[Possible ways to approach the effectiveness of open abdominal interventions to laparoscopic]. / Vozmozhnye puti priblizheniya rezul'tativnosti otkrytykh abdominal'nykh vmeshatel'stv k laparoskopicheskim.

THE PURPOSE OF THE WORK: Based on the determination of the mechanisms of negative manifestations of surgical aggression in open interventions, compared with laparoscopic, to determine ways to optimize the early postoperative period when using them. MATERIAL AND METHODS: The work is based on clinical and laboratory analysis of 147 patients with acute appendicitis complicated by acute peritonitis. In the first group (n=58), patients were operated with traditional laparotomy access. In the second group (n=47) - laparoscopic interventions were used. In the first and second groups, traditional therapy was carried out according to clinical recommendations. In the third group (n=42), patients were operated with traditional laparotomy access, and in the early postoperative period, their therapy included remaxol (intravenous injections of 800.0 ml of the drug in the first two days, then within three days - 400.0 ml). Laboratory and instrumental studies were carried out in patients, including the level of hydrophilic and hydrophobic toxins in the blood, the intensity of peroxidation of membrane lipids and antioxidant enzyme potential, the activity of phospholipase A2. The functional status of the intestine and liver was assessed. RESULTS: It was found that the most important manifestation of the reduction of surgical aggression in the early stages after surgery, which is characteristic of laparoscopic operations, are significantly low phenomena of endogenous intoxication against the background of a significant decrease in the activity of peroxidation of membrane lipids and phospholipase systems - triggers of catabolic phenomena and lesions of various organs and systems, including the intestine and liver. The inclusion of remaxol in complex therapy for patients who have undergone open surgical operations leads to a number of positive clinical and laboratory effects. The most important of them is the reduction of endogenous intoxication. This beneficial effect is associated with the restoration of the functional status of the intestine and liver, as well as a decrease in the severity of catabolic phenomena. The effectiveness of complex therapy with remaxol was marked by reducing the number of postoperative complications and the length of the patient's stay in the hospital. CONCLUSION: The use of remaxol in patients with acute peritonitis complicated by peritonitis who have undergone open surgical interventions, due to the relatively rapid restoration of the functional status of the intestine and liver, reduction of catabolic phenomena, reduces the severity of endogenous intoxication syndrome, which was the basis for a significant improvement in the course of the early postoperative period, bringing it closer to that when using laparoscopic technology.

[The variants of enteral distress syndrome correction with peritonitis]. / Puti korrektsii enteral'nogo distress-sindroma pri rasprostranennom peritonite.

OBJECTIVE: To determine the effectiveness of a new treatment regimen for patients with widespread peritonitis with an accent on enteroprotection based on the use of a drug of the metabolic type of action of remaxol and physiotherapy. MATERIAL AND METHODS: Clinical and laboratory studies of 82 patients with widespread peritonitis, mainly with grade 2 severity according to the Mannheim peritonitis Index, severe form - according to the ARASNE II scale. In the 1st group (28) patients underwent intraoperative intestinal intubation in the traditional way; in the 2nd (22) - intestinal intubation according to the original method; in the 3rd (32) - intestinal intubation according to the original method and combined use of remaxol (parenterally, enterally and intraperitoneally). An intestinal tube of an original design was used, which allows electrical stimulation of the duodenum in the postoperative period. The study evaluates clinical data, the results of instrumental and laboratory studies: ultrasound examination of the abdominal cavity, assessment of the functional state of the small intestine, a number of indicators of homeostasis. RESULTS: It was shown that in patients with acute widespread peritonitis who underwent intestinal intubation according to the original method (group 2), as well as in combination with remaxol (group 3), the postoperative period was relatively more favorable. One of the factors optimizing the course of the disease was the relatively rapid restoration of the structural and functional state of the small intestine due to its electrical stimulation. The clinical and laboratory positive effect was especially significant in the 3rd group of patients, in which the use of remaxol, which has a membrane-stabilizing effect, played a special role in the enteroprotective effect. Timely correction of enteral distress syndrome resulted in a significant decrease in the severity of the syndrome of endogenous intoxication and oxidative stress, which was important in significantly improving the results of treatment of patients. CONCLUSION: The use of technical innovations in the form of an original nasointestinal tube, which allows to quickly restore intestinal motility due to electrical stimulation, as well as the use of remaxol (parenterally, enterally and intraperitoneally) significantly optimize the course of the early postoperative period of patients with acute widespread peritonitis.

[Endotoxin production in the early stages of urgent abdominal pathology and correction ways]. / Endogennaya intoksikatsiya v rannie sroki pri urgentnoi patologii organov bryushnoi polosti i puti ee korrektsii.

OBJECTIVE: To study the features of the development of endogenous intoxication in association with damage to the organs of the detoxification system, the severity of catabolic processes associated with the activity of peroxidation of membrane lipids and phospholipases in various urgent pathology of the abdomen, on the basis of which to develop a new pathogenetically based approach to the prevention of the progression of surgical endotoxicosis. MATERIAL AND METHODS: Clinical section. The studies were conducted in 162 patients with acute urgent pathology (seven groups) with predominant aseptic inflammation (acute severe pancreatitis, acute intestinal obstruction, acute catarrhal cholecystitis) and pronounced purulent-necrotic phenomena (acute peritonitis, acute destructive cholecystitis with empyema of the gallbladder). The severity of endogenous intoxication, the functional state of detoxification system organs (liver, kidneys and intestines), the activity of peroxidation of membrane lipids and phospholipases were evaluated in dynamics. In the last two groups of patients with pancreatitis and peritonitis, complex therapy included remaxol. Experimental section. The experiments were conducted on mongrel dogs that were modeled with acute peritonitis (n=15) or biliary pancreatitis (n=15). A complex of studies similar to those in the clinic was applied in dynamics, but in the tissue structures of the liver, kidneys and intestines, the activity of peroxidation of membrane lipids and phospholipases, as well as the phospholipid composition, was studied. RESULTS: Experimental and clinical studies have shown that in the studied diseases with a different nature of the inflammatory process (aseptic or purulent) in the initial periods, the production of toxins is largely associated with catabolic phenomena associated with a significant activation of peroxidation of membrane lipids and phospholipases. A noticeable increase in the activity of these processes was noted regardless of the nature and severity of the inflammatory process and is associated with the severity of endogenous intoxication and the dysfunctional state of the detoxification system organs. Subsequently, there is a decrease in the detoxification ability of the body against the background of stabilization or even reduction of catabolic phenomena. It is shown that a significant increase in the activity of trigger agents of membrane-stabilizing phenomena occurs regardless of the nature and severity of the inflammatory process. Their significant activity was experimentally established in the tissue structures of the detoxification system organs themselves, which caused the development of pronounced membrane-stabilizing phenomena. It has been shown that the use of remaxol in the complex therapy of patients leads to a noticeable decrease in the activity of membrane modulating agents, which leads to a significant decrease in the severity of endogenous inetoxification syndrome, regardless of the nature of inflammation. This fact was an additional evidence base for the conceptual rethinking of the significance of catabolic phenomena in the pathogenesis of endotoxin production in the early stages of the studied diseases. CONCLUSION: Experimental and clinical grounds have been obtained for a conceptual rethinking of the role of membrane-stabilizing agents in flooding the body with toxins at the beginning of the disease. One of the leading roles of peroxidation of membrane lipids and phospholipase systems in catabolic processes in the earliest periods of urgent abdominal diseases and in the defeat of detoxification system organs in the subsequent ones is shown.