RU2523629C1 - Method for prevention of suppurative-septic complications in patients with acute gangrenous cholecystitis in minimal access surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: ronkoleukin is administered in a dose of 500,000 units in a 0.9% physiological saline 20.0 ml. The prepared solution in an amount of 10.0 ml is administered into a round ligament of the liver through a catheter inserted under visual control. The rest amount of 10.0 ml is introduced into incisional wound edges on the 1^st and 3^rd postoperative days.

EFFECT: method provides stimulating local immunity in both the incisional wound, and the hepatoduodenal region ensured by a separate effect of cytokines on various groups of lymphatic nodes.

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Description

The invention relates to medicine, namely to surgery, and can be used in emergency abdominal surgery.

A known method of treatment using interleukin-2 with advanced bacterial infections (German patent No. 3910011, A61K 37/02, 1990). According to this method, the introduction of interleukin-2 intravenously, subcutaneously, intraperitoneally, intramuscularly leads to an increase in the nonspecific cellular response, which helps to reduce the number of bacteria in the peritoneal cavity and lower endotoxins in the blood plasma. The method according to the patent can be used by introducing interleukin-2 at a dose of 1-3.5-106 U / kg in the postoperative period, conditions after severe trauma, widespread gram-positive and gram-negative infections, peritonitis.

The use of high doses of interleukin-2 can cause the development of toxic reactions and is very expensive.

The known "Adaptive immunotherapy method for the treatment of patients with purulent-septic processes", patent RU No. 2098125 C1, A61K 38/20, A61K 38/00, in which mononuclear cells are isolated, cultured with interleukin-2 and returned parenterally to the patient, and existing purulent cavities are washed with a solution containing a combination of cytokines obtained by culturing mononuclear cells with inteleukin-2.

This method is used only in combination with intravenous administration and is not used as an independent method of local cytokine therapy alone. The presented technique for preparing a complex of autologous cytokines requires high technical support and material costs, as well as a time factor. When washing, the solution is not absorbed and does not have a sufficiently long effect on local tissues, a higher concentration of the drug, the frequency and duration of use are required, which leads to an increase in the duration of treatment.

A known method of antibacterial prevention of infectious complications in the field of surgery on the liver, gall bladder and biliary tract. The antibiotic must be administered before the skin incision, that is, until the moment of bacterial contamination, so that the bactericidal concentration is maintained in the tissues throughout the entire operational period. An antibacterial drug should be administered 10-15 minutes intravenously or 30-60 minutes intramuscularly before a skin incision. The drugs of choice are:

1. Cefazolin 1.2 g iv

2. Cefuroxime 1.5 g iv

3. Amoxicillin / clavulanate 1.2 g iv.

However, an operation performed for acute gangrenous cholecystitis belongs to the class of "dirty" operations, which implies the mandatory conduct of antibiotic therapy. Abdominal Surgical Infection, Ed. Savelyeva B.C., Gelfanda B.R. - M. - 2011. P.73-85.

The disadvantage of this method is that today most microorganisms are antibiotic-resistant and the use of antibacterial drugs to prevent purulent-septic complications is less effective than the proposed method.

The closest is the method of antibiotic therapy through a catheter inserted into the round ligament of the liver under visual and palpation control in patients with acute destructive cholecystitis during mini-access surgery (Shevela A.I., Morozov V.V., Kuznetsov A.V. Antibacterial therapy through a round ligament of the liver in patients with acute cholecystitis during operations from mini-access // Basic research. - 2006. - No. 1 - p. 40-41).

The disadvantage of this method is local antibiotic therapy in the upper floor of the abdominal cavity and prolonged standing of the catheter.

The objective of the present invention is to increase the effectiveness of the method for the prevention of purulent-septic complications in patients with acute gangrenous cholecystitis during mini-access surgery by increasing the specific immune response in the surgical wound and in the upper floor of the abdominal cavity.

The objective is achieved by a method for the prevention of purulent-septic complications in patients with acute gangrenous cholecystitis during mini-access surgery, including the introduction of the drug into the round ligament of the liver through a catheter installed in it under visual control. Roncoleukin is administered at a dose of 500,000 IU in 20.0 ml of physiological saline solution of 0.9% sodium chloride, with 10.0 ml of the solution injected into the catheter and 10.0 ml of the solution at the edges of the postoperative wound on the 1st and 3rd day of the postoperative period .

