RU2310469C1 - Method for treating relapsing post-surgical adhesions in organs of abdominal cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: in pre-surgical period one should introduce Collagenase CC due to electrophoresis onto anterior abdominal wall in area of adhesive process. After abdominal cavitary sanitation and the main stages of operation it is necessary to introduce 500 mg Collagenase CC 250 U dissolved in 100 ml physiological solution into area of deserosed intestine. The innovation prevents the relapse of adhesions.

EFFECT: higher efficiency of therapy.

2 ex, 1 tbl

Description

The present invention relates to medicine, namely to surgery, and can be used in the treatment of patients with adhesive disease of the peritoneum.

A known treatment method using the drug trypsin for the conservative treatment of patients with adhesive disease of the peritoneum (Zhenchevsky R.A. Adhesive disease. - M. - Medicine. - 1989. - 191 S.).

The prototype is a method for the treatment of postoperative adhesions using electrophoresis with Collagenase KK 250 ED [application No. 2004131162/15, published 04.04.2006].

Collagenase KK 250 UNIT - an enzyme preparation obtained from offal of commercial species of crabs, approved by the Pharmacological Committee of the Ministry of Health of the Russian Federation, registration number 96.252.7.

The technical result is an increase in the effectiveness of the treatment of recurrent postoperative adhesions in the abdominal organs.

The specified technical result is achieved due to the introduction of the preparation Collagenase KK 250 IU by electrophoresis in the area of adhesions in the abdominal cavity in the preoperative period and the introduction of 500 mg of the drug Collagenase KK 250 IU dissolved in 100 ml of physiological solution to the deserted area of the intestine and pelvis in abdominal surgery time.

Electrophoresis Collagenase KK 250 IU is used as a complex therapy in the preoperative period in planned patients with adhesive disease of the peritoneum. The electrophoresis technique is as follows. Dissolve 100 mg of amorphous Collagenase KK 250 IU in 10 ml of a 1-2% solution of novocaine. Moisten a gauze napkin with this solution, lay a hydrophilic gasket and electrode on top. Collagenase KK 250 IU is administered from the negative pole of the galvanic apparatus. The electrode is placed on the anterior abdominal wall in the projection of the location of the adhesive process. The current strength is 10-20 mA. The duration of the first session is 20 minutes. Each subsequent session is increased by 5 minutes and adjusted to 35 minutes. The course of treatment used 4-5 sessions of electrophoresis. The duration of the course depends on the subsidence of the pain syndrome, softening of the postoperative scar.

After the described preparation, surgical treatment of patients with adhesive disease of the peritoneum was carried out. Under general anesthesia, after processing the surgical field, one of the accesses (laparotomy, minilaparotomy, laparoscopy) is performed into the abdominal cavity. The organs of the abdominal cavity and pelvis are revised. Depending on the prevalence of the inflammatory and volumetric process, indications are given for the volume of the operation. After the abdominal sanitation and the main stages of the surgical intervention, indications are given for the use of adhesive disease prophylaxis with the use of Collagenase KK 250 IU. After draining the abdominal cavity, 500 mg of the drug dissolved in 100 ml of physiological saline are injected into the deserted colon and into the pelvis. The small pelvis is drained by tubular drains, layered stitches on the wound. Tubular drains are closed with clamps for 3-4 hours, after which the clamps are removed. In the early postoperative period, 2 times a day, into the pelvic cavity, 500 mg of Collagenase KK 250 U, dissolved in 100 ml of physiological saline are injected through drainage tubes.

Example No. 1

Patient Z., 24 years old, was admitted to the surgical department of the City Clinical Hospital No. 8 with complaints of aching pain in mesogastric pain, nausea, and single vomiting. Marks a worsening condition within 2 days. From the anamnesis of the disease: suffers from adhesive disease of the peritoneum since 2000 after undergoing appendectomy. Exacerbations of the disease 1-2 times a year. I was not treated on my own.

Objectively upon admission: a state of moderate severity, a keloid scar in the right iliac abdominal region is determined, with palpation there is a sharp pain throughout the abdomen, a positive symptom (Kocher). For other systems without features.

On admission: a survey radiography of the abdominal cavity organs; single Kloiber bowls are determined.

Ultrasound revealed the presence of planar viscero-visceral and viscero-parietal adhesions in the right iliac region of the abdomen.

Diagnosed with peritoneal adhesion disease, pain form. Dynamic intestinal obstruction.

The treatment was prescribed according to the following method: infusion-antispasmodic therapy in a volume of 800.0 ml, antispasmodics, cleansing enema. On the 2nd day, electrophoresis with Collagenase KK 250 IU was used. In the dynamics on the 5th day, the patient noted a significant improvement in health, subsidence of the pain syndrome.

After the planned preparation, laparoscopic adhesiolysis was performed with 500 mg of Collagenase KK 250 ED at the end of the operation, per 100 ml of physiological saline into the deserted part of the intestine and small pelvis.

Ultrasound in the early postoperative period revealed a decrease in the number of planar viscero-parietal adhesions.

At discharge on the 7th day, the patient did not complain. Clinically, palpation of the abdomen is soft, painless. There are no symptoms of peritoneal irritation.

