spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2020-3-5-10spractice-176Research ArticleСтатьиФАКТОРЫ РИСКА ПЕРИОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ У ПАЦИЕНТОВ С ГРЫЖАМИ ПЕРЕДНЕЙ БРЮШНОЙ СТЕНКИ. ОБЗОРMETHODS FOR ASSESSING THE RISKS OF COMPLICATIONS IN PATIENTS WITH HERNIAS OF THE ANTERIOR ABDOMINAL WALL. REVIEWhttps://orcid.org/0000-0001-6171-9885СамарцевВ. А.SamartcevV. A.

Самарцев Владимир Аркадьевич — д. м. н., профессор, заведующий кафедрой общей хирургии №1

Петропавловская ул., д. 26, 614000, Пермь, Российская Федерация

Samartcev Vladimir Arkadievich — MD, Professor, Head of the Department of General Surgery #1

Petropavlovskaya St., 26, 614000, Perm, Russian Federation

https://orcid.org/0000-0002-1950-065XГавриловВ. А.GavrilovV. A.

Гаврилов Василий Александрович — к. м. н., доцент кафедры общей хирургии №1

Петропавловская ул., д. 26, 614000, Пермь, Российская Федерация

Gavrilov Vasiliy Aleksandrovich — MD, PhD, Associate Professor at the Department of General Surgery #1

Petropavlovskaya St., 26, 614000, Perm, Russian Federation

inmyplay@mail.ruhttps://orcid.org/0000-0003-2679-0613ПаршаковА. А.ParshakovA. A.

Паршаков Александр Андреевич — к. м. н., ассистент кафедры общей хирургии №1

Петропавловская ул., д. 26, 614000, Пермь, Российская Федерация

Parshakov Aleksandr Andreevich — MD, Assistent at the Department of General Surgery #1

Petropavlovskaya St., 26, 614000, Perm, Russian Federation

parshakov@live.ruhttps://orcid.org/0000-0001-5998-5375КанаеваМ. А.KanaevaM. A.

Канаева Мария Андреевна — студент 4 курса

Петропавловская ул., д. 26, 614000, Пермь, Российская Федерация

Kanaeva Maria Andreevna — 4th year student

Petropavlovskaya St., 26, 614000, Perm, Russian Federation

renovak59@gmail.comПермский государственный медицинский университет имени академика Е. А. Вагнера (ПГМУ им. академика Е. А. Вагнера)РоссияFederal State Educational Institution of Higher Education E. A. Vagner Perm State Medical UniversityRussian Federation20200312202003510Copyright © Самарцев В.А., Гаврилов В.А., Паршаков А.А., Канаева М.А., 20202020Самарцев В.А., Гаврилов В.А., Паршаков А.А., Канаева М.А.Samartcev V.A., Gavrilov V.A., Parshakov A.A., Kanaeva M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/176

Работа основана на анализе литературных данных, посвященных проблеме оценки послеоперационных осложнений у пациентов с первичными и послеоперационными грыжами передней брюшной стенки. Главная цель данного обзора — выявить существующие способы оценки местных, общих периоперационных осложнений и определить среди существующих прогностических шкал и методов оценки факторов риска наиболее достоверные.

Первая часть работы посвящена оценке общего состояния пациентов с грыжами передней брюшной стенки. Рассмотрены существующие шкалы оценки модифицируемых факторов риска (МФР), способы профилактики осложнений, включая абдоминальный бандаж. Основными факторами риска определены: класс раны по классификации CDC, возраст пациентов, размер грыжи, курение, сахарный диабет, класс 3 и выше по ASA.

Во второй части рассмотрена оценка факторов риска осложнений со стороны области хирургического вмешательства. Описана проблема стандартизации терминологии, отличия инфекции области хирургического вмешательства (ИОХВ) от неблагоприятных хирургических событий (SSO) в области хирургического вмешательства, требующей оперативной интервенции (SSOPI). Представлены шкалы оценки рисков периоперационных осложнений. Описана эволюция методов оценки SSO из четырехуровневой шкалы в трехуровневую. Представлен российский опыт оценки комбинации МФР.

В третьей части описана важность оценки у пациентов посттравматического стрессового расстройства как фактора риска неблагоприятного течения послеоперационного периода. Представлен европейский опросник EuraHS QoL, рекомендованный для использования в европейском герниологическом регистре. Также в разделе подчеркнута актуальность селекции пациентов с грыжами в амбулаторной хирургии и стационарах одного дня.

Главная идея разработки современных способов анализа осложнений после герниопластики — это комплексная оценка индивидуального профиля пациента перед операциями по поводу первичных и послеоперационных грыж в разных группах риска. Приоритет необходимо отдавать адаптированным специфичным электронным опросникам.

The work is based on the analysis of literature data devoted to the problem of assessing postoperative complications in patients with primary and incisional hernias of the anterior abdominal wall. The main purpose of this review is identifying existing methods for assessing local, general perioperative complications and determining of the most reliable prognostic scales and methods for assessing risk factors among the existing ones.

The first part of the article is devoted to the assessment of the general condition of patients with hernias of the anterior abdominal wall. The existing scales for assessing modifiable risk factors (MFR), methods of preventing complications, including abdominal bandage, are considered. The main risk factors were determined: CDC wound class, patient age, hernia size, smoking, diabetes, risk 3 and higher according to ASA.

In the second part, the assessment of risk factors for complications from the surgical site is considered. The problem of terminology standardization, the difference between surgical site infection (SSI), adverse surgical events (SSO) and surgical site occurrences requiring procedural interventions (SSOPI) is described. Scales for assessing the risks of perioperative complications are presented. The evolution of SSO assessment methods from a four level to a three level scale is described. The Russian experience in assessing the combination of MFR is presented.

The third part describes the importance of evaluating post traumatic stress disorder in patients as a risk factor for an unfavorable course of the postoperative period. The European EuraHS QoL Questionnaire, recommended for use in the European Hernia Registry, is presented. The section also highlights the relevance of the selection of patients with hernias in outpatient surgery and one day hospitals.

The main idea of developing modern methods for assessing complications after hernioplasty is a comprehensive assessment of the patient's individual profile before operations for primary and incisional hernias in different risk groups. Priority should be given to tailored specific electronic questionnaires.

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