[Principles of determination of surgical policy in general peritonitis].

Based on clinical examination and analysis of treatment results of 575 patients with general peritonitis, the most informative factors were determined which predict lethal outcome, progression of peritonitis and help choose the most effective surgical policy. It is demonstrated that conventional treatment is preferable in the interval of perioperative score of APACHE II from 0 to 10, and programmed sanation relaparotomies -- from 11 to 15. Data about efficacy of total intestinal decompression and peritoneal-enteral lavage, and also methods of mathematical prediction of postoperative complications and outcomes are presented. Prognostic value of individual symptoms, different degree of organs dysfunction and SIRS criteria in early postoperative period were determined.

[Possibilities of surgical treatment of diffuse peritonitis]. / Vozmozhnosti khirurgicheskogo lecheniia rasprostranennogo peritonita.

During 13 years 575 patients with various forms of generalized peritonitis were operated upon. The strategy of surgical treatment was determined depending on the kind of inflammation and the initial state of the patient. Mortality in semi-closed and semi-open strategy was 10.1% and 25.9% respectively. Mortality in cases with surgical complications after primary semi-closed strategy was 46.3% and the diagnostic time before the second operation was about 150 hours. An attempt to determine the prognosis of the development of complications and to work out recommendations on the strategy were made on the basis of the concept of the abdominal sepsis and using the APACHE II scoring system & Mannheimer Peritonitis-Index. The semi-open strategy was more preferable in the scores of APACHE II less than 11. The most effective method of intestinal decompression in suppurative peritonitis is total naso-intestinal decompression resulting in 29% less mortality.

[Postoperative suppurative complications and immune status in the surgical treatment of rectal neoplasms]. / Posleoperatsionnye gnoinye oslozhneniia i immunnyi status organizma pri operativnom lechenii raka tolstoi kishki.

The authors studied the course of the disease in the postoperative period in 308 patients with carcinoma of the rectum. The literature data and personal experience made it possible to reveal the high frequency of purulent complications among this category of patients. In view of this, the values of humoral and cellular metabolism were studied in some patients with uncomplicated forms of rectal carcinoma. Special attention was given for the first time to the peculiarities of local defence reactions of the peritoneum.