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D0l:10.31718/2077-1096.18.4.3 UDC 616.831-005.1-036.85 Delva I.
POST-STROKE FATIGUE AND ITS DIMENSIONS OVER THE SECOND YEAR AFTER ACUTE CEREBROVASCULAR EVENTS
Ukrainian Medical Stomatological Academy, Poltava
Post-stroke fatigue (PSF) is a common, long-lasting consequence of acute cerebrovascular events (ACE). Aim. To assess the rate and intensity of PSF over the second year after strokes and transient ischemic attacks. Material and methods. Initially patients were followed up and examined in 12 months (201 cases) and finally in 24 months (126 cases) after ACE occurrence; through these time intervals patients were examined quarterly. PSF was measured by fatigue assessment scale (FAS), multidimensional fatigue inventory-20 (MFI-20) and fatigue severity scale (FSS). Results. According to FAS and FSS, rate of PSF over the second year after ACE occurrence were unchangeable within narrow limits, 31,7%-33,0%. Rates of global, physical, mental, activity-related and motivational post-stroke fatigue, according to MFI-20, were also stable, within 25,0%-28,6%, 24,6%-27,4%, 27,8%-30,2%, 22,4%-26,2% and 19,4%-22,0%, respectively. Patients with strokes, compared with transient ischemic attack patients, had more common general, physical, mental, motivational and activity-related post-stroke fatigue domains in 12 and 15 months after ACE occurrence. Intensity of PSF due to FAS (range - 29,0 (26,0-33,0) - 28,0 (26,0-32,2)) and FSS (5,5 (5,2-5,9) - 4,8 (4,5-5,2)), as well as intensity of physical (13,0 (12,0-13,0) - 12,0 (12,0-13,0)) and activity-related (13,0 (12,0-13,0) -12,0 (12,0-13,5)) PSF domains due to MFI-20, was statistically stable, whereas severity of global (14,0 (13,015,0) - 13,0 (12,0-14,0)), mental (15,0 (14,0-16,0) - 13,0 (12,0-14,0)) and motivational (15,0 (14,0-16,0) -13,0 (13,0-15,0)) PSF domains significantly decreased through the second year after ACE. Conclusion. 1. PSF rate as well as PSF dimension rates were stable over the second year after ACE regardless the fatigue scales used. 2. Intensity of gobal, mental and motivational post-stroke fatigue domains, according to MFI-20, significantly decreased over the second year after ACE occurrence.
Key words: stroke, fatigue, dimensions, prevalence, intensity.
Introduction
Nowadays, as the consequence of the crucial lifestyle modification and environmental factor changes we face a dramatic increase of civilization diseases and their complications, including cerebrovascular events [1]. Post-stroke fatigue (PSF) is a common and often debilitating complication of acute cerebrovascular events (ACE) [2]. PSF is associated with worse rehabilitation results, higher post-stroke functional disability, decreased life quality, higher risk of death, etc [3-5].
According to recent findings, PSF is a quite dynamic phenomenon that may occur in different post-stroke terms with variable subsequent clinical course [6]. In our previous work we revealed that PSF rate significantly changed over the first three post-stroke months and then was statistically stable over the next nine months after stroke occurrence [7, 8]. Moreover, it had been discovered some nonlinear regularities of certain PSF domain intensity over the first post-stroke year [7, 8]. However, up to now little is known about the time course and severity of global PSF, as well as PSF certain dimensions over the second post-stroke time period.
The objectives of this study were to assess the
rates and intensities of PSF over the second year after ACE.
Material and methods
201 patients were enrolled in the study: 132 individuals with ischemic strokes, 24 individuals with hemorrhagic strokes, and 45 individuals with transient ischemic attacks (TIA). Patients were included into the study having previously agreed and signed the informed consent form to participate in the research project. Exclusion criteria were medical illness and conditions that could cause secondary fatigue (cancerous diseases, haematological diseases, cardiac, liver, kidney and respiratory insufficiency, progressive angina pectoris, acute myocar-dial infarction), alcohol abuse, consciousness impairments, insufficient cognitive ability (Mini-Mental State Examination scores less than 24), depressive and anxious disorders (Hospital Anxiety and Depression Scale scores more than 10 for both pathologies), impaired speech function to participate (severe dysphasia or dysarthria), impaired language or written ability to complete the study questionnaire, severe functional disabilities (modified Rankin scale scores >4).
