CC BY
31
Section 6. Medical science
group of patients after an SE only. Thus, in this group of patients compared with the control group has not changed in the content of Ig A, Ig G, Ig M and in complement system.
Study of Ig A content in the blood has not shown any difference compared groups of patients. The exception was a slight increase its concentration in the groups after SE (tabl. 2).
Changes in the immune status of patients after SE, undoubtedly accompanied by clinical symptoms. For instance, by comparing the obtained data and clinical laboratory revealed that in patients with splenectomy was occurred complications, which may be associated with impaired immune status. Such changes have a tendency to frequent respiratory infections, diagnosed in 51% of patients. At the same time 28.5% of patients had involvement in the pathological process of the lungs and bronchus and in 16.3% of the patients was observed a predisposition to pustular skin diseases.
In a clinical study by observing the late postoperative period in the group of patients with SE + HAT we have established a
tendency to frequent respiratory disease in 31.3% of patients as well as a predisposition to pustular skin diseases — in 12.5% of patients. At the same time examined changes of immune status can be explained by the lack of compensatory function of the au-tolientransplantation.
Analyzed clinical data estimated that in patients with CS tendency to respiratory infections was in17.1% of cases and a predisposition to pustular skin diseases detected only in 2.4% of cases.
Conclusion: Identified alterations lead to the development of complications after SE in 81.6% of patients; completing SE by auto-lientransplantatsiey — in 56.2% cases. These complications can be allocated to the specific (postsplenectomy), advancing as a decreasing of the immune reactivity of the organism and aggravation of the "quality oflife". After SE possible manifestation ofhumoral immune deficiency was significantly greater than in patients groups with CS or SE+HAT of the splenic tissue.
References:
1. Григорьев Е. Г., Апарцин К. А. Органосохраняющая хирургия селезенки. - Новосибирск: Наука, 2001. - 400 с.
2. Franke M., Chang D. H. A rare complication: acute ischemic stomach necrosis in non-occlusive mesenteric ischemia. - Rofo, 2015. -Vol.36. № 2. - Р. 127-9.
3. Keramidas D. C., Soutis M. W. The function of the spleen in adults after ligation of the splenic artery of the traumatized spleen in childhood//Surgery. - 2003. - Vol.133. № 5. - Р. 583-5.
4. Li W., Shen S. Q., Wu S. M., Chen Z. B., Hu C., Yan R. C. Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis//OncoTargetsTher. - 2015. - Vol.19. № 8. - Р. 2129-37.
Akilov Habibullah Ataullaevich, Vice-rector of the Tashkent Institute of postgraduate training of doctor Primov Farhod Sharifzhanovich, Senior fellow researcher at the Tashkent Institute of postgraduate training of doctor E-mail: [email protected]
Evaluation of the results of immediate postoperative period in children with injuries of spleen after splenectomy
Abstract: In the structure of all the complications in the immediate postoperative period was dominated purulence-in-flammatory complications — in 38 (28.1%) cases.
Keywords: evaluation, injuries of spleen, splenectomy.
Actuality: The most important function of spleen is to maintain immune resistance of the organism [1]. The spleen is produced in 54-70 times more cells, forming the antibody than in lymph nodes. No other immune organ does not produce enough antibodies comparable to the spleen [2, 3].
The spleen generates biologically active substances namely in-terleukins, interferon, leukotriene, taftsin, fibronectin, et al., which enhance the phagocytic ability of neutrophil, lymphocyte enhance the functional activity [4], cytotoxicity of monocytes [5].
Furthermore, lien participates in thrombocytopoiesis, after splenectomy caused by lien injury, occurs thrombocytosis and the number of platelets in the spleen is much greater than in the peripheral blood as well as the removal of the spleen leads to profound hemostatic disorders [3; 6].
Examining the changes of thrombopoietin level in plasma after splenectomy showed that regardless of the primary pathology, splenectomy leads increasing levels of thrombopoietin and other throm-
bopoietic cytokines (interleukin-6 and erythropoietin), which in turn causes thrombocytosis reaching a maximum by day 14 after surgery [6].
Based on the literature review, it can be concluded that the number of questions the treatment of closed abdominal injuries and spleen injuries in children has not been sufficient explored. Above all it concerns the choice of the complex diagnostic and treatment methods; the development of minimally invasive techniques and en-dosurgical interventions; optimization and implementation of organ transplantation techniques and technologies, which determined the purpose of this research.
Material and methods: Depending on the type of operations carried out as well as for the purpose of comparison and clarity, all patients had been divided into three groups. The first group included 62 patients who were over the trauma of the spleen made splenectomy (SE) in Republican Research Centre ofEmergency Medicine. The second group included 19 patients who had surgery after SE
Evaluation of the results of immediate postoperative period in children with injuries of spleen after splenectomy
supplemented heterotopic autologous spleen tissue (SE + HAT). In 9 patients with minor line rupture were performed conserving surgery (CS), in 5 cases by suturing the capsule of the spleen and in 4 cases with the use of the adhesive composition TachoComb.
