SIMULTANEOUS OPERATIONS DURING JOINT SURGICAL AND GINECOLOGICAL DISEASES

Z.T.SHIRINOV, V.G.ABBASOV, G.B.MIRZAYEVA

Scientific Centre of Surgery named after M.A. Topchubashev,, Baku BSI maternity hospital No 4, Azerbaijan Medical University, Baku, AZERBAIJAN

According to the information of World Health Organization joint surgical and gynecologic diseases are encountered in 30-40% of patients. Simultaneous correction – simultaneous operations for such diseases remain an urgent issue for surgeons and gynecologists. So far, indications for simultaneous operation and contraindications, selection of the operation team, intervals and sucession of operations, selection of the type of narcosis, time of operation and prophylactic of complications in postoperative period, rehabilitation care and duration of the operation, postoperative rehabilitation issues remain urgent.

In 2006-2011 we performed simultaneous operations in 126 patients. In 6 of them there was carried out subtotal subfascial strumectomy + gynecologic operations, 25 (19,85%) patients were performed cholecystectomy + gynecologic operations, 46 (36,50%) patients appendectomy + gynecologic operations (mainly removal of ovarian cyst because of its rupture) and 49 (38,88%) removal of anterior wall hernias + gynecologic operations. 46 (36,50%) patients of them were performed urgent and 80 (63,50%) patients planned operations.

We have developed and algorythm for the correction of joint surgical and gynecologic diseases by means of simultaneous operations:

1. First examination of the patients shall be agreed jointly by gynaecologist, anaesthesiologist and surgeon based on the results of instrumental and laboratory examinations.
2. Operations on endocrinologic organs that have vital functions shall be performed first.
3. Location of organs to be operated in the same anathomic zone shall be taken into consideration.
4. Operations shall be performed from “clean” to “dirty”.
5. according to severity operations shall be performed from “severe” to “easy”.
6. Operations shall be performed rapidly, accurately and technically perfect.
7. Suppurative – septic complications and preventive measures aimed at thromboemboly shall start before the operation and continue after the operation.
8. After the operation patients shall be sent to rehabilitation of intensive care department.

In postoperative period the issue of rehabilitation of patients must be taken into consideration.

INFLUENCE OF PARENTERAL NUTRITION ON THE INDICATORS OF IMMUNITY DURING GUN-SHOT PERITONITISES

M.M.SULEYMANOV

Nakhchivan Military hospital, Nakhchivan, AZERBAIJAN

Excessive physical activity, body weight deficit, disadaptation and stress factors of military personnel serving under extreme conditions cause primary immunodeficiency. In cases of abdominal gunshot wounds of contingent, mechanical injuries of lymphoid tissues located in the abdominal cavity and playing a significant role in the immunity increase immunodeficiency. As is known, surgical interventions reduce activity indicators of immunity. At the same time, the majority of drugs used in general anesthesia causes lowering of immunity. Therefore the purpose of the work is to study the application of parenteral nutrition and its role in the immunity of patients with primary immunodeficiency.

Material and method: the main group includes 14 patients with gunshot peritonitises that entered with primary immunodeficiency, and the control group includes 22 patients with peritonitises developed because of other infectious reasons of abdomen (The control group includes patients of civil hospital). Average age group of the main group was 23,2 ± 0,09, and of the control group - 24,2 ± 0,09. For parenteral nutrition we used Aminoplazmal 16G (daily dose 1000 ml, total calories – 900 ccal) that is a structural and plastic “construction” material and 40% glucose solution (total dose 800 – 1200 ml, 1 insuline t.v per 2 gr. of glucose, total calories1600 – 2000 ccal) at the same time. For their uptake with used high doses of vitamins and ATF. The use of drugs utilizing antioxidants and oxygen during parenteral nutrition prevented apoptotic immune reaction and made it manageable. In the control group each kilogram of weight was assigned 4-5 ccal, and in the main group average of 40 ccal.

Parenteral infused of was within 3 days uninterruptedly injected into the central veins of the patients of the main group by the dropping method (infusion pump). Immunological results were checked by IFA method (Bergmann device).

Despite the fatal outcome in two of the patients of the control group, in the main group there were no cases of death.

Conclusion: Parenteral nutrition (35 – 45 ccal/kg) in the gunshot peritonitises, especially in patients with primary immunodeficiency directly influence indicators of immunity. Parenteral nutrition in gunshot peritonitises shall be started early, within the term of general anesthesia.

Date: 2014-12-28; view: 917