urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2023-22-2-153-161urmj-1238Research ArticleЛитературные обзоры | Literature reviewsLiterature reviewsПатогенетические варианты сепсиса в онкологической практикеPathogenetic variants of sepsis in oncologicy practicehttps://orcid.org/0000-0002-2861-4878ФрейндГ. Г.FreyndG. G.

Генриетта Герхардовна Фрейнд – доктор медицинских наук, профессор

Пермь

 

Genrietta G. Freynd – Doctor of Science (Medicine), Professor

Perm

gfreynd@mail.ruhttps://orcid.org/0000-0002-8609-7960БулдаковаА. А.BuldakovaA. A.

Анастасия Александровна Булдакова – студентка

Пермь

 

Anastasia A. Buldakova – student

Perm

gantsek@yandex.ruПермский государственный медицинский университет им. академика Е.А. ВагнераРоссияE.A. Vagner Perm State Medical UniversityRussian Federation202330042023222153161Copyright © Фрейнд Г.Г., Булдакова А.А., 20232023Фрейнд Г.Г., Булдакова А.А.Freynd G.G., Buldakova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1238Введение

Введение. На протяжении последних 30 лет сепсис по-прежнему остается актуальной мультидисциплинарной проблемой современной медицины, что обусловлено неуклонным ростом заболеваемости и стабильно высокой летальностью. Пациенты онкологических стационаров имеют высокую предрасположенность к развитию сепсиса как в послеоперационном периоде, так и в отделениях химиои лучевой терапии. Представляют интерес не только клинико-лабораторная диагностика сепсиса у данной категории больных, но и характеристика его морфологической картины в зависимости от вида лечения. Наибольшие сложности возникают при исследовании аутопсий после противоопухолевой химиотерапии, обусловливающей вторичный иммунодефицит и ассоциированные с ним осложнения. Сепсис у данной категории больных характеризуется отсутствием классической морфологической картины. Применение современных антибактериальных препаратов и проведение патогенетической терапии сепсиса также обусловливает его патоморфоз, что значительно затрудняет диагностику.

Цель исследования – систематизация данных литературы и опубликованных результатов собственных исследований об особенностях морфологических проявлений сепсиса при онкологической патологии в зависимости от проведенного лечения.

Материалы и методы

Материалы и методы. Поиск и отбор литературных источников проводился в системах PubMed, GoogleScholar, электронной библиотеке elibrary.ru, глубина поиска – 30 лет.

Результаты и обсуждение

Результаты и обсуждение. Сепсис у онкологических больных после хирургических вмешательств характеризуется гиперэргическим типом тканевых реакций с гиперплазией лимфоидной и миелоидной ткани и классическими проявлениями септикопиемии с различной степенью выраженности гнойного метастатического процесса: от макроскопически различимых абсцессов до мини-очагов гнойного воспаления. На фоне антибиотикотерапии отмечается патоморфоз сепсиса с преобладанием расстройств микроциркуляции и значительно менее выраженными проявлениями гнойного воспаления в метастатических очагах в виде мелких скоплений нейтрофильных гранулоцитов и лейкоцитарных стазов в сосудах. У пациентов после химиотерапии, сопровождающейся лейкопенией и агранулоцитозом, отмечается угнетение миелои лимфопоэза, а во внутренних органах при сепсисе наряду с расстройствами микроциркуляции обнаруживаются очаги некроза и тяжелые дистрофические изменения в очагах скоплений микроорганизмов с отсутствием нейтрофилов в составе крайне скудного воспалительного инфильтрата.

Заключение

Заключение. Сепсис у онкологических больных с патогенетических позиций неоднороден, в зависимости от особенностей организма и вида лечения его следует подразделять на гипери анэргический. Диагноз сепсиса является клинико-морфологическим, что требует не только использования клинико-лабораторных шкал диагностики, но и определения критериев морфологической диагностики при различных его патогенетических вариантах.

Introduction Over the past 30 years, sepsis has been an urgent interdisciplinary problem of modern medicine due to the increase in morbidity and a consistently high mortality rate. Patients of oncological hospitals have a high predisposition to the development of sepsis, both in the postoperative period and in the departments of chemo and radiation therapy. In addition, sepsis may be a complication of the postoperative period in patients undergoing surgical treatment. Of interest is not only the clinical and laboratory diagnosis of sepsis in this category of patients, but also the features of its morphological picture, due to uniform diagnostic criteria. The greatest difficulties arise in the study of autopsies, after antitumor chemotherapy, which causes a secondary immunodeficiency condition characterized by the absence of a classical morphological picture of sepsis. The use of modern antibacterial drugs, as well as pathogenetic therapy of sepsis also leads to its pathomorphosis, which also complicates diagnosis.

The aim of the study is to systematize the literature data and the results of our own research on the features of morphological manifestations of sepsis in oncological pathology, depending on cancer treatment.

Material and methods The search and selection of literary sources was carried out in PubMed, GoogleScholar, electronic library systems elibrary.ru, the search depth is 30 years.

Results and Discussion Sepsis in cancer patients after surgical interventions is characterized by hyperergic type of tissue reactions with hyperplasia of lymphoid and myeloid tissue and classic manifestations of septicopyemia of varying severity of purulent metastatic process: from macroscopically distinguishable abscesses to mini-foci of purulent inflammation. Against the background of antibiotic therapy, there is a pathomorphosis of sepsis with a predominance of microcirculation disorders and small focal ulcers. In patients after chemotherapy, accompanied by leukopenia and agranulocytosis, with sepsis, hypoplasia of myeloid and lymphoid tissue is noted, and in the internal organs, along with microcirculation disorders, foci of necrosis, severe dystrophic changes with the absence of neutrophil infiltration are found.

Conclusion Sepsis in cancer patients from pathogenetic positions is heterogeneous, depending on the characteristics of the body and the nature of treatment, it should be divided into hyper- and anergic. The diagnosis of sepsis is clinico-morphological, which requires not only the use of clinical and laboratory diagnostic scales, but also the definition of criteria for morphological diagnosis.

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