RU2608658C1 - Method for prediction of peritoneal adhesions in children suffered abdominal surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for early diagnosis of adhesive process in children. Peritoneal exudate is being examined. Sampling is being performed in 10–15 hours after the surgery, sample is being thermostated for 30–40 minutes at 37 °C, then the drop of the supernatant part of the exudate is being taken, microscopic examination is being performed by wedge dehydration, and if the language fields in the facie edge zone is indicated, peritoneal adhesions are diagnosed.

EFFECT: method enables fast and efficient detection of children with high risk of peritoneal adhesions for early and efficient placing on the anti-adhesive therapy.

1 cl, 2 ex, 4 dwg

Description

The invention relates to medicine, namely to laboratory diagnostics and can be used for early diagnosis of the adhesive process in order to conduct timely and targeted therapy.

Known methods for the early diagnosis of adhesions by activity of the level of interleukin-1 in the blood serum and tumor necrosis factor alpha. An increase in the levels of these indicators in the postoperative period indicates the formation of postoperative adhesions (Saba A., Godziachvili V., Mavani A., Silva Y. Serum levels of interleukin 1 and tumor necrosis factor alfa correlate with peritoneal adhesion grades in humans after mayor abdominal surgery. Am-Surg. 1998, Aug .; 64 (8): 734-6; discussion 737; USA).

However, these methods have limitations associated with the possible course of the inflammatory process of a different localization (tonsillitis, otitis media, combined injuries of other organs or tissues, etc.); as well as an individual reaction of the body to the injected drugs, which reduces the accuracy of the forecast.

Closest to the claimed method is a method for predicting adhesive disease in children who underwent surgery on the abdominal organs (RF patent 2269133, IPC G01 33/53, 2006), including the study of the body fluid. The essence of the method is that DNA is isolated from venous blood lymphocytes, genotyping of NAT2 polymorphism is carried out by polymerase chain reaction, and if one of the NAT2 genotypes is detected, the risk of developing peritoneal adhesion disease is predicted.

However, this method has several disadvantages associated with the high cost of the study, the complexity, the need for highly qualified personnel, and taking material for the study is an additional invasive intervention, undesirable for children.

The objective of the invention was to remedy these disadvantages, increase the reliability of the forecast, reduce the complexity, high cost-effectiveness of research and the use of non-invasive biological material. In addition, given the need for surgical treatment of acute conditions in children, it would be possible to conduct a study in medical institutions of any capacity and allow the appointment of early and effective anti-adhesion therapy.

To do this, in a method for predicting adhesive disease in children who underwent surgery on the abdominal organs, including the study of the body fluid, it is proposed to study peritoneal exudate as a body fluid. In this case, the sampling is carried out 10-15 hours after the operation, it is thermostated for 30-40 minutes at 37 ° C, after which a drop of the supernatant of the exudate is taken, microscopic examination is performed by the method of wedge-shaped dehydration and when language fields are detected in the marginal zone of the facies adhesive disease.

In the proposed method, the concept of altered reactivity of the child’s body with damage to the peritoneum and the creation of conditions conducive to the development of adhesions are based on the concept. So, under hypoxic conditions, the peritoneal protein changed as a result of the inflammatory-dystrophic process acquires the properties of an antigen, on which autoantibodies are produced in the body. When a resolving factor enters the sensitized body during surgery, adhesions occur as a manifestation of a delayed-type hypersensitivity reaction with aseptic inflammation and increased exudation into the abdominal cavity. The components of this inflammatory reaction enter the peritoneal exudate, which are manifested as a morphological marker of inflammation when the exudate is transferred to the solid state by the method of wedge-shaped dehydration. That is, the detection of morphological signs of inflammatory activity in the peritoneal exudate characterizes the presence of an autoimmune component, which under conditions of hypoxia promotes enhanced exudation, which leads to adhesion and fusion of the peritoneum with nearby organs.

The need for temperature control of the peritoneal exudate extracted from the drainage under physiological temperature conditions allows us to carefully divide the fibrous structures (which would occur during centrifugation) into two parts: saturated serous-hemorrhagic exudate in the lower part of the tube and lighter exudate - at the top. An inflammatory reaction in the form of linguistic structures (fields) in the exudate facies can be fixed only in the absence of serous-hemorrhagic masses.

