RU2491887C1 - Method for typing surgical management of patients with hernia defects of anterior abdominal wall - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly herniology. The patient is suggested to perform a first static load on the abdominal muscles whereat total electric activity of the abdominal rectus muscle (TEA-1) is recorded, and a dynamic load on the abdominal muscles, and a second static load on the abdominal muscles. The study involves recording total electric activity of the abdominal muscles - TEA-2. And a fatigue level (FL) of the abdominal muscles is calculated by formula: $$FL=\frac{TEA-2}{TEA-1},$$

If the FL falls within the range of 0.9-2.4 units, the tension repair of the hernia defect. The FL exceeding 2.4 units requires performing the tension-free repair of the hernia defect with using mesh implants.

EFFECT: improved effectiveness of the method.

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Description

The invention relates to medicine, namely to functional diagnostics in surgery.

A known method of electromyographic research, including recording the electrical activity of the muscles of the cervical spine on both sides at rest of the patient and during a static stress test (patent RU 2400134 from 11/17/2008). The method consists in recording the electrical activity of the muscles of the cervical spine on both sides in two phases. In the first phase, the study is carried out at rest. In the second, a functional stress test is performed, in which the patient, without changing the position of the body and head, tries to straighten the cervical spine. On the electromyogram determine the magnitude of the amplitude of the curve, the frequency of the turn, the amplitude. The obtained parameters of the amplitude on the affected and opposite sides are compared with each other, according to their ratio, the magnitude of the asymmetry of the amplitudes is calculated. A graded assessment of biomechanical disturbances in the muscles of the neck is also carried out. But in the diagnostic complex, the results of a dynamic functional test are not given. As a result, the reserve capabilities of the studied muscles cannot be assessed; it is impossible to assess the prospects for the restoration of muscle function in the dynamics.

A known method of surface electromyography of the tongue (patent application RU 98102796/14, 02.25.1998). The method consists in determining the maximum amplitude of the bioelectrical activity of the muscles of the tongue at the level of its tip and back when swallowing saliva and with tension. The functional state of the muscles of the tongue is evaluated by the ratio of the maximum amplitude of the bioelectric activity of the muscles of the tongue during swallowing and tension, which is balanced and equal to 1 with a vibration range of 0.05. The method does not allow to evaluate the initial level of bioelectric activity of muscles, to track the dynamics of muscle fatigue.

EFFECT: development of a method for diagnosing the functional state of abdominal muscles.

The method we developed for studying the functional state of the abdominal muscles is based on calculating the degree of muscle fatigue after recording the total electrical activity of the abdominal muscles during the first static load and the second static load following the dynamic load. This method is non-invasive, convenient and simple to perform, allows you to quickly make a decision when choosing the type of surgical treatment of ventral hernias, the possibility of its use is not limited to the age and health of the patient.

The technical result is achieved as follows. At the head end of the couch, a tripod is installed with a vertically located scale graduated in centimeters. The initial position of the patient - lying on his back, the nose of the patient should be at the level corresponding to the mark "0" on the scale. Skin electrodes are symmetrically applied to the anterior abdominal wall in the projection of the rectus muscles in the mesogastrium. The patient is offered to perform the first static load: from the initial position, raise the head and shoulder girdle to the level of 12-18 cm and stay in this position for 10-20 seconds. During the first static load, the total electrical activity of the rectus abdominis is recorded by an electromyograph, for example, a VikingQuest 4-channel EMG / VP system. The obtained indicators are designated as the total electrical activity 1 (OEA-1). Further, they suggest that the patient perform dynamic loading: successively 10 lifts of the head and shoulder girdle to the level of 12-18 cm for 10-20 seconds. On the tenth rise, without lowering the head and shoulder girdle, the patient is offered to perform a second static load: to stay in the position of raising the head and shoulder girdle for 10-20 seconds. During the second static load, the total electrical activity of the rectus abdominis muscle is recorded. The obtained indicators are designated as total electrical activity 2 (OEA-2).

Calculate the degree of fatigue (SU) of the rectus abdominis muscles according to the formula:

$$\mathrm{FROM}\mathrm{At}=\frac{\mathrm{ABOUT}E\mathrm{BUT}-2}{\mathrm{ABOUT}E\mathrm{BUT}-\mathrm{one}}$$

The study was conducted in 82 patients divided into 3 groups. The control group, which included 30 people, was comprised of practically healthy people who did not reveal anterior abdominal wall defects during a clinical examination, the subjects led a normal lifestyle, and were not professional athletes.