Patients' characteristics were evaluated conse-
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quently in certain time points: in 12, 15, 18, 21 and 24 months after ACE occurrence. 19, 21, 17 and 18 patients were excluded due to different reasons during each next quarter of the second post-stroke year. Thus, in 15, 18, 21 and 24 months after ACE we examined 182, 161, 144 and 126 patients, respectively.
PSF was measured by three self-report questionnaires: fatigue assessment scale (FAS), multidimensional fatigue inventory-20 (MFI-20) and fatigue severity scale (FSS).
PSF was identified, according to FAS, at a score >22 [9], according to FSS - at a mean score >4. For every MFI-20 sub-scale dimensions (global, physical, mental, activity-related and motivational fatigue) critical value was 12 or more [10].
Distributions of continuous variables were checked by Shapiro-Wilk test. Parametric variables were represented as mean±standard deviation, non-parametric - as median (Me) and interquartile (25%-75%) range (Q1-Q3). Categorical data were represented by number (n) and percentage. Differences in categorical variables were compared using chi-square test. Univariate logistic regression analysis was performed to analyze the odds ratio (OR) with 95% confidence intervals (CI). The difference between the patients' proportions with PSF at definite time points after stroke onset was assessed using Cochran's Q-test. The Friedman F-test for repeated measurements was performed to analyze multiple non-parametric variables. When the Friedman F-test yielded a significant effect (p<0,05), it was followed by Dunnett's test for determining the differences between initial and subsequent measurements. A p-value <0,05 was considered as statistically significant.
Results
Patients' age ranged from 46 to 79 years (mean age 61,8±7,7 years). Initially there were 95 (47,3%) males and 106 (52,7%) females.
Table 1 demonstrates that in 12 months after ACE occurrence patients with strokes, compared to TIA patients, had more common PSF, according to FAS and FSS - OR 2,45 (95% CI, 1,07-5,63; p=0,04) and OR 3,98 (95% CI, 1,67-9,47; p<0,01), respectively. In 15 months, this phenomenon was preserved only for FSS measurement - OR 2,93 (95% CI, 1,21-7,07; p=0,02). Moreover, table 1 shows no differences in PSF rates, according to FAS, as well as according to FSS, over the whole second year after ACE occurrence. Cochran's Q-test of those patients who were observed through all five studied time points did not reveal any significant differences of PSF rates obtained by both fatigue scales.
The table 2 demonstrates that in 12 months after ACE occurrence, patients with strokes compared to TIA patients, had more common PSF domains: global - OR 3,66 (95% CI, 1,36-9,50; p=0,01), physical - OR 3,45 (95% CI, 1,28-9,29; p=0,01), mental - OR 3,77 (95% CI, 1,40-10,14; p=0,01), motivational - OR 3,19 (95% CI, 1,079,49; p=0,04), activity-related - OR 2,95 (95% CI, 1,09-7,97; p=0,03). In 15 months, these regularities were also observed: stroke patients had more common global PSF - OR 2,86 (95% CI, 1,11-7,19; p=0,03), physical PSF - OR 2,64 (95% CI, 1,046,75; p=0,04), mental PSF - OR 3,01 (95% CI, 1,18-7,66; p=0,02) and activity-related - OR 2,95 (95% CI, 1,09-7,97; p=0,03); whereas, in 18 months after stroke, only global PSF component was more frequently observed than after TIA (OR, 2,84; 95% CI, 1,03-7,85; p=0,04).
The percentages of each PSF domain regardless PSF types were more or less the same in all five studied time points (Table 2). According to Cochran's Q-test, there were no significant changes in prevalence of any PSF dimension over the observation period.