The volume of the surgical intervention in the spleen was determined depending on the results of intraoperative revision: the nature of traumatic injury (line rapture, crushing, abruption of the organ) localization of lesions (upper, middle and lower poles of the gate of the spleen), the depth of the lesions of the spleen, the degree of its vitality, the amount of hemorrhage, lesions of other abdominal cavity organs. The indication for autologous transplantation of the spleen tissue and SE were:
1. "Mirror" injuries of great vessels of the gate of spleen.
2. Linear bursting the organ with active parenchymal bleeding and inefficiency of the surgical hemostasis.
3. Unipolar or double polar injury with the volume of the residual splenic parenchyma 50 cm3 or more;
4. Injury to the of the pulp caused by inefficiency of the hemostasis during the performing organ conserving surgery with the EC;
5. Pathological changes in the pulp of the spleen — the presence of internal hematomas.
Autotransplantation of the spleen tissue was performed on 19 patients with splenic injury, including 15 patients in the greater omentum by the method ofY. E. Vinogradov et al., (1983) and three patients into the retroperitoneal by the method proposed by S. Af-endulov et al., (1997).
Results and Discussion: According to the data, postoperative complications was observed in 9 (100%) patients who underwent to CS, in 14 (73.7%) patients after SE +HAT and in 41 (66.1%) after SE. The nature and number of complications, depending on the operation is presented in the table 1.
As can be seen from the table in the comparative aspect, the qualitative and quantitative differences in complications had been observed after SE and conservative surgery. Hence, frequency of intra-abdominal complications in patients with SE and in the group SE+HAT was 5.3% and 9.6% of complications, respectively.
Extra-peritoneum complications were divided into surgical wound abscess, broncho-pulmonary complications, aggravation of pyelonephritis and various thrombotic complications. Thus, as can be seen from the table, the average rate extra-peritoneum complications was more progressed in the group of patients that produce SE.
Table 1. - The frequency and structure of the early postoperative complications in the studied groups
Postoperative complications SE (n=62) CS (n=19) SE+HAT (n=18)
abs % abs % abs %
Intraperitoneal
Abscess in the left subdiaphragmatic space 4 6,5 0 0 1 5,6
Peritonitis 1 1,6 0 0 0 0
abdominal bleeding 2 3,2 1 1,9 0 0
Acute pancreatitis 3 4,8 1 1,9 1 5,6
Outperitoneal
Suppuration after operation wound 6 9,7 3 5,6 1 5,6
Exacerbation of bronchitis 3 4,8 0 0 0 0
Pneumonia 3 4,8 1 1,9 0 0
Pleurisy 7 11,3 0 0 0 0
The above table characterizing complications with the main manifestations of the effects of intervention on the spleen in its traumatic injury can be interpreted as follows; septic complications were abdominal abscesses, surgical wound abscess, pneumonia, plevritis. In this context, complications after the CS on the spleen to the effects SE was 1:11.
Conclusion: Thus, in the structure of all the complications in the immediate postoperative period was dominated purulence-
inflammatory complications — in 38 (28.1%) cases. Thrombotic complications was observed in 13 (9.6%) and other 4 (3%) cases. In the comparative aspect of the highest frequency of complications was established in groups ofpatients with the removal of the organ: the SE in 21 (33.9%) and in 5 (26.3%) patients with SE + HAT.
The immediate postoperative period was much better in patients after autologous transplantation in the CS or transplantation of the spleen than in patients carried out SE.
References:
1. Григорьев Е. Г., Апарцин К. А. Органосохраняющая хирургия селезенки. - Новосибирск: Наука, 2001. - 400 с.
2. Franke M., Chang D. H. A rare complication: acute ischemic stomach necrosis in non-occlusive mesenteric ischemia. - Rofo, 2015. -Vol.36. № 2. - Р. 127-9.
3. Li W., Shen S. Q., Wu S. M., Chen Z. B., Hu C., Yan R. C. Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis//OncoTargetsTher. - 2015. - Vol.19. № 8. - Р. 2129-37.
4. Lin J. N., Chen H. J., Lin M. C., Lai C. H., Lin H. H., Yang C. H., Kao C. H. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study//ThrombHaemost. - 2015. - Vol.115, № 1. - Р. 2633-3870.
5. Lin J. N., Lin C. L., Lin M. C., Lai C. H., Lin H. H., Yang C. H., Kao C. H. Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy: A Nationwide Cohort Study. - Medicine (Baltimore). - 2015. - Vol.94, № 35. - Р. 1458.
6. Somasundaram S. K., Massey L., Gooch D., Reed J., Menzies D. Laparoscopic splenectomy is emerging 'gold standard' treatment even for massive spleens//Ann R CollSurg Engl. - 2015. - Vol.97, № 5. - Р. 345-8.
