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14Список литературы
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THE EFFECT OF OZONE ON THE COURSE AND DEVELOPMENT OF COMPLICATIONS OF PERITONITIS IN CHILDREN IN EXPERIMENT Abduvoyitov B.B.1, Djalolov D.A.2, Ishankulov R.T.3, Shavazi R.N.4
1Abduvoyitov Bobur Baxodirovich - Student; 2Djalolov Davlatshokh Abduvokhidovich - Student;
3Ishankulov Rauf Tokhirovich - Student;
4Shavazi Ramiz Nuralievich - Student, DEPARTMENT OF PEDIATRIC SURGERY,
MEDICAL SCHOOL SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: an experimental model of peritonitis was created on 41 white rats of the Wistar breed of both sexes, weighing 140-160 g. The animals were divided into 2 groups. In experimental peritonitis without ozone therapy, the death among 18 animals of the first (control) group was 30.4%, 7 animals died. In the second (main) group, losses from death of the animals were not observed. Morphological studies on the effect of ozone therapy on the course of peritonitis and the formation of adhesions in experimental animals have made it possible to establish the high effectiveness of this method in the treatment of inflammatory processes in the abdominal cavity and the prevention of the formation of adhesions. Keywords: diffuse appendicular peritonitis, ozone therapy, laparotomy, adhesions formation, complication.
Relevance. According to the World Health Organization, peritonitis in children develops 8 times more often than in adults. Based on global research on diffuse appendicular peritonitis (DAP) in children, various solutions are proposed to improve the results of surgical treatment of this terrible disease. In recent years, reports on the successful use of ozone in clinical practice in various groups of patients with a surgical and general therapeutic profile with endo- and exotoxicosis of varying severity have begun to appear more and more often in the medical literature. At the present stage of development of domestic health care, many measures are being taken to improve the results of surgical treatment of children with acute abdominal pathology. In this direction, in particular, in improving the quality of diagnosis and results of treatment of children with destructive forms of appendicitis, positive results have been achieved. At the same time, in order to
improve the system of medical care, scientifically-based results are needed to assess the effectiveness of new diagnostic methods.
In the present period, research is continuing in the world to improve the results of surgical treatment of children with complicated forms of appendicitis. The steady growth of this cohort of patients, the ambiguity of approaches in matters of treatment tactics and the unsatisfactory outcomes of treatment determine the need for further research into the clinical aspects of this pathology. The emergence of modern diagnostic methods, new laparoscopic technologies in surgery, a modern view of the drainage of the abdominal cavity allow us to study the problem of treatment of DAP from the new position of the modern level of pediatric surgery.
Purpose of the research. To study the effects of ozone therapy on the course of peritonitis and adhesions in the experiment.
Material and research methods. An experimental model of peritonitis was created on 41 white rats of the Wistar breed of both sexes, weighing 140-160 g. The animals were divided into 2 groups: 23 rats of the first (control) group under ether anesthesia produced a median laparotomy and draining the abdominal cavity from pus with sterile wipes, after which a drainage tube was left in the lower corner of the wound and the abdominal cavity was sutured. The outer end of the drainage tube was sealed and fixed on the back of the animal. 18 animals of the second (main) group, after draining the abdominal cavity from pus, performed its ozonization. Evaluated the severity, nature and prevalence of peritonitis, as well as adhesions, studied the morphological changes in the sheets of the peritoneum and in the intestinal wall.
The results of the research and their discussion. In experimental peritonitis without ozone therapy, the death rate among 18 animals of the first (control) group was 30.4% 7 7 animals died. In the second (main) group, no loss of animals was observed. Thus, the peritoneum of 18 animals of the first group and all 18 animals of the second group were subjected to morphological examination at various periods of experimental peritonitis.
Light-optical testing have shown that as a result of ozone therapy, changes due to bacterial peritonitis were expressed to a much lesser extent. Thus, in the investigated sections of the peritoneum, a slight degree of infiltration with polymorphic-cell elements with the predominance of lymphocytes was noted. There were minor perivascular infiltrates and moderate thickening of the vascular wall without the presence of blood clots. Adipose tissue dominated in the mesentery.
