RU2534844C2 - Method for preventing peritoneal adhesions following surgical operation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. A polyethylene tube is inserted into a mesentery. A solution containing proserine in a dose of up to 50 mg is introduced through the inserted tube. A synovial fluid 2 ml dissolved in normal saline 10 ml is additionally administered along the enteroenteroanastomosis.

EFFECT: method provides preventing peritoneal adhesions following the abdominal surgical operation by administering the preparations promoting better peristalsis and slide of the intestinal loop in the abdominal cavity.

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Description

The invention relates to medicine, namely to bowel surgery. A known method of preventing adhesions in the abdominal cavity.

Prototype

The prototype of the proposed method for the prevention of adhesive disease in the abdominal cavity after surgery is a method for the prevention of adhesions, proposed R.A. Zhenchevsky (1989) (Zhenchevsky R.A. Adhesive disease. M.: “Medicine”, 1989, p.192), which consists in the following: fibrinolysin, trypsin, hydrocartisone, dissolved in hemodesis, are introduced into the abdominal cavity through a microirrigator.

Prototype criticism

1. The method of prevention proposed by R.A. Zhenchevsky (R. Zhenchevsky Adhesive disease. M .: "Medicine", 1989, p.192) has the following disadvantages.

1. Local use of fibrinolytic agents is strictly contraindicated after the formation of inter-intestinal anastomoses after bowel resection.

2. After applying this method, only 77.4% had good results, according to R. Zhenchevsky.

3. The author does not use drugs that stimulate intestinal motility. Atony of the intestine contributes to adhesions.

The purpose of the invention

The aim of the invention is the prevention of adhesive disease after surgery in the abdominal cavity.

The essence of the invention.

In an experiment on 10 dogs of the control group, laparotomy was performed under general anesthesia. A violation of the integrity of the serous membrane in several sections of the small intestine was made and nodal sutures were applied to the deserted sections of the intestine in order to eliminate areas of damage to the serous membrane of the small intestine. The abdominal cavity was sutured and the dogs were observed. In 8 dogs, an adhesive disease in the abdominal cavity was found in the postoperative period.

In an experiment on 10 dogs of the main group, laparotomy was performed under general anesthesia and small intestine was deserted in several sections and these sections were sutured with nodal sutures.

Intramural blood pressure in the wall of the small intestine was studied before and after administration of 1 ml of prozerin into the mesentery. by the method of M.Z. Sigal (Sigal MZ Transillumination during operations on hollow organs. - Moscow: “Medicine”, 1974, 183 pp.) [4] by the apparatus of M.R. Ramazanova et al. (Ramazanov M.R., Akhmedov R.A., Ramazanov M.M., Akhmedov E.R. Apparatus for measuring blood pressure in intramural and extraorgan vessels of hollow organs // Utility Model Patent RU 109391 U1 of 20 October 2011) [3].

It turned out that proserin is statistically significant (P <0.0001) increases intramural pressure in the wall of the small intestine (table 1).

The introduction of prozerin into the mesentery of the small intestine increased intestinal contractions.

Given the pharmacological action of proserin, a thin polyethylene tube 2 mm in diameter with holes at the end of 10 dogs of the main group was installed in the mesentery of the small intestine between the peritoneum sheets.

The tube was fixed with polysorb N4 absorbable suture material.

The other end of the hole tube, which was introduced into the mesentery of the intestine, is removed to the anterior abdominal wall. On the anterior abdominal wall, this tube is connected to a bottle of physiological saline in which proserin is dissolved or 1 ml of proserin with antibiotics is injected through this tube into the mesentery 3 times a day.

We did not find data in the literature that proserin increases intramural pressure.

For a day you can keep 50 mg of proserin (Mashkovsky VD Medicines. - M., 2005, p.203) [2].

An additional synovial fluid is introduced into the abdominal cavity through a microirrigator installed in the area of surgical intervention. Synovial fluid is obtained by puncture of the knee or hip joint in 2 ml, which is dissolved in 10 ml of physiological saline with antibiotics and injected near the anastomosis in the abdominal cavity 1-2 times a day.

