UA123924U - METHOD OF PERITONNEAL LAVAGE IN GENERAL PERITONITIS - Google Patents

Abstract

Method for peritoneal lavage for common peritonitis involves removal of peritonitis lesion, drainage of abdominal cavity by polyvinyl chloride drainage: right and left sub-diaphragmatic areas, right lateral canal and small pelvis, flushing of abdominal cavity with antiseptic solution through the lower drainage within 3-4 days after surgery. Intraoperative rehabilitation of the abdominal cavity is completed by the introduction into the abdominal cavity of an antiseptic gel solution based on hyaluronic acid and in the postoperative period fractional injection of this solution into the upper drainage every 8 hours 250-500 ml for 3-4 days after surgery.

Description

A useful model belongs to medicine, in particular to abdominal surgery, and can be used in the treatment of patients with general peritonitis. Peritonitis - acute inflammation of the parietal and visceral peritoneum, is one of the most frequent and severe complications in abdominal surgery. With acute appendicitis, peritonitis is observed in 20-65 95 patients, perforated gastroduodenal ulcer - in 7-30 96, diseases of the large intestine - in 15-2195, small intestine - in 10-1595, acute cholecystitis - in 10-12 95, purulent- inflammatory gynecological diseases - in 3-12 9o, intestinal obstruction - in 3-5 9o, acute pancreatitis - in 1 95 (Bereznytskyi Y.S., Zakharash M.P., Mishalov V.G. 2012). Postoperative peritonitis has a high specific gravity - 1-2 95. The overall mortality rate for peritonitis is 14-27 U (Arsent'ev O.V., 2012; Toriaz T.O., 2010; Redeghiso S.S., 2011), and under the conditions of multiple organ failure, with long-term disease in the terminal stage, the mortality rate reaches 85-10095 (Shurkalin B.K., 2003; Romaschenko P.N., 2013; RogpeIpu K.N., Noiitapp A., 2014;

Apapinakgiznpap 5., ZeKegsiodiyu M., Eyiaz V. ei ai. 2014).

The main steps in the treatment of general peritonitis are elimination of the focus of infection, intraoperative sanitation and drainage of the abdominal cavity, peritoneal lavage, adequate antibacterial and detoxification therapy.

In recent years, among the large arsenal of complex medical measures, tactical and technical, to eliminate the cause of peritonitis, much less has been discussed in the literature compared to the problem of effective sanitation of the abdominal cavity, which largely determines the results of treatment. It has been proven that the successful outcome of the treatment of a severe form of abdominal infection - peritonitis depends 15-20 95 on effective antibacterial therapy, and the last 80-85 95 on effective surgical rehabilitation of the abdominal cavity (Saveliev V.S., 2006).

Currently, for the treatment of general peritonitis, MAS therapy is used in combination with laparostomy, without reducing the edges of the wound. The effectiveness of MAS therapy is associated with active aspiration of contents and reduction of the microbial number in the abdominal cavity, which contributes to the reduction of intra-abdominal pressure and earlier closure of the abdominal cavity (Livshits Yu.3., 2012). At the same time, laparostomy in combination with MAS therapy has a number of significant disadvantages. In connection with the removal of a large amount of exudate from the abdominal cavity, the daily amount of which reaches up to 1300 ml or more, a large loss of protein is noted (Bezmozgin B.G.,

From 2014). Prolonged intestinal intubation during laparostomy in combination with MAS therapy often leads to the occurrence of intestinal fistulas, nosocomial infection, healing of the postoperative wound by secondary tension with the subsequent occurrence of postoperative ventral hernias, as well as the high cost of consumables, the risk of repeated operations (Zyubrytskyi N.M., Cossack

I.A., 2015). According to a number of authors (Kondratenko P.G., Konchev E.A., 2013), programmed relaparotomy has certain advantages over laparostomy: lower probability of abdominal wall hernias and intestinal fistulas, while the disadvantages are a high probability of wound suppuration, intra-abdominal hypertension syndrome.

