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24According to the received results in Group 3 on the Day 7 45.0% of patients registered decrease in the intensity of dyspeptic symptoms of did not have any. In comparison, the same measure in the Group 4 was lower -17.6% - although no statistical difference was evaluated (p=0.549).
On the Day 15 the results of the treatment effectiveness were significantly higher in the Group 3 (65.0%) than in the Group 4 (35.3%) - p=0.020.
On the Day 30 some of the treated subjects registered the recurrence of dyspeptic symptoms. The treatment was effective in 55.0% cases in the Group 3 and in 29.4% cases in the Group 4. The combined treatment was statistically more effective than ET alone - p=0.031.
Treatment efficacy rates were higher in Group 1 than in Group 3. The results in these two groups on Day 7 did not differ statistically (p = 0.684), but the effectiveness of combined therapy in Group 1 on Day 15 and Day 30 increased more significantly than in Group 3. The risk of detecting dyspeptic symptoms in Group 1 in comparison with Group 3 on day 7 is reduced by 20% - OR = 0.8 (0.242.4), on Day 15 - by 70% OR = 0.3 (0, 07-1.2), on Day 30 the risk is lower by 60% - OR = 0.4 (0.11-1.3).
As a result, combined treatment with anxiolytic buspirone was more effective in reducing the intensity of dyspeptic symptom than eradication therapy alone, both in the group of patients with PDS and among patients with EBS on Day 15 and Day 30. Its efficacy was higher among patients with PDS than among patients with EBS, although not statistically significant. The effectiveness of eradication therapy alone did not differ in terms of the intensity of dyspeptic symptoms, depending on the type of FD.
There were no statistical differences evaluated for the effectiveness of eradication and amount and severity of adverse events in study groups (p>0.005).
Conclusions. Combined treatment with anxiolytic buspirone was more effective in reducing the intensity of dyspeptic symptom than eradication therapy alone, both in
the group of patients with PDS and among patients with EBS on Day 15 and Day 30. Its efficacy was higher among patients with PDS than in patients with EBS, although not statistically significant.
References
1. Наказ, М. О. З. "Укра!ни вщ 03.08. 2012 № 600 «Про затвердження та впровадження медико-техно-лопчних докуменлв 3i стандартизацп медично! допо-моги при диспепсп»." Ушфжований клшчний протокол первинно! медично! допомоги «Диспепшя». Адап-тована клшчна настанова «Ведення диспепсп у дорослих».
2. Aziz I., Palsson O.S., Tornblom H., et al. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol. 2018; 3(4): 252-262.
3. Chuah, Kee-Huat, and Sanjiv Mahadeva. "Functional dyspepsia." Clinical and Basic Neurogastroenterol-ogy and Motility. Academic Press, 2020. 281-292.
4. Drossman, Douglas A., and William L. Hasler. "Rome IV—functional GI disorders: disorders of gut-brain interaction." Gastroenterology 150.6 (2016): 12571261.
5. Mahadeva, Sanjiv, and Khean-Lee Goh. "Epidemiology of functional dyspepsia: a global perspective." World journal of gastroenterology vol. 12,17 (2006): 2661-6. doi:10.3748/wjg.v12.i17.2661.
6. Mak, A.D.P., et al. "Dyspepsia is strongly associated with major depression and generalised anxiety disor-der-a community study." Alimentary pharmacology & therapeutics 36.8 (2012): 800-810.
7. Tack, Jan, et al. "Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia." Clinical Gastroenterology and Hepatology 10.11 (2012): 1239-1245.
THE CAUSES OF POSTOPERATIVE INTRA-ABDOMINAL ABSCESSES IN CHILDREN AND
WAYS OF THEIR PREVENTION
Shamsiev A.
Samarkand state medical institute, Department of pediatric surgery, MD, professor
Yusupov Sh. Samarkand state medical institute, Head of the department ofpediatric surgery, MD, professor
Shakhriev A. Samarkand state medical institute, Department of pediatric surgery, MD, docent
Djalolov D. Samarkand state medical institute, 4th-year student of the faculty ofpediatrics
Abstract
In abdominal surgery and intensive care of children, the main problem is the treatment of patients with abdominal diseases caused by destructive processes in the organs and the development of peritonitis. Despite the identification and elimination of the source of infection, sanitation and drainage of the abdominal cavity, active detoxification and massive antibacterial therapy, every second patient develops manifestations of a systemic inflammatory reaction with signs of multiple organ failure, often leading to the development of abdominal sepsis, the mortality rate of which even with modern medical achievements ranges from 20% to 80%. Abdominal abscesses (AA) of various localization according to different authors make up from 10% to 44% of all intra-abdominal complications.
The causes of AA are very diverse. The existing literature provides contradictory statistical data on the etiology of AA. Many authors consider acute appendicitis to be the most common cause of AA, but some note that the frequency of intraperitoneal abscess formation after elective surgery prevails over that after emergency operations.
