APPLICATION OF HYPERVOLEMIC HEMODILUTION IN THE TREATMENT OF HIRSHPRUNG DISEASE IN CHILDREN

Purpose of the study . To study the effectiveness of hypervolemic hemodilution in combination with ozone therapy in children with Hirschsprung’s disease.

Material and research methods. The results of prospective and retrospective treatment in 143 children with Hirschsprung’s disease were analyzed. Forms of Hirschsprung’s disease: ultrashort form -2 (1.4%), rectal - 48 (33.6%), rectosigmoidal - 89 (62.2%), segmental - 2 (1.4%), subtotal - 1 (0, 7%), and the total form - 1 (0.7%). Hirschsprung’s disease is divided into three stages along the course: compensated 10 (7.0%), subcompensated 73 (51%) and decompensated 60 (42%).The patients were divided into 2 groups: the first (control) included 55 (38.5%) children who received traditional methods of treatment: preoperative preparation, double-barrel colostomy on the ascending colon for a period of 2 to 6 months. The second group (main) included 88 (61.5%) children who underwent preoperative preparation, taking into account the degree of endogenous intoxication (EI), intra- and postoperative management, and one-stage surgical treatment.

We have studied the effectiveness of hypervolemic hemodilution in combination with ozone therapy, which was performed in 88 children with Hirschsprung’s disease.

In connection with the existing chronic fecal intoxication, in 88.5% of patients with the inflammatory process of the colon and intestinal dysbacteriosis, there was a violation of all, ringing hemostasis. The study of the hemostasis system included the determination of blood clotting time (BTC), protein C, prothrombin index (PI), prothrombin ratio (PO), soluble fibrin-monomer complexes (RMFC), reference test, fibrin and fibrinogen dehydration products (PDF), antithrombin III (AT-III), activated partial thromboplastin time (APTT).Statistical processing of the material was carried out using the methods of variation and difference statistics with the calculation of М±m and the assessment of the reliability of the results using the Fisher-Student criterion.

Results of the study and their discussion. When analyzing the clinical manifestations and course of Hirschsprung’s disease, depending on the form, stage and duration, conservative therapeutic measures, 3 degrees of severity of endogenous intoxication were identified: degree 1 in 3.8% of children, degree 2 in 57.8%, degree 3 in 26, 9%. In 9 (11.5%) out of 35 patients (5 patients with rectal and 4 patients with rectosigmoidal form) in the compensated stage, the phenomena of chronic endogenous intoxication were not observed.   These children were constantly under the supervision of a pediatrician and a pediatric surgeon from 2 to 12 years old with the organization of proper care. All this contributed to the prevention of the development of endogenous intoxication. These patients underwent surgical interventions in a planned manner, as patients with a compensated stage.

In 5 (3.5%) patients with acute HD, conservative measures were ineffective, as evidenced by the remaining high level of CEI. These children underwent a sigmostoma over the dilated portion of the intestine.

Conclusion . Despite the decrease in the compensatory capabilities of the child’s body against the background of anesthetic and surgical aggression, the presence of endogenous intoxication in children with Hirschsprung’s disease, differentiated preoperative preparation using sparing methods of surgical intervention leads to a decrease in postoperative complications.

A medical ozone-oxygen mixture with an ozone concentration of up to 150 mg/l with a power consumption of 85 VA and a gas flow rate of 0.25 to 1.0 l/min has a positive effect in regulating the hemostasis process.

Conducted preoperative therapy taking into account CEI, the use of methods of decontamination, hypervolemic hemodedulation, medical ozone therapy contribute to a favorable course of the intra- and postoperative course of the disease.

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