RU2708455C1 - Method for assessing the risk of developing cosmetic defects in the postoperative wound in surgical patients with connective tissue dysplasia - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to surgery, and is a method of assessing the risk of developing cosmetic defects in the postoperative wound in surgical patients with connective tissue dysplasia, comprising determining the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX, characterized by the fact that the examination is performed one week before the operation, and one week after the operation, with reducing the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX after operation, a high risk of developing cosmetic defects in the postoperative wound is detected, otherwise, the risk of developing cosmetic defects in the postoperative wound in the surgical patients with connective tissue dysplasia is insignificant.EFFECT: invention provides reliable detection of a high risk of developing cosmetic defects in the postoperative wound in surgical patients with connective tissue dysplasia.1 cl, 1 tbl, 3 ex

Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to surgery.

State of the art

Connective tissue dysplasia is a group of systemic diseases of the connective tissue caused by impaired development of the connective tissue in the embryonic and postnatal periods and manifested by various pathological signs that are somehow related to defects in the fibrous structures and / or the main substance of the connective tissue. Differentiated forms of connective tissue dysplasia (Ehlers-Danlos, Marfan, Stickler syndromes, imperfect osteogenesis, etc.) are distinguished - diagnosis is possible due to the vivid clinical manifestations of hereditary syndromes, and undifferentiated forms of connective tissue dysplasia - diagnosis requires additional research methods due to the polymorphism of symptoms .

The presence of connective tissue dysplasia is one of the risk factors for complications during surgical treatment in all age groups [1, 2]. Currently, a number of techniques have been developed to assess the risk of developing long-term complications in operated patients with connective tissue dysplasia [3, 4]. However, to date, no methodology has been developed for assessing the risk of cosmetic defects in the area of postoperative wounds in surgical patients with connective tissue dysplasia.

The well-known "Method for predicting postoperative complications after hernia repair in the distant postoperative period" (RF patent for the invention No. 2644938 dated 02/14/2018). The method consists in conducting an ultrasound examination of the surgical intervention area and differs in that. that ultrasound is performed 6 months after surgery, the thickness of the fibrous capsule around the mesh implant is determined, and if its thickness is less than or equal to 0.3 cm, a smooth course of the wound process is predicted, and if the thickness is more than 0.3 cm, a complication in the form of inflammatory changes in the soft tissues and the preservation or development of pain [5]. From the literature it is known that all patients with hernias have certain manifestations of connective tissue dysplasia, which makes it possible to use this method as an analogue.

This is cheap, simple and minimally invasive, but has the following disadvantages:

- the study is carried out 6 months after the operation, when it is impossible to prevent the development of complications of the distant postoperative period,

- the thickness of the fibrous capsule varies from the age of the patient and from his physique, which can lead to a diagnostic error.

As a prototype, we adopted the description of the "Method for predicting the occurrence of postoperative complications" (RF patent for the invention No. 2170934 from 07.20.2001). The authors propose to predict the occurrence of inflammatory postoperative complications by determining the general clinical and biochemical parameters of blood, characterized in that they determine the rate of spontaneous HCT test, the number of leukocytes, the content of lipid peroxidation products and the number of segmented neutrophils in the patient’s blood, the sum of classification points S1 and S2 using the formulas S1 = -45.68 + 19.08X1 + 4.06X2 + 13.87X3 + 0.78X4, S2 = -38.71 + 15.11X1 + 3.62X2 + 10.82X3 + 0.74X4, where X1 is an indicator of a spontaneous HCT blood test of a patient; X2 - the number of leukocytes in the blood of the patient; X3 - an indicator of the content of lipid peroxidation products in the patient's blood; X4 is the number of segmented neutrophils in the patient’s blood, then the obtained points are compared and, with S1 greater than S2, the absence of postoperative complications is predicted, with S1 less than S2, the risk of postoperative complications is predicted [6].

