gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2016-0-4-15-21gnck-44Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESТРАНСАНАЛЬНОЕ УКРЕПЛЕНИЕ НИЗКОГО КОЛОРЕКТАЛЬНОГО АНАСТОМОЗА: ПЕРВЫЙ ОПЫТ И ПЕРСПЕКТИВЫTHE TRANSANAL REINFORCEMENT OF LOW COLORECTAL ANASTOMOSIS: FIRST EXPERIENCE AND PERSPECTIVESАлексеевМ. В.AlekseevM. V.noemail@neicon.ruШелыгинЮ. А.ShelyginYu. A.noemail@neicon.ruРыбаковЕ. Г.RybakovE. G.noemail@neicon.ruФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава РоссииРоссияState Scientific Centre of ColoproctologyRussian FederationФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России; ГБОУ ДПО «РМАПО» Минздрава РоссииРоссияState Scientific Centre of ColoproctologyRussian Federation201630122016041521Copyright © Алексеев М.В., Шелыгин Ю.А., Рыбаков Е.Г., 20162016Алексеев М.В., Шелыгин Ю.А., Рыбаков Е.Г.Alekseev M.V., Shelygin Y.A., Rybakov E.G.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/44

ЦЕЛЬ РАБОТЫ. Оценить влияние применения трансанального укрепления низкого колоректального анастомоза на частоту несостоятельности анастомоза. МАТЕРИАЛЫ И МЕТОДЫ. В исследование включено 13 пациентов, из них шести выполнена низкая передняя резекция прямой кишки по поводу рака, проведено трансанальное укрепление анастомоза отдельными швами. Формирование превентивной стомы не производилось. РЕЗУЛЬТАТЫ. В исследовании приведен анализ непосредственных: результатов лечения больных. У 3 из 6 пациентов выявлены признаки несостоятельности анастомоза, что потребовало разобщения анастомоза у одного и формирование двуствольной стомы у двух больных. ВЫВОДЫ. Первый опыт применения трансанального укрепления низкого колоректального анастомоза нельзя признать удачным, в связи с возникновением несостоятельности у каждого второго пациента. Возможно, необходим более тщательный подбор пациентов для проведения данной методики и применение других методов профилактики несостоятельности анастомоза.

AIM. It was to evaluation the effect of using of transanal reinforcement of low colorectal anastomosis to the frequency of anastomotic leakage. MATERIALS AND METHODS. The study included six patients who underwent a low anterior resection for rectal cancer and the transanal reinforcement anastomosis. Preventive stomas not formed. RESULTS. The study contains an analysis of the immediate results of patients treatment. The leakage of the anastomosis was developed in 3 of 6 patents. This required break down of the anastomosis in one and the formation of diverting stoma in two patients. CONCLUSION. The first experience of the transanal reinforcement for low colorectal anastomosis is unsuccessful because of leakage appeared in every second patient. More careful selection of patients for this method is required.

