Завтра принять участие в обсуждении, к сожалению, не смогу - весь день в "scrubbs". Конспективно, из лучшей хирургической клиники:
Anastomotic leakage
This may occur in the early postoperative period (2-3 days) when it is deemed due to technical failure or later (3-7 days) when it is thought more likely to be due to ischaemic changes in the stomach, usually close to the suture line. This is associated with significant mortality and morbidity. Occasionally, small radiologically demonstrated leaks are seen at 7-10 days but these can be clinically insignificant or associated with little disturbance. These may be treated conservatively with confidence. Early leaks or gastric ischaemia may be associated with profound acidosis and respiratory distress. Such signs should alert the team to the possibilities of a leak or ischaemia and prompt early investigation, preferably by endoscopy, but contrast swallow may also be of help. Early leaks and ischaemia should be treated aggressively by re-exploration and appropriate resection, defunctioning or re-anastomosis where appropriate.
Upper GI Unit, Royal Infirmary of Edinburgh. Lauriston Place, Edinburgh EH3 9YW
|