ASSESSMENT OF OPERATIVE TRAUMA SEVERITY IN GASTRIC CANCER SURGERY BY THE RESULTS OF STUDYING HEMOSTATIC FACTORS

Aim. Experience of surgical treatment of 50 patients with gastric cancer using a new retractor - a subsequent technical development of M. Z. Sigal’s retractor and its modification worked out by E. A. Girev, V. V. Ferapontov - is presented in the paper. Comparative assessment of hemostatic indices when applying different instrumental techniques of improving operative approach in surgery of gastric cancer was carried out. Materials and methods. Patients were divided into two groups: the main group ( n =25) and the comparison group (n=25) with different instrumental techniques of forming operative approach. In both groups, ulnar venous blood was taken for analysis before the operation, during the operation and on the days 3, 7 and 14 after the operation. The following hemostatic indices were assessed: 1) thrombocyte number; 2) spontaneous thrombocyte aggregation; 3) blood coagulation time; 4) APTT - activated partial thromboplastin time; 5) PTT - prothrombin time; 6) international normalized relation (INR) calculated by the formula: INR=(patient’s prothrombin time /normal plasma prothrombin time); 7) thrombin time; 8) fibrinogen; 9) antithrombin III; 10) von Willebrand factor; 11) XIIa-dependent fibrinolysis; 12) hematocrit. Hemostasis indices were determined by the generally accepted methods. Results. Changes in prothrombin time and fibrinogen occurred simultaneously and almost did not exceed the normal physiological bounds. It indicated absence of negative effects of retractor hooks on hepatic function. Hemostatic indices including international normalized relation (INR), thrombin time, antithrombin III, blood coagulation time, XIIa-dependent fibrinolysis, von Willebrand factor after gastrectomy were altered simultaneously in both groups, without statistically reliable differences. Dynamics of changes in antithrombin III in all the observed groups varied within physiological norm. On the day 3 rd after the surgery, fall to critical level was detected in the comparison group. In the main group, these changes were not noted. Conclusion. Turning of hepatic tissue aside by means of two hooks using RGF-2 retractor in patients who underwent gastectomy does not worsen hepatic function in the postoperative period compared to the group of patients with RGF-1. Application of retractor RGF-2 decreases patient’s anticoagulative system activity, thereby, reducing the operative trauma.

Retractor, operative approach, gastric cancer, hemostasis, operative trauma