Selivanov A.V., Kolbasin P.N., Alexanyan G.

Chair of Surgery (Postgraduate Education Division, head prof. Starosek V.N)

SI “Crimea State Medical University named after S. I. Georgievsky”

Diagnostic criteria for different methodical approaches of chronic hemorrhoids surgical treatment

Hemorrhoids is quite a problematic pathology in surgery, its abundance and variety of treatment methods indicate this. According to the data of different authors its abundance in coloproctology is very high and is about 140-180 people per 1000 healthy persons (Vorobiev G.I, 2002.). The level of hospitalization of such patients in proctologic and surgical units is about 30-40%. Among adults and seniors this level is about 210-240 people per 1000.

Nowadays surgical treatment of hemorrhoids is the most widely spread nowadays both in case of chronic and acute type of disease. But the results of such treatment cannot be named satisfactory because postsurgical period is adjoined with manifested pain in wound area, impairments of urination and defecation, bleeding risk and risk of acute and chronic paraproctitis development. Incorrect surgical operation significantly increases risk of complications development, which is about 4-8%.

Based on the foregoing we can say that target of our investigation is the carrying out of peripheral blood neutrophils level cytochemical monitoring in patients with chronic hemorrhoids with different types of treatment. The material for our investigations was the peripheral blood of patients who were surgically treated due to chronic hemorrhoids. We composed two groups of patients (37 persons) in age from 30 to 53, among them 15 females and 22 males. First group (control group) was composed of 14 patients who were treated by traditional method of surgical treatment, second group composed from 23 patients treated with our modified method of chronic hemorrhoids surgical treatment. Blood sampling was performed before surgery and also of 7^th, 14^th, 21^st and 30^th day after the operation. Cytochemical researches of patients’ peripheral blood included neutrophils’ succinate dehydrogenase (SDH) and lactate dehydrogenase (LDH) activity study as the heterospecific index of cellular reaction on the chronic hemorrhoids surgical treatment.

For the measurement of blood cells enzymes activity we used the methodic of medium cytochemical index (MCI) calculation:

MCI χ = ( (x*1)+(x*2)+(x*3)+(x*4) )/100,

where x – number of cells with enzyme certain activity among 100 neutrophils; 1,2,3,4 – levels of activity, 100 – number of viewed neutrophils in a smear. Four levels of activity were marked: level 4 – neutrophil is fully covered with formazan granules, level 3 – ¾ of activity level, level 2 – ½ of activity level, level 1 – ¼ of activity level.

During the analyze of neutrophils cytochemical indexes in patients with acute hemorrhoids the statistically significant (p₁<0.05) decrease of anaerobic oxidation and growth of anaerobic glycolysis were marked both in main and in control groups. By the 7^th day after operation SDH activity level in control group was about 1,27±0,06 c.u., what is 23% lower (p₁<0.05) than control indexes, and LDH activity was 2,53±0,14 c.u., what is 19,3% higher (p₁<0.05) than control indexes. By the 14^th day after the chronic hemorrhoids traditional surgical treatment SDH activity progressively decreased and was about 1,1±0,05 c.u., what was about 32,7% (p₁<0.01) lower than control level, herewith LDH activity in neutrophils was increased on 31,1% (p₁<0.01) and was about 2,78±0,11 c.u. Hereafter on 21-30 days the stabilization and distinct tendency to blood cytochemical indexes normalization was marked. But during the studying of peripheral blood neutrophils cytochemical activity in basic group of patients (patients treated with our modified method of chronic hemorrhoids surgical treatment) we found another results, the statistically significant (p₁<0.05) decrease of anaerobic oxidation and growth of anaerobic glycolysis were also marked, but by the 7^th day after operation SDH activity level was about 1,28±0,08 c.u., what is 22,4% lower (p₁<0.05) than control group indexes, and LDH activity was 2,51±0,11 c.u., what is 18,3% higher (p₁<0.05) than control indexes. By the 14-21 days after the chronic hemorrhoids traditional surgical treatment SDH activity progressively decreased and was about 1,37±0,05 c.u., what was about 16% (p₁<0.05) lower than control group level, herewith LDH activity in neutrophils was about 2,30±0,12 c.u. Hereafter on 30th day after the operation cytochemical indexes normalization was marked and level of peripheral blood neutrophils cytochemical activity was almost equal to control level.

In this case we came to conclusion that chronic hemorrhoids course is accompanied with cytochemical imbalance and impairments (statistically significant decrease of anaerobic oxidation and growth of anaerobic glycolysis were marked) and carrying out of surgical manipulations exacerbates cytochemical imbalance. In case of traditional surgical treatment peripheral blood neutrophils cytochemical activity imbalance extends to 21-30 days, while in case of our modified surgical methods it finishes on 14-21 days.