Example No. 2

Patient M., 42 years old, was admitted to the surgical department of Clinical Hospital No. 8 with complaints of persistent, dull pain in mesogastric pain, nausea. Marks worsening within 12 hours. From the anamnesis of the disease: suffers from adhesive disease of the peritoneum since 1994, after suffering a perforated duodenal ulcer. He was operated repeatedly for peritoneal commissural disease (1996, 1998, 2000). Exacerbations of the disease 2-3 times a year.

Objectively at admission: a state of moderate severity, a keloid scar along the midline of the abdomen is determined, with palpation, sharp pain throughout the abdomen, locally positive symptoms of peritoneal irritation. For other systems without features.

On admission: a panoramic radiography of the abdominal cavity determines a single Kloiber bowl. The passage of barium through the intestines is slow, partially pass.

Ultrasound revealed a large number of planar viscero-visceral and viscero-parietal adhesions along the midline of the abdomen.

Diagnosed with peritoneal adhesion disease, pain form. Partial adhesive intestinal obstruction.

The treatment was prescribed according to the following method: infusion-antispasmodic therapy in a volume of 800.0 ml, antispasmodics, cleansing enema. On the 2nd day, electrophoresis with Collagenase KK 250 IU was used.

In dynamics on the 6th day, the patient noted improvement in well-being, subsidence of pain. Ultrasound revealed a decrease in the number of planar viscero-parietal adhesions.

The patient underwent surgery: laparoscopic adhesiolysis, during the operation softening of the adhesive process, the transition of planar adhesions to heavy or filiform were noted. After dissection of adhesions at the end of the operation, 500 mg of Collagenase KK 250 IU was introduced per 100 ml of physiological saline into the area of the deserted colon and small pelvis.

At discharge, the patient did not show complaints. Clinically, palpation of the abdomen is soft, painless. There are no symptoms of peritoneal irritation.

Thus, the use of Collagenase KK 250 IU by electrophoresis and injection into the abdominal cavity during surgery contributed to the regression of adhesions of the abdominal cavity and a subsequent reduction in the formation of adhesions. The authors conducted an experimental study on animals in order to identify a qualitative and quantitative indicator of the effect of Collagenase KK 250 IU on the process of adhesion formation.

Studies were carried out on 30 white rats-female Wistar strain weighing 190 ± 24 g. All animals were divided into 2 groups (15 rats each). Under ether anesthesia, experimental animals perform median laparotomy. In the first group (control) after laparotomy by rough contact with dry wipes (before the appearance of “blood dew”) on the parietal and visceral peritoneum of the pelvic organs (uterus, uterine horns, intestines), a background is formed for adhesions, the middle wound was sutured tightly. The second group (main) rats are applied with the liquid enzyme preparation Collagenase KK 250 ED on the contact area of the uterus appendages, loops of the small intestine and peritoneum.

After 7 days, rats undergo relaparotomy to study the degree of adhesion formation in both groups, as well as material sampling for histological and histochemical studies.

The severity of the adhesion process is evaluated according to the formula proposed by Vorobyov A.A., Beburishvili A.G. (2001):

USP = (X * Y) + Z

USP - the level of adhesion process,

X - the number of adhesions at places of localization,

Y is the morphological type of adhesions (heavy adhesions were estimated equal to 1; membranous - 1.5; planar - 2),

Z is the area of adhesions (if the adhesion was attached to the organ at a distance of up to 0.5 cm, then Z is 1; if from 0.5 to 1 cm - 2; from 1 to 2 cm - 3).

Adhesion process evaluation results

In group 2, the formation of adhesions around the place of application of the protective film was noted in 10 cases (33.3%), which significantly differs from the control group 29 (96.6%) (P <0.001). The average values of the density, type, prevalence of postoperative adhesions are presented in table 1.

Analysis of the data showed that the use of the liquid enzyme preparation Collagenase KK 250 IU can significantly reduce the formation of postoperative adhesions in the abdominal cavity.

The authors first studied and proved the anti-adhesion effect of the use of the drug Collagenase KK 250 Units. Thus, the claimed invention meets the criterion of "inventive step".

The method is easily reproducible and when used, the indicated technical result is achieved. Thus, the invention meets the criterion of "industrial applicability".

Table 1.
The frequency of formation, prevalence, type and density of postoperative adhesions in rats depending on the protection of the surgical wound (n = 30). Frequency and nature of the adhesion process Group Frequency (number of cases,%) Qty Type of Density Total points 1st control 29 (96.6%) 4.2 ± 0.3 2.0 3.2 ± 0.1 11.6 ± 0.4 2nd experience 10 (33.3%) 2.2 ± 0.1 1.5 ± 0.1 1.0 ± 0.2 4.3 ± 0.4

Claims (1)

A method for the treatment of recurrent postoperative adhesions in the abdominal organs, including the introduction in the preoperative period of Collagenase KK 250 ED by electrophoresis, characterized in that after sanitation of the abdominal cavity and the main stages of the operation, 500 mg of Collagenase KK 250 ED dissolved in the pelvis are introduced in 100 ml of physiological saline.