RU2464980C2 - Method of preventing purulent-septic complications after radical mastectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to oncology, and concerns prevention of purulent-septic complications after radical mastectomy. For this purpose against the background of generally accepted complex therapy hypodermically at the level of vertebras Th II - Th VI medical mixture in composition: local anesthetic 1 ml, glucose 40% to 1 ml, 0.9% solution of sodium chloride 4 ml, glutoxim 3% 2 ml, is introduced. Procedure is carried out five times -a day before operation, on the first day after operation and then three times with 24 hour interval.

EFFECT: method ensures reduction of purulent-septic complication frequency as a result of efficient reduction of terms of lymphorrhea duration and correction of local immune-inflammatory reaction.

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Description

The invention relates to medicine, namely to oncology, can be used to improve the results of treatment of patients with malignant neoplasms of the mammary gland, which shows a radical mastectomy.

The present method has no analogues; it is distinguished by simplicity of execution, accessibility and effectiveness.

Lymphorrhea after radical mastectomy (REM) is the cause of early and late postoperative complications, worsens the quality of life, lengthens the rehabilitation period, and contributes to disability. To date, there is no generally accepted method for the prevention of lymphorrhea. We did not find any works devoted to the correction of local immune status in order to reduce the time of lymphorrhea after radical mastectomy and, accordingly, prevent further complications directly associated with prolonged lymphorrhea - maceration of wound edges, marginal necrosis of flaps, suppuration, etc. Increasing the radicality of surgical intervention, various neoadjuvant therapy options that are carried out before the operation and often increase the volume and duration of postoperative lymphorrhea, require the selection of an adequate method for the management of this category of patients and the development of new methods for influencing postoperative complications and especially lymphorrhea.

It is proposed that the doctor conduct in the intensive care unit or treatment room a course of subcutaneous lymphotropic injections at the level of the vertebrae ThII-ThVI of a complex drug mixture consisting of: local anesthetic (lidocaine 2% 1 ml); glucose 40% to 1 ml, 0.9% sodium chloride solution 4 ml, glutoxim 3% - 2 ml. The procedure is performed five times: a day before the operation, on the first day after the operation and then with an interval of 24 hours three times.

The technical result consists in a marked decrease in the activity of the destructive-inflammatory process, the formation of adequate adaptive reactions in the early postoperative period, which positively affects the dynamics of lymphorrhea and related purulent-septic complications.

In order to determine the effectiveness of the action of subcutaneous lymphotropic injections on markers of cell destruction, the level of proinflammatory cytokines in the wound discharge (lymph), and ultimately on the duration of lymphorrhea and associated purulent-septic complications, a study was conducted involving 107 patients who underwent radical Madden mastectomy about breast cancer.

The first control group (“1A”) consisted of 55 women who underwent radical Madden mastectomy for breast cancer (breast cancer), who underwent standard treatment in the postoperative period.

The second, main, group (“2G”) consisted of 52 patients with breast cancer, who included a subcutaneous lymphotropic injection in the preoperative preparation program. Subcutaneous lymphotropic injections with an immunomodulator (glutoxim) were performed to patients of this group five times - a day before surgery, on the first day after surgery and then three times with an interval of 24 hours. As in the patients of the control group, the postoperative management scheme included analgesia, parenteral administration of antibacterial drugs, infusion therapy, according to indications - transfusion of protein preparations, metabolic therapy. The technique of subcutaneous lymphotropic injections was as follows. A mixture of drugs for subcutaneous lymphotropic injections was prepared ex tempore, the nurse collected the drugs and labeled the syringe depending on the composition of the complex drug mixture. The drugs included in it do not enter into chemical interaction. It is permissible to store the finished drug mixture in a syringe for 12 hours in a refrigerator at a temperature of +4 degrees Celsius.

The composition of the complex drug mixture used for subcutaneous lymphotropic injections in patients undergoing radical mastectomy for breast cancer, we included the following drugs:

- local anesthetic (lidocaine 2% 1 ml);

- glucose 40% to 1 ml;

- 0.9% sodium chloride solution 4 ml;

- glutoxim 3% - 2 ml.

Subcutaneous lymphotropic injections were performed by a doctor in an intensive care unit or treatment room.

When performing subcutaneous lymphotropic injections, the patient is lying on her side in a knee-elbow position with the maximum bent back. The introduction of the drug mixture was carried out at two points in adjacent segments of the spinal column with an interval of one segment. It is recommended to administer the complex drug mixture not at the same place, but alternate the injection site, shifting the injection point 1 segment higher or lower with each subsequent manipulation. The level of subcutaneous lymphotropic injection for this nosology is from vertebrae thoracicae (Th) II to VI. When carrying out subcutaneous lymphotropic injections in our study, there were no allergic reactions to the drugs that make up the complex drug mixture, local complications and hypotonic reactions after the procedures.

The concentration of IL-6 in the wound discharge (Table 1) of patients of the 1st subgroup was 893 ± 78 pg / ml, which was reliable, 1.57 times lower than the concentration of this interleukin on the first day of the postoperative period (1405 ± 78 pg / ml, p <0.05).

Table 1 The content of IL-6 in the wound discharge (PG / ml) Standard technique The proposed method 1st day 1405 ± 78 1405 ± 78 7th day 893 ± 78 510 ± 110 * * - differences are statistically significant when compared between groups (p <0.05).