низкая передняя резекция прямой кишкинесостоятельность анастомозатрансанальное укрепление анастомозаlow anterior resectionanastomotic leakagetransanal reinforcement of anastomosisReferencesAnderin K., Gustafsson U.O., Thorell A. et al. The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program. EJSO. - 2015. -№ 41. - р. 724-30.Anderin K., Gustafsson U.O., Thorell A. et al. The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program. EJSO. - 2015. -№ 41. - р. 724-30.Baek S.J., Kim J., Kwak J. et al. Can transanal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy? World J. Gastroenterol. - 2013. -№ 19 (32). - р. 5309-13.Baek S.J., Kim J., Kwak J. et al. Can transanal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy? World J. Gastroenterol. - 2013. -№ 19 (32). - р. 5309-13.Chow A., Tilney H.S., Paraskeva P. et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int. J. Colorectal. Dis. - 2009. -№ 24 (6). - р. 711-23.Chow A., Tilney H.S., Paraskeva P. et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int. J. Colorectal. Dis. - 2009. -№ 24 (6). - р. 711-23.Gadiot R., Dunker M., Mearadji A. et al. Reduction of anastomotic failure in laparoscopic colorectal surgery using antitraction sutures. Surg. Endosc. -2011. - № 25. - р. 68-71.Gadiot R., Dunker M., Mearadji A. et al. Reduction of anastomotic failure in laparoscopic colorectal surgery using antitraction sutures. Surg. Endosc. -2011. - № 25. - р. 68-71.Gastinger I., Marusch F., Steinert R. et al. Working Group ‘Colon/Rectum Carcinoma’. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br. J. Surg. - 2005. - № 92 (9). -р. 1137-42.Gastinger I., Marusch F., Steinert R. et al. Working Group ‘Colon/Rectum Carcinoma’. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br. J. Surg. - 2005. - № 92 (9). -р. 1137-42.Giuliani D., Willemsen P., Van Elst F. et al. A defunctioning stoma in the treatment of lower third rectal carcinoma. Acta Chir. Belg. - 2006. - № 106 (1). -р. 40-3.Giuliani D., Willemsen P., Van Elst F. et al. A defunctioning stoma in the treatment of lower third rectal carcinoma. Acta Chir. Belg. - 2006. - № 106 (1). -р. 40-3.Hidaka E., Ishida F., Mukai S. et al. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg.Endosc. - 2015. - № 29. - р. 863-7.Hidaka E., Ishida F., Mukai S. et al. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg.Endosc. - 2015. - № 29. - р. 863-7.Huser N., Michalski C.W., Erkan M. et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann. Surg. - 2008. - № 248 (1). - р. 52-60.Huser N., Michalski C.W., Erkan M. et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann. Surg. - 2008. - № 248 (1). - р. 52-60.Kaidar-Person O., Person B., Wexner S.D. Complications of construction and closure of temporary loop ileostomy. J. Am. Coll. Surg. - 2005. -№ 201 (5). - р. 759-73.Kaidar-Person O., Person B., Wexner S.D. Complications of construction and closure of temporary loop ileostomy. J. Am. Coll. Surg. - 2005. -№ 201 (5). - р. 759-73.Marusch F., Koch A., Schmidt U. et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis. Colon Rectum. - 2002. - № 45 (9). -р. 1164-71.Marusch F., Koch A., Schmidt U. et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis. Colon Rectum. - 2002. - № 45 (9). -р. 1164-71.Matthiessen P., Hallbook O., Andersson M. et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. - 2004. -№ 6 (6). - р. 462-9.Matthiessen P., Hallbook O., Andersson M. et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. - 2004. -№ 6 (6). - р. 462-9.Matthiessen P., Hallbook O., Rutegard J. et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann. Surg. - 2007. - № 246. - р. 207-14.Matthiessen P., Hallbook O., Rutegard J. et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann. Surg. - 2007. - № 246. - р. 207-14.Miccini М., Bonapasta S.A., Gregori M. et al. Ghost ileostomy: real and potential advantages. The American Journal of Surgery. - 2010. - № 200. -р. 55-57.Miccini М., Bonapasta S.A., Gregori M. et al. Ghost ileostomy: real and potential advantages. The American Journal of Surgery. - 2010. - № 200. -р. 55-57.Peeters K.C., Tollenaar R.A., Marijnen C.A. et al. Dutch Colorectal Cancer Group. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br. J. Surg. - 2005. - № 92 (2). - р. 211-6.Peeters K.C., Tollenaar R.A., Marijnen C.A. et al. Dutch Colorectal Cancer Group. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br. J. Surg. - 2005. - № 92 (2). - р. 211-6.Rahbari N.N., Weitz J., Hohenberger W. et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. - 2010. - № 147 (3). - р. 339-51.Rahbari N.N., Weitz J., Hohenberger W. et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. - 2010. - № 147 (3). - р. 339-51.Xiao L., Zhang W-B,. Jiang P-C. et al. Can Transanal Tube Placement after Anterior Resection for Rectal Carcinoma Reduce Anastomotic Leakage Rate? A Single-institution Prospective Randomized Study. World J. Surg. - 2011. - № 35. - р. 1367-1377.Xiao L., Zhang W-B,. Jiang P-C. et al. Can Transanal Tube Placement after Anterior Resection for Rectal Carcinoma Reduce Anastomotic Leakage Rate? A Single-institution Prospective Randomized Study. World J. Surg. - 2011. - № 35. - р. 1367-1377.

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