Among the reasons for the formation of AA, technical errors of the operation are of great importance, which can include shortcomings of operational equipment, inadequate sanitation and drainage of the abdominal cavity. Among
other reasons for the formation of AA, it should be noted the neglect of purulent-inflammatory processes caused by the main disease due to late hospitalization of patients, violations of the clotting and anti-clotting systems of the blood, which are expressed in increased tissue bleeding.
Prevention and early diagnosis of complications, the expansion of indications for relaparotomy, the timely completion of a second operation can improve the results of treatment of peritonitis in children.
Keywords: peritonitis, abdominal abscesses, intra-abdominal purulent complications, cecostomy, appendi-costomy.
Purpose of the research. Improving the results of treatment of children with appendicular peritonitis by identifying the causes of postoperative AA and improving methods of their prevention.
Research materials and methods. During the period from 1990 to 2017, 1744 patients with appendicular peritonitis were treated in the 2nd clinic of the Samarkand state medical institute. Of these, 71 (4.1%) patients had abdominal abscess in the postoperative period.
To identify the causes of postoperative AA and their prevention, a comparative retrospective analysis of the medical histories of these 1744 patients with peritonitis in different years was conducted. Of these, 868 patients were treated in 1990-1998 using traditional methods of treatment. 876 patients with peritonitis were treated in 19992017 with strict adherence to the principles developed in the clinic.
In the second period in the treatment of peritonitis, after opening the abdominal cavity and visually assessing the prevalence of the purulent process, a thorough intraoperative revision and sanitation was performed by aspiration of pus, drying and ozonation of the abdominal cavity at a dosage of 5-8 mg/l. with an exposure of 5
From the data shown in table 1, it can be seen that with limited peritonitis, out of 1287 patients, the disease was complicated by an intraperitoneal abscess in 27 (2.1%). At the same time, out of 457 patients with widespread peritonitis, this complication occurred in 44 (9.6%), which clearly demonstrates the dependence of the formation of postoperative AA on the prevalence of the purulent process.
In the local form of peritonitis, the incidence of postoperative intra-abdominal abscesses in the groups does not differ significantly (1.9% and 2.3%, respectively).
Here we can conclude that the main cause of postoperative AA in local peritonitis is errors in the operation technique. Ligate the vermiform process as close as possible to the wall of the caecum, otherwise a part of the vermiform process will remain. In the remaining stump of the Appendix, inflammatory phenomena may progress with the development of abscesses in the form of long-running postoperative infiltrates in the depth of the right iliac region.
With continued inflammation in the stump of the process, a purulent effusion enters the closed small-volume cavity, and increased pressure is created. If the stump of the worm-like process is tied with a catgut, and the silk pouch seam is applied tightly, and even strengthened with a z-shaped seam or a second pouch, it is most likely that the formed abscess, having melted the catgut thread, will break into the caecum.
minutes, decompression of the intestine in its paralysis through cecostomy or appendicostomy.
In the main group we completely refused abdominal lavage and introduce antibiotics into it.
Results and discussion. As can be seen from the above research material, the number of appendicular peritonitis has been noticeably decreasing from year to year. Thus, our study clearly shows that against 868 children with appendicular peritonitis for 9 years from 1990 to 1998 in the control group, almost the same number of patients (876) were observed for 19 years from 1999 to 2017 in the main group, this is 2 times less. This may be due to improved diagnosis of appendicitis in the early stages of the disease due to the alertness and care of parents, as well as primary health care professionals.
The results of a retrospective analysis of the treatment of peritonitis showed the effectiveness of the principles of surgical treatment developed in the clinic and the dependence of the occurrence of postoperative AA on the prevalence of appendicular peritonitis. Table 1 shows the frequency of postoperative ABP depending on the prevalence and method of treatment of peritonitis, for which the primary operation was performed.
Table 1.
The method of applying a pouch seam used to hide the stump of the wormlike process is technically simple, but if you do not have experience at this stage of the operation, mistakes may be made that will cause postoperative complications.
The wall of the caecum is relatively thinner than the wall of the ileum, and if the surgeon takes a thin needle, and the thread of the pouch suture does not correspond to the eye of the needle, then when stretching a double thread under the serous lining of the intestine, it will touch and tear the tissue. Because of this, there are micro-ruptures of the intestinal wall.
More dangerous are needle punctures of the intestinal wall, if the surgeon will conduct the needle deeper with the expectation of capturing the muscle lining of the intestinal wall. On the other hand, too superficial needle holding, and even with a very small length of thread stretching under the serous membrane, is also ineffective.
Such a superficial suture can not tightly connect the serous membranes of the intestinal wall, so it is fragile, and the infected liquid accumulated under the pouch will leak into the abdominal cavity, which is a possible cause of postoperative AA. Also, hematomas, minor bleeding, errors in the treatment of the stump of the vermiform process can lead to the development of postoperative intraper-itoneal purulent complications.
