Vadim12, Vlad Ion12, Mirciu Oleg12
 
1 Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“,
2 IMSP Institutul de Medicină Urgentă
 
Disponibil în IBN: 6 iunie 2022


Rezumat

Ileusul intestinal aderențial acut (IIAA) reprezintă o problema stringenta in chirurgia de urgenta. Intalnit la toate grupele de varsta, preponderent la persoanele in etate, IIAA este consecinta operatiilor pe viscerele abdominale marind considerabil numarul adresarilor si letalitatii (1,6-43%). Scopul: Analiza rezultatelor tratamentului pacientilor cu IIAA. Material si metoda: Studiul retrospectiv a constituit 148 pacienti cu IIAA, perioada 2020-2021. Raportul barbati/femei – 86/62, varsta medie - 54,3?1,6 ani. Majoritatea pacientilor (88,6%) au fost internati de AMU, restul –sinestatator sau dezvoltand ocluzii precoce postoperatorii in stationar. Rezultate: Toti pacientii au prezentat dureri colicative abdominale, din ei (n=76) - lipsa emisiei de gaze si absenta scaunului. In 90,3% au predominat greturi si vome. Interventii chirurgicale in anamneza ( >1 an) au suportat 127 pacienti, restul mentionand in antececente traumatisme abdominale, inflamatia anexelor si TBC abdominal (n=2). Interventiile suportate: apendiceectomie (20,2%), cura herniei (9,4%), interventii ginecologice (18,4%), ulcer perforat (10,2%), cancer al organelor intraperitoneale (5,4%), litiaza veziculara (7,9%) si traumatisme abdominale (7,2%). Tratament conservativ initial au urmat toti 148 pacienti, in 74,7% cazuri cu dinamica pozitiva, evitandu-se laparotomia. In 25,6% cazuri s-a recurs la visceroliza (64,9%), rezectii de intestin cu anastomoze primare (21,6%), aplicarea derivatiilor externe (13,5%). Letalitatea postoperatorie a constituit 1,4% ca consecinta a peritonitei in evolutie. Concluzii: IIAA preponderent survine in urma interventiilor chirurgicale abdominale, tratamentul conservativ fiind eficace in majoritatea cazurilor. Volumul operatiei depinde de timpul adresarii, iar prezenta peritonitei limitează pastrarea integritatii TGI, fiind si cauza nemijlocita a mortalitatii.

Acute aderential intestinal ileus (AAII) is a pressing problem in emergency surgery. Found in all age groups, mainly in older people, AAII is the consequence of operations on abdominal viscera greatly increasing the number of referrals and fatality (1,6-43%). Purpose: Analysis of treatment outcomes of patients with AAII. Materials and methods: The retrospective study consisted of 148 patients with AAII during 2020-2021. Ratio of male/female - 86/62, average age range - 54,3?1,6 years. The majority of patients with AAII (88,6%) were admitted by the Emeregency Medical Service, the rest developed early postoperative occlusions at the hospital. Results: All patients had abdominal colicky pain, of them (n=76) - lack of gas emission and absence of stool. In 90,3% cases, nausea and vomiting prevailed. Surgical interventions in history (>1 year) were performed on 127 patients, the rest mentioning previous abdominal trauma, adnexal inflammation and abdominal tuberculosis (n=2). Interventions supported: Appendectomy (20,2%), hernia repair surgery (9,4%), gynecological surgical procedures (18.4%), perforated ulcer (10.2%), intraperitoneal organ cancer (5.4%), calculous cholecystitis (7.9%) and abdominal trauma (7.2%). All 148 patients underwent initial conservative treatment, 74.7% of them with positive outcome, avoiding laparotomy. In 25,6% cases, was performed viscerolysis (64,9%), intestinal resections with primary anastomoses (21,6%), application of external derivatives (13,5%). Postoperative case fatality was 1.4% as a result of evolving peritonitis. Conclusions: AII predominantly occurs following abdominal surgery, with conservative treatment being effective in most cases. The volume of surgery depends on the time of referral, and the presence of peritonitis limits the preservation of the integrity of the GIT and is the direct cause of mortality.

Cuvinte-cheie
IIAA, visceroliza, peritonită,

AAII, viscerolysis, peritonitis