WAYS OF IMPROVING THE RESULTS OF TREATMENT OF PATIENTS WITH ACUTE OB-STRUCTION OF THE SMALL INTESTINE AFTER ITS RESECTION

Acute obstruction of the small intestine (AOSI) is a complicated, ultimately unresolved urgent problem in urgent abdominal surgery. The purpose of the study was to develop new and improve existing decompressing surgical and medical methods for the prevention and treatment of motor and evacuation disorders of the digestive canal in the intra and postoperative periods in patients with acute obstruction of the small intestine after resection of its necrotized area. The complex examination of 22 patients with AOSI, which performed surgical treatment using resection methods for the removal of obstruction, was conducted. Clinical examination of patients in addition to clinical methods included X-ray examination, ultrasound examination, determination of intoxication level (leukocyte index of intoxication), nonspecific resistance, cardiovascular system status, pulmonary with the following definition of functional state of the patient, and comorbidity index. The ASA scale determined the degree of surgical and anesthetic risk. In addition, the terms of recovery of the motor-evacuation function of the digestive tract after the operation were determined. In addition, to determine the effect of corrective therapy, patients were divided into subjects without correction (n = 7) and correction (n = 15). The index of comorbidity in patients with AOSI was as follows: at the age of 59, he was 1.70, at the age of 60 - 74 years - 4.33 and at the age of 75 and more - 5.5. In 50.0% of patients, severe compensated and decompensated diseases were observed, which in 11.1% of cases a permanent threat to the patient's life was. With the first stage of ASA, there were 4 patients (21.1%), the second - 5 patients (26.3%), the third and fourth patients - 8 (42.1%) and 2 (10.5%) cases, respectively. Treatment of AOSI against the back-ground of acute common peritonitis in this group was performed in 17 (72.27%) patients. Single-moment decompression of SI was performed for all 22 (100%) patients intraoperatively. At 8 (36.36%), the operation was completed by overlaying the ileostomy according to own methodology; in 9 patients, the primary entero-enteroanastomosis with laparostomy was formed according to own methodology, and in 5 (22.73%) patients the operation was completed by the formation of a direct entero-enteroanastomosis In the postoperative period, depending on the functional state of the small intestine, the medication therapy was aimed at correcting metabolic processes in the intestine, which contributed to the early recovery of the motor-evacuation function. In addition, from 2-3 days, used the method of intra-cavity stomach massage of the digestive canal. In patients with acute obstruction of the small intestine after resection of the necrotic area, it is necessary to take into account the comorbidity and degree of compensation of the functional state of the patient, the surgical and anesthetic risk, which will allow the use of stage in surgical intervention using various decompression methods and methods for completing the operation. The proposed treatment program helped to restore the motor-evacuation function for 1-2 days, reducing the duration of inpatient treatment by almost to 4 days and the number of complications by 8.46%.