No abstract

The relevance of studying the measures to prevent the development of endotoxemia in acute intestinal obstruction is stipulated with an increasing incidence of multiple organ failure in debilitated patients and infectious−toxic shock. The development of endotoxemia is often accompanied with a secondary infection. Toxic effects of bacteria in small intestine, the trigger of which is their translocation and transformation of the small intestine into a focus of microbial invasion, prolongs the postoperative period, which increases the length of stay in the surgical hospital. Much attention is paid to the pathogenesis of the development of small bowel contamination syndrome, which results in changes in intestinal biocenosis and increased intoxication of the body, which worsens the patient general condition. To examine the results of entersorption as a method of detoxification and control of infectious and toxic complications in the patients with an acute intestinal obstruction before surgery to optimize surgical tactics and prevent post−surgery complications, a study was conducted in 36 patients with different stages of the disease. The effectiveness of detoxification in the combined treatment of an acute intestinal obstruction has been confirmed, which is indicated by the reduced pain, regression of radiological signs of obstruction in the patients and early normalization of their main clinical, laboratory and instrumental parameters. The use of the method of enterosorption as part of a comprehensive approach in the period after surgery contributed to the early restoration of intestinal motility, reducing the number of complications, improving the general condition of patients. Thus, the method of enterosorption is one of the most effective of modern detoxification methods, which determines its relevance and further prospects to study this problem. Key words: acute intestinal obstruction, endotoxemia, enterosorption.

Summary. Objective — increasing the efficiency of diagnosis and treatment in patients with destructive forms of pancreatitis. Materials and methods. 89 patients with acute destructive pancreatitis were examined. There were 37 men (41,5 %), 52 women (58,4 %). The average age of patients ranged from 28 to 64 years. In order to objectively assess the severity of the inflammatory process in the pancreas and surrounding tissues, organs of the abdominal cavity, clinical and biochemical studies were used, as well as high-tech methods such as ultrasound examination with dopplerometry, computed tomography. Results. According to ultrasound, the edematous form of acute pancreatitis was diagnosed in 22 (27,4 %) patients during the examination, fatty pancreatic necrosis was diagnosed in 19 (21,3 %) patients. Hemorrhagic pancreatic necrosis was found in 31 (34,8 %) patients, mixed in 17 (19,1 %) patients. The study revealed the main etiological factors of the disease, while in 63 (70,8 %) patients the cause of acute pancreatitis was biliary pathology, alcohol etiology occurred in 17 (19,1 %) patients, and 9 (10,1 %)) - she had a post-traumatic character. Computed tomography was performed in cases of doubt in the data of ultrasound examination, especially in patients with overweight, and for the purpose of differential diagnosis in 23 (25,8 %) patients. Conclusions. Acute destructive forms of pancreatitis have a polymorphic echography picture. Ultrasound diagnostics and computed tomography should be mandatory elements of the diagnostic algorithm for various forms of acute destructive pancreatitis. The diagnostic accuracy of these non-invasive methods in verification of acute destructive pancreatitis and its complications as a whole was 92,8 %. A decrease in the level of postoperative complications and mortality associated with a decrease in the progression of pancreatic necrosis because of suppression of pancreatic secretion.

Summary. Improving the results of treatment in patients with liver abscesses by treatment using minimally invasive interventions. Materials and methods. We examined and treated 87 patients with liver abscesses aged 21 to 80 years. Of these, 82 patients underwent 102 surgeries. Abscess drainage was performed 95 times in 82 patients in four ways: under ultrasound guidance — to 45 (54.88 %) patients, laparoscopic - to 20 (24.4 %), under the control by angiography — 2 (2.44 %) and laparotomic access — 15 (18.28 %) to patients. 7 patients underwent resection operations. Results. So, in our analysis of the clinical picture of liver abscesses, specific symptoms were not noted. Therefore, the combination of the results of ultrasound and CT (the sensitivity of which was 98 % and 100 %, respectively) was decisive in the diagnosis and differential diagnosis of liver formations. Most often strains were sown from the abscess cavity E. coli and Kl. Pneumoniae in 43.91 % of cases. A positive effect was noted after the first minimally invasive intervention occurred in 76 (92.68 %) patients. In operated patients with laparotomic access, the main indications were, first of all: the inefficiency of external drainage under ultrasound control or the inability to use the puncture drainage method itself due to the localization of the abscess; the presence of concomitant surgical pathology, which requires surgical treatment, choledocholithiasis with complications, peritonitis Conclusions. The main task in the treatment of purulent diseases of the hepatobiliary system is the decompression and rehabilitation of the biliary tract, further antibiotic therapy, taking into account sensitivity with the active use of ultrasound-controlled drainage methods. Laparoscopic and open interventions are indicated for multiple and giant multi-chamber abscesses.