New Methods of Treatment of the Diffused Peritonitis

Abstract


Despite the achievements of the modern medicine, diffused peritonitis until the present time remains the urgent problem in the emergent abdominal surgery. According to the data of the leading Russian and foreign clinics, mortality rate in this pathology in the last decades has not showed any reduction tendency and varied in the range of minimum 20-30%, achieving at maximum 50-70%. The article presents analytical review of new approaches to the treatment of the diffused peritonitis. The authors describe in detail their own developed three methods of treatment of peritonitis and indications for their application. In traditional (semi-closed method of treatment) sanitation of the abdominal cavity was conducted with the use of immobilized forms of sodium hypochlorite in the gel of carboxymetilcellulose. Deponent of the antiseptic prolongs its bactericidal action, while the gel of carboxymetilcellulose prevents the gluing of the organs’ surfaces , by which reduces the severity of adhesive process. In surgical-laporoscopic method of treatment video-endoscopic sanitations of the abdominal cavity were done by pulsating irrigation of antiseptic. To close the defects of the abdominal cavity in semi-open method of treatment there was used large-net endoprothesis made from polypropylene. Between the edges of the wound there was left diastases, at which intra-abdominal pressure was below 15 mm. of mercury column. For selection of the appropriate method of treatment there was used the original scale of quantitative evaluation of factors, influencing lethality rate of patients. It was proved that semi-closed method of treatment is reasonable to use in patients without signs of the abdominal sepsis, while programmed video-laparoscopic sanitations should be used in cases of abdominal sepsis without poly-organic dysfunction and intra-abdominal pressure below 20 mm. of mercury column, programmed surgical sanitations are indicated for patients with severe abdominal sepsis with poly-organic insufficiency and abdominal hypertension above 20 mm of mercury column. Introduction of new methods of treatment to practice enabled to decrease the number of post￾operative complications by 10% and lethality – by 8,2%

Kursk State Medical University, 3 K.Marks Str., Kursk, 305041, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com

Russian Federation MD, Professor, head of General Surgery Department. Address: 305041 Kursk, Karl Marx str., 3. Kursk state medical university, Department of General Surgery

Kursk State Medical University, 3 K.Marks Str., Kursk, 305041, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD, Professor, head of General Surgery Department. Address: 305041 Kursk, Karl Marx str., 3. Kursk state medical university, Department of General Surgery

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