Результати хірургічного лікування хворих на післяопераційний перитоніт
| Autor: | O. Ya. Popadyuk, I. M. Shevchuk, V. M. Dronyak, M. M. Dronyak, M. B. Fedorkiv |
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| Rok vydání: | 2018 |
| Předmět: | |
| Zdroj: | Шпитальна хірургія. Журнал імені Л. Я. Ковальчука. |
| ISSN: | 2414-4533 1681-2778 |
| DOI: | 10.11603/2414-4533.2018.1.8860 |
| Popis: | The aim of the study. To improve the results of surgical treatment of patients with postoperative peritonitis complicated by abdominal sepsis, by improving timely diagnosis and implementation of optimal surgical tactics. Materials and Methods . In 2010-2017, intraperitoneal complications were diagnosed in 209 (2.4 %) among 8762 patients operated after acute and chronic diseases of the abdominal cavity. Results and Discussion. Abscesses of the abdominal cavity take place in 142 (67.9 %) cases, generalized peritonitis – 67 (42.1 %) patients. Mini invasive techniques (laparoscopic sanation of abscesses in the abdominal cavity with drainage of abscesses by stylet-catheter under ultrasound guidance) were effective in 129 (61.7 %) cases. Relaparotomy (RL) was performed in 80 (38.3 %) cases. Among them: in patients with generalized postoperative peritonitis in 61 (91 %) among 67 patients, with localized postoperative peritonitis – in 19 (13.4 %) of 142 patients. The first manifestations of intraabdominal complications after postoperative peritonitis were: the acute respiratory failure – in 95 (45.5 %) cases, cardiovascular failure – in 68 (32.5 %) cases, liver and renal dysfunction – in 46 (22 %) cases in the absence of clear local signs of the disease. 34 (42.5 %) out of 80 patients, who underwent the relaparotomy had 9–12 points of the Marshall score. One relaparotomy was performed in 46 (57.5 %) cases. Two relaparotomies were performed in 26 (32.5 %) cases, three relaparotomies – in 8 (10 %) cases. The need to repeat relaparotomy in 34 (42.5 %) cases was accompanied by a significant increase of mortality. So, after the first relaparotomy, 7 (15.2 %) out of 46 patients died, after the second relaparotomy – 12 (63.2 %) out of 19, after the third relaparotomy 6 (75 %). The use of precision technology, lavages of the abdominal cavity with solutions of antiseptics (8–12 liters) untill clean waters, intraabdominal applications of "Extranil", nasointetestinal intubation of the small intestine with other methods of treatment, helped to accelerate the elimination of signs of abdominal sepsis, decrease in the number of repeated relaparotomy, decrease postoperative lethality from 47.7 to 11.1 %. |
| Databáze: | OpenAIRE |
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