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Khirurgii

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Year 2011 Vol. 19 No 3

GENERAL AND SPECIAL SURGERY

SUKOVATYKH B.S., BLINKOV YU.YU., IVANOV P.A.

NEW APPROACH TO THE CHOICE OF TREATMENT METHOD AT DIFFUSE PURULENT PERITONITIS

Objectives. To improve the treatment results in patients with diffuse purulent peritonitis by means of objectification of the indications for the choice of surgical treatment.
Methods. The analysis of the complex diagnostics and the following treatment of 380 patients with diffuse purulent peritonitis was performed. According to the choice of treatment method the patients were divided into two groups. Control group included 245 patients; the choice of treatment method for them was made without quantitative characteristics of risk factors for progressing peritonitis. The basic group included 135 patients; the choice of treatment method for them was made on the base of the scale developed by the authors using quantitative assessment of risk factors for progressing peritonitis.
Results. On determining the indications for the choice of the treatment method of diffuse peritonitis it is necessary to perform quantitative assessment of 6 risk factors directly influencing the outcome of the disease: severity of the abdominal sepsis, degrees of intra-abdominal hypertension, the source of peritonitis, types of exudates, amount and properties of fibrin on peritoneum, severity of paralysis of the intestines. Depending on the score, if the number of points varies from 1 to 7, the choice is made in favor of traditional (semi-closed) method of treatment, the range from 8 to 14 means that combined method should be applied, if the score is 15 points and above - semi-opened method of treatment is preferred.
Conclusions. In the basic group the number of patients with post-operative complications decreased by 10% and lethality decreased by 8,2%.

Keywords: diffuse purulent peritonitis, choice of the treatment method
p. 51 – 56 of the original issue
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