Role of prolonged intraarterial catheter therapy in general peritonitis

The analyses of treatment results in 82 patients with general purulent peritonitis are presented. In these patients long-term intraarterial catheter therapy (IACT) was included in the complex of postoperative treatment after elimination of infection source. Postoperative peritonitis was in 66 patients, 52 patients of them underwent reoperations for persisting general peritonitis. Use of IACT promoted arrest of abdominal inflammatory process and polyorganic insufficiency due to high concentration of antibiotics in the affection focus, improvement of regional circulation, reduced number of postoperative complications and a sharp fall of lethality of 8.5%.     

Pathogenetic aspects of the treatment of diffuse suppurative peritonitis

Experience with the treatment of 130 patients with generalized purulent peritonitis is analysed. The complex of therapeutic measures included intraoperative cleansing of abdominal cavity with ultrasound; postoperative prolonged laparoscopic cleansing with the use of rational antibacterial therapy and laser irradiation of the abdominal cavity. The cell immunity values in patients with peritonitis were studied and the principles of immunocorrective therapy substantiated. It is shown that detoxification measures are necessary in the treatment of this category of patients. A complex approach to the treatment of purulent peritonitis led to a decrease in mortality to 13.8%.     

老年人急性腹膜炎的临床研究

为探讨７０岁以上老年人急性腹膜炎围手术期处理，对２８３例施行了急诊剖腹手术的７０岁以上老年人急性腹膜炎的临床资料进行了分析。结果显示：原发疾病有腹内脏器急性感染１５２例（５３．７％），腹内脏器急性穿孔９６例（３３．９％），各种绞窄性肠梗阻３０例（１０．６％），原发性腹膜炎５例（１．８％）。其临床表现不典型（６７．４％），易被误诊、漏诊（３４．８％）；直肠指诊和诊断性腹腔穿刺对诊断意义重大。结果提示：７０岁以上老年人急性腹膜炎围手术期处理关键是术前在处理好并存疾病的同时做到早诊断、早手术，术中严密监测病人生命体征、血气和水电解质酸碱平衡，术后维护重要脏器的功能，控制并发症的发生     

Influence of the temperature regimen of sanitation of the abdominal cavity on the course of the syndrome of post-sanitation intoxication in patients with acute diffuse peritonitis

The aim of the investigation was to work out and study effectiveness of the method of sanitation of the abdominal cavity in patients with acute diffuse peritonitis based on a combination of using the properties of hypo- and hyper-thermal solutions. The complex of experimental investigations has proved the safe clinical use of the proposed method to be possible, discovered main pathogenetic mechanisms of a positive influence of heterothermy when performing sanitation of the abdominal cavity against the background of acute peritonitis. The results of clinical approbation of the method in 86 patients have shown sufficiently high efficiency of using sanitation of the abdominal cavity in heterothermal regimen in a complex of measures for treatment of patients with acute peritonitis that allowed getting reliably lower degree of post-sanitation intoxication, less number of complications and lethal outcomes.     

Effects of intravascular laser irradiation of blood on erythrocyte stereo-ultrastructure in the treatment of generalized suppurative peritonitis]

The authors analysed the course and the results of examination of peripheral blood in dynamics and study of red cell stereo-ultrastructure in dynamics before and after sessions of intravascular laser irradiation of blood (ILIB) and treatment in 120 patients with peritonitis, in 60 of them ILIB was applied in the complex of intensive therapy (main group). The control group was made up of 60 patients. The studies showed a favorable curative effect of ILIB: the morphological characteristics of red cells and peripheral blood in patients with peritonitis improves. The laser irradiated blood evidently stimulates the bone marrow and the organs in which blood elements are stored as a result of which their ejection into circulation intensifies. The favorable effect of ILIB is also manifested by increase of the number of intermediate and reduction of the number of prehemolytic and degenerating forms of red cells in various stages of peritonitis, i.e. ILIB affects mainly the retransformation of stomatocytes into discocytes but produces no marked effect on echinocytic transformation.     

Disorders of vital functions in acute peritonitis in children

Changes in vital functions in endotoxicosis were appraised in 41 patients with acute peritonitis during stages of intensive therapy in a complex fashion. Correlative relations were revealed between the severity of endotoxicosis and the function of blood circulation, blood gases, and respiration. Endotoxicosis was characterized by increased level of middle mass molecules, circulating immune complexes, leukocytic index of intoxication, asparagate and alanine transferase. Hemodynamics functioned in hyperdynamic regimen in the reactive stage of peritonitis, in the normodynamic regimen in the transitional stage, and in the hypodynamic regimen in the toxic stage. The immune status was inhibited in the toxic stage of peritonitis. Normalization of vital functions in the postoperative period occurred in parallel with decrease of the severity of endotoxicosis. The studied values approximated the average-age indices in patients with the toxic stage of peritonitis by postoperative days 7-10; sorption methods of detoxification were included in the complex intensive therapy measures in these children.     

