Sedack V. The ways of diagnostics and complex forms of acute paraproctitis local treatment optimization.

Object of the study: Purulent inflammation of the pararectal tissue. Purpose of the study: To improve the results of treatment of the patients with complex forms of acute paraproctitis by improving the methods of diagnosis, operative treatment and further local treatment. Methods of the study: Standard clinical-laboratory methods (rec-toromanoscopy, ultrasound study), bacteriological study, statistical evaluation of the obtained findings were used. Practical significance of the obtained results: The investigation allowed to show new capabilities of early diagnosis of acute paraproctitis, which allows to treat timely the patients with complex forms of the disease. The suggested program of therapeutic diagnostic measures allows not only to improve complex diagnosis of acute paraproctitis but also to determine the choice of surgical technique and further local drug therapy depending on the phase of the wound process, the character of the causative agent and radical character of the operation. This programprovides improvement of the functional results and reduction of the duration of treatment for acute paraproctitis. Novelty of the obtained results: For the first time, an algorithm of clinical diagnosis of complicated forms of acute paraproctitis with the use of transcutaneous and endorectal ultrasound study was worked out. High informativity of ultrasound study in diagnosis of complicated forms of acute paraproctitis, especially when typical local clinical signs are absent was proved. For the first time an original technique of ultrasound diagnosis for acute horse-shoe-shaped paraproctitis which allows to reveal these form of the disease and to determine the volume of surgical intervention was worked out. An original classification of acute paraproctitis with the account of the character of the causative agent, distinguishing localized and disseminated forms of the process, and the degree of severity, was suggested. The advantages of two-stage surgical treatment for complicated forms of acute paraproctitis with the use of combined drug therapy were substantiated. An algorithm of local treatment for acute paraproctitis with the use of differentiated choice of surgical treatment of the purulent focus and further technique of local drug therapy was worked out. A differentiated choice of drug composition (drugs) for local treatment of the purulent wound depending on the phase of the wound process, the character of microflora and its sensitivity to drugs as well as peculiarities of surgical treatment of the purulent focus was substantiated scientifically. Degree of introduction: The results of the research were introduced into the work of proctology department of City Clinical Hospital No. 2 (Kharkiv), proctology department of regional Clinical Hospital (Kharkiv), surgery department of Merefa Central District Hospital. Area of application: medicine, surgery.