2687-0940Актуальные проблемы медицины2687-094010.52575/2687-0940-2026-49-2-168-183287ХИРУРГИЯПрофилактика несостоятельности швов при ушивании перфоративной гастродуоденальной язвыPrevention of Suture Dehiscence in the Repair of Perforated Gastroduodenal UlcerСергацкийКонстантин ИгоревичSergatskiyKonstantin I.sergatsky@bk.ruУлыбинаДарина ВладимировнаUlybinaDarina V.МуромцеваЕлена ВладимировнаMuromtsevaElena V.ГаврюшинМаксим АндреевичGavryushinMaksim A.ДуховноваКристина МихайловнаDukhovnovaKristina M.КалинушкинаАнна ОлеговнаKalinushkinaAnna O.АльджабрМохаммадAljabMohammadМаркинаОльга МихайловнаMarkinaOlga M.202649200

Перфорация гастродуоденальной язвы является жизнеугрожающим осложнением язвенной болезни, требующим экстренного хирургического вмешательства. Наиболее частым и серьёзным осложнением после ушивания перфоративного дефекта является несостоятельность швов, частота которой достигает 17 %. В свою очередь, летальность больных при развитии несостоятельности достигает 40 %. Своевременная идентификация факторов риска и выбор адекватной интраоперационной тактики являются значимыми элементами профилактики несостоятельности швов. Ключевую роль в предотвращении данного осложнения играет техника ушивания и применение дополнительных методов укрепления швов непосредственно во время операции. Цель обзора – на основе классического обзора литературы провести сравнительный анализ литературных данных о существующих подходах к профилактике несостоятельности швов при ушивании перфоративной гастродуоденальной язвы. Выполнен анализ наиболее значимых зарубежных и отечественных источников в поисковых системах https://pubmed.ncbi.nlm.nih.gov/, https://www.elibrary.ru/ и https://cyberleninka.ru/. Заключение. Проанализированы преимущества и ограничения каждого метода профилактики несостоятельности швов, обоснована их эффективность в улучшении герметичности и стимуляции репаративных процессов в области ушитого перфоративного отверстия. Оментопластика остаётся наиболее изученным методом, демонстрируя высокую эффективность (95 %) и низкую частоту несостоятельности. Применение лапароскопического доступа при ушивании перфоративного дефекта уменьшает сроки госпитализации пациентов, но не влияет на частоту несостоятельности швов. Комбинированное применение традиционных и современных методик рассматривается как наиболее перспективное направление для снижения риска несостоятельности швов у пациентов с перфорацией гастродуоденальной язвы.

Perforation of a gastroduodenal ulcer is a life-threatening complication of peptic ulcer disease that requires emergency surgical intervention. The most common and severe complication after suturing a perforated defect is suture failure, which occurs in up to 17 % of cases. In turn, the mortality rate among patients with suture failure reaches 40 %. Timely identification of risk factors and the selection of appropriate intraoperative tactics are crucial for preventing suture failure. The key to preventing this complication is the suturing technique and the use of additional methods to strengthen the sutures during the surgery. The purpose of the review is to conduct a comparative analysis of literary data on existing approaches to the prevention of suture failure in the treatment of perforated gastroduodenal ulcers based on a classical literature review. The most significant foreign and domestic sources were analyzed using the search engines https://pubmed.ncbi.nlm.nih.gov/, https://www.elibrary.ru/, and https://cyberleninka.ru/. Conclusion. The advantages and limitations of each method for preventing suture failure have been analyzed, and their effectiveness in improving the tightness and stimulating reparative processes in the area of the sutured perforation has been substantiated. Omentoplasty remains the most studied method, demonstrating high efficiency (95 %) and a low frequency of failure. The use of laparoscopic access during the suture of a perforation defect reduces the duration of hospitalization for patients, but does not affect the frequency of suture failure. The combined use of traditional and modern techniques is considered the most promising approach to reducing the risk of suture failure in patients with gastroduodenal ulcer perforation.

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