Morphological determinants for the local hemostatic effect of exogenous fibrin monomer in its systemic administration after injury with inhibition of platelet aggregation in the experiment

Background. In our previously published studies, we demonstrated a high hemostatic activity of a low dose of exogenous fibrin monomer during its systemic administration in a model of dosed liver injury with preliminary inhibition of platelet aggregation. However, the analysis of platelet involvement in the mechanisms of local fibrin formation has not been analyzed. The aim of the study. To conduct a comparative analysis of the cellular composition of venous and wound blood, as well as blood in the wound vessels to assess the contribution of platelets to the hemostatic effect of exogenously administered fibrin monomers in dosed liver injury under conditions of pharmacologically determined thrombocytopathy. Methods. In a model of dosed liver injury in rabbits after inhibition of platelet aggregation by  acetylsalicylic acid in combination with clopidogrel, the effect of the administration of fibrin monomer was evaluated in comparison with the use of tranexamic acid. We studied the number of platelets in venous and wound blood smears, as well as in the contents of wound vessels. Results. It has been established that with the systemic administration of exogenous fibrin monomer, the number of platelets in wound blood smears decreases by 17.2 % in comparison with free circulating venous blood. Platelets in wound blood form aggregates and are in an activated state. In the wound vessels, the number of these cells was maximum (150 per lower field) compared with the number of platelets in the placebo and tranexamic acid groups (55 and 84 per lower field, respectively). Also in the wound blood, erythrocytes with altered forms (echinocytes, schistocytes, stomatocytes and ovalocytes) were found. Conclusion. Systemic administration of exogenous fibrin monomer affects the redistribution of platelets between the systemic circulation, wound vessels and wound blood, determining its hemostatic effect and local wound fibrin formation in dosed liver injury. The presence of receptor-mediated platelets recruitment due to fibrin monomer in the wound vessels with the  participation of damaged erythrocytes is assumed

Несостоятельность колоректального анастомоза после передней резекции прямой кишки: частота, факторы риска

Purpose of the study. To study the frequency and risk factors for the development of colorectal anastomosis leakage after anterior rectal resection for cancer.Materials and Methods. In a retrospective cohort study between April 2011 and February 2018. The data of the case histories of patients who underwent combined treatment for rectal cancer were analyzed. The study included patients who underwent neoadjuvant chemoradiotherapy followed by surgery. The influence of risk factors on the incidence of AN was assessed based on multivariate analysis using the logistic regression method.Results. The study was conducted in 474 patients who underwent anterior resection for rectal cancer. Depending on the outcome of the operation, the patients were divided into two groups: with the formation of a preventive intestinal stoma (main group, n = 344) and without formation (control group, n = 140) The overall incidence of postoperative complications was 20.6 % in patients with preventive stoma (PS) and 26.1 % without PS (p = 0.198). Colorectal anastomosis (RCA) leaks were detected in 40 (11.6 %) patients in the PS group and in 9 (6.9 %) patients in the non-PS group (р = 0,134). This complication was detected on the 7th day (2–12 days) after the operation in 5 (9.8 %) patients, while in patients with PS on the 10th day (11.6 %) and without PS on 3 (6.9 %) %), (p = 0.134). According to the classification of NCA severity, grade A was detected in 12 patients, B – at 24, C – in 11 patients. The frequency of reoperations in patients with PS was 10.8 %, while in patients with PS it was 15 % (p <0.001). The most common reason for reoperations in patients with LCA in the group without PS was the development of peritonitis (5.4 %, p <0.001). In a statistical multivariate analysis, the most significant risk factors for the development of NCA were: the presence of preoperative chemoradiotherapy (p = 0.001), diabetes mellitus (p = 0.031) and stage III–IV of the disease (p = 0.051).Conclusions. The formation of a preventive intestinal stoma after anterior resections does not reduce the incidence of colorectal anastomosis leaks (p = 0.134), however, it reduces the degree of manifestation of AN in the severity of the course of the postoperative postoperative period (p = 0.029). The frequency of reoperations in patients without a PS is significantly higher than in patients with a stoma (p <0.0001). Diabetes mellitus, chemoradiotherapy, and stage III–IV of the disease are factors influencing the development of leakage.Цель исследования – изучить частоту и факторы риска развития несостоятельности колоректального анастомоза (НКА) после передней резекции прямой кишки по поводу рака.Материалы и методы. В ретроспективном когортном исследовании за период с апреля 2011 по февраль 2018 г. проанализированы данные историй болезни пациентов, которым проведено комбинированное лечение по поводу рака прямой кишки. В исследование были включены пациенты, которым проведена неоадъювантная химиолучевая терапия с последующим хирургическим вмешательством. Оценивали влияние факторов риска на частоту развития несостоятельности анастомоза на основании многофакторного анализа методом логистической регрессии.Результаты. Исследование было проведено у 474 пациентов, перенесших переднюю резекцию по поводу рака прямой кишки. В зависимости от исхода операции больные были разделены на 2 группы: с формированием кишечной превентивной стомы (ПС) (основная группа, n = 344) и без формирования ПС (контрольная группа, n = 140). Общая частота послеоперационных осложнения составила 20,6 % у больных с ПС и 26,1 % – без ПС (р = 0,198). НКА была выявлена у 40 (11,6 %) пациентов в группе с ПС и у 9 (6,9 %) – в группе без ПС (р = 0,134). Данное осложнение выявлялось на 7-е (медиана) сутки (2–12 сут) после операции у 5 (9,8 %) больных, при этом у больных с ПС (11,6 %) – на 10-е сутки и без ПС (6,9 %) на 3-и, (р = 0,134). По классификации тяжести НКА степень A выявлена у 12 больных, B – у 24, C – у 11 пациентов. Частота повторных операций у больных с ПС составила 10,8 %, в то время как у больных без ПС – 15 % (р <0,001). Наиболее частой причиной повторных операций у больных с НКА в группе без ПС являлось развитие перитонита (5,4 %, р <0,001). При многофакторном анализе наиболее значимыми факторами риска развития НКА являлись наличие предоперационной химиолучевой терапии (р = 0,001), сахарный диабет (р = 0,031), а также III–IV стадия заболевания (р = 0,051).Выводы. Формирование превентивной кишечной стомы после передних резекций не снижает частоту НКА (р = 0,134), однако снижает степень проявления НКА в послеоперационном периоде. Частота повторных операций у больных без ПС достоверно выше, чем у больных с наличием ПС. Сахарный диабет, проведенная химиолучевая терапия, а также III–IV стадия заболевания являются факторами, влияющими на развитие НКА