In the postoperative period, intestinal contractions were examined with a 4 M Sobakin electrogastrograph, which showed the effectiveness of the proposed method.

After the wound has healed, the polyethylene hole tube is removed by pulling it by the end on the anterior abdominal wall.

The advantages of our proposed method are as follows:

1. With our proposed method, a synovial fluid is introduced into the abdominal cavity, obtained by puncture from large joints of the patient, which helps to slip intestinal loops in the abdominal cavity and heal anastomoses due to protein content, unlike P.A. Zhenchevsky, in which the enzymes trypsin, fibrinolysin are introduced, which do not allow the healing of the intestinal anastomosis due to the destruction of the scar along the suture line.

2. The introduction of proserin into the mesentery of the intestine helps to reduce intestinal loops and prevents adhesions, since the intestines will not stick together with peristaltic movements as is observed with postoperative paresis and atony.

3. When the method of R.A. Zhenchevsky may have postoperative paresis, since drugs that reduce the intestines are not administered. On the contrary, with the proposed method, postoperative paresis is not observed, since proserin causes peristaltic movements of the intestine.

4. With the proposed method, we synovial fluid promotes healing of the intestinal anastomoses after resection of the intestine, which is not observed with the method R.A. Zhenchevsky, on the contrary, trypsin, fibrinolysin, which is used in the prototype, destroy the scars of the intestinal anastomosis.

5. The proserin used by us increases intramural pressure in the suture strip, promotes the healing of the anastomosis, which is not observed in the prototype.

6. The proposed feature, the introduction of prozerin in the indicated dosages, provides the necessary effect so that serous membranes do not stick together and so that adhesions do not form.

The proposed method for the prevention of adhesive disease after surgery in the abdominal cavity was used in an experiment in 10 dogs in the postoperative period with adhesive intestinal obstruction.

There were no complications in the postoperative period. The method is simple and effective.

Table 1 Intramural pressure in the small intestine before and after conducting proserin into the mesentery in the experiment in mmHg (10 dogs). Pressure, _{m ±} m Pressure, m _{± m} OK, n = 10 After maintaining proserin, n = 10 Intramural General Intramural General 66 ± 0.5 / 44 ± 0.8 122 ± 1/75 ± 0.9 82.5 ± 0.8 / 55 ± 0.5 P <0.0001 122 ± 1.5 / 75 ± 1.1

Information sources

1. Zhenchevsky R.A. Adhesive disease. M .: "Medicine", 1989, p. 192. - prototype

2. Mashkovsky V.F. Medicines M .: 2005, p.203.

3. Ramazanov M.R., Akhmedov R.A., Ramazanov M.M., Akhmedov E.R. Apparatus for measuring blood pressure in intramural and extraorgan vessels of hollow organs // Utility Model Patent RU 109391 U1 dated October 20, 2011.

4. Seagal M.Z. Transillumination during operations on hollow organs. - Moscow: “Medicine”, 1974, 183 p.

5. Pavlova V.N. The synovial environment of the joints. - M., "Medicine", 1980.

Examples of specific performance of the method

Patient M. had a laparotomy for adhesive intestinal obstruction. During the audit, adhesive intestinal obstruction of the small intestine was found. The bowel loop is swollen and swollen above the obstruction.

The study of blood pressure in the intramural vessels of the intestine according to the method of M.Z. Sigal (Sigal MZ Transillumination during operations on hollow organs. - Moscow: "Medicine", 1974, 183 pp.) During an operation using the apparatus of M.R. Ramazanova et al. (Ramazanov M.R., Akhmedov R.A., Ramazanov M.M., Akhmedov E.R. Apparatus for measuring blood pressure in intramural and extraorgan vessels of hollow organs // Utility Model Patent RU 109391 U1 of 20 October 2011). Then, the vitality index of the suture strip was calculated according to the formula proposed by M.R. Ramazanov:

, где

where

D _p - intramural pressure at the mesenteric edge of the intestine;

D _b - intramural pressure at the mesenteric margin;

D _with - systemic pressure on the patient’s shoulder according to N.S. Korotkov (Ramazanov M.R. Intestinal cancer surgery. - Makhachkala, 2008. P.219-220).