Causes of postoperative peritonitis occurrence in the injured persons with gun-shot abdominal wounds

In 43 (39.1%) injured persons with gun-shot abdominal wounding postoperative complications have occurred, demanding reoperations. The most frequent of them were postoperative peritonitis, purulent complications, recurrent hemorrhage, early adhesive ileus. Inadequate abdominal cavity sanation in gun-shot wounding, perforation of deserosated places of intestinal wall, an acute ulcers of hollow organs, lost and not revealed foreign bodies in abdominal cavity were the causes of the progressing postoperative peritonitis occurrence. Absence of some signs, characteristic for postoperative peritonitis, made the diagnosis difficult, that is why in majority of observations the relaparotomy conduction was very delayed. Relaparotomy was conducted on the first-second day, as a rule, for insufficiently sanated abdominal cavity and on the 5-7th day--for perforation of the compound places in hollow organs. Antibacterial therapy was conducted for progressing peritonitis, duration of which depended on dynamics of the peritonitis course. The complications rate reduction was promoted by conduction of an active postoperative sanation of abdominal cavity and potent antibacterial therapy. One patient died because of the wounding severity.     

Changes in gastric secretion in patients in the early period after surgical interventions on the abdominal organs

The gastric secretion was systematically examined in 58 patients during the first days after operations on organs of the abdominal cavity, 23 of them having it considerably increased. In three of these patients the operation was followed by gastric bleeding from acute ulcers. Higher gastric secretion was most frequently observed in patients with mechanical jaundice, purulent peritonitis and intestinal obstruction. Changes in the gastric secretion depend on the composition and volume of infusion therapy.     

Hemodynamics in the region of the visceral branches of the abdominal aorta in diffuse suppurative peritonitis

Hemodynamics of the region of visceral branches of the abdominal aorta was investigated in 75 patients (40 patients with diffuse peritonitis and 35 patients without any pathology of the abdominal organs as a control group). In patients with diffuse purulent peritonitis the volume blood flow in the celiac trunk, mesenterial and renal arteries was reliably reduced, the conditions for the development of acute hepato-renal insufficiency being made.     

Laparoscopy in intra-abdominal infection. Its diagnostic value and therapeutic possibilities

In 550 patients with the clinical features of acute abdomen a surgical laparoscopy was performed. In 121 cases there was found an unspecific reason of the acute abdominal disease that did not require surgical therapy. In 349 cases a regional peritonitis was found, 80 times a diffuse peritonitis. The diagnostic validity of laparoscopy was 96% as compared to 42% for sonography. The laparoscopic access resulted in a complication rate of 0.2%. In 239 cases (43%) the disease could be managed laparoscopically, 190 cases (35%) required open surgery.     

Disorders of acid-alkaline status and electrolyte composition in appendicitis-related peritonitis in a child

In children with diffuse appendicular peritonitis the disorders of acidic-alkaline state (AAS) and the electrolytes composition (EC) of venous blood were studied. Before the operation in patients with extended peritonitis metabolic and respiratory alkalosis dominated, with general one--metabolic acidosis. In diffuse local peritonitis the conduction of ethiotropic antibacterial therapy and intravenous infusion of 2.5% thiotriazolin solution was effective; in extended peritonitis without concurrent pathology the application of potassium chloride was the method of choice. After the laparostomy conduction with programmed sanation the prolonged therapy using 2.5% thiotriazolin solution in maximal concentration was administered, in patients with general peritonitis and closed abdominal cavity the sittings of hyperbaric oxygenation were applied. Application of proposed differential complex correction of the AAS and EC disorders in conjunction with surgical methods of treatment had permitted to avoid mortality as a complication of appendicular peritonitis in last decade.     

Acute surgical diseases and injuries of the abdominal organs in mentally ill patients

The work analyses the results of treatment of acute surgical diseases and traumas of the abdominal organs in 84 patients 18 to 81 years of age suffering from various mental disorders. Schizophrenia was encountered in 47 patients, the manic-depressive syndrome in 16, epilepsy in 8, reactive psychosis in 8, and senile psychosis in 5 patients. Among 66 patients who were admitted for suspected acute surgical disease of the abdominal organs, in 54 the diagnosis was confirmed. Operation was conducted on 59 of them. Eighteen patients had an abdominal trauma. Fourteen patients were operated on for closed (2) and open (12) abdominal injury. All in all 73 patients were treated by operation. Eight patients died. The causes of death were peritonitis and intoxication (4), thromboembolism of the pulmonary artery (1), acute cardiovascular insufficiency (2), and pulmonary edema (1). The peculiarities of the diagnosis and postoperative management of these patients are discussed.     

Place of laparoscopy in the diagnosis of acute surgical diseases of the organs of the abdominal cavity]

The author reports the results of 76 laparoscopies performed in 75 patients with clinically suspected acute surgical diseases (22), peritonitis (38), injuries to internal organs in a blunt abdominal trauma (16 patients). As a result of laparoscopic studies the precise clinical diagnosis was established in 39 patients, and the necessity of urgent therapy was supported, in 3 cases the operation was postponed. Acute surgical diseases were excluded in 33 of 75 examined subjects. There were no cases of pseudonegative diagnosis.     

