The dissertation is devoted to improving the results of prevention and treatment of children with postoperative adhesive intestinal obstruction (AIO).
Another direction of research was the study of disorders of the oxidant-antioxidant system and energy metabolism in children with postoperative AIO. It was established that the course of the postoperative period in children with AIO is characterized by the activation of free radical processes, a decrease in the antioxidant potential in blood serum and a violation of the balance indicators of energy metabolism. It was established that the most significant violations were in children with a severe degree of the AP. The content of diene conjugates and thiobarbituric acid active products (TBA-AP) in severe cases was significantly higher than in children with mild cases. The content of ceruloplasmin was significantly reduced even with a mild degree of AP, and with a severe degree of AP it was lower than with a mild one. A significant decrease in the level of glutathione transferase compared to a mild degree of AP has also been proven. A significant decrease in the content of ATP, pyruvate and a significant increase in the concentration of lactate compared to the indicators with a mild degree of severity.
The author proved for the first time the effectiveness and safety of using gels based on carboxymethylcellulose and sodium hyaluronate for the prevention of recurrence of postoperative SCN in children. Their use made it possible to reduce the frequency of recurrence of adhesion obstruction by 4.18 times, and the frequency of relaparotomy due to recurrence of SCN by 4.19 times compared to patients who received traditional methods of prevention and treatment. A significant improvement in the indicators of the course of the postoperative period was revealed in patients to whom anti-adhesive gels were applied.
The problem of predicting the development of postoperative adhesion formation in children based on the determination of the acetylation phenotype received further development. It has been proven that 57.14% of children with peritoneal adhesions, who underwent surgery for appendicitis and peritonitis, had a rapid acetylation phenotype (PRA), while in children without signs of adhesions, it was found in only 6.25% of patients. The author proved for the first time the relationship between the acetylation phenotype and the degree of severity of AP and the frequency of recurrence of AIO in operated children. In 60.0% of children with a severe degree of AP, PRA was detected, and only 5.0% of them had a slow acetylation phenotype, while with a mild degree, the frequency of PRA was 3.4 times lower than that of slow acetylation. It was also established that among children with relapsing AIO, PRA was detected 2.3 times more often than among patients without relapse of the disease.
We acquired further scientific study of the pathogenetic role of the oxidant-antioxidant system disorders of the body and energy metabolism in the postoperative period in children with AIO. It has been proven that the processes of lipid peroxidation are activated in operated children with AIO (the content of diene conjugates (DK) and thiobarbituric acid-active products (TBK-AP) in the blood increases) and the indicators of antioxidant protection significantly decrease (the content of ceruloplasmin and redox enzymes glutathione system) in operated patients. It was established that the most significant violations were in children with a severe degree of AP. A marked disturbance of energy metabolism in severe AP is evidenced by a decrease in ATP content, pyruvate levels, and a significant increase in lactate concentration compared to indicators in mild AP severity.
Pathogenetically substantiated and obtained new data on the effectiveness of including the antioxidant and energizing complex L-carnitine-containing drug Cardonat in the treatment complex for children with AIO, which potentiates the reduction in the levels of primary and secondary lipid products, contributes to a significant increase in the content of antioxidant enzymes (ceruloplasmin, glutathione reductase, glutathione peroxidase, glutathione transferase). The use of Cardonate has a positive effect on the normalization of energy metabolism, mainly due to the increase in the level of ATP and a significant reduction in the signs of lactic acidosis (increase in the content of pyruvate and decrease in the content of lactate).
Key words: adhesion intestinal obstruction, adhesion process, appendicular peritonitis, anti-adhesive barrier agents, acetylation phenotype, antioxidant protection, energy metabolism, prevention, prognosis, treatment, children. Branch-Medicina.