Scale Time point after ACE occurrence
12 months 15 months 18 months 21 months 24 months
FAS
TIA, n (%) 8 (17,8%)* 9 (22,0%) 8 (21,1%) 7 (18,4%) 6 (20,7%)
strokes, n (%) 54 (34,6%) 51 (36,2%) 44 (35,8%) 39 (35,1%) 34 (35,1%)
total ACE, n (%) 62 (30,8%) 60 (33,0%) 52 (32,3%) 46 (31,9%) 40 (31,7%)
FSS
TIA, n (%) 7 (15,6%)* 7 (17,1%)* 6 (15,8%) 6 (18,2%) 5 (17,2%)
strokes, n (%) 66 (42,3%) 53 (37,6%) 45 (36,6%) 39 (35,1%) 35 (36,1%)
total ACE, n (%) 73 (36,3%) 60 (33,0%) 51 (31,7%) 45 (32,2%) 40 (31,7%)
* - significant difference (р<0,05) by chi-square test in comparison with stroke patients.
Table 1
Frequencies of PSF over the second year after A CE occurrence, according to FAS and FSS
АктуальН проблеми сучасно!' медицины
Table 2
Frequencies of PSF domains, according to MIF-20, over the second year after ACE occurrence
PSF domain Time point after ACE occurrence
12 months 15 months 18 months 21 months 24 months
Global
TIA, n (%) б (11,1%)* 6 (14,6%)* б (13,2%)* б (1б,2%) б (17,2%)
strokes, n (%) 49 (31,4%) 46 (32,6%) 37 (30,1%) 31 (27,9%) 27 (27,8%)
total ACE, n (%) б4 (26,9%) б2 (28,6%) 42 (26,1%) 36 (2б,0%) 32 (2б,4%)
Physical
TIA, n (%) б (11,1%)* 6 (14,6%)* б (13,2%) б (1б,2%) б (17,2%)
strokes, n (%) 48 (30,8%) 44 (31,2%) 36 (29,3%) 32 (28,8%) 26 (26,8%)
total ACE, n (%) б3 (26,4%) б0 (27,4%) 41 (2б,б%) 37 (2б,7%) 31 (24,6%)
Mental
TIA, n (%) б (11,1%)* 6 (14,6%)* 6 (1б,8%) 6 (18,2%) 6 (20,7%)
strokes, n (%) б0 (32,1%) б0 (3б,б%) 40 (32,б%) 34 (30,6%) 32 (33,0%)
total ACE, n (%) бб (27,4%) б4 (29,7%) 46 (28,6%) 40 (27,8%) 38 (30,2%)
Motivational
TIA, n (%) 4 (8,9%)* 6 (14,6%) 4 (10,б%) 4 (12,1%) 4 (13,8%)
strokes, n (%) 37 (23,7%) 44 (31,2%) 31 (2б,2%) 24 (21,6%) 21 (21,6%)
total ACE, n (%) 41 (20,4%) 40 (22,0%) 3б (21,7%) 28 (19,4%) 2б (19,8%)
activity-related
TIA, n (%) б (11,1%)* 6 (14,6%)* б (13,2%) б (1б,2%) б (17,2%)
strokes, n (%) 42 (26,9%) 36 (2б,б%) 31 (2б,2%) 30 (27,0%) 28 (28,9%)
total ACE, n (%) 47 (23,4%) 42 (23,1%) 36 (22,4%) 3б (24,3%) 33 (26,2%)
* - significant difference (p<0,05) by chi-square test in comparison with stroke patients.
The Table 3 demonstrates no significant those patients, who were not excluded within the changes of FAS and FSS scores over the second observation period, did not reveal any statistical year after ACE occurrence. The Friedman F-test of changes of FAS and FSS scores.
