Khirurgiia
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The experience of treatment of 73 wounded with gunshot injuries of the rectum is reviewed. Classification of gunshot injuries of the rectum is proposed which permits to choose rational surgical policy depending on the location of the rectal injury is proposed. Terms of closing colostomas in remote periods after operation were determined. The authors believe that because of the complicated anatomo-topographic characteristics of the rectum and frequency of the combined injuries it is advisable to perform operations bor gunshot wounds of the rectum as an urgent specialized aid.
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The results of treatment of 73 patients with surgical sepsis are analysed. 57% of the patients were older than 60 years. In 35.6% of the cases sepsis was caused by soft tissue infection, in 35.6%-pyo-inflammation of the blood vessels. In 81% of the cases infective agents were verified; in 45.2% they were found in associations. ⋯ Early treatment of abscesses, adequate antibacterial and detoxication therapy are major tasks in the treatment of sepsis. Intravenous injections of immunoglobulins (Endobulin., Intraglobin and Pentaglobin), extracorporeal detoxcication and polyorganic disorders correction have led to positive results in most cases. The mortality rate in this group was 14.5% compared with 38.5% in the control group.
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The changes in the system of hemostasis were studied in 36 patients with sepsis managed with sorptive detoxication. The starting status of the system of hemostasis in patients with favorable outcome of the disease can be considered as the 2d stage of the disseminated intravascular coagulation (DIC), and in patients with the unfavorable outcome--as the 3d (hypocoagulative) stage. The sorptive detoxication provides the treatment of the DIC syndrome in favorable outcome, as well as further progression of the process in unfavorable outcome of sepsis. Conservative treatment provides stabilization of the hemostatic system and gives opportunity to perform delayed hemosorption with a positive clinical result.