Year 2013 Vol. 21 No 5

GENERAL AND SPECIAL SURGERY

A.B. LARICHEV1, E.J. POKROVSKIJ2, A.A. DYLENOK1

THE TREATMENT RESULTS OF GENERALIZED PURULENT PERITONITIS WITH DECOMPENSATION OF MULTIPLE ORGAN DYSFUNCTION

SBEE HPE "Yaroslavl State Medical Academy"1,
SBEE HPE "Ivanovo State Medical Academy"2,
The Russian Federation

Objectives. To estimate efficiency of a complex surgical treatment of patients with the generalized purulent peritonitis in the stage of decompensation of multiple organ dysfunction.
Methods. The analysis of treatment results of 98 patients with the urgent abdominal pathology, complicated by the generalized purulent peritonitis with the multiorgan dysfunction decompensation is presented in this paper. Operative intervention including liquidation of a source of peritonitis, nasogastrointestinal intubation and peritoneal lavage in a series of staged remedial relaparotomies. Extra corporal methods of detoxification was presented by hemo- and lymph sorption. Efficiency of medical actions was estimated by means of physical, clinical-laboratory, biochemical and special methods of investigation (bacteriological, gas-liquid chromatography, computer phonoenterography, cystomanometry).
Results. Despite of absoluteness of indications for the staged sanitation of the abdominal cavity and extra corporal detoxification, decompensation of vital systems essentially limited its application. Taking into account the severity of patients condition the sanitation actions under the program having low chances for success were realized in 43 patients. Expressed adhesion process in the abdominal cavity, massive deposition of fibrin and stable intestinal paresis didnt permit to perform video laparoscopic sanitation. Presence of intoxication on the insufficient efficiency background of primary intracorporeal resuscitative actions in the abdominal sphere, supplemented by a series of staged sanitation relaparotomies incapable to eliminate endotoxemia have defined the indications for lymph- and hemosorption. The enumerated measures were accompanied by a high lethality (77,4%).
Conclusions. At treatment of patients with generalized purulent peritonitis in the stage of multiorgan dysfunction decompensation, traditional surgery doesnt stop the progressing of the pathological process. More aggressive approach to the given disease is associated with the problem of possible failure of the functional status of vital systems. Often observable extreme degree of the cardiovascular insufficiency does not allow realizing the potential of staged sanitations of the abdominal cavity under the program, including video laparoscopy technique as well as limits essentially clinical opportunities of extra corporal methods of detoxification.

Keywords: peritonitis, multiorgan dysfunction, treatment
p. 50 57 of the original issue
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Address for correspondence:
150000, Rossiiskaia Federatsiia, g. Iaroslavl', ul. Revoliutsionnaia, d. 5, GBOU VPO Iaroslavskaia gosudarstvennaia meditsinskaia akademiia, kafedra obshchei khirurgii,
e-mail: larich-ab@mail.ru,
Larichev Andrei Borisovich
Information about the authors:
Larichev A.B. MD, professor, a head of department of general surgery SEI HPE "Yaroslavl State Medical Academy".
Pokrovskij E.J. PhD, an associate professor, a head of department of surgery hospital SEI HPE "Ivanovo State Medical Academy".
Dylenok A.A. a graduate student, a chair of general surgery SEI HPE "Yaroslavl State Medical Academy".
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