Table 3
FAS and FSS scores over the second year after ACE occurrence, Me (Q1-Q3)
Scale Time point after ACE occurrence
12 months 1б months 18 months 21 months 24 months
FAS 29,0 (26,0-33,0) 31,0 (27,0-3б,0) 30,0 (27,0-33,3) 29,0 (26,3-32,0) 28,0 (26,0-32,3)
FSS б,б (б,2-б,9) б,6 (б,1-6,2) б,2 (4,8-б,9) 4,7 (4,3-б,6) 4,8 (4,б-б,2)
Table 4
MFI-20 sub-scales scores over the second year after ACE occurrence, Me (Q1-Q3)
PSF domain Time point after ACE occurrence
12 months 1б months 18 months 21 months 24 months
global 14,0 (13,0-1б,0) 1б,0 (14,0-16,0) 14,0 (13,0-1б,8) 13,0 (12,0-14,0)* 13,0 (12,0-14,0)*
physical 13,0 (12,0-13,0) 12,0 (12,0-13,0) 12,0 (12,0-13,0) 13,0 (12,0-13,0) 12,0 (12,0-13,0)
mental 1б,0 (14,0-16,0) 1б,0 (14,0-16,0) 1б,0 (14,0-1б,0) 13,0 (12,0-13,0)* 13,0 (12,0-14,0)*
activity-related 13,0 (12,0-14,0) 13,0 (12,0-14,0) 13,0 (12,0-13,0) 13,0 (12,0-13,0) 12,0 (12,0-13,б)
motivational 1б,0 (14,0-16,0) 1б,0 (1 б,0-17,0) 1б,0 (14,0-16,0) 14,б (13,8-16,0) 13,0 (13,0-1б,0)*
* - significant differences (p<0,05) according to Dunnett's test compared to 12 month sub-scale score.
Table 4 shows that severity of global, mental and motivational PSF domains were significantly decreasing through the third and fourth quarters of the second post-stroke year compared to the 1 year
values. At the same time, scores of physical and activity-related PSF domains were statistically stable over the whole second year after ACE occurrence.
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Discussion
Up to now, literature reports on PSF prevalence in any time point within the second year after ACE are still limited. In 15-months after stroke, PSF (measured by FSS) was found within a range from 51,5% [11] 57,0% of patients [12]. The prevalence of PSF in 18 months following stroke (rated by the Checklist Individual Strength) was 33% [13] of cases. PSF (according to MFI-20 global fatigue sub-scale) was found out among 40% of stroke patients in 2 years following the hospitalization [14]. Our results are somewhat lower that may be explained by heterogeneity of patients with different ACE (whereas the above mentioned works dealt only with stroke populations) and we applied more stringent exclusion criteria for minimizing secondary fatigue cases.
In comparison with TIA, we found the significant prevalence of PSF (irrespective of fatigue scales) and PSF domains during the beginning of the second post-stroke year. The same peculiarity we previously revealed within the whole first year after ACE occurrence [15, 16]. This phenomenon may be determined to a certain degree by extended and permanent ischemic brain lesions due to stroke (PSF, at least partially, may be of central origin [17]). Anyway, up to now we have not found any other reasonable explanation of this peculiarity. But it needs to underscore that higher PSF prevalence in stroke patients is present only during the first and second quarters (maybe due to decreasing in the number of patients studied at each next observation that leads to statistical threshold increasing and disappearing of statistical significance, or may be due to some specialties of PSF natural course).
This is only the second longitudinal observation study describing the course of global PSF and the only single one devoted to course of certain PSF dimensions over the second year after ACE. We have found that rates of global PSF as well as rates of each PSF dimension are statistically stable over the whole observation period. Single longitudinal study devoted to global PSF prevalence (measured by MFI-20) within the second post-stroke year also demonstrated PSF stability (38% through the first and 40% through the second post-stroke year) [14].
The important findings in our study demonstrated significant changes of certain PSF domains values over the second post-stroke year. Whereas the severity of PSF, according to FAS and FSS, as well as the severity of physical and activity-related PSF, due to MFI-20, were statistically stable, intensity of general, mental and motivational PSF dimensions had been significantly decreased over the studied period. In relevant literature, we found only one work describing the similar design, according to which the levels of PSF (measured by FSS) did not vary significantly between 12 and 18 months after stroke [18]. It is quite difficult to explain our contradictory results; anyway, these phenomena require further special investigations, especially about fatigue scales consistency. Each of the ap-
plied fatigue scales has its own characteristics and includes quite heterogeneous questions. FAS consists of 5 questions about mental components and 5 questions about the physical part of fatigue [19]. The FSS captures the individual's experience of mental or psychological fatigue and how it interferes with performing certain activities (exercise, work and family life). MFI-20 general fatigue measures overall feelings of tiredness, physical fatigue measures physical sensations related to feelings of tiredness, reduced activity measures through the daily activities, reduced motivation measures in daily activities, and mental fatigue includes deficits in cognitive functioning.
