Age interval

Introduction: The right choice of tactical scheme of treatment of advanced peritonitis (PD) largely determines the prognosis of treatment in this pathology. The main supplier of mortality (20-80%) is a common pyoperitonitis (RSE) [2,3,6]. Development of surgical treatment does not facilitate the solution of specific diagnostic and tactical problems at the bedside, in the course of which must be determined by the choice of one of the following methods of treatment WP: half-closed way - the traditional, most commonly used method of surgical treatment, which consists in laparotomy, removal of the source of peritonitis, rehabilitation and drainage of the abdominal cavity, semi-open way - Improved sanitation landmark relaparotomy. The method is applied at a high bacterial contamination of the abdominal cavity, the impossibility in a single operation to eliminate completely the source of peritonitis or factors of progression in the presence of multiple organ dysfunction syndrome, open way - laparostomy is used in large neudalimyh destructive changes in the abdominal cavity, intestinal fistulas, and infected pancreatic necrosis .

The choice of surgical approach in practice often presents considerable difficulties. The main selection criteria are: the nature of exudates (including quantitative and qualitative bacteriological data), while the development of peritonitis, the degree of dysfunction of major organ systems. It is obvious that the time before surgery, as a reflection of the human factor is important for all patients. Prognostic and momentary assessment of the severity of patients with APACHE II scales and IPI [8,9] has clinical and scientific value and is recommended by the Conciliation Conference Societies pulmonologists and intensive care specialists, as well as [4,7,9], during the Plenary Session Problem Commission "emergency surgery" and "Purulent surgery" (Rostov-on-Don, 1999) [9].

Materials and methods: Results of treatment of 554 patients operated on for various forms of RP during 1990 to 2002. Separately analyzed the results of treating 273 patients with RSE. Of the group study excluded cases with cancer, mesenteric thrombosis, pancreatitis. In a survey before surgery and retrospectively studied the criteria scale APACHE II and Mannheim Peritonitis Index (preoperative score (DSS)). A survey of electrolytes and blood pH was performed using the analyzer Easy Lyte (USA). Analyzed the postoperative period in all operated patients. In a retrospective analysis of patients divided into 3 groups based research in accordance with the clinical characteristics of PD and postoperative course: patients with generalized peritonitis, treatment is carried out semi-closed method, the patients with RP, whose treatment was carried out semi-open way; patients operated on within a half-closed circuits, but due to the development of postoperative complications, it took at least one surgical intervention. That patients with progressive inflammation of peritoneum, which can be both objective and subjective (iatrogennye) reasons [5]. The initial state of peritonitis at the first operation can contribute to the development of intra-abdominal complications with destruction of the hollow body, and without it.

For alleging multiple organ dysfunction syndrome elected the brand viagra following symptoms: heart rate (sinus rhythm)> 110/min, respiratory rate> 24/min, mean arterial pressure <71 mm Hg, the level of hematocrit <21%, the Glasgow Coma Scale <11. The presence of one of the symptoms characterized "monoorgannuyu dysfunction, the presence of two or more symptoms defines" multiple organ dysfunction.

Results and discussion: The age interval examined patients from 14 to 92 years (average age 45.6 years). Main nosology noted in study groups: acute appendicitis, trauma, abdominal and retroperitoneal space, perforated ulcer of the stomach or duodenum, strangulated hernia of the anterior abdominal wall, acute intestinal obstruction (adhesive, gut volvulus, and other forms), gynecological pathology (purulent inflammation of the appendages , including abstsedirovaniem, metroendometrit).

In Table 1 we can trace the correlation between the severity of preoperative status and mortality rates, however, the main task of post-operative period is to reduce the diagnostic time in the event or the progression of RP.

Discussed in the literature how to decompress the gastrointestinal tract represent a real clinical interest [1]. The main purpose of the study was to evaluate the effectiveness of the primary (the first surgery for RSE) of the total intestinal intubation, peritoneal-enteral lavage and adequate drainage of the abdominal cavity as a single complex intra-operative measures in cases when they are absolutely shows. In each of the groups into separate subgroups identified patients whose method was not used and which method was used. Marker of treatment effectiveness was considered recovery of the patient. Indication to the above complex intraoperative events was considered the presence of RGP. In the group of patients whose treatment was carried out semi-closed method, summarizing the results excluded cases of gynecologic as cases in which testimony and intestinal decompression and enteral lavage are not certain.

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