The novelty of the invention:

- Roncoleukin is administered at a dose of 500,000 units in 20.0 ml of physiological saline sodium chloride 0.9%;

- 10.0 ml of the solution is injected into the catheter and 10.0 ml of the solution into the edges of the postoperative wound on the 1st and 3rd day of the postoperative period.

This allows you to quickly create a higher concentration in areas of interest, which increases the effectiveness of the drug. In addition, the introduction of roncoleukin stimulates the production of its own interleukin-2, which significantly increases local immunity.

The subcutaneous route of administration, in contrast to the intravenous, intramuscular and application, allows you to quickly create a higher concentration of the drug in the zone of interest, which seriously increases the effectiveness of the action. The drug is injected directly into the area of the postoperative wound, where a local immune response and an increase in immunological reactivity are formed, which makes it possible to more effectively sanitize the source of infection.

For the first time in surgical practice, combined loco-regional immunotherapy was used to prevent purulent-septic complications in patients with acute gangrenous cholecystitis during mini-access surgery.

The combination of essential features can significantly increase local immunity, both in the area of the surgical wound and in the hepatoduodenal region, which significantly improves the prevention of wound and intra-abdominal purulent-septic complications in acute gangrenous cholecystitis.

The method is as follows.

When performing a cholecystectomy from the mini-access, using the “mini-assistant” apparatus for acute gangrenous cholecystitis, after the main stage of the operation, 1-2 cm and 1 cm to the right in the midline of the abdomen make an injection of the needle perpendicular to the skin . The needle is inserted deeper, piercing the aponeurosis of the broad muscles of the abdomen to the sensation of failure. A needle is inserted inside the round ligament of the liver, controlling the position of the needle visually. A conductor is inserted through the lumen of the needle and a polyethylene catheter is inserted. Roncoleukin is administered in a dose of 500,000 units in 20.0 ml of physiological saline sodium chloride 0.9%. 10.0 ml of the solution is introduced into the catheter and 10.0 ml of the solution into the edges of the postoperative wound. The skin is punctured with a needle at a distance of 1.0 cm from the incision and 5.0 solution is injected into the subcutaneous tissue on each side on the 1st and 3rd day of the postoperative period.

Clinical example No. 1

A woman, 55 years old (medical history 216), was admitted to the emergency surgical department of the MDLP GKB 1 of Novokuznetsk on 01/18/13 with a diagnosis of ZhKB. Acute calculous cholecystitis.

From the moment of admission, a comprehensive conservative therapy of acute cholecystitis was carried out: infusion, antispasmodic therapy. Despite all the ongoing therapy, the patient's condition remained without positive dynamics.

01/19/13 the operation was performed: cholecystectomy from mini-access, catheterization of the round ligament of the liver. The intraoperative diagnosis was established: cholelithiasis. Acute gangrenous cholecystitis. Local serous peritonitis.

1st day after surgery, a state of moderate severity, moderate pain. Body temperature 38.4 ° C.

The prepared solution of roncoleukin in a dose of 500,000 DB in 20.0 ml of physiological solution of sodium chloride 0.9% was injected 10.0 ml into the catheter and 10.0 ml of solution into the edges of the postoperative wound. The skin is punctured with a needle at a distance of 1.0 cm from the incision and a solution of 5.0 is injected into the subcutaneous tissue on each side on the 1st and 3rd day of the postoperative period.

After completion of therapy according to the proposed method, the patient's condition improved, her temperature returned to normal, her appetite improved, the patient became active, and abdominal pain did not bother with the abolition of pain relief. According to laboratory tests: normalization of the leukoformula, ESR, ultrasound control: there are no accumulations of fluid in the gallbladder bed. 01/26/13 the patient was discharged in satisfactory condition for outpatient aftercare.

Thus, the method allowed to prevent the development of purulent complications.

Using the proposed invention increases the effectiveness of the method for the prevention of purulent-septic complications in patients with acute gangrenous cholecystitis during mini-access surgery, by increasing the specific immune response in the surgical wound and in the upper floor of the abdominal cavity.

Claims (1)

A method for the prevention of purulent-septic complications in patients with acute gangrenous cholecystitis during mini-access surgery, including the introduction of the drug into the round ligament of the liver through a catheter installed in it under visual control, characterized in that 500,000 units of roncoleukin are administered in 20.0 ml of physiological solution of sodium chloride 0.9%, and 10.0 ml of the solution is injected into the catheter and 10.0 ml of the solution into the edges of the postoperative wound on the 1st and 3rd day of the postoperative period.