Conclusions
1. PSF rate, according to FAS and FSS, as well as all PSF dimensions rates according to MFI-20, were stable through the second year after ACE occurrence. 2. Intensity of PSF due to FAS and FSS, intensity of physical and activity-related PSF domains were stable, whereas intensity of general, mental and motivational PSF domains significantly decreased through the third and fourth quarter of the second year after ACE occurrence.
Further investigations should be directed toward the longitudinal observation of the rate and intensities of PSF according to different fatigue scales, and determination of factors associated with PSF over the studied post-stroke period.
The research described in this paper was performed within the framework of scientific plan "Clinical and pathogenetic optimization of diagnosis, prognosis, treatment and prevention of complicated central nervous system's disorders and neurological impairments due to therapeutic pathologies" (state registration number 0116U004190), at the neurological department with neurosurgery and medical genetics, Ukrainian medical stomatological academy.
References
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АктуальН проблеми сучасно! медицины
8. Delva M, Delva I, Lytvynenko N. Post-stroke fatigue and its dimensions over the second half year after stroke. Wiad Lek. 2018; 71 (2): 314-317.
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Реферат
ПОСТ1НСУЛЬТНА ВТОМА I II КОМПОНЕНТИ ПРОТЯГОМ ДРУГОГО РОКУ П1СЛЯ ГОСТРИХ ЦЕРЕБРОВАСКУЛЯРНИХ ПОД1Й Дельва I.
Ключовi слова: Ысульт, втома, роз1^ри, поширенють, штенсивнють.
Постшсультна втома е поширеним, тривалим наслщком гострих цереброваскулярних подш. Мета. Оцшити частоту i штенсивнють постшсультноТ втоми протягом другого року пюля шсульту та транзи-торноТ iшемiчноl атаки. Матерiали i методи. Па^енти були обстежен через 12 мюя^в (201 випадок) i через 24 мюяц (126 випадш) пюля появи гострих цереброваскулярних подш, мiж цими часовими точками па^енти обстежувалися щоквартально. Постшсультну втому вимiрювали за шкалою оцшки втоми (FAS), багатовимiрною шкалою оцшки втоми -20 (MFI-20) i шкалою тяжкост втоми (FSS). Результа-ти. За даними FAS i FSS, показники постшсультноТ втоми протягом другого року пюля появи гострих цереброваскулярних подш були стабтьн у вузьких межах - 31,7% -33,0%. Показники глобального, фн зичного, розумового, пов'язаного з дiяльнiстю i мотивацiйного компонент, згiдно MFI-20, також були стабтьы - в межах 25,0% -28,6%, 24,6% -27,4%, 27,8% - 30,2%, 22,4% -26,2% i 19,4% -22,0% вщповщ-но. Па^енти з шсультом, вiдносно пацiентiв з транзиторною iшемiчною атакою, мали бiльш частi глобально фiзичнi, психiчнi, мотивацiйнi та пов'язан з активнiстю домени постшсультноТ втоми через 12 i 15 мюя^в пiсля появи гострих цереброваскулярних подш. !нтенсивнють постiнсультноТ втоми, згщно FAS (дiапазон - 29,0 (26,0-33,0) - 28,0 (26,0-32,2)) i FSS (5,5 (5,2-5,9)) - 4,8 (4,5-5,2)), а також штенсивнють фiзичного (13,0 (12,0-13,0) - 12,0 (12,0-13,0)) i пов'язаного з активнютю (13,0 (12,0-13,0) - 12,0 (12,0-13,5)) домеыв постшсультноТ втоми, згщно MFI-20, були статистично стабтьними, тодi як вира-женiсть глобального (14, 0 (13 , 0-15,0) - 13,0 (12,0-14,0)), печного (15,0 (14,0-16,0) - 13,0 (12,0-14, 0)) i мотивацшного (15,0 (14,0-16,0) - 13,0 (13,0-15,0)) домешв постшсультноТ втоми значно знижувалися протягом другого року пюля гострих цереброваскулярних подш. Висновки. 1. Частота зус^чаемосп постшсультноТ втоми, як i ТТ компонентiв, була стабiльною протягом другого року пюля гострих цереброваскулярних подш, незалежно вщ використаних шкал оцшки втоми. 2. !нтенсивнють глобально! постшсультноТ втоми, психiчного та мотивацшного домешв постшсультноТ втоми, згщно MFI-20, значно знижувалася протягом другого року пюля появи гострих цереброваскулярних подш.