In FIG. 1 shows a fragment of the facies of peritoneal exudate of a patient with appendicular peritonitis in the early postoperative period, and FIG. 2 - in the late postoperative period of patient K. (example 1). In FIG. 3 is a fragment of the facies of peritoneal exudate of a patient with appendicular peritonitis in the early postoperative period, and in FIG. 4 - in the late postoperative period, patient F. (example 2).

The method is as follows.

After 10-15 hours of the postoperative period, 1 ml of exudate is taken from the abdominal cavity organs into a test tube from the polymer tube of the abdominal drainage. Next, the exudate is placed in a thermostat at 37 ° C for 30-40 minutes. Then, a drop (20 μl) is taken from the top of the tube with exudate and placed on the surface of a glass slide, a wedge-shaped dehydration study is performed. After 16-18 hours of dehydration at a temperature of 25 ° C and a relative humidity of 55-60%, the facies is microscopic and, in the presence of lingual fields in the marginal region, adhesions are predicted.

Example 1

Patient K., 12 years old, was admitted with a clinical picture of an acute abdomen, peritonitis on the 4th day from the onset of the disease. Diagnosis: gangrenous-perforated appendicitis, diffuse peritonitis. After 3 hours of preoperative preparation, the patient was operated on. Peritoneal exudate from the patient was taken 10 hours after surgery. A study on the proposed method.

In the marginal zone of the facies of the resulting exudate, language fields were found in the form of flaming structures (Fig. 1, arrow 1).

Conclusion: adhesive disease is predicted.

To confirm the forecast made on the fifth day of the postoperative period, exudate was again taken from the patient and the study was conducted by the claimed method. It was found that in the exudate facies, against the background of “split” language fields (Fig. 2, arrow 1), a special substance of a grayish color — the so-called “gluten” (Fig. 2, arrow 2) was determined in some individuals, which indicates the occurrence of adhesions (Mukanov M.U. Acute adhesive intestinal obstruction due to visceroparietal adhesions. Abstract of thesis for the degree of Doctor of Medical Sciences, M., 1997, 45 pp.).

Conducting conservative anti-adhesion therapy to the patient began on the 6th day of the postoperative period, however, on the ninth day, the child revealed ultrasonographic signs of adhesive disease.

The patient underwent laparoscopic adhesolysis due to the ineffectiveness of conservative therapy.

Example 2

Patient F., 11 years old, was admitted with a clinical picture of an acute abdomen, peritonitis on the 3rd day from the onset of the disease. Diagnosis: gangrenous-perforated appendicitis, diffuse peritonitis. After 2 hours of preoperative preparation, the patient was operated on.

Peritoneal exudate from the patient was taken 15 hours after surgery. In the marginal zone of the facies of the resulting exudate, loose masses located in the form of coarse balls (fibrin deposits, Fig. 3, arrow 3) were determined. No fragments of language fields were found.

Conclusion: adhesive disease is not predicted.

To confirm the forecast made on the fifth day of the postoperative period, the patient was again taken exudate and a study was conducted by the claimed method. It was found that in the marginal zone of the facies, soft fibrous rings are determined (Fig. 4, arrow 4), which indicates the lysis of fibrinous deposits. No fragments of language fields were found.

The postoperative period in the patient proceeded without complications. Ultrasonographic signs of adhesive disease were absent.

Using the proposed method, peritoneal exudate was studied in 46 children with appendicular peritonitis. 11 out of 46 children were given a prognosis of adhesive disease. The course of anti-adhesion therapy for these patients was started earlier in the postoperative period. Ultrasonographic signs of adhesive disease were revealed in 7 of 11 children from 10-12 days after surgery. However, conservative therapy was ineffective in 4 out of 11. These patients underwent timely surgical intervention - laparoscopic adhesolysis. In the remaining 35 children who were not given a prognosis of adhesive disease, the treatment proceeded without complications until complete recovery.

The proposed method is highly economical, accessible for setting in laboratories of health facilities of any capacity and allows you to quickly and efficiently identify children with a high risk of developing adhesive disease for the early and effective administration of anti-adhesive therapy.

Claims (1)

A method for predicting adhesive disease in children who underwent surgery on the abdominal organs, including the study of the body’s body fluid, characterized in that peritoneal exudate is examined as the body’s body fluid, moreover, sampling is carried out 10-15 hours after surgery, thermostat it for 30-40 minutes at 37 ° C, then a drop of the supernatant of the exudate is taken, microscopic examination is performed by the method of wedge-shaped dehydration and when language fields are detected in the marginal zones Facies predict adhesion disease.

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