The symptoms and surgical tactics for complicated forms of the abdominal cavity tuberculosis

The results of treatment of 12 patients, suffering complicated forms of abdominal tuberculosis and external intestinal fistulas, were presented. Late diagnosis of abdominal tuberculosis in the patients, suffering the complications phase of the disease, is caused by unclear symptoms presence in early stages of the disease. Clinical and laboratory indices in peritonitis of a phthisis origin are nonspeciphic. In 91% of patients, admitted to the hospital for complicated forms of abdominal tuberculosis and external intestinal fistulas, the operative treatment was indicated. Surgical intervention (more frequently right-sided hemicolectomy, enterostomy, the abscesses opening, the caseously-changed lymph nodes excision, formation of anastomosis) was performed in 11 patients for peritonitis and external intestinal fistulas. The method of a secure invagination anastomoses formation was elaborated, permitting to perform primary restoration operations. An early diagnosis, early effective therapy and radical surgical intervention conduction for complicated abdominal tuberculosis promote the patients to survive.     

Treatment of peritonitis

Different forms of peritonitis were observed in 209 patients. Generalized results of treatment have shown positive effects of the complex treatment including preoperative management, timely radical operation aimed at liquidation of the source of peritonitis, lavage of the abdominal cavity and adequate drainage and finally, intensive therapy in the postoperative period. Lethality in generalized peritonitis was 11.1%.     

Early signs of decompression of the body in acute suppurative peritonitis and ways of increasing the effectiveness of intensive therapy

In studying the oxygen regimen, circulation and metabolism in 95 patients with acute purulent peritonitis at the toxic stage, it was established that the disorders in transcapillary exchange and oxygen regimen were the early functional criteria for decompensation of the general state of an organism. Differential, in accordance with a phase of the course of the disease, inclusion into the complex of intensive therapy, beginning from the preoperative preparation and anesthesiologic aid, of ornid and ornid with alupent permitted to improve considerably the results of surgical treatment of the patients.     

Accurate diagnosis of infarction of omentum and appendices epiploicae by computed tomography

Segmental infarction of the omentum and epiploic appendages presents with acute abdominal findings that may be confused with a surgical illness. Computed tomography, however, demonstrates a consistent and well-recognized pattern that allows safe, nonoperative treatment. Infarction of omental or mesenteric fat may present clinically as localized peritonitis, mimicking appendicitis, diverticulitis, or cholecystitis. Spontaneous recovery without operation is to be expected if an accurate diagnosis is established. We describe the diagnosis, treatment, and outcome of 15 patients who had infarction of the greater omentum (eight) and epiploic appendage (seven) and presented with localized abdominal pain and tenderness, with six demonstrating regional peritonitis and fever. All underwent CT imaging during their initial evaluation, and 12 of the 15 patients were diagnosed with focal omental or mesenteric fat infarction radiographically and managed nonoperatively. Three patients who had characteristic CT findings nevertheless underwent operation. All patients had complete resolution of their abdominal pain regardless of treatment. The clinical presentation of infarction of the omental or epiploic appendages may be difficult to differentiate from surgical causes of acute abdominal pain. The characteristic findings on computed tomography are diagnostic and allow safe, conservative management in the majority of patients.     

Risk factors and methods of prevention of complications in digestive organs after myocardial revascularization in patients with generalized atherosclerosis]

The clinico-hemodynamic and angiographic findings in 66 patients with ischemic heart disease were analysed to identify the risk factors of complications in the digestive system and to determine the methods for their prevention after myocardial revascularization. It was found that complications in the gastrointestinal tract develop after extracorporeal circulation more often in patients with lesions of the visceral branches of the abdominal aorta than in those without them. With purposeful preventive therapy and observance of definite precautions before, during, and after the operation, the incidence of complications in abdominal organs and the organs of the retroperitoneal space reduced to one fourth while the nature of these complications was less aggressive. This was confirmed by no postoperative deaths in the group of patients who had undergone preventive treatment.     

Effect of endolymphatic antibiotic therapy on the status of cellular immunity in peritonitis

The immune status in 68 patients with diffuse and generalized peritonitis was studied. It was established, that a degree of the impairment in immune response depended on peritonitis spreading. Endolymphatic antibiotic therapy had immunostimulating effect in patients with diffuse peritonitis, in generalized peritonitis, this was not observed. In patients with generalized peritonitis, it is necessary to include into the complex of treatment the other methods of immunologic correction.     

活血化瘀中药对清解通下中药增效作用的实验研究I——治疗急性细菌性腹膜炎的实验观察

目的:通过大鼠急性细菌性腹膜炎动物模型,观察联合应用活血化瘀和清解通下中药对急性腹膜炎的治疗效果。方法:采用盲肠结扎加穿孔法(CLP)制作急性细菌性腹膜炎动物模型,分别经口投予复方丹参方、加味小承气汤以及二者合用(活血清下汤),观察腹腔脏器的病理损害,以及腹膜的渗出与吸收功能。结果:活血清下汤组病理损害最轻,腹膜的渗出受到抑制,对蛋白的吸收功能增强。结论:二方合用优于单方,表明活血化瘀中药对清解通下中药存在增效或协同作用。