Реферат
ПОСТИНСУЛЬТНАЯ УСТАЛОСТЬ И ЕЕ КОМПОНЕНТЫ В ТЕЧЕНИЕ ВТОРОГО ГОДА ПОСЛЕ ОСТРЫХ ЦЕРЕБРОВАСКУЛЯРНЫХ СОБЫТИЙ Дельва И.
Ключевые слова: инсульт, усталость, размеры, распространенность, интенсивность.
Постинсультная усталость является распространенным, длительным следствием острых церебро-васкулярных событий (ОЦС). Цель. Оценить частоту и интенсивность постинсультной усталости в течение второго года после инсультов и транзиторных ишемических атак. Материал и методы. Пациенты были обследованы через 12 месяцев (201 случай) и через 24 месяца (126 случаев) после появления острых цереброваскулярных событий, между этими временными точками пациенты обследовались ежеквартально. Постинсультную усталость измеряли по шкале оценки усталости (FAS), многомерной шкале оценки усталости -20 (MFI-20) и шкале тяжести усталости (FSS). Результаты. По данным FAS и FSS показатели постинсультной усталости в течение второго года после появления острых цереброваскулярных событий были стабильны в узких пределах - 31,7% -33,0%. Показатели глобальной, физической, умственной, связанной с деятельностью и мотивационной постинсультной усталостью, согласно MFI-20, также были стабильны: в пределах 25,0% -28,6%, 24,6% -27,4%, 27,8% -30,2%, 22,4% -26,2% и 19,4% -22,0% соответственно. Пациенты с инсультом, по отношению к пациентам с транзиторной ишемической атакой, имели более частые глобальные, физические, психические, мотивационные и связанные с активностью домены постинсультной усталости через 12 и 15 месяцев после появления острых цереброваскулярных событий. Интенсивность постинсультной усталости, согласно FAS (диапазон - 29,0 (26,0-33,0) - 28,0 (26,0-32,2)) и FSS (5,5 (5,2-5,9) ) - 4,8 (4,5-5,2)), а также
В1СНИК Украгнська медична стоматологгчна академя
интенсивность физического (13,0 (12,0-13,0) - 12,0 (12,0-13,0)) и связанного с активностью (13,0 (12,013,0) - 12,0 (12,0-13,5)) доменов постинсультной усталости, согласно 1^1-20, были статистически стабильными, тогда как выраженность глобального (14, 0 (13,0-15,0) - 13,0 (12,0-14,0)), психического (15,0 (14,0-16,0) - 13,0 (12,0-14, 0)) и мотивационного (15,0 (14,0-16,0) - 13,0 (13,0-15,0)) доменов постинсультной усталости значительно снижались в течение второго года после острых цереброваску-лярных событий. Заключение. 1. Частота встречаемости постинсультной усталости, а также её компонентов, была стабильной в течение второго года после острых цереброваскулярных событий, не зависимо от используемых шкал оценки усталости. 2. Интенсивность глобальной постинсультной усталости, психического и мотивационного доменов постинсультной усталости, согласно 1^1-20, значительно снижалась в течение второго года после появления острых цереброваскулярных событий.
D0l:10.31718/2077-1096.18.4.8 УДК: 616.384/.352-007-089.8
Дудченко М.О., Кравцв М.1., ващенко Д. М., Прих'дько Р.А., Мшура З.1. ПОР1ВНЯЛЬНИЙ АНАЛ1З РЕЗУЛЬТАТА Х1РУРГ1ЧНОГО Л1КУВАННЯ ХРОН1ЧНОГО ПАРАПРОКТИТУ, ВИСОКИХ РЕКТАЛЬНИХ НОРИЦЬ В ЗАЛЕЖНОСТ1 В1Д ВИКОРИСТАНОГО МЕТОДУ
Украшська медична стоматолопчна акаде1^я, м. Полтава.
