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SM ISO690:2012 TIMIŞ, Tudor, HOTINEANU, Adrian, BENDELIC, Valentin, PALII, Lucian. Diagnosticul și tratamentul chirurgical al bolii Crohn perianale. In: Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, 21-23 octombrie 2020, Chişinău. Chişinău: USMF, 2020, p. 456. |
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Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină şi Farmacie „Nicolae Testemiţanu” 2020 | ||||||
Congresul "Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”" Chişinău, Moldova, 21-23 octombrie 2020 | ||||||
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Background. Perianal Crohn's disease (pCD) is a marker of severe CD, associating with multiple relapses and operations. Can evolve in isolation (25%) or strike intestinal CD (75%). Correct early diagnosis, timed surgical implications constitute preconditions for success in the treatment of pCD. Objective of the study. Study of clinical, diagnostic and curative peculiarities of perianal Crohn’s disease with the argumentation of surgical indications and performed intervences, analysis of the early and late postoperative results. Material and Methods. Retrospective study (2000-2019), based on the analysis of clinical observation files, results of paraclinical explorations and treatment of 52 patients with pCD. The investigation program was included: examination under anesthesia; endoscopy; imaging modalities (MRI, CT, fistulography, endorectal USG); histological explorations (biopsy, operatory specimens). Results. Based on clinical, radiological, endoscopic and histological data, the definite diagnosis of pCD was possible in 72.7% of cases. Conservative treatment was according to ECCO Protocol (2012) and assured recovering of 31 (59.6%) of assisted patients. Were operated 21 (40.4%) of patients with pCD – drainage of perianal abscess (2), closure of the transphincterian fistula on Seton (6), fistulotomy (2), fistulectomy (3), closure of the recto-vaginal (2) or extrasphincterian (3) fistula with "advancement mucous flap", ileostomy (1), rectal resection with anastomosis (1), procectomy (1). Conclusion. The surgical attitude, individualized in each case, associated with biological therapy (infliximab), allows the essential reduction of relapses (23.8%), postoperative complications (14.3%) and lethality (4.8%). |
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Cuvinte-cheie Crohn's disease, seton, advancement flap, boala Crohn, seton, lambou avansat |
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Perianal Crohn's disease (pCD) is a marker of severe CD, associating with multiple relapses and operations. Can evolve in isolation (25%) or strike intestinal CD (75%). Correct early diagnosis, timed surgical implications constitute preconditions for success in the treatment of pCD. Objective of the study. Study of clinical, diagnostic and curative peculiarities of perianal Crohn’s disease with the argumentation of surgical indications and performed intervences, analysis of the early and late postoperative results. Material and Methods. Retrospective study (2000-2019), based on the analysis of clinical observation files, results of paraclinical explorations and treatment of 52 patients with pCD. The investigation program was included: examination under anesthesia; endoscopy; imaging modalities (MRI, CT, fistulography, endorectal USG); histological explorations (biopsy, operatory specimens). Results. Based on clinical, radiological, endoscopic and histological data, the definite diagnosis of pCD was possible in 72.7% of cases. Conservative treatment was according to ECCO Protocol (2012) and assured recovering of 31 (59.6%) of assisted patients. Were operated 21 (40.4%) of patients with pCD – drainage of perianal abscess (2), closure of the transphincterian fistula on Seton (6), fistulotomy (2), fistulectomy (3), closure of the recto-vaginal (2) or extrasphincterian (3) fistula with "advancement mucous flap", ileostomy (1), rectal resection with anastomosis (1), procectomy (1). Conclusion. The surgical attitude, individualized in each case, associated with biological therapy (infliximab), allows the essential reduction of relapses (23.8%), postoperative complications (14.3%) and lethality (4.8%).</p></description> <description xml:lang='ro' descriptionType='Abstract'><p>Introducere. Boala Crohn perianală (BCp) constituie un marker al BC severe, asociindu-se cu recidive și operații multiple. Poate evolua izolat (25%) sau greva BC intestinală (75%). Diagnosticul precoce corect, implicațiile chirurgicale oportune constituie premizele succesului în tratamentul BCp. Scopul lucrării. Studierea particularităților clinice, de diagnostic și tratament conservator cu argumentarea indicațiilor operatorii și operației selectate, analiza rezultatelor postoperatorii precoce și tardive în BCp. Material și Metode. Studiul retrospectiv (2000-2019), bazat pe analiza fișelor de observație clinică, al rezultatelor explorărilor paraclinice și tratamentului medico-chirurgical al 52 de bolnavi cu BCp. Programul de investigații a inclus: examinare sub anestezie; endoscopie; modalități imagistice (RMN, TC, fistulografie, USG endorectală); examen histologic (bioptate, piese operatorii). Rezultate. În baza datelor clinice, radiologice, endoscopice și histologice, diagnosticul cert al BCp a fost posibil în 72.7% cazuri. Tratamentul conservator a fost conform ECCO Protocol (2012) și s-a dovedit a fi efectiv în 31 (56.6%) cazuri. Au fost operați 21 (40.4%) bolnavi cu BCp – drenajul abcesului perianal (2), închiderea fistulei transfincteriene pe Seton (6), fistulotomie (2), fistulectomie (3), închiderea fistulei recto-vaginale (2) sau extrasfincteriene (3) cu lambou mucos «de avansare», ileostomie (1), rezecție rectală cu anastomoză (1), proctectomie (1). Concluzii. Atitudinea medicochirurgicală, individualizată la fiecare caz, asociată cu terapie biologică (infliximab), permite reducerea esențială a recidivelor (23.8%), a complicațiilor (14.3%) și a letalității postoperatorii (4.8%).</p></description> </descriptions> <formats> <format>application/pdf</format> </formats> </resource>