In the main group, when treating common forms of peritonitis, the number of postoperative AA decreased by
Frequency of AA in patients with peritonitis in the postoperative period in different years
Groups Peritonitis
local common
Number of patients with peritonitis AA after surgery Number of patients with peritonitis AA after surgery
Main 629 12 (1,9%) 247 16 (6,5%)
Control 658 15 (2,3%) 210 28 (13,3%)
Total 1287 27 (2,1%) 457 44 (9,6%)
2 times compared to traditional methods of treatment (from 13.3% to 6.5%).
Therefore, thorough revision and sanitation by pus aspiration, drying and ozonation of the abdominal cavity, decompression of the intestine in its paralysis through ce-costomy or appendicostomy, as well as complete refusal
of washing and administration of antibiotics to the abdominal cavity are preventive measures for the formation of postoperative AA.
In addition to the above causes of intra-abdominal purulent complications, the significance of late reversibility and neglect of peritonitis can be traced. Table 2 shows the dependence of the frequency of ABP formation on the age of peritonitis before admission to the clinic.
Table 2.
Frequency of postoperative ABP depending on the age of peritonitis
Age of peritonitis The number of peritonitis Abdominal abscesses
1-3 days 1207 (69,2%) 40 (3,3%)
4-6 days 469 (26,9%) 25 (5,3%)
7-8 days or later 68 (3,9%) 6 (8,8%)
Total 1744 (100%) 71 (4,1%)
As can be seen from the data shown in table 2, the largest number of postoperative AA occurs in children who were admitted later than 3 days after the onset of the disease. Among patients with peritonitis who were admitted to the clinic on 1-3 days, intra-abdominal abscesses were noted in 3.3% of cases, on 4-6 days-in 5.3%, on 7-8 days or later - in 8.8%. That is, the appearance of postoperative intra-abdominal abscesses in proportion to the number of days spent by a child on admission to the hospital after onset of symptoms.
Conclusions.
1. Recently, the number of appendicular peritonitis has been noticeably decreasing from year to year. This is due to improved diagnosis of appendicitis in the early stages of the disease due to the alertness and care of parents, as well as primary health care professionals.
2. In the local form of peritonitis, the frequency of formation of postoperative intra-abdominal abscesses in groups does not differ significantly. The main cause of postoperative AA in local peritonitis is errors in the operation technique.
3. The frequency of formation of postoperative intra-peritoneal abscesses depends on the prevalence, late reversibility and neglect of appendicular peritonitis.
4. Thorough revision and sanitation by pus aspiration, drying and ozonation of the abdominal cavity, decompression of the intestine in its paralysis through ce-costomy or appendicostomy, as well as complete refusal of washing and administration of antibiotics to the abdominal cavity are preventive measures for the formation of postoperative AA.
References
1. Abduvoyitov B.B. et al. IMMUNOLOGICAL FEATURE OF THE BODY IN CHILDREN WITH DIFFUSED APPENDICULAR PERITONITIS Abdu-voyitov B.B., Djalolov D.A. 2, Ishankulov R.T. 3,
Khasanov A.B. 4 //Вопросы науки и образования. - С. 115.
2. Abduvokhidovich D.D., Nuralievich S.R., Shav-katovna Y.S. Prediction of postoperative intrabrusive purulent complications with appendicular peritonitis in children //Вопросы науки и образования. - 2019. - №. 20
(67). . . . .
3. Bahodirovich A. B. et al. Approaches to intestinal decompression during different appendicular peritonitis in children //Достижения науки и образования. - 2018. -№. 18 (40).
4. Gervais D.A., Ho C.H. Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages. //AJR Am J Roentgenol. - 2004. - Vol. 182, N 2. - P. 463466
5. Yusupov S. et al. The diagnostics of postoperative abscesses of abdominal cavity in children //Medical and Health Sciences Journal. - 2010. - Т. 3. - С. 56-59.
6. Шамсиев А.М., Юсупов Ш.А. Репродуктивная функция женщин, перенёсших в детстве распространённый аппендикулярный перитонит //Вестник Авиценны. - 2019. - Т. 21. - №. 3.
7. Шамсиев А.М. и др. Особенности предоперационной подготовки детей с распространенными формами аппендикулярного перитонита //Российский вестник детской хирургии, анестезиологии и реаниматологии. - 2013. - Т. 3. - №. 1.
8. Юсупов Ш.А. и др. Оценка интенсивности синдрома эндогенной интоксикации у детей с распространенным аппендикулярным перитонитом //Медицинский альманах. - 2019. - №. 5-6. - С. 57-61.
9. Юсупов Ш.А. Диагностическая значимость ультразвуковой сонографии при аппендикулярных перитонитах у детей //Сибирский медицинский журнал (Иркутск). - 2009. - Т. 86. - №. 3.
