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INNOVATIVE APPROACHES IN THE TREATMENT OF PATIENTS
WITH DISSEMINATED PURULENT PERITONITIS
Sattarov Shokir Khasanovich
1,2
Atoeva Mokhigul Otabekovna
3
Usmonov Amirbek Usmonovich
3
Saymurodova Shaxnoza Ziyodullayevna
3
1
Samarkand branch of the Republican Scientific
Centre for Emergency Medical Care
2
Department of Surgical Diseases and Urology.
Samarkand State Medical University.
3
Bukhara State Medical Institute named after Abu Ali ibn Sino.
https://doi.org/10.5281/zenodo.14005280
Relevance of the research
. Disseminated purulent peritonitis is
associated with high mortality and significant difficulties in treatment [2, 6, 9,
11]. Purulent peritonitis is a severe, life-threatening condition that requires a
comprehensive and timely approach to diagnosis and treatment. Despite
modern advances in intensive care, surgical techniques and antibiotic therapy,
mortality in widespread purulent peritonitis remains high [1, 3, 4, 7]. The
development and implementation of an effective algorithm for the management
of such patients is essential to improve treatment outcomes, reduce
complications, and increase survival. Research in this area is necessary to
optimise the treatment and diagnostic process and to form standards of medical
care aimed at improving the quality of life of patients with this severe disease [5,
8, 10].
Purpose of the study
to develop an algorithm for the management of
patients with widespread purulent peritonitis on the basis of a differentiated
approach to the choice of treatment depending on the degree of abdominal
sepsis.
Materials and methods of research.
The study is based on the results of
treatment of 276 patients with widespread purulent peritonitis admitted to the
surgical department of the Samarkand branch of RCEMP in the period from
2015 to 2024. Patients were conditionally divided into two groups: In 2015-
2019, 132 (47.8%) patients who constituted the comparison group were
operated on, they underwent traditional methods of treatment, elimination of
the source, sanation of the abdominal cavity with antiseptics and drainage of the
abdominal cavity by both open and laparoscopic methods. From 2020 to 2024,
144 (52.2%) patients who were included in the main group were under our
observation. Depending on the severity of peritonitis stage, the patients of the
THEORETICAL ASPECTS IN THE FORMATION OF
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main group were conditionally divided into two subgroups. 1 subgroup
consisted of 78 (54.2% out of 144) patients, they used ozonated sodium
hypochlorite solution as an antiseptic for the purpose of abdominal cavity
lavage. Subgroup 2 consisted of 66 (45.8% out of 144) patients, in this subgroup
patients with severe form of abdominal sepsis, who required intravenous
injection of ozonated sodium hypochlorite solution in addition to abdominal
cavity sanation with ozonated sodium hypochlorite solution.
The choice of access method, which was determined by the patient's
condition and the prevalence of peritonitis. Both in the main group and in the
comparison group, laparotomy and laparoscopic accesses were performed for
patients with widespread peritonitis depending on the patients' condition.
Whenever possible, diagnostic laparoscopy was not missed and then it was
decided to continue the operation or to proceed to conversion.
Results of the research.
Based on the results of surgical treatment of
patients with widespread purulent peritonitis, we have developed an algorithm
of tactics for the management of patients in this category. The frequency of
postoperative complications and lethality in patients with widespread purulent
peritonitis is presented in Table 2. We observed such complications as wound
suppuration in 16,7% of cases, pneumonia in 8,7% of cases, abdominal cavity
abscess in 0,7% of cases, eventure in 0,7%, pleural empyema in 0,7%, pleurisy in
1,1% and thrombophlebitis in 1,15 cases.
In the comparison group 41 (31.1%)
patients developed 45 complications, and in the main group 32 (22.2%) patients
registered 37 complications. Consequently, the number of complications in the
main group was reduced by 8.9%. Postoperative mortality in the main group
was 4.2% lower than in the comparison group. In general, the complex
application of ozonated sodium hypochlorite solution in the postoperative
period contributes to faster recovery of patients, reduction of complications and
improvement of overall clinical results.
Conclusions.
The use of ‘Letel doctor’ insufflator with a maximum of 500 ml of
antiseptic was effective for complete sanation of the abdominal cavity, also the
duration of surgery was reduced from 86,5±4,9 to 62,4±2,9 minutes (t-criterion
= 4,23; p<0,001). The use of Letel doctor insufflator for abdominal cavity lavage
through drainage tubes with ozonated sodium hypochlorite solution reduced the
number of programmed sanation interventions from 18.9% to 6.9%.
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THEORETICAL ASPECTS IN THE FORMATION OF
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