Concerning Determination of Indications for Staging Abdominal Cavity Sanitation at the Extentive Purelent Peritonitis

Abstract


The purpose of the study To assess advisability of staging abdominal cavity sanitation and multimodality therapy efficiency of extensive purulent peritonitis patients with compensated multiple organ dysfunction. Materials and methods Prospective results estimation of therapy 438 extensive purulent peritonitis patients with multisystem disorders is represented in work. The base of individual care was operative intervention, including nidus peritonitis eradication, nasogastricintestinal intubation and peritoneal lavage within the set of staging procedures, which were carried out by video laparoscopic method. The efficiency of remedial measures was assessed with the help of physical, clinical laboratory, biochemical and special diagnostic techniques (bacteriological, gas-liquid chromatography, computer phonoenterography, cystomanometry). Results and their discussion In the course of therapy of extensive purulent peritonitis at the stage of compensated multiple organ dysfunction, the main problems were connected with the solution of a question concerning necessity of staging sanitations. For this purpose, intraoperative assessment of abdominal membrane lesion was taken into consideration. In the event that abdominal cavity index was in “blind” interval from 10 to 13 scores (indications of occasional sanitation can be interpreted as doubtful), dynamics of volatile fatty acids in biological objects took on special significance. Tendency to rising the level of acetic, propionic and butyric acids in blood, and also “stagnation” of its quantity in peritoneal exudates at the level of 0,150±0,004; 0,00012±0,00002; 0,00008 ±0,00001 mmol/L respectively, indicated on after sensation of ill being in abdomen. Accordingly, twenty four hours later, after original surgery video laparoscopy was carried out for 28 patients. For 9 of them full endoscopic sanitation was carried out in the connection with identifications of signs protract peritonitis. For the rest patients, the totality of received information allowed to give up peritoneal lavage. Conclusion At therapy organization of patients with extensive purulent peritonitis in the stage of compensation multiple organ dysfunction for determination of indications to staging abdominal cavity, the role of “secondary endpoint” can implement the assessment of changes volatile fatty acids content in blood and peritoneal exudates during 24-28 hours after the original surgery.Video laparoscopic technique of staging sanitation among the most of patients allows to lower intervention traumatism up to the level of diagnostic test. Evaluating it, the lethality at the level of 0, 5% as a whole proves the accuracy of chosen method of such patients’ management.

Yaroslavl State Medical Academy, Yaroslavl, Russian Federation;
Ivanovo State Medical Academy, Ivanovo, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com
Doctor of Medicine, Prof., Head of the Department of General Surgery, Yaroslavl State Medical Academy, Yaroslavl, Russia

Yaroslavl State Medical Academy, Yaroslavl, Russian Federation;
Ivanovo State Medical Academy, Ivanovo, Russian Federation

Email: author@vestnik-surgery.com
Candidate of Medicine, Assoc. Prof., Head of the Department of Hospital Surgery, Ivanovo State Medical Academy, Ivanovo, Russia;

Yaroslavl State Medical Academy, Yaroslavl, Russian Federation;
Ivanovo State Medical Academy, Ivanovo, Russian Federation

Email: author@vestnik-surgery.com
Post-Graduate Student of the Department of Hospital Surgery, Ivanovo State Medical Academy, Ivanovo, Russia;

Yaroslavl State Medical Academy, Yaroslavl, Russian Federation;
Ivanovo State Medical Academy, Ivanovo, Russian Federation

Email: author@vestnik-surgery.com
Post-Graduate Student of the Department of General Surgery, Yaroslavl State Medical Academy, Yaroslavl, Russia.

