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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">nogr</journal-id><journal-title-group><journal-title xml:lang="ru">Экспериментальная и клиническая гастроэнтерология</journal-title><trans-title-group xml:lang="en"><trans-title>Experimental and Clinical Gastroenterology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-8658</issn><publisher><publisher-name>«Global Media Technologies»</publisher-name></publisher></journal-meta><article-meta><article-id custom-type="elpub" pub-id-type="custom">nogr-588</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ХИРУРГИЧЕСКАЯ ГАСТРОЭНТЕРОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>SURGICAL GASTROENTEROLOGY</subject></subj-group></article-categories><title-group><article-title>ЯЗВЫ ТОНКО-ТОНКОКИШЕЧНЫХ АНАСТОМОЗОВ КАК ИСТОЧНИК КРОВОТЕЧЕНИЯ У ПАЦИЕНТОВ С РЕЗЕКЦИЕЙ ТОНКОЙ КИШКИ В АНАМНЕЗЕ</article-title><trans-title-group xml:lang="en"><trans-title>ULCERS THIN-INTESTINAL ANASTOMOSIS AS THE SOURCE OF BLEEDING IN PATIENTS WITH RESECTION OF THE SMALL INTESTINE IN HISTORY</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Иванова</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Ivanova</surname><given-names>E. V.</given-names></name></name-alternatives><email xlink:type="simple">katendo@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тихомирова</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Tikhomirova</surname><given-names>E. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ларичев</surname><given-names>С. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Larichev</surname><given-names>S. E.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Юдин</surname><given-names>О. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Yudin</surname><given-names>O. I.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Михалева</surname><given-names>Л. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Mikhaleva</surname><given-names>L. M.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Болихов</surname><given-names>К. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bolikhov</surname><given-names>K. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Федоров</surname><given-names>Е. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Fedorov</surname><given-names>E. D.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-6"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБОУ ВПО РНИМУ им. Н. И. Пирогова Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>FSBEI HPE rnsmu. N. And. Pirogov; ”K+31” Clinic</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ «ГКБ № 17 ДЗМ»; МГУ имени М. В. Ломоносова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Clinical Hospital № 17; Lomonosov Moscow State University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ГБУЗ «ГКБ № 17 ДЗМ»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Clinical Hospital № 17</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>АО «Клиника К+31»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>”K+31” Clinic</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>ГБУЗ «ГКБ № 31 ДЗМ»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Clinical Hospital № 31</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-6"><aff xml:lang="ru"><institution>ФГБОУ ВПО РНИМУ им. Н. И. Пирогова Минздрава России; ГБУЗ «ГКБ № 31 ДЗМ»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>FSBEI HPE rnsmu. N. And. Pirogov; City Clinical Hospital № 31</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2018</year></pub-date><pub-date pub-type="epub"><day>20</day><month>04</month><year>2018</year></pub-date><volume>0</volume><issue>4</issue><fpage>30</fpage><lpage>36</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Иванова Е.В., Тихомирова Е.В., Ларичев С.Е., Юдин О.И., Михалева Л.М., Болихов К.В., Федоров Е.Д., 2018</copyright-statement><copyright-year>2018</copyright-year><copyright-holder xml:lang="ru">Иванова Е.В., Тихомирова Е.В., Ларичев С.Е., Юдин О.И., Михалева Л.М., Болихов К.В., Федоров Е.Д.</copyright-holder><copyright-holder xml:lang="en">Ivanova E.V., Tikhomirova E.V., Larichev S.E., Yudin O.I., Mikhaleva L.M., Bolikhov K.V., Fedorov E.D.