Increasing the depth of knowledge of the pathophysiology of peritonitis did not lead to a change in priority of surgery, known since Kirschner, such as the removal of the causes of peritonitis, brushing the abdomen and effective drainage of the [8.18]. In recent years the doctrine of treatment WP surely includes such methods as "laparostomy", "Decompression of the gastrointestinal tract", "peritoneal-enteral lavage [1], therapy of abdominal sepsis" [4.19], "detoxification" [14 ], which are aimed at removing the most significant pathophysiological links of the ER. Development of new surgical treatments are not always easy solutions specific diagnostic and tactical problems at the bedside, during which should guide the selection of one of the following methods of treatment WP:
Closed-way - rarely used, at a low level of bacterial contamination of the abdominal cavity and in terms of developing the disease, not to exceed 6 hours.
Laparoscopic (laparoscopic assisted) method - is used since the late 90s. Indications for this method are similar to the testimony at the closed method, but need to be clarified.
Semi-closed method - a traditional, most commonly used method of surgical treatment, which consists in laparotomy, removal of the source of peritonitis, sanitation 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.
Clear the way - laparostomy is used in large neudalimyh destructive changes in the abdominal cavity, intestinal brand viagra fistulas, and infected pancreatic necrosis.
We have analyzed results of treatment of 575 patients with various forms of RP. For a more adequate assessment of the outcome of treatment patients were divided into four main groups according to the choice of surgical approach.
1. Peritonitis, treatment of which was half-closed manner. It took a single operation, during which eliminated the cause of Poland, made an effective drainage and sanitation of the abdominal cavity. As an objective macrofactors determining the severity of the patient can distinguish the initial intoxication and operating a trauma.
2. The next group consisted of patients whose treatment was half-open manner. This tactical option chosen on the basis of the above criteria. Improved sanitation landmark relaparotomy performed 24-36 hours after the previous operation. Efficacy of treatment in this group depended on the initial severity of the patient, surgical trauma, the effectiveness of the stages of organo-resuscitation in the abdominal cavity, the methods of detoxification.
3. Group consisted of patients whose starting point for the development of peritonitis is an elective surgery on unmodified tissue of the abdominal cavity or emergency intervention on the pathology, not complicated by peritonitis. In these cases, we apply the term "appearance of RP. The time of surgery for RP of this group can and must be well justified. Tactics of treatment may be different depending on the pre-and intraoperative data.
4. Group of patients who had peritonitis (any distribution) took place at the first operation, but complications led to its progression. A distinctive feature of this group is the ability to influence the initial state of the inflamed peritoneum in the formation of complications.
This division of patients into groups aims to not only reflect the most common tactical schemes, but also to define a springboard for further research. For example, interest is the dynamics of clinical and laboratory parameters in the event or the progression of RP prior to installation of this diagnosis, identify the most weight (or pathognomonic) of symptoms in these patients.
Considering the whole set of patients studied, it should be noted that it did not include patients with pancreatic necrosis, oncopathology, bowel infarction, since the pathophysiology of RP in these cases is quite different. Main nosology: 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 (inflammation of the appendages, abstsedirovanie, metroendometrit).
obese patients
wrong interpretation
sympathetic activation
effectiveness
tactics
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