Intramural pressure in the intestinal loop was 25/25 mm Hg, i.e., systolic and diastolic pressures were equal, which corresponds to passive non-viable blood pressure in the intestinal wall. In this case, the calculated intestinal viability index is set below unity. A small bowel resection was performed and an intestinal anastomosis was formed at intramural pressure in the proximal suture strip 100/62 mm Hg, and in the distal suture strip 98/60 mm Hg. at a system pressure on the shoulder of 120/80 mm Hg

In the mesentery of the intestine in the area of the anastomosis between the leaves of the peritoneum, the micro-irrigator is fixed with a nodal suture of the polysorb, and the other end of the micro-irrigator is brought to the front abdominal wall and is fixed to the skin with a nodular suture. In the postoperative period, the microirrigator is connected to a bottle of physiological saline 300 ml, which contained 3 ml of proserin. A solution of proserin was slowly dripped into the microirrigator during the day to the end. Thus, 3 ml of prozerin were taken per day for the first 7 days.

During the operation, a second microirrigator was inserted through the anterior abdominal wall and left near the intestinal anastomosis. Through the second microirrigator, 2 ml of synovial fluid was introduced, obtained by puncture of the knee joint in 10 ml of physiological saline. The second knee joint is punctured on the second day and the resulting synovial fluid in the amount of 2 ml in 10 ml of physiological saline is introduced into the abdominal cavity. One knee joint was punctured in the morning, and the second knee joint in the evening.

The next day, one hip joint was punctured in the morning, and the other hip joint in the evening. So continued treatment for the first 7 days after surgery. Together with synovial fluid, 1 gram of ampiox was administered. The patient was discharged home without complications. In the postoperative period, the patient was observed for 1 year. There were no manifestations of adhesive disease after examination of the intestine.

Patient A. suffered laparatomy due to adhesive intestinal obstruction. During revision of the organs of the abdomen, a swollen and edematous loop of the sigmoid colon was detected due to the formation of adhesions.

Intramural pressure in this intestinal loop was 30/20 mm Hg. Moreover, the calculated index according to the above formula was found below 1. Resection of the sigmoid colon was performed. An intestinal anastomosis is formed end to end with intramural pressure in the proximal suture strip 103/62 mm Hg, and in the distal suture strip 96/50 mm Hg. In the area of the intestinal anastomosis between the peritoneum sheets, one end of the microirrigator is fixed with the help of a nodular suture of the polysorb, and the other end is brought to the front abdominal wall and fixed with a nodular suture of the nylon ligature to the skin. The microirrigator is connected to a syringe and in 10 ml of physiological solution, dissolved 1 ml of proserin was administered three times a day slowly three times during the first 7 days.

During the operation, a second microirrigator was introduced through the anterior abdominal wall into the abdominal cavity and its end was left near the inter-intestinal anastomosis. A synovial fluid in an amount of 2 ml dissolved in 10 ml of physiological saline was injected through a second microirrigator. Synovial fluid was obtained in the morning from one knee joint, and in the evening from the second knee joint. On the second day in the morning, the patient was aspirated from one hip joint, and in the evening from the second hip joint. So continued the maintenance of synovial fluid up to 6 days.

Together with synovial fluid, 1 gram of ampiox was taken into the abdominal cavity. On day 7, microirrigators were removed. The patient recovered without complications. The patient was monitored for one year and examined periodically every 3 months. The manifestation of adhesive disease was not detected.

Claims (1)

A method for preventing commissural disease in the abdominal cavity after surgery, characterized in that a polyethylene tube is installed in the mesentery of the intestine and a solution containing proserin in a dose of up to 50 mg is administered, 2 ml of synovial fluid is added in addition to the inter-intestinal anastomosis, which is dissolved in 10 ml of physiological solution.