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.nogr.org/jour/article/view/588">https://www.nogr.org/jour/article/view/588</self-uri><abstract><p>Цель исследования: изучение причин образования язв области энтеро-энтероанастомозов у пациентов, перенесших тонкокишечное кровотечение (ТКК) путем оценки клинико-инструментальных данных и результатов проведенного лечения. Материалы и методы: в период с 14.02.2007 г. по 30.10.2017 г. из 213 пациентов, обратившихся для дообследования в связи с наличием кровотечения из желудочно-кишечного тракта неясной этиологии, язвы области энтеро-энтероанастомоза были выявлены у 8 (3,7%) пациентов: мужчин - 7 (87,5%) и женщин - 1 (12,5%), в возрасте от 19 до 59 лет (средний возраст 38,0 ± 14,4 лет). Клиническая картина явного кровотечения имела место у 7 (87,5%) пациентов, скрытого кровотечения - у 1 (12,5%) пациентки. Всем пациентам при поступлении была проведена комплексная диагностика, включающая капсульную и гибкую энтероскопию. Первичная диагностика патологии тонкой кишки выполнялась с помощью видеокапсульной энтероскопии (ВКЭ) у 6 (75,0%) пациентов, из которых в 2 случаях последующая БАЭ оказалась безуспешной. Попытки выполнения баллонно-ассистированной энтероскопии (БАЭ) проводились всем 8 больным, эффективно БАЭ была выполнена у 6 (75,0%), в том числе у 2-х пациентов, без предварительной ВКЭ. Результаты: язвы области энтеро-энтероанастомоза тонкой кишки первично были зарегистрированы при ВКЭ во всех случаях, с последующим подтверждением и локацией при БАЭ (4) и при оперативном вмешательстве (2); ещё в 2 случаях язвы были выявлены при БАЭ. Консервативная терапия, назначенная 6 (75,0%) пациентам, была эффективной у 1 пациента, тогда как в 5 случаях не поддающаяся коррекции анемия и рецидивы ТКК явились поводом для планового оперативного вмешательства. Оперативное лечение без консервативной терапии было выполнено у 2 (25,0%) пациентов. По результатам хирургического лечения и анализа послеоперационного материала 7 пациентов, язвы с локализацией в области энтеро-энтероанастомоза были у 4 (57,1%) пациентов и посередине длинных «слепых концов» тонкой кишки ещё у 3 (42,9%). По данным гистологического исследования, признаков ишемии и болезни Крона выявлено не было. У 2 (28,6%) пациентов было выявлено наличие шовного материала в дне язв. В отдаленном периоде (1-7 лет) признаков рецидива кровотечения у всех прооперированных больных, так же, как у пациента, получающего консервативное лечение, не отмечалось. Заключение: Применение методик ВКЭ и БАЭ позволило верифицировать источник ТКК у длительно страдающих пациентов с язвами области энтеро-энтероанастомозов. По результатам оперативного вмешательства и гистологического заключения у 7 больных, наличие длинных «слепых концов» и шовного материала в дне язв может быть причиной образования язв энтеро-энтероанастомоза в отдалённом периоде. Для более глубокого и полноценного анализа этиологии язв энтеро-энтероанастомозов в отдаленном постоперационном периоде требуется накопление клинического материала.</p></abstract><trans-abstract xml:lang="en"><p>Objectives: to evaluate the etiology of anastomotic ulcers (AU), being the sources of small bowel bleeding, using clinical, instrumental features and results of treatment. Materials and methods: From 14.02.2007 to 30.10.2017 from 213 patients, having applied to our hospital with suspected small bowel bleeding, AU were revealed in 8 (3,7%) pts (m-7, f-1, mean age 38,0±14,4 years, range 19-59). There were 7 (87,5%) pts. with obscure overt and 1 (12,5%) with obscure occult bleeding. Diagnostic procedures included videocapsule endoscopy (VCE) and balloon-assisted enteroscopy (BAE) in all of pts. VCE was performed in 6 (75,0%) pts, followed by BAE, which was ineffective in 2 cases. BAE was performed in all 8 pts: it was effective in 6 cases, including 2 pts without previous VCE. Results: Anastomotic ulcers were initially revealed, using VCE, in all cases, then - confirmed using BAE (4) and surgery (2); using only BAE - in 2 pts. Initial conservative treatment, recommended to 6 (75,0%) pts, was effective in 1 case; in other 5 cases surgery was performed because of persisted anemia and rebleeding episodes. Surgery at once was performed in 2 (25,0%) pts. After surgery and histology in 7 pts we revealed ulcers at the anastomotic area in 4 (57,1%) pts, in the middle of long blind loops area in 3 (42,9%) pts. Signs of ischemia and Crohn’s disease were not revealed. Suture material was detected in ulcer bases in 2 (28,6%) pts. All patients have been free of relapse (1-7 years). Conclusions: Using VCE and BAE gave the opportunity to reveal the source of bleeding in pts with AU, suffering for a long time. Having analysed surgery and histology results in 7 pts, we can suppose, that long blind loops, as well as suture material can lead to anastomotic ulceration in patients after SB resection. Further accumulation of clinical material is needed for complete analysis of etiology of AU.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>язвы энтеро-энтероанастомоза</kwd><kwd>тонкокишечное кровотечение</kwd><kwd>резекция тонкой кишки</kwd><kwd>энтероскопия</kwd></kwd-group><kwd-group xml:lang="en"><kwd>anastomotic ulcers</kwd><kwd>small bowel bleeding</kwd><kwd>small bowel resection</kwd><kwd>enteroscopy</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Bhargava S.A. et al. Gastrointestinal bleeding due to delayed perianastomotic ulcers in children. Am J Gastroenterol 1995; 90:807-809.</mixed-citation><mixed-citation xml:lang="en">Bhargava S.A. et al. Gastrointestinal bleeding due to delayed perianastomotic ulcers in children. 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