RU2393865C1 - Method for prevention of recurrent lapse of postoperative abdominal adhesions - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to surgery. After abdominal sanation and main stages of the operation, 200 mg of Cyclophosphamide dissolved in 100 ml of physiologic saline is introduced into the area of a deseroused intestine and small pelvis. ^ EFFECT: invention prevents development of recurrent postoperative abdominal adhesions and postoperative complications. ^ 1 tbl, 2 ex

Description

The invention relates to medicine, namely to abdominal surgery.

A known method for the prevention of relapse of peritoneal adhesions with intraperitoneal administration of hydrocortisone and fibrinolysin at the end of abdominal surgery (R. Genchevsky. Adhesive disease. - M. - Medicine. - 1989. - 168 S.).

The main disadvantage of this method is that the use of glucocorticosteroid hormones inhibits the regeneration processes, the activity of the cellular component of the immune system, can lead to impaired function of the adrenal cortex, up to absolute adrenal insufficiency, and fibrinolysin, even in small doses, can cause intraperitoneal bleeding.

The technical result is the prevention of postoperative complications.

The specified technical result is achieved due to the fact that in the method for the prevention of recurrence of postoperative adhesions in the abdominal organs, including intraoperative single administration of a drug into the abdominal cavity, according to the invention, 200 mg of cyclophosphamide dissolved in 100 ml of physiological saline is administered as a drug.

Cyclophosphamide [cyclophosphamide, mitoxane, cytoxane, endoxan] is the most selective antitumor drug from the class of alkylating agents with a relatively wide spectrum of action. The mechanism of action of cyclophosphamide is the inhibition of the synthetic activity of fibroblasts (Labor G., 1970). It is widely used in clinical practice for the treatment of autoimmune and allergic diseases, in organ transplantation, in oncological practice [Khmelnitskaya E.Yu. et al., 2000].

In the available medical, scientific and patent literature, no information was found on the use of this method for the prevention of adhesions in the abdominal cavity. Thus, the claimed invention meets the criterion of "world novelty."

The proposed method is as follows.

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 adhesion disease prophylaxis with the use of cyclophosphamide. After draining the abdominal cavity, 200 mg of cyclophosphamide, dissolved in 100 ml of physiological saline, is introduced into the area of the deserted colon and into the pelvis.

The authors conducted an experimental study on animals in order to identify a qualitative and quantitative indicator of the effect of cyclophosphamide on the process of adhesion formation.

Studies were carried out on 60 rabbits of the Chinchilla breed weighing 3-3.5 kg weighing 190 ± 24 g. All animals were divided into 2 groups (30 in each). In group I (control group), a standard model for the development of peritoneal adhesions was invoked on 30 rabbits. Desorption of the parietal peritoneum of the side walls to capillary bleeding was performed. In addition, the distal ileum was deserted over 3.0 cm from the ileocecal angle until the appearance of “bloody dew”. Animals were removed from the experiment on days 7, 14, 21 by instant decapitation under ether anesthesia.

In group II (the main group), 30 rabbits were also operated on to develop an adhesion process in the abdominal cavity. Anesthesia - ether anesthesia. The abdominal cavity was opened with a midline incision, the side wall of the abdomen was turned to the side, exposing the parietal peritoneum. On both sides, the parietal peritoneum of the side walls was deserted to capillary bleeding. Additionally, the distal ileum was deserted for 3.0 cm from the ileocecal angle until the appearance of "bloody dew". The abdominal cavity was irrigated with a solution of Cyclophosphamide 100 ml (30 mg / kg). The anterior abdominal wall was sutured in layers with continuous catgut sutures. On days 7, 14, 21, animals were euthanized, a macroscopic examination was performed, and samples of the parietal peritoneum and adhesions were taken for histological examination.

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 assessment results.

The results of assessing the severity of the adhesive process.

In the main group of animals, the presence of postoperative adhesions in 6 cases, which significantly differs from the control group 30 (p <0.05). The average density of postoperative adhesions are presented in the table.

Analysis of the data showed that the use of cyclophosphamide 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 Cyclophosphamide. Thus, the claimed invention meets the criterion of "inventive step".

The proposed method is illustrated by the following clinical examples.

Example 1: Patient S., 48 years old, I. B. 1217, was admitted to the gynecological department of City Clinical Hospital No. 8 on an emergency basis. Based on complaints, medical history, clinical and laboratory data, the diagnosis was made: Exacerbation of chronic salpingo-oophoritis on the right. Piosalpinx on the left. Pelvioperitonitis. The patient was shown therapeutic and diagnostic laparoscopy with correction of the revealed pathology. Laparoscopy was performed under endotracheal anesthesia. An audit of the pelvic organs revealed: the uterus is of normal size, not enlarged. The fallopian tube on the right is clearly shaped, hyperemic, swollen. On the left, the fallopian tube is thickened throughout, the ampullar end is soldered to the posterior wall of the uterus, hyperemic, strained. There are loose planar adhesions, deforming pipes. Ovaries without features. It was decided to dissect adhesions, debridement, drainage of the pelvis. After dissection of adhesions, salpingostomy, and pelvic rehabilitation, 200 mg of Cyclophosphamide, diluted in 100 ml of physiological saline, were intraperitoneally administered. Ultrasound control in the postoperative period did not reveal adhesions.

Example 2

Patient M., 45 years old, was admitted to the surgical department of City Clinical Hospital No. 8 (medical history No. 128) 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 has been operated repeatedly for peritoneal commissural disease. Exacerbations of the disease 2-3 times a year.

Objectively upon admission: a state of moderate severity, a keloid scar along the midline of the abdomen is determined, with palpation there is a sharp pain throughout the abdomen, locally the symptoms of peritoneal irritation are positive. 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.

The diagnosis was established: Adhesive disease of the peritoneum, pain form. Partial adhesive intestinal obstruction.

The patient underwent surgery: laparoscopic adhesiolysis. After dissection of adhesions, 200 mg of cyclophosphamide per 100 ml of physiological saline was added at the end of the operation.

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 cyclophosphamide by introducing into the abdominal cavity during surgery helped to reduce the formation of peritoneal adhesions.

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

Table The level of adhesions depending on immunosuppression. (M ± m, n = 60) Group Frequency and nature of the adhesion process Frequency (number of cases) Distributed
nost Type of Density Total points 1st control (30) thirty 3.2 ± 0.3 2.5 ± 0.2 2.2 ± 0.1 7.9 ± 0.6 2nd experience (30) 6 1.0 ± 0.1 1.0 ± 0.1 0.5 ± 0.2 2.5 ± 0.4 p <0.05 p <0.05 p <0.05 p <0.05

Claims (1)

A method for the prevention of recurrence of postoperative adhesions in the abdominal organs, including a single intraoperative injection of a drug into the abdominal cavity, characterized in that 200 mg of cyclophosphamide dissolved in 100 ml of physiological saline is administered as a drug.