In a comparative analysis of the dynamics of changes in the concentration of IL-6 in two subgroups, it was found that a significant more pronounced decrease in its concentrations by 1.75 times was detected in patients of the 2nd subgroup (893 ± 78 pg / ml and 510 ± 110 pg / ml, respectively , p <0.05).

The concentration of IL-8 in the wound discharge (Table 2) of patients of the 1st subgroup was 1235 ± 123 pg / ml, which was significantly 1.65 times lower than the concentration of this interleukin on the first day of the postoperative period (2093 ± 24 pg / ml, p <0.05).

A similar dynamics was found for the concentration of IL-8 in the wound discharge of patients of the 2nd subgroup, where it was 810 ± 79 pg / ml. The obtained value of the indicator was significantly 2.55 times lower than the concentration of IL-8 in the wound discharge on the first day of the postoperative period (2093 ± 24 pg / ml, p <0.05).

In a comparative analysis of the dynamics of changes in the concentration of IL-8 in two subgroups, it was found that a significantly more pronounced decrease in its concentrations by 1.54 times was detected in patients of the 2nd subgroup (1235 ± 123 pg / ml and 810 ± 79 pg / ml, respectively , p <0.05).

table 2 The content of IL-8 in the wound discharge (PG / ml) Standard technique The proposed method 1st day 2093 ± 24 2093 ± 24 7th day 1235 ± 23 810 ± 79 * - differences are statistically significant when compared between groups (p <0.05).

Thus, it was shown that a pronounced decrease in the content of biologically active substances with pro-inflammatory properties (IL-6, IL-8), as well as a decrease in the activity of local and systemic inflammatory processes occur in patients under the influence of subcutaneous lymphotropic injections with glutoxim, a drug with immunotropic properties. When using the technique, a marked decrease in the activity of the destructive-inflammatory process is noted.

Thus, the use of the proposed technique in patients after radical mastectomy allows optimizing the results of treatment in the postoperative period, as a result of a decrease in the activity of the local destructive-inflammatory process, the formation of adequate adaptive reactions in the early postoperative period, which positively affects the dynamics of lymphorrhea, as well as a decrease in the frequency the occurrence of purulent postoperative complications (table 3).

Clinical example

Patient T., 32 years old, was admitted to the mammological department of an oncology clinic with Ds: Blastoma mammae dextrae T2N1M0 (IIb) stage. A day before the radical Madectomy mastectomy was performed, blood was taken on the right for immunological examination: a day before the operation, on the first day after the operation and then at a 24-hour interval, the patient was given three times subcutaneous lymphotropic injections with the drug mixture in the following composition: local anesthetic ( lidocaine 2% 1 ml); glucose 40% to 1 ml; 0.9% sodium chloride solution 4 ml; glutoxim 3% - 2 ml.

The concentration of IL-6 cytokine, which has pro-inflammatory activity in the blood serum, increased 1.6 times on the 1st day of the postoperative period, and decreased 2.8 times on the 7th day. A similar dynamics was detected for the concentration of IL-6 in the wound discharge on the 7th day - 510 ± 110 pg / ml (normal version). The obtained value of the indicator was 2.75 times lower than the concentration of IL-6 in the wound discharge on the 1st day of the postoperative period - 1405 ± 78 pg / ml. The concentration of IL-8 in the wound was 810 ± 79 pg / ml. The obtained value of the indicator was 2.55 times lower than the concentration of IL-8 in the wound discharge on the first day of the postoperative period (2093 ± 24 pg / ml).

The dynamics of lymphorrhea is presented in table 4. Given the small amount of lymphorrhea, the drainage was removed on the 3rd day, which did not contribute to the secondary infection and there were no postoperative complications.

Table 4 The timing Amount of lymph 1 day 75 2nd day fifty 3rd day 40 4th day thirty 5th day twenty 6th day 10 7th day 5 8th day 0

Thus, patient T. experienced a marked decrease in the content of biologically active substances with pro-inflammatory properties (IL-6, IL-8), a decrease in the activity of manifestations of local and systemic inflammatory processes. Clinically, this resulted in a reduction in the duration of lymphorrhea, the absence of postoperative complications and signs of endogenous intoxication in the postoperative period.

Thus, the use of the proposed technique in patient T. after a radical mastectomy made it possible to optimize the results of treatment in the postoperative period, to start adjuvant polychemotherapy courses in a timely manner, and also to shorten the hospital bed.

The use of the presented method of prevention leads to a decrease in the level of proinflammatory cytokines in the wound, which results in an effective reduction in the duration of lymphorrhea and associated purulent-septic complications in patients after radical treatment of malignant neoplasms of the mammary gland.

Claims (1)

A method for the prevention of purulent-septic complications after radical mastectomy, characterized in that against the background of complex therapy, including analgesia, parenteral administration of antibacterial drugs, infusion and metabolic therapy, a complex drug mixture is administered to patients subcutaneously at the level of vertebrae Th II - Th VI: local anesthetic 1 ml, glucose 40% to 1 ml, 0.9% sodium chloride solution 4 ml, glutoxim 3% 2 ml, the procedure is performed five times - a day before the operation, on the first day after the operation and then three times with and with an interval of 24 hours