  1. Akaizin E.S., Bulygina V.V. Novye vozmozhnosti dlya bystroj diagnostiki vozbuditelej gnojnoj infekcii i bystroe
  2. ocenka ehffektivnosti lecheniya [New opportunities for rapid
  3. diagnosis of pathogens of purulent infection and rapid
  4. assessment of the effectiveness of treatment]. Klinicheskaia
  5. laboratornaia diagnostika, 1999; 6: 45-47. - (In Russian)
  6. Ardatskaia M.D., Minushkin O.N., Ikonnikov N.S. Sposob
  7. opredeleniia infitsirovannogo vypota briushnoi polosti i
  8. sposob lecheniia zabolevanii, soprovozhdaiushchikhsia
  9. vypotom v briushnuiu polost' [The method of infected
  10. abdomen effusion and method of desease treatment
  11. involving the abdominal cavity exudate]. Patent RF, no.
  12. , 2007. - (In Russian)
  13. Gostishchev V.K., Sazhin V.P., Avdovenko A.L. Peritonit
  14. [Perotinitis]. Moscow, GEOTAR-MED Publ., 2002; 240 p.
  15. - (In Russian)
  16. Gostishchev V.K., Stanoevich U.S., Aleshkin V.A. Tretichnyj peritonit: vozmozhnost' predotvrashcheniya [Tertiary
  17. peritonitis: the possibility of preventing]. Khirurgiia, 2007;
  18. : 15-18. - (In Russian)
  19. Karpishchenko A.I. Meditsinskie laboratornye tekhnologii
  20. i diagnostika [Medical laboratory technology and
  21. diagnostics]. Saint-Petersburg, Intermediko Publ., 1999;
  22. p. - (In Russian)
  23. Larichev A.B., Volkov A.V., Abramov A.Iu. Lechenie peredovyh posleoperacionnogo peritonita [Treatment of
  24. advanced postoperative peritonitis]. Rossiiskii meditsinskii
  25. zhurnal, 2006; 1: 8-12 p. - (In Russian)
  26. Larichev A.B., Davydov A.Iu., Volkov A.V., Abramov A.Iu.
  27. Poliorgannaia disfunktsiia i vozmozhnosti ee korrektsii pri
  28. rasprostranennom peritonite. Metodicheskoe posobie dlia
  29. vrachei [Multiple organ dysfunction and the possibility of
  30. its correction at the widespread peritonitis. Handbook for
  31. doctors]. Yaroslavl, 1997; 36. - (In Russian)
  32. Larichev A.B., Pokrovskii E.Zh., Dylenok A.A.
  33. Ob"ektivizacii pokazanij k sanaciyu bryushnoj polosti s shiroko rasprostranennym gnojnym peritonitom v stadii sub kompensacii disfunkcii poliorgannoj [Objectification of the indications for sanation of the
  34. abdominal cavity with widespread purulent peritonitis
  35. in stage of subcompensation multiple organ dysfunction].
  36. Khirurgiia: Vostochnaia Evropa, 2012; 3: 72-73. - (In
  37. Russian)
  38. Lutsevich O.E., Gordeev S.A., Prokhorov Iu.A.
  39. Laparoskopicheskaya lechenie rasprostranennyh form peritonita [Laparoscopic treatment of common forms of peritonitis].
  40. Endoskopicheskaia khirurgiia, 2001; 3: 53. - (In Russian)
  41. Savel'ev V.S., Gel'fand B.R., Filimonov M.I. Peritonit:
  42. prakticheskoe rukovodstvo [Peritonitis: a practical guide].
  43. Moscow, Litterra Publ., 2006; 208 p. - (In Russian)
  44. Pokrovskii E.Zh., Stankevich A.M., Kon'kov O.I.
  45. Vozmozhnost' videolaparoscopic sanaciyu bryushnoj polosti s vtorichnym peritonitom [Possibility of videolaparoscopic sanation of the abdomen
  46. with secondary peritonitis]. Endoskopicheskaia khirurgiia,
  47. ; 1: 13-15. - (In Russian)
  48. Popova T.S., Tamazashvili T.Sh., Shestopalov A.E. Sindrom
  49. kishechnoi nedostatochnosti v khirurgii [The syndrome of
  50. intestinal failure in surgery]. Moscow, Meditsina Publ.,
  51. ; 240 p. - (In Russian)
  52. Savel'ev V.S., Filimonov M.I., Podachin P.V. Vybor taktiki lecheniya peritonita [The choice of
  53. treatment tactics in peritonitis]. Annaly khirurgii, 1998; 6:
  54. -36. - (In Russian)
  55. Shain M. Zdravyi smysl v neotlozhnoi abdominal'noi
  56. khirurgii [Good sense in emergency abdominal surgery].
  57. Moscow, GEOTAR-MED Publ., 2003. 271 p. - (In Russian)
  58. Shapoval'iants S.G., Lindenberg A.A., Marchenko I.P.
  59. Osobennosti sanitarno-gigienicheskih meropriyatij po peritonita [Features of sanation interventions for peritonitis]. Rossiiskii
  60. zhurnal gastroenterologii, gepatologii, koloproktologii,
  61. ; 3: 46-50. - (In Russian)
  62. Shurkalin B.K., Faller A.P., Gorskii V.A. Hirurgicheskie aspekty lecheniya peritonita [Surgical aspects
  63. of the treatment of peritonitis]. Khirurgiia, 2007; 2: 24–28.
  64. - (In Russian)
  65. Shurkalin B.K., Faller A.P., Gorskii V.A. Rol' kishechnika v patogeneze MOF [The role of
  66. the intestine in pathogenesis of MOF]. Riv. Ital. Nutr.
  67. Parenterale enterale, 1990; 8: 1: 1-5.

Views

Abstract - 99

PDF (Russian) - 84

PlumX

Dimensions


Copyright (c) 2013 ., ., ., .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies