This journal is
indexed in Scopus
Year 2018 Vol. 26 No 2
GENERAL & SPECIAL SURGERY
A.YA. KOROVIN, M.B. ANDREEVA, D.V. TURKIN, N.A. TRIFANOV
COMPLEX TREATMENT OF PATIENTS WITH ACUTE MESENTERIC ISCHEMIA AND PERITONITIS
Kuban State Medical University,
The Russian Federation
Objective. To develop surgical tactics in acute mesenteric ischemia and purulent peritonitis and to find ways to improve the results of treatment of this complicated pathology.
Methods. 118 cases of acute mesenteric ischemia complicated by diffuse peritonitis were analyzed. For urgent diagnosis of the pathology, computed tomography was used. In the first group (n=72), one-step procedures were applied – the intestinal resection and embolthrombectomy with application of the primary anastomosis. Reoperations were performed «on demand». In the second group (n=46), operations were of a separate nature, along with thrombembolectomy and intestinal resection at the stages of the programmed relaparotomy, delayed interintestinal anastomoses were used. The maximum number of relaparotomies in both groups was 3. The gradual treatment outcomes were assessed during the first day hospital mortality and integrated rates of severity of the sepsis APACHE II and SOFA, the peritonitis index of Mannheim (IPM) and the abdominal cavity index (IAC) in the intervals between relaparotomies. At the final stage, hospital mortality was compared in the groups of patients.
Results. The mortality rate after the first operation in the groups was 43.6% and 41.3%, respectively. Reduction in the severity of abdominal sepsis was registered at the time of the third relaparotomy, in the second SOFA group <8, the IPM decreased by 16%, and the IAC by 27%. Significant differences in IPM and IAC indicators were registered only with the third relaparotomy, and the tendency of the positive dynamics of peritonitis course was traced in the second group of observations. Hospital lethality exceeded the staged predicted values and constituted 87.5% in the first, and 84.8% in the second group.
Conclusions. Surgical tactics, including the use of obstructive bowel resections with the delayed anastomosis after restoration of mesenteric hemocirculation and relief of the reperfusion syndrome at the stages of the programmed relaparotomy, contributes to improving the treatment results of acute mesenteric ischemia and diffuse peritonitis.
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350063, The Russian Federation,
Krasnodar, Sedin Str., 4,
Kuban State Medical University,
Department of the Faculty
Surgery with the Course of Anesthesiology
and Intensive Care,
Tel. mobile: + 7 988 244-69-44,
Korovin Alexander Ja.
Korovin Alexander Ja., MD, Professor, Head of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
Andreeva Marina B., PhD, Assistant of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
Turkin Denis V., PhD, Assistant of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
Trifanov Nikolay A., Post-Graduate Student of Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.