gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2024-23-2-108-116gnck-1915Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESХирургическое и неоперативное лечение острых воспалительных осложнений дивертикулярной болезни в ковидном госпиталеSurgical and non-operative treatment of acute complicated diverticulitis in a COVID hospitalhttps://orcid.org/0000-0003-0558-4079ТягуновА. Е.TyagunovA. E.

Тягунов Александр Евгеньевич — д.м.н., профессор кафедры факультетской хирургии №1 ЛФ, заведующий отделом абдоминальной хирургии НИИ клинической хирургии 

тел. (916)-502-23-24 

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

 Alexander E. Tyagunov 

Ostrovityanova st., 1, Moscow, 117997, Russia 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

 

tyagunov1@mail.ruhttps://orcid.org/0000-0002-5250-6359ЩербаковН. А.ShcherbakovN. A.

Щербаков Никита Алексеевич — ординатор кафедры факультетской хирургии №1 ЛФ по специальности «Хирургия», лаборант отдела абдоминальной хирургии НИИ клинической хирургии 

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

Ostrovityanova st., 1, Moscow, 117997, Russia

nikita.shche98@gmail.comhttps://orcid.org/0000-0002-0846-1616АхмедовР. Р.AkhmedovR. R.

Ахмедов Рамиль Рашидович — врач-хирург хирургического отделения №2 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

Ostrovityanova st., 1, Moscow, 117997, Russia

Ramil4512@yandex.ruhttps://orcid.org/0000-0002-8926-2183ДонченкоН. С.DonchenkoN. S.

Донченко Наталья Сергеевна — врач-рентгенолог 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

natalydonbass@gmail.comhttps://orcid.org/0000-0002-5776-3653ЛайпановБ. К.LaipanovB. K.

Лайпанов Борис Камалович — к.м.н., доцент кафедры факультетской хирургии № 1 ЛФ, с.н.с. отдела абдоминальной хирургии НИИ клинической хирургии; врач-хирург хирургического отделения №2  

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

Ostrovityanova st., 1, Moscow, 117997, Russia 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

Blaypanov@mail.ruhttps://orcid.org/0009-0006-1503-8134АлиеваЗ. М.AlievaZ. M.

 Алиева Зарипат Мунировна — ординатор кафедры факультетской хирургии №1 ЛФ 

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

Ostrovityanova st., 1, Moscow, 117997, Russia

alievazarana@gmail.comhttps://orcid.org/0000-0001-9414-7588СтрадымовЕ. А.StradymovE. A.

Страдымов Егор Андреевич — к.м.н., ассистент кафедры факультетской хирургии № 1 ЛФ, с.н.с. отдела абдоминальной хирургии НИИ клинической хирургии; врач-хирург хирургического отделения №2  

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

Ostrovityanova st., 1, Moscow, 117997, Russia 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

egr.stradymov@mail.ruhttps://orcid.org/0000-0003-3479-266XТавадовА. В.TavadovA. V.

Тавадов Арсен Владиславович — к.м.н., заведующий хирургическим отделением №1 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

tavadovarsen@gmail.comhttps://orcid.org/0000-0001-6526-9324МирзоянА. Т.MirzoyanA. T.

Мирзоян Айк Тигранович — к.м.н., доцент кафедры факультетской хирургии №1 лечебного факультета; заведующий хирургическим отделением №2  

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

tigranovic@gmail.comhttps://orcid.org/0009-0002-6004-3291ФёдоровД. Д.FyodorovD. D.

Фёдоров Дмитрий Дмитриевич — врач-хирург хирургического отделения №2 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

Sosenskiy Stan st., 8, Moscow, 142770, Russia 

Dimafedoro_@mail.ruhttps://orcid.org/0000-0002-2953-3404ТягуновА. А.TyagunovA. A.

Тягунов Антон Александрович — соискатель кафедры факультетской хирургии №1 лечебного факультета 

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

Ostrovityanova st., 1, Moscow, 117997, Russia

toxan1992@gmail.comhttps://orcid.org/0000-0001-6188-6093СажинА. В.SazhinA. V.

Сажин Александр Вячеславович — д.м.н., профессор, член-корреспондент РАН, директор НИИ клинической хирургии, заведующий кафедрой факультетской хирургии № 1 

