MODERN TECHNOLOGIES FOR THE DIAGNOSIS AND TREATMENT OF COLORECTAL CANCER

Abstract. Introduction. The problem of tumor lesions of the large intestine remains acute in clinical medicine due to the widespread prevalence and tendency to increase colorectal cancer (CRC), the lack of effective methods of prevention and treatment of formidable complications that often develop. The purpose of the study is to improve the results of surgical treatment of patients with CRC by studying the possibilities of video laparoscopy and choosing the optimal tactics based on the assessment of the severity of the condition and the patient’s cytokine status. Material and methods. The results of the treatment of 155 patients with CRC who were treated in the clinic State institution «Institute of General Emergency Surgery V.T. Zaitsev of the National Academy of Medical Sciences of Ukraine», which is the clinical base of the Department of Surgery No. 1 of KhNMU. When choosing the tactics of treating patients, the stage of tumor damage, the level of acute intestinal obstruction (AIO), the level of endogenous intoxication, assessed according to the APACHE II and SAPS severity scales, as well as the state of the immune system according to the level of IL-6 in the blood, were taken into account. The results. In all cases, the nature and time of preoperative preparation was determined based on the study of clinical and laboratory indicators of the level of IL-6 in blood serum, as well as the point assessment of the severity of the physiological state of patients according to the integral scales of APACHE II and SAPS. With the correct selection of patients, laparoscopically assisted operations were performed, which give a lower percentage of complications, a more favorable postoperative period, and a shorter period of hospitalization than traditional operations. Thus, in emergency patients, intestinal peristalsis appeared on the third day after surgery (3.85±0.11), and the release of gases began after 4 days (4.33±0.04), the appearance of independent defecation was noted on the fifth day after surgery. Conclusions. The integral point assessment of the condition of patients with AIO in CRC according to the APACHE II and SAPS system allows choosing the optimal amount of surgical intervention: at 1-2 the severity of the condition according to the objectification scales of APACHE II (< 20) and SAPS (< 11) and the level of IL-6 concentration in blood serum up to 100 pg/ml extended pathogenetically determined, radical surgical interventions; at 3 st. the severity of the condition according to the objectification scales of APACHE II (> 20) and SAPS (> 11) and the level of IL-6 concentration in the blood serum is more than 100 pg/ml the minimum, palliative scope of the operation, which allows to eliminate the phenomena of AIO. Laparoscopically assisted operations left-sided hemicolectomy, resection of the sigmoid colon, anterior resection of the rectum: are optimal, which contributes to the early recovery of intestinal peristalsis and early activation of patients, and also reduces the postoperative bed-day.