Yevtushenko O. Individualization of surgical treatment of complicated intraabdominal infection

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

State registration number

0823U101646

Applicant for

Specialization

  • 222 - Медицина

Specialized Academic Board

СВР 26_2957

Kharkiv National Medical University

Essay

The purpose of the work is to improve the results of surgical treatment of patients with complicated intra-abdominal infection based on the individualization of the treatment program, taking into account the severity of organ disorders and the individualized prognosis of the course of the disease. The work is based on the analysis of the results of surgical treatment of 285 patients with complicated intra-abdominal infection-peritonitis, abdominal abscess. Depending on the source of infection, three groups are distinguished. The first group consisted of 150 patients with gangrenous and gangrenous-perforating appendicitis complicated by periappendicular abscess or peritonitis; the second group - 60 patients with peritonitis or abscess of the abdominal cavity due to perforation of the stomach, duodenum, small or large intestine.The cause of peritonitis and abdominal abscesses as manifestations of complicated intra-abdominal infection are: appendicitis – 52.6%; cholecystitis – 26.3%; perforation of a gastroduodenal ulcer – 10.2%; colon perforation – 3.9%; perforation of the small intestine - 3.5%; previous surgical interventions on organs of the abdominal cavity - 2.1%; perforation of a purulent tubovarial tumor – 1.4%. Postoperative complications after removal of the source of infection were observed in 17.2% of patients and 13.7% required surgical treatment - relaparotomy.Postoperative mortality was 5.3%. The development of complicated intra-abdominal infection is accompanied by changes in the picture of peripheral blood: leukocytosis with neutrophilic shift to the left, lymphopenia. Changes in the leukocyte blood formula reflect hematological indices: leukocyte intoxication index; Reiss leukocyte intoxication index; intoxication index, neutrophil-lymphocyte coefficient. A high level of C-reactive protein and interleukin-6 indicates the development of a complicated intra-abdominal infection, the presence of a pronounced systemic inflammatory response. Microflora in complicated intra-abdominal infection is represented by associations of microorganisms. n case of gangrenous appendicitis and its perforation, 37 strains of microorganisms were isolated, of which 54.1% were represented by gram-negative microorganisms, mainly Escherichia coli, and 21.6% showed anaerobic flora. In peritonitis due to perforation of the gastrointestinal tract, 25 strains of microorganisms were isolated, 76% of which are represented by both obligate aerobes and obligate and facultative anaerobes. In the case of perforation of the gallbladder, gram-positive flora, primarily Enterococcus faecalis and Escherichia coli, were found in 65% of the contents of the abscess and in 66.7% of the affected surrounding tissues, and in the presence of liver abscesses, Enterococcus faecium and Escherichia coli were found in 57.1%. The greatest sensitivity of the isolated microflora to cefepime, moxifloxacin, gatifloxacin, imipenem, meropenem and teicoplanin. The improved scale for assessing the severity of acute sepsis II and the scale for assessing enteric insufficiency II are proposed, which make it possible to identify a group of patients with a high risk of mortality. The severity of the condition of patients on the scale of sepsis II over 24 points and on the scale of enteral insufficiency II over 29 points indicates a high risk of mortality in patients with complicated intra-abdominal infection. A mathematical model for predicting the mortality of patients with peritonitis due to perforation of the gastrointestinal tract has been developed, the sensitivity of which is 88, 9%, and the specificity is 95.7% and the mathematical model for predicting the mortality of patients with complicated intra-abdominal infection, the sensitivity of which is 85.7%, the specificity is 81.0%.

Research papers

1. Сипливый ВА, Гринченко СВ, Евтушенко ДВ, Евтушенко А.В. Шкала оценки тяжести сепсиса II .Сучасні медичні технології. 2019; 2 (41): 40-44.

2. Сипливый ВА, Гринченко СВ, Горголь НИ, Евтушенко ДВ, Евтушенко АВ, Колотилов АВ. Энтеральная недостаточность при перитоните. Шкала оценки энтеральной недостаточности II. Харківська хірургічна школа. 2019; 1 (94):54 – 58.

3. Сипливий ВО, Криворучко ІА, Євтушенко ОВ, Менкус БВ, Євтушенко ДВ. Релапаротомія в лікуванні інтраабдомінальних ускладнень хірургічних операцій на органах черевної порожнини. Харківська хірургічна школа. 2020; 2 (101):156-160.

4. Євтушенко ОВ. Хірургічне лікування гангренозного та гангренозно-перфортивного апендициту. Аналіз проявів та безпосередніх результатів. Art of Medicine. 2022; 3 (23): 121 -124.

5. Kryvoruchko IA, Antonova MS, Yevtushenko OV, Andreieshchev SA. Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operation. Клінічна хірургія. 2020; (1-2): 24-29.

6. Євтушенко ОВ, Сипливий ВО, Мішина ММ, Криворучко ІА, Євтушенко ДВ. Антибіотикорезистентність мікрофлори при перфоративному холециститі та абсцесі печінки. Харківська хірургічна школа. 2023; 1-2 (118-119):100-103 doi : http//doi.org/10.37699/2308-7005.1-22023.21.

7. Kryvoruchko IA, Sykal NA, Yevtushenko OV, Riabtsev RS. A focus on abdominal sepsis: The problem of prognostik markers. Medical Science. 2021; 25 (114): 2068-76.

8. Kryvoruchko IA, Boyko VV, Sykal NA, Yevtushenko OV. Predicting of Postoperative Mortality in Cases of Abdominal Sepsis for Two Surgical Strategies Using a New Mathematical Model : Two Centers Review of a 10 Years` Experience with the Same Diagnostic and Tactical Approaches to the Treatment. Annals of Medical and Health Sciences Research. 2021; 11(52): 383-92.

9. Syplyviy V, Ievtushenko O, Ievtushenko D, Nekrasova Y. Surgical Treatment of Gallbladder Perforation. Hepato- Pancreato-Biliary (HPB). 2022;24 supplement 1:S499-S500.

10. Syplyviy V, Ievtushenko D, Ievtushenko O, Nekrasova Y. Iatrogenic Bile Duct Injury during Cholecystectomy: Characteristics, Consequences, Surgical Treatment. Hepato- Pancreato-Biliary (HPB). 2022;24 supplement 1: S514.

11. Сипливий ВО, Євтушенко ОВ, Євтушенко ДВ. Оцінка складності холецистектомії при гангренозно-перфоративному холециститі за шкалою Tokyo Guidelines 2018. General Surgery. 2022; (2: Інформаційний додаток до журналу. Актуальні питання загальної та судинної хірургії. Матеріали науково-практичної конференції з міжнародною участю; 2022 Жовт 28-29; Київ, Україна):90-1.

12. Kryvoruchko IA, Sykal NA, Yevtushenko OV. Predicting early mortality in treatment of patient with acute infection pancreatitis using two surgical strategies. Medical Science. 2021; 25(III):1092-105.

13. Сипливий ВО, Русин ВІ, Євтушенко ДВ, Євтушенко ОВ. Хірургічне лікування ускладнень холелітіазу [монографія] . Харків, ХНМУ; 2021; 84 с.

14. Криворучко ІА, Бойко ВВ, Горчарова НМ, Арсен’єв ОВ, Тесленко СМ, Сивожелізов АВ. Сикал МО, Євтушенко ОВ. Математична модель прогнозування летального результату на ранній стадії абдомінального сепсису [літературний твір] ( 7 травня 2021 р). Свідоцтво про реєстрацію авторського права на твір № 104589 (Трав 7, 2021).

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