Transmission electron microscopy (TEM) also showed that ozone therapy leads to a significant reduction of pathological changes in ultrastructures caused by bacterial experimental peritonitis. Already in the early periods of observation, the mesothelial cells closely approached each other and the basement membrane, forming a continuous lining. Subject vessels were moderately dilated. Endotheliocytes with a flat luminal surface and narrow cytoplasm. Between the wall of the vessels and the basement membrane of mesotheliocytes, moderate thicknesses of bundles of collagen fibers and processes of single fibroblasts were located.
When assessing the severity of adhesions in the abdominal cavity on a 5-point scale, it was noted that, against the background of ozone therapy, only one-third of experimental animals observed the development of single adhesions corresponding to the 1st degree, while in the rest of the animals of this group, autopsy did not reveal development adhesions. At the same time, in animals of the control group that were not subjected to ozone therapy, on the 3rd day in all 5 cases, the development of multiple adhesions of the 2nd degree was observed, and in subsequent periods of observation in all animals, this process was more pronounced. In the main group of animals on the 3rd day after surgery and 3-fold ozone therapy in the abdominal cavity there was a small amount of translucent effusion. At 7-14 days macroscopically, the peritoneum is clean, shiny, there is no effusion. There were single
tender adhesions that were easily torn and did not deform the intestines. In 78.9% of animals, no adhesions were detected.
Conclusions. Morphological studies on the effect of ozone therapy on the course of peritonitis and the formation of adhesions in experimental animals made it possible to establish the high effectiveness of this method in the treatment of purulent-inflammatory processes in the abdominal cavity and the prevention of the formation of adhesions. Ozonation of the abdominal cavity can be recommended for clinical use in the surgical treatment of a severe category of patients with purulent-inflammatory diseases of the abdominal cavity.
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APPROACHES TO INTESTINAL DECOMPRESSION DURING DIFFERENT APPENDICULAR PERITONITIS IN CHILDREN Abduvoyitov B.B.1, Khasanov A.B.2, Djalolov D.A.3, Yusupova Sh.Sh.4
1Abduvoyitov Bobur Bahodirovich - Student;
2Khasanov Aziz Batirovich - Student;
3Djalolov Davlatshokh Abduvokhidovich - Student;
4Yusupova Shakhlo Shavkatovna - Student, DEPARTMENT OF PEDIATRIC SURGERY MEDICAL SCHOOL
SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: functional intestinal insufficiency due to diffuse purulent peritonitis is an actual problem in surgery. The results of the surgical treatment of 164 children hospitalized with diffuse appendicular peritonitis is perfomed. The results of the treatment of intestinal paresis with the method of intestinal decompression by appendico or cecoenterostomy are analyzed.
Keywords: decompression, peritonitis, paresis, cecoenterostomy, appendix ceco enterostomy.
Introduction. A common and most severe complication of acute appendicitis in children is diffuse appendicular peritonitis (DAP) [1, 4, 9, 19, 23]. Frequently in such cases DAP is complicated by functional failure in intestinal tract (paresis) [6, 10, 18, 20]. To resolve intestinal paresis, decompression of the gastrointestinal tract (GIT) is used, which is an essential component of surgical treatment of children with RAP, aimed at eliminating increased intra-intestinal and intra-abdominal pressure, ensuring continuous aspiration and sanitation of toxic intestinal contents, improving the microcirculation of the intestinal wall [3, 7, 17, 24]. Nasointestinal intubation of the small intestine and transrectal colon intubation are most commonly used for intestinal decompression [2, 5, 16, 22].
However, these methods, in our opinion, have several disadvantages. Thus, with nasointestinal intubation of the small intestine, there are well-known technical difficulties in conducting a nasointestinal probe in children due to the anatomical features of the
