Year 2015 Vol. 23 No 3

GENERAL & SPECIAL SURGERY

B.M. BELIK, S.U. EFANOV, A.I. MASLOV,
V.A. SUYARKO, A.R. SAPRALIEV

THE ROLE OF INTRAPORTAL INFUSIONS IN CORRECTION OF FUNCTIONAL LIVER FAILURE AND ENDOTOXICOSIS IN GENERALIZED PERITONITIS

SBEE HPE "Rostov State Medical University"
The Russian Federation

Objectives. Comparative estimation of the clinical efficiency of traditional intravenous (intracaval) and intraportal infusion therapy (IPIT) in correction of functional liver failure and endotoxicosis (ET) in generalized peritonitis (GP).
Methods. The patients with GP (n=324) manifesting abdominal sepsis and ET had been enrolled in the study and divided into 2 groups according to the principle approach to treatment. In the first group (n=175) the patients were traditionally treated with intracaval infusion therapy according to the conventional standards. In the second group (n=167), redrainage and catheterization of the umbilical vein were performed intraoperatively and further combined with a standard therapy IPIT was applied. In the comparative aspect the laboratory indicators of the liver functional status and endotoxicosis had been investigated, including the severity of the systematic inflammatory reaction (SIR) as well as the immediate treatment results of both groups.
Results. In the second group, on the IPIT background in the early stages the leukocytosis, concentration of C-reactive protein, fibrinogen, general bilirubin, concentration of cytolysis markers of hepatocytes, laboratory indicators of ET (urea, creatinine, myoglobin, Leukocyte Index of Intoxication and Average Molecular Peptide) were reduced as well as a distinct increase of general protein and albumins in comparison with the analogical values was registered in the first group of patients. The complication rate (the average) in the main group was lower by 9,1% and the postoperative mortality – 8,2% compared with the control group.
Conclusion. In the early postoperative period using IPIT in patients with GP promotes the rehabilitation of the functional liver failure and significantly reduces the severity of ET allowing improving the immediate treatment Results.

Keywords: generalized peritonitis, liver insufficiency, endotoxicosis, intraportal infusions, rehabilitation, complications, postoperative mortality
p. 296-301 of the original issue
References
  1. Savel'ev VS, Gel'fand BR, Filimonov MI. Peritonit: Prakticheskoe rukovodstvo [Peritonitis: a practical guide]. Moscow, RF: Litterra, 2006. 205 p.
  2. Gostishhev VK. Infekcii v hirurgii. Rukovodstvo dlja vrachej [Infections in surgery. Guidelines for physicians]. Moscow, RF: GJeOTAR-Media, 2007. 763 p.
  3. Briskin BS, Hachatrjan NN, Dibirov MD, Karsot'jan GS, Mihajlin AA, Fesenko TA. Antibakterial'naja terapija u bol'nyh s tjazhelymi formami rasprostranennogo peritonita [Antibiotic therapy in patients with severe diffuse peritonitis]. Consilium Medicum. Khirurgija, 2008;(1):23-26.
  4. Dmitrieva NV, Petuhova IN. Posleoperacionnye infekcionnye oslozhnenija. Prakticheskoe rukovodstvo [Postoperative infectious complications. A. practical guide]. Moscow, RF: Prakticheskaja Medicina, 2013; 424 p.
  5. Bosscha K, Hulstaert PF, Visser MR, van Vroonhoven TJ, van der Werken C.Open management of the abdomen and planned reoperations in severe bacterial peritonitis. Eur J Surg. 2000 Jan;166(1):44-49.
  6. Giessling U, Petersen S, Freitag M, Kleine-Kraneburg H, Ludwig K. [Surgical management of severe peritonitis]. [Article in German]. Zentralbl Chir. 2002 Jul;127(7):594-97.
  7. Gostishhev VK, Sazhin VP, Avdovenko AL. Peritonit [Peritonitis]. Moscow, RF: GJeOTAR-MED. 2002. 240 p.
  8. Wolff H. [On the history of surgical treatments of peritonitis]. [Article in German]. Zentralbl Chir. 2002 Jan;127(1):62-67.
  9. Erjuhin IA. Khirurgija gnojnogo peritonita [Surgery peritonitis]. Consilium Medicum. Moscow, RF: Media Medika. 2003;(5)6:337-41.
  10. Erjuhina IA, Gel'fanda BR, Shljapnikova SA. Khirurgicheskie infekcii. Prakticheskoe rukovodstvo [Surgical infection. A practical guide]. Moscow, RF: Litterra, 2006. 736 p.
  11. Khanevich MD, Selivanov EA, Starokon' PM. Peritonit [Peritonitis]. Moscow, RF: MedEkspertPress. 2004. 203 p.
  12. Chernov VN, Belik BM, Efanov SIu. Patogenez narusheniia vistseral'nykh funktsii pri rasprostranennom peritonite [Pathogenesis of visceral functions in generalized peritonitis]. Vestn Khir. 2014;(173)4:35-38.
  13. Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg. 2000 Jan;24(1):32-37.
  14. Teichmann W, Herbig B. [Therapy principles in diffuse peritonitis]. [Article in German]. Chirurg. 2000 Jan;71(1):120-28.
  15. Puga R, Rodríguez R, González C, Muñoz J. Ozone Therapy in the Treatment of Patients with Secondary Immunodeficiencies. 2nd International Symposium on Ozone Applications Havana, Cuba - Mach 24-26, 1997.
Address for correspondence:
344010, Rossiyskaya Federatsiya,
g. Rostov-na-Donu, pr. Voroshilovskiy, d. 105,
GBOU VPO "Rostovskiy gosudarstvennyiy meditsinskiy universitet,"
kafedra obschey khirurgii,
tel. mob. 7 903 406-00-97,
e-mail: efanov_su@mail.ru,
Efanov Sergey Yurevich
Information about the authors:
Belik B.M. MD, a head of the general surgery chair of SBEE HPE "Rostov State Medical University".
Efanov S.U. PhD, an assistant of the general surgery chair of SBEE HPE "Rostov State Medical University"
Maslov A.I. PhD, an associate professor of the general surgery chair of SBEE HPE "Rostov State Medical University."
Suyarko V.A. A post-graduate student of the general surgery chair of SBEE HPE "Rostov State Medical University".
Sapraliev A.R. A senior laboratory assistant of the general surgery chair of SBEE HPE "Rostov State Medical University".
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