The first group consisted of 24 patients with medium and small-sized median hernias, the size of the hernia gate did not exceed 8 centimeters, which were subsequently operated on with restoration of the topography of the abdominal wall. The duration of hernias was less than 2 years.

The second group included 28 patients with large and gigantic median hernias, the width of the hernia gate was 8 centimeters or more, which were operated using the “non-stretch repair” method with a mesh prosthesis closing the hernia gate without restoring the topography of the abdominal wall. The duration of hernias was more than 2 years.

The results are shown in table 1.

Table 1 Dependence of restoration of abdominal wall muscle function on the degree of their fatigue Group n Duration of hernias (years) The degree of fatigue of the rectus muscles Ability to restore muscle function No hernias thirty - 0.4-0.8 Muscle function does not suffer hernia gate up to 8 cm 24 less than 2 years 0.9-2.4 Recovery of muscle function is possible. Functionally oriented treatment of hernias is indicated. hernia gate 8 cm or more 28 2 years or more 2.5-4.4 Restoring muscle function is difficult or impossible. The use of non-stretch treatment with the use of prostheses is shown.

It was found that practically healthy people who have never had a history of ventral hernias have no indications of injuries to the abdominal wall, pregnancy, surgical interventions on the abdominal organs, and a clinical examination of the hernial defect was not found, the degree of fatigue of the abdominal muscles was from 0.4 units to 0.8 units. In patients with medium and small hernias and a duration of hernia less than 2 years, the degree of fatigue of the abdominal muscles was more than 0.9 units, but less than 2.4 units. These patients are shown functionally oriented treatment, since restoration of muscle function is possible. In patients with large and gigantic hernias and a hernia duration of more than 2 years, the degree of fatigue was more than 2.4. Due to the impossibility of restoring muscle function, these patients are shown the use of non-stretch treatment using mesh prostheses.

Based on this, the study of the degree of fatigue of the rectus abdominis muscles allows not only to predict the possibility of restoration of the abdominal muscles function, but also to choose the method of surgical intervention.

Clinical examples.

Patient K., 44 years old. He entered the Research Institute of Herniology, VGMA. NN Burdenko with complaints of the presence of hernial protrusion in the epi-, mesogastric left. 6 years ago, after a trauma to the abdomen, a hernial protrusion appeared. Obese 2 degrees. On examination, the size of the hernia gate is 8.5 cm. The diagnosis of ventral hernia in the epi-mesogastrium on the left, obesity 2 degrees The degree of fatigue of the rectus muscles was 2.8, units. Considering the obtained large value of SU, the patient was recommended to perform an operation using a mesh prosthesis, the patient refused this option, insisted on suturing the hernial defect without using a prosthesis. Surgical treatment was performed. The edges of the surgical wound are reduced without the use of a mesh prosthesis. In the early postoperative period, the patient's condition began to deteriorate. A repeated operation with the use of a mesh prosthesis was performed.

Patient I., 42 years old. He entered the Research Institute of Herniology, VGMA. NN Burdenko with complaints of the presence of hernial protrusion in the mesogastrium in the middle. 2 years ago, in connection with peritonitis, an upper-midline laparotomy was performed. After 6 months after this there was a postoperative hernia. On examination, the size of the hernia gate was 12 cm. A postoperative ventral hernia was diagnosed. The degree of fatigue of the rectus muscles was 2.7 units. Surgical treatment using a mesh prosthesis was performed. Early and late postoperative periods - without complications.

Thus, the developed method allows you to choose the most appropriate type of surgical treatment for patients with hernias, as well as to avoid mistakes that are dangerous for patients in the management of such patients.

Claims (1)

A method for selecting the type of surgical treatment for patients with hernial defects of the anterior abdominal wall, which consists in the fact that the patient is offered to perform the first static load on the abdominal muscles, during which the total electrical activity of the rectus rectus OEA-1 is recorded, and the dynamic load on the abdominal muscles the press and the second static load on the abdominal muscles, during which the total electrical activity of the rectus abdominal wall muscles OEA-2 is recorded; calculate the degree of fatigue (SU) of the rectus abdominis muscles according to the formula

;
if SU lies in the range of 0.9-2.4 units, patients undergo stretch repair of a hernial defect; if SU exceeds 2.4 units, patients undergo a non-stretching treatment of a hernial defect with mesh prostheses.