Проведен анализ результатов хирургического лечения распространенного перитонита, и разработан новый алгоритм прогнозирования исходов лечения на основе наиболее информативных предикторов. При сравнении прогнозированной летальности установлены преимущества метода программированных релапаротомий при 4–5 баллах разработанной шкалы с точностью 83% и более. Представленные регрессионные уравнения легли в основу программно-диагностического модуля, при помощи которого определяются рекомендации для выбора хирургической тактики.
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.
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.