Koichev Y. Substantiation of surgical management of patients with the diffuse purulent peritonitis

The work deals with a retrospective analysis of management of 177 patients with the diffuse purulent peritonitis (DPP) at the age from 18 to 90 - women 57 (32.2 %), men - 120 (67.8 %). Depending on the type of surgical management all patients were divided into two groups. The first group consisted of 71 patients who were conducted "demand relaparotomy" in the complex medical treatment of diffuse purulent peritonitis. The second group included 106 patients who were conducted a method of "programmable sanitation" of abdominal region in the complex treatment of diffuse purulent peritonitis. There was developed the algorithm of treatment of patients with the diffuse forms of acute purulent peritonitis, which allowed to decrease lethality from 38.6% to 22.6 %, and complications rate - from 42.2 % to 11.3 %. The fact of occurrence of intra-abdominal hypertension in 72.2 % in patients with acute DPP, and abdominal compartment-syndrome at 20,5 % even at partial or complete laparostomy was established, which allowed to execute its timely correction. Drainage is improved for one-stage abdominal drains and measuring intra-abdominal pressure which allows to control the value of intra-abdominal pressure in the real-time mode. The work revealed that "exposition sanitation" of abdominal region by octenidine dihydrochloride solution in case of stage sanitation allows to reach normalization of quantitative morphological indices of peritoneum inflammation in 48 hours, that can serve as a criterion of periodicity of implementation of programmed sanitations. Recommendations for VAC-therapy usage in patients with acute DPP in combination with sanitation relaparotomy are presented in the work. Bacterial flora of peritoneal exudate at acute DPP is studied, microorganisms of Enterobacteriacae (67 % of all aerobic, mainly E. Coli) family, gram-positive staphylococci and streptococci (22.6 %) and Ps. Aeruginosa (10.4 %) prevail in the aerobic component, which explains the advantages of de-escalation antibacterial therapy. The final materials of the thesis can be useful in the educational process for training clinical interns, doctors-interns, students of higher medical universities, they are recommended for practice of surgical doctors who manage with acute diffuse purulent peritonitis.