СБОРНИК
.
ТЕЗИСОВ
«АКТУАЛЬНЫЕ ВОПРОСЫ ДЕТСКОЙ ХИРУРГИИ
» 14.10.2023
27
REHABILITATION PROGRAM FOR CHILDREN WITH
ANORECTAL MALFORMATION
Narbaev T.T., Madjidov T. Kh., Turaeva J.T., Parpiev M.M.,
Abdukodirov O.A., Abduhakimov A.A.
Tashkent Pediatric Medical Institute, Uzbekistan
Background.
A lot of research has been devoted to rehabilitation issues in children with anorectal
malformation, but the stages and methods of their implementation are contradictory and cause
controversy. Rehabilitation of children with anorectal malformation should take place during the
examination and surgical treatment. The operation is only a stage in the complex treatment of
children with malformations of the anorectal region. Choosing it correctly and getting its perfect
execution, the absence of postoperative complications, of course, will contribute to obtain good
functional results. But the final result wil be determined mostly by the quality of rehabilitation
measures in the near and further postoperative period. Rehabilitation, in combination with the use
of physiotherapy procedures, should be carried out without interruption until the normal function of
the newly formed anus and rectum is achieved.
Aims.
Improving the results of treatment of anorectal malformations through a program of
rehabilitation measures.
Materials and methods.
The work is based on the results of pre and postoperative
rehabilitation
treatment
for 309 children with anorectal malformation in the
departments of
surgery departments
of the clinic of the Tashkent Pediatric Medical Institute for the period from 2000 to 2021. All
children, along with routine and general clinical examination methods, underwent: plain
radiography of the abdominal cavity, fistuloirrigography, excretory urography, cystography,
ultrasound of the perineum (pelvis), neurosonography (NSG), screening tests. Physiotherapeutic
procedures (electrophoresis with lidase, magnetotherapy, intrarectal darsonval, ultrasound, exercise
therapy, perineal electrical stimulation and massage).
Results.
Treatment results are better in the group where the rehabilitation was carried out
according to the program, as well as in full and constantly, until the intestine reaches the full
functionality, which helped to reduce disability, improve treatment results, improve the quality of
life and social adaptation of children with anorectal malformation.
After engraftment of the rectum brought down in any way to the center of the external sphincter
of the rectum (2.5-3 weeks after the operation), gradual bougienage of the newly formed anus with
Hegar's dilators began. If before the closure of the colostomy, bougienage was carried out 2-3 times
a day for 3-5 minutes, then after its elimination - at least 1 time per day. The duration of bougienage
depended on the condition of the anus. In cases where there are no signs of its stenosis, after 1-1.5
months, control bougienage can be done 1 time in 3-5 days for the same period, and then 3 times a
month for a year. In the future, the issue was resolved individually.
With this method of forming the anus, the muscles of the external sphincter and the pelvic floor
are gradually stretched, but not torn or even torn. After removing the bougie, they return to their
original shape. From the moment when the anus begins to pass the nail phalanx of the index finger
of the mother of the child, bougienage is carried out with a finger with a constant desire to insert it
deeper and deeper to the proximal end of the main phalanx. This tactic made it possible to prevent
the development of cicatricial narrowing of the foramen. Along with this, there was a gradual
expansion of the anal canal, as well as the formation of a reflex to the act of defecation.
Bougienage and finger massage of the anus to the child were carried out in conjunction with
physiotherapy
Conclusions.
The use of a
rehabilitation
program led to a reduction in complications and a
reduction in disability. It was possible to significantly improve the quality of life of patients, to
prevent anal incontinence, which helped to reduce the frequency of hospitalization, reoperations
and improve the social adaptation of children with anorectal malformation.
СБОРНИК
.
ТЕЗИСОВ
«АКТУАЛЬНЫЕ ВОПРОСЫ ДЕТСКОЙ ХИРУРГИИ
» 14.10.2023
28
References:
1. Daminova, L. T., et al. "The State Of The Cardiovascular System In Patients With Covid-
19 In The Early Rehabilitation Period." The American Journal of Medical Sciences and
Pharmaceutical Research 3.7 (2021): 99-104.
2. Jabbarov, O. O., et al. "Associations of polymorphic markers aluins/deli> D Ace T-786C
gene Enos3 in diabetic nefropate progressing for type 2 diabetes mellitus." International
Journal of Research in Pharmaceutical Sciences 11.4 (2020): 6028-6032.
3.
Каримджанов
,
Илхамджан Асамович
, and
Лола Каримовна Рахманова
. "
Некоторые
аспекты течения и лечения хронической болезни почек у детей
."
Детская медицина
Северо-Запада
7.1 (2018): 144-144.
4. ABDULLAEVA, VASILA K., et al. "Features of affective disorders and compliance of
patients with chronic renal failure receiving replacement therapy by
hemodialysis." International Journal of Pharmaceutical Research (09752366) 12.4 (2020).
