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ru2en: Treatment. Therapeutic tactics in acute appendicitis is possible
earlier removal of the appendix. When the diagnosis of "acute
appendicitis, "an emergency operation performed in all patients, because
rate of complications and mortality are directly dependent on the time
elapsed from onset to surgery. The longer this period,
the more frequently encountered complications and the higher postoperative mortality.
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ru2en: In order to prevent septic complications, all patients
before and after introducing broad-spectrum antibiotics that act
both aerobic and anaerobic flora on. When neoslozhnennom appendicitis the most effective medications find cephalolosporiny 4th generation ("Zinatsef", "Cefuroxime") in combination with linkozamidami ("Dalatsin", "Clindamycin") or metronidazole ("Metrogil"
"Trihopol"). In complicated acute appendicitis, it is expedient to appoint
karbopenemy ("Tienam", "Imipenem", "Meronem") or ureidopenitsilling.
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ru2en: In patients with HIV infection while reducing the number of CD4 lymphocyte
elements (500) in the presence of leukopenia below shows the immunoglobulin
and G-CSF (a factor that stimulates neutrophil colony).
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ru2en: Appendectomy is performed under general (intravenous or endotraheAlno) or under local anesthesia. It is conducted by open or laparoscopic
method. With laparoscopic appendectomy varies

only on-line access. Methods of removal process is the same


as during normal operation. The advantages of endoscopic appendectomy
are the simultaneous solution of the diagnostic and therapeutic challenges
minor trauma, fewer complications (suppuration of wounds). In
Therefore, reducing post-operative period and duration of rehabilitation.
The duration of laparoscopic surgery a few
more than open. In addition, a small proportion of patients (3-5%)
it is necessary to convert to traditional endoscopic surgery
because of dense adhesions, internal bleeding, abscess, expressed
obesity. The cost of operations using video endoscope
technique is 4 times greater than for open appendectomy. Contraindication
Laparoscopy is a pregnancy. However, when using
gasless method (no insufflation of gas into the abdominal cavity)
It's easy and safe.
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ru2en: In the "open" appendectomy often use kosoperemenny access
while the middle section passes through Mac Berneya, rarely used
adrectal access. If you suspect a common
pyoperitonitis midline laparotomy should be performed,
which allows a full audit and carry out any
surgery on the abdominal organs, if the need arises.

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ru2en: After laparotomy the cecum dome with appendage to deduce
the wound, bandage mesenteric vessels of the appendix, then placing absorbable
ligature at its base. After this process is cut off and
immersed in his stump cecum purse-string and Z-shaped stitches. If
dome cecum is inflamed and purse-string suture imposition impossible
stump sprouts peritoniziruyut linear sero-muscular suture grasping
only the unmodified fabric cecum. Children under 10 years of stump
process tie nonabsorbable material and visible
mucous membrane burn elektrokoagulyatorom or 5% solution of iodine.
Some surgeons in children invaginating stump appendicitis. Laparoscopic
appendectomy at the base of the appendix impose metal
clip. Immersion stump sprouts in the cecum did not produce.

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ru2en: If you find accumulations of fluid in the abdominal cavity (peritonitis)
the wound was washed with an antiseptic solution, injected into the abdominal cavity
drainage tube through a remote section of the abdominal wall.
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ru2en: There is a point of view that should not backfill
abdominal cavity. At the same time, some surgeons place of one or
multiple double-barreled set of drainages tampon: 1) it is impossible
remove the appendix or a portion of the infiltrate, and 2) when
autopsy periappendikulyarnogo abscess, 3) retroperitoneal phlegmon;
4) the uncertainty about the solvency of joints, embedding
stump sprouts.

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ru2en: In the treatment of abscesses should strive to use more maloinvazivnye surgical techniques - a puncture and drainage of the delineated
accumulation of pus under ultrasound or computed tomography
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phy. If there is no appropriate equipment, abscess reveal outperitoneal access.
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ru2en: In the presence of loose bodies spayaniya forming appendicular
infiltration, it is usually possible to divide adhesions and make-appendekto
mission, after which the peritoneal cavity drained. Dense appendicular
infiltrate treated conservatively, since the separation of closely
welded bodies can be damaged, exposing the gut. The first

2.4 days a patient is prescribed bed rest, local - on the right


lower quadrant of the abdomen - the cold, prescribe antibiotics and gentle
diet. At the same time are closely monitored the condition of the patient:
monitor the dynamics of the complaints, the change in pulse rate, temperature
curve, muscle tension of the abdominal wall, leukocytosis. At
normalization of the general condition, the disappearance of pain on palpation
stomach complementary medical therapies physiotherapy (UHF).
2-3 months after the resorption of infiltration must perform
routine appendectomy for chronic residual appendicitis
to prevent a repeat attack of acute appendicitis.
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46 %,
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2530 %.
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0,5 % , 16 %.
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ru2en: Results of treatment of acute appendicitis. The overall fatality rate over the past
60 years in most countries is stable and is 0.1-0.25%.
When ruptured appendix, it increases to 4-6%, with diffuse
local peritonitis is 5-10%, and the common background of diffuse
peritonitis is 25-30%. Most often, the appendicitis
dying children and the elderly. In uncomplicated appendicitis pregnant die
0.5% of cases, fetal death rate in this case - 1-6%. At
HIV likelihood of adverse outcome determined by the severity
immunodeficiency: in the early stages of disease outcomes
not differ from the average in the population, at the stage of AIDS mortality
reaches 50%.
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ru2en: Late hospitalization of patients - a major factor influencing the
the frequency of deaths. On admission patients in up to 24 hours
from the onset of lethality 0,07-0,1%. At a later
(Over night), this figure increases to 0.6-0.8%.
Sent at 4:24 PM on Sunday
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( 410 % ).
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6 %), (0,52,0 %),
(0,30,8 %), (0,30,6 %),
(0,20,5 %), (0,030,2 %).
ru2en: The most frequent complications in the postoperative period are
inflammatory infiltrate and suppuration of the wound (in 4-10% of patients).
Among other complications appear less frequent but more dangerous
life - a common postoperative purulent peritonitis (5 -

6%), infiltrates and abscesses of the abdominal cavity (0.5-2.0%), intestinal


fistula (0.3-0.8%), eventration (0.3-0.6%), acute intestinal obstruction
(0.2-0.5%), bleeding and hematoma (0.03-0.2%).
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200/ 6080 % .
ru2en: In patients with HIV infection likelihood of suppurative complications directly
depends on the level of C04-lymphocytes. With an increase in their number
(More 500/mkl), these complications occur in 4-8% of patients with a decrease in
to the level of 200/mkl or less - already at 60-80% of cases.
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ru2en: In the later stages after the operation, complications such as postoperative
hernia (15%), ligature fistulas, adhesive disease, infertility (due to adhesive obstruction of the fallopian tubes). It should be
emphasize that 70% of patients with chronic partial
adhesive intestinal obstruction, the first operation was the appendectomy, performed on the "mere" appendicitis. Abdominal pain,
similar pre-operative are stored in 30-55% of operated on
about "catarrh" appendicitis in terms of more than 1 year after surgery.
Suggest that there is a relationship between appendectomy and the onset
carcinoma of the colon.