THERAPEUTIC TACTICS FOR ACUTE PERIITONITY IN PATIENTS WITH COMORBID PATHOLOGY

Abstract

The objective of the study: justification of the treatment of patients with acute peritonitis (AP) with comorbid pathology (CP). Materials and methods: 420 white rats with simulated AP, diabetes mellitus, pathology of the liver, kidneys; 726 patients with acute surgical pathology. The clinical parameters, immune, proteolytic, cytokine, oxidative-reduction systems, hemostasis, biochemical, microbiological, morphological changes were investigated. Results. Mutual burdening syndrome was found to be a pathogenic basis of changes in the course of AP in patients with comorbid diseases. The stages of its development are determined. The new classification of CP for emergency abdominal surgery is developed, which involves the selection of four classes. A management tactics is developed within CP, which provides a differentiated choice of the activities amount at all stages of treatment, considering the classes of CP. The indications are extended before preoperation, which should be performed in patients who belong to the II and III class of CP. To assess AP spread a method has been developed, which is based on the changes of the laser beam dispersion zone width by the parietal peritoneum. For a reasonable choice of the amount of surgery and place of applying intestinal stitches a method of determining viability is developed, which involves the detection of the photoluminescence index. To increase the connection zone reliability of the hollow digestive organs continuous no-penetrating and single-row stitches are developed. To protect and fix the suture lines on the hollow digestive organs methods of local influence are developed, enabling to regulate the course of the regeneration processes. The indications for the use of programmed repeated sanitization of the peritoneal cavity are extended. For patients belonging to class II of CP such surgery is recommended to be performed starting with the II degree of severity of AP, and those belonging to the III class – starting with the I degree of severity. The method of the prolonged peritoneal cavity sanitization is developed by means of drainage devices, which enables to accelerate the regression of inflammation, reduce the number of repeated surgery and duration of treatment. Conclusions. 1. The pathogenetic and clinical features of AP in patients with CP are caused by mutual burdening syndrome. 2. The developed prognostic scale assuming four classes of CP, enables to reasonably choose the necessary volume of treatment for a particular patient. 3. The use of the developed therapeutic tactics, based on the suggested evaluation scale, can significantly improve the results of treatment of patients with AP.