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12МЕДИЦИНСКИЕ НАУКИ
COMPLICATIONS IN ANORECTAL MALFORMATIONS IN CHILDREN (CLINICAL OBSERVATION) Yusupov Sh.A.1, Atakulov J.O.2, Rakhimov A.K.3, Suvankulov U.T.4
1Yusupov Shukhrat Abdurasulovich - Professor, DSc, MD;
2Atakulov Jamshed Ostonokulovich - Professor, DSc, MD;
3Rakhimov Anvar Komilovich - Assistant;
4Suvankulov Uktam Toirovich - Assistant, DEPARTMENT OF PEDIATRIC SURGERY № 1, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: surgical treatment of congenital anorectal malformations in children is a complex task. The significance of the problem is due, firstly, to the significant incidence of this pathology among other anomalies of the gastrointestinal tract, and secondly, to unsatisfactory results, both in the immediate and long-term postoperative periods. This article presents an analysis of the examination of 52 children with late postoperative complications and relapses of anorectal defects. As a result of the study, we found out the most common causes of complications in anorectal anomalies, as well as the optimal treatment.
Keywords: anorectal malformations, proctoplasty, rectal fistulas, children.
According to different authors, the frequency of long-term unsatisfactory results in this pathology is from 30 to 60%. On the one hand, this is due to abnormalities in the anatomical and physiological relations of the anorectal area, underdevelopment of the muscle structure of the nervous system and pelvic diaphragm [1, 5, 6, 7]. On the other hand, the reasons for the unsatisfactory outcome of surgical treatment for anorectal malformations (AM) are insufficient surgery chosen, errors in the implementation of the intervention, incorrect evaluation of surgical entry [2, 3, 4, 8]. The above has shown that the issue is of high relevance and is a prerequisite for this work.
The aim of the research was to study the causes of relapses and complications of anorectal defects after undergoing proctoplasty.
Materials and methods of the research. The study was based on the results of treatment of 52 children with late postoperative complications and relapses of AM, who developed after various types of proctoplasty and required repeated surgical correction. Prior to admission, the patients underwent from 1 to 3 surgical interventions in the form of various perineal and abdominal-perineal anorectoplastics. As a rule, children were admitted after performing the most commonly used type of surgery - various types of perineal proctoplasty, there were 31 such patients (59.6%). Relatively less frequently, complications and relapses of AM were observed after trans-interventional extirpation of the rectovestibular fistula in 1 (1.9%) case and invaginal extirpation of the Lenyushkin H-fistula in 3 (4.2%) cases, as well as abdominal-perineal proctoplasty in 4 (5.7%) cases.
Almost half of the patients with AM relapses were children with difficult - to-correct forms of the defect-32 (45.7%), whose radical elimination required the use of technically complex reconstructive and reconstructive interventions and who were characterized by a high frequency of postoperative complications.
Results of the research. The main clinical sign of recurrence up all 52 patients had fecal incontinence, including in 15 (21,4%), encopresis was associated with constipation, when postoperative scar stenosis of the anus leads to a strong stretching of the end of the rectum stagnant fecal masses, causing nerve endings and muscles of this area lose sensitivity and the ability to react, in order to keep the stool.
The analysis of the causes that led to the postoperative failure of the sphincter apparatus of the rectum showed that 32 (45.7%) children had diagnostic and tactical errors in 16 (22.8%) cases, as well as technical errors in 13 (18.5%) cases in the performance of primary operations. Only in 9 (12.8%) patients, the cause of AM relapse was postoperative purulent-inflammatory complications.
It should be noted that 19 (27.1%) children were operated on in general surgical departments of district hospitals by surgeons who did not receive specialized training in the surgical treatment of newborns with AM. Local surgeons did not differentiate well between high and low forms of the defect, as a rule, they did not diagnose rectal fistulas with the genitourinary system, they were fond of performing proctoplasty with perineal access, which does not always provide adequate and radical elimination of the defect. Thus, 47 (90%) patients were admitted after perineal proctoplasty. The most common technical errors made by general surgeons were inadequate mobilization of the rectum by perineal access in the supraelevator forms of AM. At the same time, the reduced part of the intestine was fixed to the neoanus with tension, which was the main cause of postoperative necrosis and intestinal retraction. Not always after the initial operation, the necessary rehabilitation measures were carried out. In particular, the generally accepted schemes of postoperative neoanus augmentation were not followed, courses of electrostimulation of the sphincter apparatus were not conducted, procedures aimed at increasing the tone of the newly formed sphincter apparatus were not performed.
