Use of endovideosurgical technology and membrane plasmapheresis in the complex treatment of patients with acute diseases of abdominal organs in a multi-specialty city hospital

Aim of the work:

To improve the results of treatment of patients with destructive forms of acute diseases of abdominal organs based on the application of endovideosurgical interventions combined with the use of an effluent method — membrane plasmapheresis.

Objectives of the study

1. To study clinical materials on surgical treatment of patients with acute abdomen, forming a cohort of patients with severe forms of purulent-septic diseases of the abdominal cavity for determining the tactics of their treatment;
2. To optimize the tactics of laparoscopic interventions in the most common acute surgical diseases of abdominal organs, to determine indications and contraindications for the use of membrane plasmapheresis in the complex treatment of patients with severe forms of purulent-septic diseases of the abdominal cavity;
3. To develop methods for monitoring the efficacy of treatment and the degree of endogenous intoxication when using membrane plasmapheresis;
4. To carry out a comparative analysis of the results of videolaparoscopic and traditional interventions in destructive forms of "acute abdomen";
5. To carry out a comparative evaluation of the use of plasmapheresis in the complex therapy of patients with acute diseases of abdominal organs and to determine its effect on the treatment results of patients with this pathology.

Scientific novelty

Indications and contraindications for videolaparoscopic interventions in destructive forms of acute abdomen have been substantiated, new techniques of endovideosurgical dissection of the vermiform appendix and gallbladder in conditions of an acute destructive process have been developed, an evaluation of the results of various types of videolaparoscopic and traditional interventions in patients with acute destructive diseases of abdominal organs has been carried out, and the advantages of endosurgical treatment technology have been convincingly demonstrated.
Indications and contraindications for performing the membrane plasmapheresis procedure in acute surgical diseases of abdominal organs accompanied by endotoxemia have been determined.
A technique for performing effluent therapy methods and ways to monitor endogenous intoxication in purulent diseases of abdominal organs has been developed. The expediency and necessity of performing effluent detoxification methods as a mandatory stage in the complex treatment of patients with severe forms of destructive diseases of the abdominal cavity have been proven.

Practical significance of the work:

The proposed non-standard methods of laparoscopic interventions in destructive forms of acute diseases of abdominal organs make it possible to make maximum use of the possibilities of endovideosurgical treatment technology and to reduce the number of cases requiring conversion to a traditional access with laparotomy.
An evaluation of the efficacy of using membrane plasmapheresis on the “GEMOPHENIX” device with the use of the "Rosa" plasma filter for performing PP in destructive forms of "acute abdomen" has been given.
It has been proven that the application of exchange plasmapheresis as a method of effluent therapy in the complex treatment of patients with purulent-septic diseases of abdominal organs will increase the efficacy and improve the treatment results of patients with this pathology.
As a result of the studies carried out, a new medical technology in the treatment of acute surgical diseases of abdominal organs has been created and is proposed for practical application, which makes it possible to increase the efficacy of patient treatment by improving the results, reducing the invasiveness of the operation and increasing the cosmetic effect of the operation, shortening the length of hospital stay of patients and reducing the period of temporary disability.

Provisions submitted for defense

Given that in 26.1% of patients with acute destructive diseases of abdominal organs the course of the pathological process is accompanied by symptoms of endogenous intoxication, in addition to performing surgical intervention, it is necessary to apply effluent detoxification methods, in particular membrane plasmapheresis.
The complex use of the endovideosurgical method and membrane PP in the treatment of patients with destructive diseases of abdominal organs makes it possible to significantly reduce the invasiveness of the operation, decrease the number of postoperative complications, shorten the period of hospital stay of patients and increase the cosmetic effect of the operation.

Approval of the work

The materials and main provisions of the work were presented at the meetings of the Novgorod Regional Scientific Society of Surgeons in 2008 and 2009, the Third International Congress "Scientific research in the implementation of the program 'Health of the population of Russia'" — Moscow, February 21–24, 2008, the XII Moscow International Congress on Endoscopic Surgery, April 23–25, 2008, the 3rd International Conference of Endoscopic Surgeons, Saint Petersburg, May 15–16, 2008, the First International Conference on Thoracoabdominal Surgery dedicated to the 100th anniversary of B.V. Petrovsky, Moscow, June 5–6, 2008, the 16th International Congress of the European Association of Endoscopic Surgeons, Stockholm, Sweden, June 11–14, 2008, the XV International Conference of Hepatologic Surgeons of Russia and CIS countries, Kazan city, September 17–19, 2008, the XII Congress of the Russian Society of Endoscopic Surgeons, Moscow, February 18–20, 2009, the XXVI scientific-practical conference of surgeons of the Republic of Karelia, Petrozavodsk, May 20–22, 2009, the 17th International Congress of the European Association of Endoscopic Surgeons, Prague, Czech Republic, June 17–20, 2009, the XIII Congress of the Russian Society of Endoscopic Surgeons, Moscow, February 17–19, 2010.

Personal contribution of the author

The author has developed and approved a technique of membrane plasmapheresis in the complex treatment of patients with destructive forms of acute abdomen, as well as methods for monitoring the efficacy of treatment and the degree of endogenous intoxication. A comparative analysis of the results of videolaparoscopic and traditional interventions in destructive forms of "acute abdomen" has been carried out. The share of participation in accumulating information and conducting research is more than 90%, in generalization and analysis — up to 100%.

Publications on the topic

17 printed papers on the topic of the dissertation have been published, including 5 in journals recommended by the Higher Attestation Commission of the Russian Federation for publishing the results of dissertation research.

Implementation of the research results

The results of the study have been implemented in the practical work of surgical departments and intensive care units of the First City Clinical Hospital, the Novgorod Regional Clinical Hospital, and the Novgorod Central City Clinical Hospital. The materials of the dissertation are used in the educational process of the Department of Postgraduate Education, the Department of General and Faculty Surgery, and the Department of Hospital Surgery of the Institute of Medical Education of Novgorod State University named after Yaroslav the Wise.

Volume and structure of the dissertation.

The dissertation is written on 155 pages of text. It consists of an introduction, 4 chapters, a conclusion, conclusions and practical recommendations. The list of references includes 259 sources, of which 120 are domestic and 139 are foreign. The work is illustrated with 18 tables and 38 figures.