RU2325169C1 - Preventive method of intraperitoneal adhesions formations caused by surgeries of bowels - Google Patents

Abstract

FIELD: EFFECT: medicine; surgery.

SUBSTANCE: heparin solution dosed 150-200 units/kg of body weight is mixed with 1-2 ml of 0.9% sodium chloride solution. This solution is applied for intraoperative slow injection in neurovascular bundle tissue of mesentery the most proximally of surgical insult point. After that puncture point ligation is performed.

EFFECT: effective intravascular inactivation of blood thrombin; reduction of vascular walls permeability; reduction of adhesion formation.

6 dwg

Description

The invention relates to medicine, to abdominal surgery, and can be used for the prevention of postoperative intra-abdominal adhesions during bowel operations.

A known method for the prevention of postoperative adhesion during operations on the abdominal organs, in which, after surgery and sanitation of the abdominal cavity, sterile phosphate-citrate buffer solution with a pH of 5.6 in the amount of one liter and washing off the abdominal organs is poured into it. Then most of it is removed, leaving up to 200 ml of solution in the abdominal cavity (RU No. 2252575, IPC A61K 31/191, A61P 41/00, publ. 05.27.2005).

However, the method is time-consuming, requires quite a lot of time to conduct, there is an inactivation of thrombin contained in the exudate of the abdominal cavity.

The technical result consists in the simplicity of the method, and also in that the effectiveness of preventing the formation of adhesions in the abdominal cavity when using an anticoagulant (heparin) during surgery with the creation of a “depot” of the drug in the paravasal tissue of the mesenteric vessels of the intestine, which maintains its optimal concentration in blood to inactivate thrombin and reduces the permeability of the vascular wall.

The technical result is achieved by the fact that a method for preventing intra-abdominal adhesion during surgical intervention in the intestine consists in preliminarily mixing a solution of heparin in a dose of 150-200 u / kg body weight with 1-2 ml of a 0.9% sodium chloride solution, the resulting solution is intraoperative injected slowly, jet into the tissue of the neurovascular bundle of the mesentery of the intestine proximal to the site of surgical injury, followed by ligation of the puncture site.

Figure 1 shows the formation of a small intestinal anastomosis with a single-row interrupted suture of the end-to-end type; figure 2 - diagram of the ligation of the mesenteric vessels of the small intestine; figure 3 - ligation of the marginal mesenteric vessels of two arcades of the superior mesenteric artery of the ileum with the shutdown of 16-20 pairs of direct vessels of the organ from the bloodstream; figure 4 - the injection site of the drug (proximal to the ischemic section of the intestine); figure 5 - multiple adhesions between the parietal peritoneum, intestinal loops and a large omentum in the ischemic area of the intestine; in Fig.6 - single adhesions in the ischemic area of the intestine with a fragment of the greater omentum soldered to it.

The method is as follows.

To study the prophylactic effect of heparin on the process of postoperative adhesion formation in the abdominal cavity, two groups of animals were used: animals (10 dogs) of the first group that did not undergo intraoperative heparin therapy, and animals (10 dogs) of the second group that underwent intraoperative heparin administration. Under thiopental sodium anesthesia (40-45 mg / kg body weight) after a mid laparotomy, the proximal ileum was removed into the wound. The small intestinal anastomosis was formed with a single-row interrupted suture of the end-to-end type (Fig. 1). Then, edge mesenteric vessels (Fig. 2) were ligated in the same areas of the ileum within two arcades of the superior mesenteric artery in such a way that 16-20 pairs of direct vessels of the organ were turned off from the bloodstream (model of an operative trauma with impaired blood supply to the ileum) (Fig. .3). From a venous vessel directly adjacent to the ischemic section of the small intestine, 20 minutes after the creation of a model of impaired blood supply to the organ, bloodletting was performed in an amount of 1-2 ml so that the blood entered the mesentery of the small intestine. Then, blood was taken from the same blood vessel with the subsequent study of a number of indicators of the coagulation-lytic blood system: Lee-White coagulation time, prothrombin time and prothrombin ratio, antithrombin III activity. After taking blood from a venous vessel, the latter was ligated.

Previously, a solution of heparin in a dose of 150-200 units / kg body weight was mixed with 1-2 ml of a 0.9% sodium chloride solution. The resulting solution was intraoperatively injected slowly, jet into the fiber of the neurovascular bundle of the mesentery of the intestine proximal to the site of the surgical injury (Fig. 4). The puncture site was carefully ligated. Then the surgical wound was sutured in layers. No animals were treated in the postoperative period.

After the operation, the general condition of the animals, their behavior, appetite, nature and frequency of stools were monitored. The terms of observation of animals amounted to 1 month. After 7, 20, 30 days, the animals underwent anesthetic relaparotomy, followed by a study of postoperative changes in the abdominal cavity. At the same time, attention was drawn to the nature, prevalence and severity of the adhesive process, the presence of exudate in the abdominal cavity, and the peculiarities of pathomorphological changes in the examined intestine. Photographing of the studied object was carried out.

In the early postoperative period, 2 dogs from the first group died. The cause of death in both cases was mesenteric thrombosis of the small intestine.

Studies have found that in animals of the first group, 20 minutes after vascular ligation, a slight change in the parameters of the blood coagulation system was recorded in the studied area of the organ, and the difference between them was unreliable. So, the coagulation time of venous blood increased only by 4.6% (P> 0.05). The prothrombin time and prothrombin ratio practically did not differ from the control data. At the same time, the anticoagulant activity of venous blood increased, as evidenced by a significant increase in antithrombin III activity - by 19.4% (P <0.05).

In animals of the second group, 20 minutes after mesenteric vessel ligation, an increase in coagulation of venous blood was observed by a factor of 1.9 (P <0.05), an increase in antithrombin III activity by 23.2% (P <0.05), which was associated with diffusion of heparin from the paravasal fiber of the mesentery of the small intestine into the vascular bed.

After a relaparotomy, the animals of the first group in the abdominal cavity in the vast majority of cases revealed a significant adhesion process. The latter was represented by multiple adhesions between the parietal peritoneum, intestinal loops, especially in the ischemic area of the organ, and a large omentum covering this section of the intestine (Fig. 5).

In animals of the second group, the adhesion process was represented by single adhesions, and in almost half of the cases it was practically not determined. In most dogs, adhesions were found in the ischemic area of the ileum, to which a large omentum was soldered (Fig.6).

Thus, in contrast to the method of intraperitoneal administration of a sterile phosphate-citrate buffer solution with a pH of 5.6, which reduces to the inactivation of thrombin contained in the exudate of the abdominal cavity, intraoperative injection of heparin solution in the indicated ratios into the paravasal tissue of the mesenteric vessels of the intestine is proximal to the site of the surgical injury with the creation of a “depot” of the drug and its subsequent gradual transition into the blood, it can most effectively influence the process of decreasing adhesion in the abdominal Lost due to intravascular thrombin inactivation of blood and reduce the permeability of the vascular wall. In addition, the method is simple to implement, does not require much time for its implementation.

Claims (1)

A method for the prevention of intra-abdominal adhesions during surgical intervention in the intestine, which consists in preliminarily mixing a solution of heparin at a dose of 150-200 units / kg of body weight with 1-2 ml of a 0.9% sodium chloride solution, and the resulting solution is intraoperatively injected , jet into the tissue of the neurovascular bundle of the mesentery of the intestine proximal to the site of the surgical injury, followed by ligation of the puncture site.

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