Lugansk State Medical University, Lugansk, UKRAINE
Introduction: A steady increase in the number of patients with adhesive disease of abdominal cavity is noted in recent decades. The unsatisfactory results of the treatment of patients of this group force surgeons to continue the search of the new pathogenetically based methods of prophylaxis and treatment of adhesive disease.
Materials and methods: The analysis of the results of the treatment of 26 patients with adhesive disease of the organs of abdominal cavity in the age from 21 to 65 years was laid in the basis of the present study. The degree of ischemic affection of abdominal aorta and its visceral branches was verified by ultrasonic dopplerography (USDG).
Results: Disorders of the regional blood flow in intestinal mesentery were revealed in all patients. Were allocated two groups of patients: patients with lesions of inferior mesenteric artery and its stenosis up to 60% of the diameter of the artery (hemodynamically insignificant lesions) and over 60% (hemodynamically significant). In the affection of the lower mesenteric artery the thickness of its wall ranged from 0.9 to 1.7 mm (mean 1.3 mm). The maximum blood flow velocity in stenosis has increased immediately after the constriction and in the first group has made 0,75 ± 0,01 m / s (p <0.01). Volumetric blood flow in haemodynamically insignificant stenosis of inferior mesenteric artery has reduced up to 0,059 ± 0,0025 l / min (p <0.001). In hemodynamihemodynamically significant disorders a maximal blood flow has decreased to 0,016 ± 0,08 m / s (p <0.001), volumetric blood flow has decreased to 0,009 ± 0,02 l / min (p <0.001).
Conclusions: Thus it was found out that all patients with adhesive disease had ischemic disorders of intestines, which requires timely pathogenetically rationale surgical correction
PROGRAMMED SANATIONS OF ABDOMINAL CAVITY WITH USAGE OF THERAPEUTIC BACTERIOPHAGES IN THE SURGICAL TREATMENT OF ACUTE PERITONITIS
Lugansk State Medical University; Lugansk, UKRAINE
Introduction: In surgical treatment of acute total peritonitis (ATP) the priority is given to the method of programmed postoperative sanations of abdominal cavity. Application of therapeutic bacteriophages which are active against many micro-organisms isolated from patients with ATP can significantly improve postoperative rehabilitation.
Materials and methods: In 55 patients with ATP after elimination of the source of peritonitis,of abdominal contents and sanation of the latter with saline solution processing of abdominal cavity with therapeutic bacteriophages (BP) was carried out. Sekstofag (polyvalent piobakteriofag ) intestibakteriofag koliproteal, Pseudomonas Aeruginosa. At the same time 20-40 ml of
BF were injected with a syringe (2 ml) into the foci of purulent lesions of omentum of parietal peritoneum. Then, the therapeutic dose of BF was diluted in 100-150 ml of 0.25% solution of novocaine and infiltrated the root of thin mesentery. In the presence of massive infiltrative purulent process in abdominal cavity was used a technique known as a "phage block" - peritoneal lesions were infiltrated with 200 ml of undiluted phages.
Results. The developed a scheme of bakteriofagotherapy during sanation of abdominal cavity precedes data of bacteriological analysis. The appointment of sekstofag or intesti-bakterofag bacteriophages is justified in assessing the severity of patients on SAPS scale (n <10) . The use of combined phage therapy with sekstofag - Pseudomonas aeruginosal, Pseudomonas aeruginosal - koliproteal, intesti-pseudomonal is recommended in patients (n> 10).
Conclusion. The developed method of sanation allowed reducing the number of recurrences of abdominal infections almost in 1.2 times, complications from 56.4% to 32.4% and mortality rate from 28.3% to 16.4%.