Актуальнсть. Бльше, н1ж у 30% хворих на хрон1чний парапроктит виявляються саме складн фор-ми ц1'еУ патологи. Найчастше вони ускладнюються недостатнстю зовншнього сф1нктера за ра-хунок деформацУУ анального каналу та рубцевими змнами м'яз'т, що стискують заднй прох'д. Недостатнють анального сф1нктера спостергаеться у 4,9-33% хворих, а виконання повторних опе-рац1й з приводу рецидив'т нориць прямоУ кишки часто супроводжуються розвитком елемент1в ней-рогенноУ та моторноУ ¡нконтиненцУ внасл'док велико)' травми затульного апарату. Мета роботи. Провести пор1вняльний анал1з результат¡в х1рург1чного лкування хрон1чного парапроктиту м'ж традиц1йним та запропонованим методами оперативного лкування. Об'екти та методи. В даному експеримент1 приймали участь 58 пац1ент1в з екстрасф1нктерними норицями прямоУ кишки р1зного ступеню складностi, як були прооперован1 за двома методами: 1 група - 32 патента, прооперован1 за допомогою л1гатурного методу; друга група складалась з 26 пац1ент1в прооперованих за новим методом з використанням препарату «Тахокомб». Результати. Ранн1 п1сляоперац1йн1 ускладнення &дмЫен'1 у 37,5% хворих першоУкл/'н/'чноУгрупи, i у 15,4% в друг1й груп1. Також, через пвроку спосте-режень, значення тиску в анальному каналi в проекцУУ внутршнього сф1нктера в спокоУ у II груп1 пе-ревищили так у хворих прооперованих за традиц1йним методом. У 6 хворих (18,8%), що прооперо-ванi традиц1йним методом, протягом 6 мюяц1в розвинувся рецидив нориць, у 11 (34,4 %) були отриман1 задовльн функцюнальн1 результати, i у 15 (46,8%) - добрi функцюнальн1 результати. В друг1й кл1н1чн1й груп1 у 16 пац1ент1в (61,5%) отримано добрий результат; у 8 (30,7%) - задов'тьний i лише у 1 хворого (5,9%) виявлено рецидив захворювання. Результати лкування оц'1нен'1 через 3, 6, 12 i 18 мюяц1в, а м1н1мальн1 терм1ни монторингу хворих статистично оброблених груп склали больше року. Висновки. Таким чином, отриман1 добрi та задовльн вддаленi результати лкування високих ректальних нориць у хворих другоУ кл/'н/'чноУ групи, яким виконувалась операц1я за новим методом з використанням препарату Тахокомб, дозволяють рекомендувати розроблений метод для широкого застосування в кл1н1чн1й практиц при екстра- та транссф1нктерних норицях 3-4 ступеню тяжкост'!.
Ключов1 слова: парапроктит, екстрасфшктерна нориця, 1нконтиненц1я, анальна манометр1я, Тахокомб.
анального сфшктера спостер^аеться у 4,9-33% хворих, а виконання повторних операцш з приводу рецидивiв нориць прямо!' кишки часто супроводжуються розвитком елеметчв нейроген-но! та моторно! шконтиненцп внаслщок велико! травми затульного апарату [2,5,8].
В даному експеримент приймали участь 58 па^енпв з екстрасфшктерними норицями прямо! кишки рiзного ступеню скпадносп, як були проопероваш за двома методами: 1 група - 32 патента, проопероваш за допомогою л^атурно-го методу; друга група складалась з 26 па^енпв прооперованих за новим методом з використан-ням препарату «Тахокомб».
При оцшц результат хiрургiчного лкування
Бшьше, шж у 30% хворих на хрошчний парапроктит виявляються саме склады форми ^е! патологи [3]. Наявнють високих транссфшктер-них та екстрасфшктерних нориць прямо! кишки зазвичай ускладнюеться формуванням шфтьт-ративних змш, безперервним переб^ом та час-тими загостреннями запального процесу [4,6,7]. Найчаспше це викликае розвиток тяжких мюце-вих змш, що обумовлюють деформацш анального каналу та промежини, рубцевими змшами м^в, що стискують заднш прохщ, в результат чого виникае, в першу чергу, недостатнють зов-шшнього сфшктера [1]. Незважаючи на велику ктькють запропонованих методик хiрургiчного лкування нориць прямо! кишки, недостатнють
