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The results of single-step and staged procedures in the management of neoplastic colonic obstruction


Author: Zastavniţchi Gheorghe
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2012
Scientific adviser: Igor Mişin
doctor habilitat, associate professor (docent), State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Nicolae Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.27
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 28 March, 2012
Approved by NCAA on the 23 May, 2012

Abstract

Adobe PDF document – 0.46 Mb / in romanian

Keywords

Сolon, malignancy, obstruction, collagen metabolism, sentinel lymph node mapping, single-step procedures, staged procedures

Summary

The thesis includes introduction, 5 chapters, resolution, conclusions, recommendations, bibliography of 273 sources, 136 pages of basic text, 83 figures, 30 tables. The obtained results were published in 22 scientific works.

The research domain: 14.00.27 – surgery.

Study aim: To improve the treatment results for the patients with malignant colonic obstruction by means of selection as well as optimal technical criteria for single-step and staged procedures. The research objectives: Experimental argumentation of the optimal modality to apply primary anastomoses in colonic obstruction; to study the collagen metabolism in experimental colonic obstruction; to study the collagen metabolism in patients with malignant colonic obstruction; to establish the patients’ selection criteria for different surgical management modalities of neoplastic colonic obstruction; to appreciate the possibility and the results of sentinel lymph node mapping in patients with neoplastic bowel obstruction; to appreciate the immediate and long distance outcomes of single-step and staged procedures in the management of neoplastic colonic obstruction.

The novelty and the scientific originality: In experimental study was demonstrated the possibility of primary anastomoses for bowel obstruction by study of hydroxyproline concentration. In experimental study were established the particularities of anastomotic healing in bowel obstruction. For the first time was studied the collagen metabolism by hydroxyproline concentration in patients with neoplastic colonic obstruction. The optimal selection criteria for patients’ selection for different surgical procedures were established. The technical particularities of staged and single-step procedures were established. For the first time was performed the sentinel lymph node mapping in patients with neoplastic bowel obstruction. The actual and prognosed survival rate according to Kaplan-Meier were determined.

The scientific solved problem: The optimal criteria for patients’ selection for different surgical procedures for the management of malignant colonic obstruction were established, as well as the optimal technical particularities of resection and primary anastomosis for obstructed malignant colonic obstruction.

The theoretical significance: In experimental and clinical study the optimal treatment modalities in the management of malignant bowel obstruction based upon the study of reparative processes in the bowel wall, as well as optimal technical criteria for single-step and staged procedures were established.

The applicative value of the work:

The optimal treatment algorithm for malignant bowel obstruction upon the optimal complex of patients’ selection criteria for staged and single-step procedures surgical procedures was established.

The implementation of the scientific results: As a result of the present study new treatment procedures of the malignant bowel obstruction were introduced for the patients’ management (single-step and staged procedures) in the 4 surgical and endoscopy departments of the Chisinau Emergency Hospital of the Republic of Moldova, as well as in the training curricula at the surgical department N.1 “Nicolae Anestiadi”.