Different aspects of nutritive support in early postoperative period after the extended reconstructive-plastic surgery in urology

In this article we report on the possibilities of the nutritive support optimization in early postoperative period in patients after extended reconstructive-plastic operations in urology by means of the estimation of biochemical parameters of blood and microcirculation state using laser Doppler flowmetry. Aim of the study: to estimate clinical efficacy of the nutritive support with early introduction of the lipids in patients with bladder cancer after radical cystectomy with one-step ileocystoplasty. Design of the study: prospective controlled randomized single-center study. Randomization was made using non-transparent envelopes with the proportion 1:1. This study was conducted in the period from 30.01.2010 to 28.02.2011. Inclusion criteria were: age more than 18 years; bladder cancer T2-4N0-1M0 studer ileocystoplasty at time of radical cystectomy. End points: length of the stay in the intensive care unit, dynamics of the blood proteins (total protein, albumin), associated with the elements of cell immunity (leukocytes, lymphocytes), clinical signs of the syndrome of the systemic inflammatory response (SIRS), C-reactive protein level (CRP), pro-inflammatory cytokines (tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), procalcitonin (PCT) levels. Inclusion criteria were fulfilled by 28 patients, who were operated in urology clinic of the Bashkortostan State Medical University. It was denoted, that early balanced nutritive support with inclusion of the lipid preparations led to the decrease in the overall severity state of the patient and in the duration of the clinical signs of SIRS, to the improvement of the nutritive status and capillary blood flow in the area of the operative wounds, accelerating the reparative processes in the damaged tissues.