In this connection, the peritoneal lavage of the abdominal cavity is gaining relevance, to which insufficient attention is devoted (Matviychuk O.B., Pogoretskyi R.M., 2012). Classical methods of peritoneal lavage with antiseptics used for sanitation of the abdominal cavity: aqueous solution of chlorhexidine 0.02 95, decamethoxine 0.02 95, physiological solution are effective only for the first 24 hours, because due to the process of adhesion in the abdominal cavity, the antiseptic flows along the channels that are formed, and in the places of stagnation of the solution, a pathomorphological substrate for the formation of interloop abscesses occurs, there is no adequate irrigation of the entire abdominal cavity and internal organs.

The basis of this useful model is the task of optimizing peritoneal lavage in patients with general peritonitis by performing peritoneal lavage using an antiseptic gel based on hyaluronic acid, which improves the results of treatment of general peritonitis.

The task is solved by the fact that in a method that includes elimination of the source of infection, intraoperative sanitation of the abdominal cavity with antiseptic solutions with the introduction of a gel antiseptic intraoperatively, and drainage of the abdominal cavity with polyvinyl chloride drains from four points: the right and left subdiaphragmatic areas, the right lateral canal and the small pelvis, for further lavage of the abdominal cavity, an antiseptic solution is used - a gel based on hyaluronic acid, which is introduced into the upper drains in fractions of 250-500 ml every 8 hours for 3-4 days, the outflow of washing fluids is carried out through the lower drains.

This method of peritoneal lavage using a gel antiseptic solution based on hyaluronic acid provides optimal irrigation of the parietal and visceral peritoneum, prevents the formation of adhesions, the formation of separate channels due to the gel component, as well as the maximum effect of the antiseptic on the entire area of the peritoneum. Due to the gel form of the antiseptic, the elimination period increases, which reduces the energy consumption of the peritoneal lavage process, and due to the formation of a gel barrier covering the visceral and parietal peritoneum, the absorption of toxins from the abdominal cavity decreases.

The method is illustrated by an example of a specific implementation.

Example 1.

Patient M., 37 years old, was hospitalized in the department of the surgical inpatient unit of Kyiv City Clinical Hospital Me5 in an urgent order with a diagnosis of duodenal ulcer. Acute perforation of duodenal bulb ulcer. General fibrinous-purulent peritonitis. ITSH 1 st. From the anamnesis, it is known that about 30 hours have passed since the onset of the disease. Urgent surgical treatment is prescribed. The patient underwent a laparotomy. Excision of a perforating ulcer of the GI tract, pyloroplasty according to Jad. The abdominal cavity was cleaned intraoperatively with a decamethoxine solution in a volume of 200 ml, drained, and fibrin films were mechanically removed. The abdominal cavity was drained from four points: the right and left subdiaphragmatic areas, the right lateral canal, and the small pelvis. The wound was sutured in layers. 500 ml of antiseptic based on hyaluronic acid was injected into the upper drains. Reintroduction of dialysate was carried out through the upper drains at 8, 16, 24 hours in 500 ml, and at 32, 40, 48, 56, 64, 72 hours in 250 ml, the outflow of dialysate took place through the lower drains. The upper drains were removed for 4 days, the lower ones - for 2 days. Postoperative course without complications. The patient was discharged on the 7th day in a satisfactory condition. The patient was examined on the 14th day after the operation, completed

Ultrasound of the abdominal organs and barium passage through the intestine - there were no interloop abscesses and violation of the passage through the intestine.

According to the developed method of peritoneal lavage, 32 patients with general peritonitis of various genesis were comprehensively treated, no complications were observed in the postoperative period.

Thus, the method of peritoneal lavage proposed by us is effective and minimizes the occurrence of interloop abscesses and early adhesion disease of abdominal organs. The method is available and can be used in surgical hospitals.

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Claims (1)

USEFUL MODEL FORMULA Method of peritoneal lavage for general peritonitis, which includes removal of the peritonitis focus, drainage of the abdominal cavity with polyvinyl chloride drains: right and left subdiaphragmatic areas, right lateral canal and small pelvis, washing of the abdominal cavity with an antiseptic solution intraoperatively and dosed introduction of an antiseptic solution in the postoperative period through upper drains and removal of the solution through the lower drains within 3-4 days after the operation, which differs in that the intraoperative sanitation of the abdominal cavity is completed by the introduction of an antiseptic gel solution based on hyaluronic acid into the abdominal cavity, and in the postoperative period, the fractional introduction of this solution into the upper drains every 8 hours for 250-500 ml for 3-4 days after the operation.