Besides, at the initial surgery in over half of patients 28 (53,8%) neoanus was formed not in your typical place, out puborectalis muscles did not provide a functioning neoanus and made it extremely difficult to re-reconstructive-restorative operations. At the same time, the traumatic nature of surgical intervention was significantly increased. Conclusions:
1. The causes of complications and recurrences of AM are: diagnostic, tactical and surgical errors.
2. Surgical treatment of children with AM should be carried out in specialized children's surgical hospitals.
3. Postoperative rehabilitation is one of the main parts of the comprehensive treatment of children with AM.
References
1. Shamsiev J.A., Saidov M.S., Aipov R.R., Atakulov D.A. Rehabilitation of children after repeated surgical interventions regarding anorectal malformations. // European science review. № 3 - 4, 2017. P. 70-73. (14.00.00. №19).
2. Shamsiev J.A., Saidov M.S., Aipov R.R. Ultrasound sonography in the diagnosis of anorectal malformations in children // Coloproctology, 2017. № 3S. P. 49a-50.
3. Shamsiev A., Yusupov S., Shakhriev A. & Djalolov D. (2020). THE CAUSES OF POSTOPERATIVE INTRA-ABDOMINAL ABSCESSES IN CHILDREN AND WAYS OF THEIR PREVENTION. The Scientific Heritage (48-2), 5-7.
4. Djalolov D.A., Shavazi R.N. & Yusupova S.S. (2019). PREDICTION OF POSTOPERATIVE INTRABRUSIVE PURULENT COMPLICATIONS WITH APPENDICULAR PERITONITIS IN CHILDREN. Voprosy nauki i obrazovaniya (20), 37-41.
5. Yusupov ShA, Muhammadiev A.A., Djalolov D.A. CLINICAL AND DIAGNOSTIC FEATURES OF MECKEL'S DIVERTICULUM IN CHILDREN // Voprosy nauki i obrazovaniya. № 23(101), 2020. P. 56-60.
6. Mukhamadovna S.M., Umidovich I.S. & Abdurasulovich Y.S. (2019). Factors contributing to the formation of a complicated course of duodenal ulcer in persons of young age. Voprosy nauki i obrazovaniya(6 (52)).
7. Djalolov D.A., Abduvoyitov B.B., Khasanov A.B. & Shavazi R.N. (2018). Features of microflora in the etiological structure of diffuse appendicular peritonitis. Voprosy nauki i obrazovaniya. 8(2), 116.
8. Alisherovna S.L. & Ostanokulovich A.J. (2020). DIAGNOSIS AND SURGICAL TREATMENT OF HIRSCHSPRUNG'S DISEASE IN CHILDREN. Science and education today (8 (55)).
БИОХИМИЧЕСКИЕ ИЗМЕНЕНИЯ В ОРГАНИЗМЕ
ПРИ КАНЦЕРОГЕНЕЗЕ
1 2 Ходжаева М.Ю. , Буранова Д.Ж.
1Ходжаева Мупаррах Юлдашевна - доцент, кафедра медицинской и биологической химии, факультет детской стоматологии;
2Буранова Дильфуза Жамаловна - доцент, кафедра внутренних болезней, медико-педагогический и лечебный факультет, Ташкентский государственный стоматологический институт, г. Ташкент, Республика Узбекистан
Аннотация: канцерогены - это факторы окружающей среды, которые вызывают повреждения генетического аппарата и в результате клетки претерпевают опухолевую трансформацию. Большинство канцерогенов существует в форме проканцерогенов и в печени происходит их превращение в активные формы, которые могут реагировать с белками и нуклеиновыми кислотами. Ферменты детоксикации в печени обладают полиморфизмом и если у них активность низкая, тогда проканцерогены не превращаются в активные формы и выводятся из организма. Этим можно объяснить различную чувствительность людей к действию различных канцерогенов.
Актуальность
В настоящее время в силу тех или иных причин канцерогены вошли в нашу жизнь. Эти вещества в силу своих физических или химических свойств могут вызывать необратимые изменения и повреждения в генетическом аппарате. Таким образом, канцерогены — это вещества, влияющие на целостность ДНК и приводящие к формированию и размножению злокачественных клеток.
Цель работы.
В нашей повседневной жизни из обычных продуктов при их переработке образуются канцерогенные вещества. Исключить из рациона все до одного канцерогены на сегодняшний день невозможно. Но можно снизить риск. Для этого необходимо научится выбирать продукты и готовить их правильно.
Результаты и обсуждения.
В 1916 году японские ученые смогли вызвать рак у кролика в эксперименте. Они каждый день обмазывали его каменноугольной смолой. Таким образом, удалось увидеть, как под воздействием химических веществ у абсолютно здорового кролика возникла злокачественная опухоль (1,2). Так как смола является смесью сложных химикатов, ученые начали поиски других веществ, которые могут вызывать рак. Было известно, что канцерогены чаще встречаются в синтетических веществах, но оказалось, что растительные соединения тоже обладают канцерогенными свойствами. И, тем не менее, ни те, ни другие, мы не можем считать, безусловно, опасными (1).
До настоящего времени нет четкой классификации воздействий, которые способны вызывать рак. Их пытались разделить на радиоактивные, включающие все виды опасных облучений и на генетические, которые связаны с воздействием окружающей среды, куда