ул. Островитянова, д. 1, г. Москва, 117997, Россия 

ул. Сосенский Стан, д. 8, д. Москва, 142770, Россия 

 Ostrovityanova st., 1, Moscow, 117997, Russia 

 Sosenskiy Stan st., 8, Moscow, 142770, Russia 

sazhin-AV@yandex.ruФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России; ММКЦ «Коммунарка» ДЗМРоссияPirogov Russian National Research Medical University; Moscow Multidisciplinary Clinical Center “Kommunarka”Russian FederationФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian FederationГБУЗ ММКЦ "Коммунарка" ДЗМРоссияPirogov Russian National Research Medical UniversityRussian FederationГБУЗ ММКЦ "Коммунарка" ДЗМРоссияMoscow Multidisciplinary Clinical Center “Kommunarka”Russian FederationФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России; ММКЦ «Коммунарка» ДЗМРоссияMoscow Multidisciplinary Clinical Center “Kommunarka”Russian Federation202421062024232108116Copyright © Тягунов А.Е., Щербаков Н.А., Ахмедов Р.Р., Донченко Н.С., Лайпанов Б.К., Алиева З.М., Страдымов Е.А., Тавадов А.В., Мирзоян А.Т., Фёдоров Д.Д., Тягунов А.А., Сажин А.В., 20242024Тягунов А.Е., Щербаков Н.А., Ахмедов Р.Р., Донченко Н.С., Лайпанов Б.К., Алиева З.М., Страдымов Е.А., Тавадов А.В., Мирзоян А.Т., Фёдоров Д.Д., Тягунов А.А., Сажин А.В.Tyagunov A.E., Shcherbakov N.A., Akhmedov R.R., Donchenko N.S., Laipanov B.K., Alieva Z.M., Stradymov E.A., Tavadov A.V., Mirzoyan A.T., Fyodorov D.D., Tyagunov A.A., Sazhin A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1915

Оперативное лечение острого живота в пандемию SARSCoV-2 сопровождалось чрезвычайно высокой летальностью, однако только несколько исследований представили результаты лечения острых воспалительных осложнений дивертикулярной болезни (ОВОДБ).ЦЕЛЬ: анализ результатов лечения пациентов с ОВОДБ в ковидном стационаре.ПАЦИЕНТЫ И МЕТОДЫ: в ретроспективное исследование включено 78 пациентов ковидного госпиталя с ОВОДБ, подтвержденным на КТ. Оценка Covid-пневмонии, коморбидности, органной дисфункции, данных КТ, перитонита, методов лечения и госпитальной летальности среди пациентов были проведены.РЕЗУЛЬТАТЫ: на момент диагностики ОВОДБ, Соvid-пневмония выявлена у 56 (71,8%) пациентов. У 46 (59,0%) пациентов имелась органная дисфункция ≥ 1 балл по шкале qSOFA. По данным КТ, внепросветный дистантный газ в брюшной полости был выявлен у 48 (61,5%) пациентов, периколический — у 14 (17,9%) пациентов. Сегментарная резекция ободочной кишки была выполнена 60 (76,9%) пациентам, лапароскопический лаваж (ЛЛ) брюшной полости — 3, неоперативное лечение (НОЛ) с дренированием жидкостных скоплений — 6 и только НОЛ — 10 пациентам. После резекции у 52 (86,7%) пациентов развилась или прогрессировала органная дисфункция ≥ 2 баллов по SOFA, которая привела к смерти 38 (63,3%) пациентов. Все пациенты после НОЛ, включая 7 пациентов с внепросветным газом, и 2 пациента после ЛЛ выжили.ВЫВОД: хирургическое лечение ОВОДБ у пациентов с Covid-19 сопровождалось чрезвычайно высокой летальностью, в связи с чем при отсутствии очевидных признаков диффузного перитонита начальное неоперативное лечение может быть жизнеспасительным для них.

Surgical treatment of acute abdomen during the SARS-CoV-2 pandemic was accompanied by an extremely high mortality rate, however, only a few studies have presented the results of acute inflammatory complications of diverticular disease (AICDD).AIM: analysis of treatment of AICDD in a COVID-19 hospital.PATIENTS AND METHODS: the retrospective study included 78 patients with acute diverticulitis (AD) from a COVID hospital, confirmed by CT or intraoperative revision. Assessment of COVID pneumonia, comorbidities, organ dysfunction, CT findings, peritonitis, treatment methods, and in-hospital mortality among patients was performed.RESULTS: organ dysfunction of ≥ 1 point on the qSOFA scale was detected in 59.0% of the patients. According to CT data, abdominal distant gas was detected in 48 (61.5%) patients, and pericolic gas in 14 (17.9%) patients. Segmental colon resection was performed in 60 (76.9%) patients, laparoscopic lavage (LL) of the abdominal cavity — in 3, non-operative treatment (NOT) with drainage of fluid collections — in 6, and only NOT in 10 patients. Most patients with distant or pericolic gas were operated on within an average time of 1 [0; 3.5] hours after admission. Diffuse peritonitis was detected during surgery in 45 (75%) of them. After resection, organ dysfunction of ≥ 2 points on the SOFA scale developed or progressed in 52 (86.7%) patients. The overall mortality rate was 48.7%, and the postoperative mortality was 63.3%. All patients (n = 38) died after segmental colon resection. Successful NOT was achieved in 4 patients with pericolic gas and 3 patients with distant gas.CONCLUSION: surgery for AICDD in patients with COVID-19 is associated with extremely high mortality, therefore, in the absence of obvious signs of diffuse peritonitis, initial non-operative treatment may be life-saving.

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The authors declare that there are no conflicts of interest present.