Surgical Aspects of Operative Treatment of Patients With Epithelial Coccygeal Courses
About the author:
Lul’ka A. N.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Analysis of surgical treatment of 188 patients with ECC that were hospitalized in the surgical ward number 1 city hospital № 2 of Poltava during 2003-2012 has been performed. The age of patients ranged from 16 to 64 years, males were 149 (79. 3 %), women - 39 (20. 7 %). Most patients - 139 (74 %) were under 30 years old. The course of disease was divided into uncomplicated ECC (without clinical manifestations) and complicated by inflammation of suppuration (acute or chronic). The majority of the 188 patients who applied for medical assistance, hospitalized in urgent procedure on the stage of acute inflammation with suppuration - 141 (75 %). Routinely received 47 patients, including those with signs of chronic inflammation - 39 (21 %) and 8 (4 %) - with uncomplicated course. Recurrence of the disease being treated in hospital has been met in 5 (2. 6 %) patients in the period from 6 months to 3 years from the first operation. All patients must perform research probe of the ECC through the outer hole, on the indications - ultrasonography, anoscopy, fistulography. In cases of purulent inflammation research conducted microbiological content of the abscess cavity. The structure of the microflora of wounds in patients with purulent inflammation of ECC dominated by Gram-positive strains (Staphylococcus aureus, Staphylococcus epidermidis) - 86,5 %, Gram-negative microflora (Escherichia coli, Enterobacter faecalis) was found in 13. 5 % of patients. All patients were operated. Postoperatively received antimicrobial, anti-inflammatory, local and symptomatic therapy. Antibiotic therapy for patients started with empirical course of 2-3 generations cephalosporins or fluoroquinolones with transition, as appropriate, to other medications in accordance with the sensitivity of cultured bacteria from the wound. One-stage radical ECC excision surgery performed to 76 patients in cases of acute purulent inflammation with infiltration size less than 3 cm and in cases of uncomplicated and chronic course and had positive effects. So, once achieved radical surgery, antibiotic and anti-inflammatory therapy had a high efficiency, the conditions were formed for initial wound healing. Duration of hospitalization usually made 8-10 days, stitches removed at the same time depending on the condition of the wound. Disease recurrence was observed in 4 (5. 2 %) patients. Also, in 3 (4 %) cases, there was discomfort, but at one - persistent pain in the area of operations. This is due to the formation of trigger points through rough hypertrophic scar. The reasons were asymmetric cut and subcutaneous tissue deformation in the area of surgery. Suppurating wounds was diagnosed in 6 (7.9 %) observations: in 5 cases after primary radical surgery in patients with acute purulent inflammation and 1 - after surgery for chronic inflammation. Closure of wounds in these patients has been performed by secondary healing. In 112 cases of acute purulent ECC inflammation size of the inflammatory infiltrate was not allowed to perform one-stage radical operation. These patients underwent two-stage surgery: after opening and rehabilitation of purulent foci in 4-6 day (11.6 % - 7-9 days) radical ECC excision has been performed. The advantages of such tactics were: less traumatic surgery, more adequate than when expressed purulent inflammation, ECC visualization. Reducing the size of infiltration allowed to make small symmetrical incision and prevent excessive deficit of tissues that leads to tension and the consequent inability of seams, edges of necrotic wounds fester and secondary healing. So in the second group of patients was diagnosed 1 (0. 9 %) recurrence case, and suppurating wounds with secondary healing was observed in 5 cases (4.5 %).
epithelial coccygeal courses, surgical treatment
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 (106), 2014 year, 139-142 pages, index UDK 617. 59-007. 253-089