Droniak M. Surgical treatment of patients with postoperative peritonitis and its complications (clinical and experimental study)

The work is devoted to improving the results of treatment of patients with postoperative peritonitis and its complications – abdominal sepsis, by creating an objectified scale for predicting and prevention the risk of development of this pathology, which is based on deep analysis of anamnesis, clinic, biochemical indicators, using of developed methods of lavage of abdominal cavity, targeted antibiotic therapy and extracorporeal detoxification methods. On the basis of a new method of modeling experimental postoperative peritonitis were supplemented scientific data on the dynamics of changes in lipid peroxidation (malonic aldehyde, diene conjugates), medium weight molecules, C-reactive protein, procalcitonin and their role in the development of endogenous intoxication. Scientifically confirmed the effectiveness of determining procalcitonin and C-reactive protein in the developed complex scale for assessing the severity and prediction of postoperative peritonitis with abdominal sepsis. Supplemented scientific data on the dynamics of changes in nonspecific resistance and cytokine regulation in patients with postoperative peritonitis with abdominal sepsis. Scientifically it was proved clinical effectiveness of a combination of decamethoxine and extranil solution for the lavage of the abdominal cavity in generalized peritonitis; expediency of application of express methods of bacteriological research of pathological contents (blood, pus, bile, peritoneal exudate) and the characteristic spectrum of microorganisms was determined depending on localization of the center of an infection. The schemes of etiotropic antibacterial therapy and indications for the use of extracorporeal detoxification methods in patients with postoperative peritonitis with abdominal sepsis was improved. The algorithm of application of minimally invasive and early repeated open operative interventions in treatment of patients with postoperative peritonitis and its complications was substantiated. It was developed and implemented in practical activity of health care units: method of lavage of the abdominal cavity and intra-abdominal abscesses in patients with postoperative peritonitis and its complications (patent of Ukraine №134318); method of pyloroduodenoplasty in patients with complicated duodenal ulcers (patent of Ukraine № 54200); methods of prevention of postoperative peritonitis; laparoscopic lavage and drainage of abdominal abscesses, as the operation of choice in patients with postoperative peritonitis; diagnostic and treatment algorithm for assessing the severity of the condition and prognosis of the disease, based on the dynamics of clinical and laboratory parameters in patients with abdominal sepsis.