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23EARLY DIAGNOSTICS OF POSTOPERATIVE PURULUS COMPLICATIONS WITH DISSEMINATED APPENDICULAR PERITONITIS IN CHILDREN Akhmedov I.Yu.1, Rafikov B.R.2, Azizov Sh.F.3, Dalerov A.D.4
1Akhmedov Islomjon Yusufjonovich - Student; Rafikov Bekhbudjon Rustamovich - Student;
Azizov Sherzod Farhodovich - Student; 4Dalerov Akbarkhon Dilshodovich - Student, DEPARTMENT OF PEDIATRIC SURGERY, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the disseminated appendicular peritonitis (DAP) is the most severe purulent-septic disease of childhood with mortality rates reaching 20 - 30%. The successes of modern medicine have given surgeons a number of effective methods to save the lives of patients with peritonitis. However, the number of postoperative complications in the most severe forms of DAP in the last decade has remained at the level of 10 - 15% and has no tendency to further decrease. Moreover, the development of these complications remains low predict and, therefore, insufficiently controlled process. Existing at the present stage, differences in surgical tactics, antibacterial therapy do not have a significant impact on the further reduction in the number of intra-abdominal postoperative complications.
Keywords: diffuse appendicular peritonitis, spontaneous agglomeration of leukocytes, Index nuclear segmentation of neutrophils, ultrasound sonography.
Introduction. According to the World Health Organization, "operations for acute appendicitis occupy a leading position in the structure of emergency abdominal operations performed on children, and account for more than 70% of all surgical interventions" [2, 5, 10, 11, 15]. According to world statistics, the total incidence of appendicitis ranges from 3 to 6 per 1000 children with a peak in incidence between the ages of 9 and 12 years [1, 5, 9, 13, 18]. "Peritonitis on the background of
destructive forms of appendicitis in children develops 8 times more often than in adults, and its generalized forms are found 2.5 times more often than local ones." Despite advances in the diagnosis of acute appendicitis, the incidence of its destructive forms ranges from 20 to 74% [2, 6, 11, 17]. The successes of modern medicine have given surgeons a number of effective methods to save the lives of patients with peritonitis [3, 4, 7, 8, 12, 14, 16]. However, the number of postoperative complications in the last decade has remained at the level of 1015% and has no tendency to decrease. Moreover, the development of these complications remains unpredictable and, therefore, insufficiently manageable process. In this regard, the further improvement of surgical tactics in children with destructive forms of appendicitis remains a priority.
Purpose of the research. Develop effective methods of forecasting and early diagnosis of postoperative purulent complications of disseminated appendicular peritonitis in children.
Material and research methods. In the 2nd clinic Samarkand State Medical Institute under our supervision there were 282 sick children in the period from 1 year to 23 years, operated for RAP, which in order to identify postoperative intra-abdominal purulent complications, informative estimated indicators were carried out (indicator of spontaneous agglomeration of leukocytes - ISAL and the index of nuclear segmentation of neutrophils - INSN) in combination with dynamic ultrasound sonography (USS).
The results of the research and their discussion. Postoperative ultrasound monitoring of patients was carried out by daily transabdominal sonographic scanning of all areas of the abdominal cavity for 7 days. As additional auxiliary criteria for early diagnosis of abdominal abscesses, we also used ISAL and INSN indicators, the deterioration of which, compared with standard values, in dynamics indicates a high probability of developing inflammatory complications. In this category of patients, we extend the time of ultrasound monitoring to detect intra-abdominal abscesses or to normalize these indicators.
With the development of intra-abdominal inflammatory complications, the ISAL values after some decrease in the first day after the operation by 5-6 days begin to rise again, which conform to the approximate timing of the formation of intraabdominal abscesses.
Against the background of the development of intra-abdominal purulent complications, the INSN depression lasts for a long time, whereas with an uncomplicated postoperative course, the INSN approaches an average of 7-8 days.
The developed methods of predicting and early diagnosis of postoperative purulent complications of DAP in children, including research ISAL, INSN and USS allowed significantly reduce the number of relaparotomies, terms of hospitalization of patients and reduce mortality.
Conclusions. Thus, patients with a high risk of postoperative intra-abdominal abscesses, estimated by the results of the ultrasound monitoring, ISAL, INSN studies should be timely programmed relaparotomy before the development of intraabdominal complications.
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