Given that the implementation of this method takes into account indicators indicating the presence of a dysplastic process in the body, we can say that the use of this method allows predicting the development of postoperative complications in patients with connective tissue diplasia. However, this method has the following disadvantages:

1) indicators of the immune response are used, which can give a false positive or false negative result in patients who have had acute respiratory infections, in patients with chronic persistent infection and in patients with impaired immune systems;

2) the proposed formula is complex and requires accurate mathematical calculations;

3) conducting a spontaneous HCT test worldwide is considered an outdated method.

Thus, the development of a new method for assessing the risk of cosmetic defects in the area of postoperative wounds in surgical patients with connective tissue dysplasia is required. In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to improve the quality of medical services to the population, by identifying, among surgical patients with connective tissue dysplasia, patients with a high risk of cosmetic defects in the area of postoperative wounds.

The technical result of the method is to provide reliable identification of patients with a high risk of cosmetic defects in the area of postoperative wounds in surgical patients with connective tissue dysplasia, by analyzing the clinical and biochemical patterns of the development of the wound process, against the background of connective tissue dysplasia.

The implementation of the invention

The claimed technical result can be achieved as follows:

- A week before the planned operation, a biochemical blood test is taken from the patient, including determination of the level of matrix metalloproteinase I (ng / ml) and the level of matrix metalloproteinase IX (ng / ml).

- A week after the operation, the study is repeated.

- For patients with an active dysplastic process that negatively affects wound healing, a decrease in the level of matrix metalloproteinase I (ng / ml) and the level of matrix metalloproteinase IX (ng / ml) after provocation (surgical intervention) is characteristic. If in the second study there is a decrease in the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX, then a high risk of cosmetic defects in the area of the postoperative wound is revealed.

- If the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX do not change after surgery, the dysplastic process is in the cold stage and the risk of cosmetic defects in the area of the postoperative wound is negligible.

The novelty of the proposed method is that:

- For the first time, to predict the risk of cosmetic defects in the area of a postoperative wound, such stable indicators as the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX are used.

- For the first time, the phenomenon of unidirectional changes in stable clinical and biochemical blood parameters (matrix metalloproteinases I and IX) is used. This phenomenon is characteristic only for a pronounced active dysplastic process in the body.

- For the first time, the risk of cosmetic defects in the area of a postoperative wound is detected in the early stages when the patient is under the supervision of a surgeon treating him.

- The study is carried out using ready-made factory laboratory test systems, which reduces the risk of an erroneously overestimated or erroneously underestimated analysis result.

Distinctive features of the method:

- the study is carried out a week before the operation and a week after the operation,

- calculate the dynamics of the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX,

- with a decrease in the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX after surgery, a high risk of cosmetic defects in the area of the postoperative wound is revealed, otherwise the risk of cosmetic defects in the area of the postoperative wound in surgical patients with connective tissue dysplasia is insignificant.

The proposed method is illustrated by the following examples [5].

A biochemical blood test was performed in 257 patients at the Clinical and Diagnostic Laboratory Clinic and Polyclinic of the SBEI HPE of the Tver State Medical University of the Tver Ministry of Health, License No. FS-69-01-000780 dated 04/23/2015. The level of matrix metalloproteinase I and the level of matrix metalloproteinase IX were determined. Sample 1 - 1 week before surgery, sample 2 - 1 week after surgery.

List of references

1. The quality of life of patients with signs of connective tissue dysplasia ten years after surgical treatment / Murga VV, Ivanov Yu.N., Arinchev RS, Rybakova MV, Zhukov SV // Journal of scientific articles Health and education in the XXI century. 2016. Vol. 18. No. 2. S. 314-317.

2. Long-term results of surgical treatment of patients with signs of connective tissue dysplasia / Murga VV, Ivanov Yu.N., Arinchev RS, Rybakova MV, Zhukov SV // Modern problems of science and education. 2017. No5. S. 18.

3. Age-related dynamics of the diagnostic value of objective examination data to assess the risk of complications in the treatment of surgical pathology in patients with connective tissue dysplasia / Murga VV, Arinchev RS, Zhukov SV // Journal of scientific articles Health and education in the XXI century. 2017. Vol. 19. No. 7. from. 89-91.

4. The program for assessing the quality of the provision of medical services to patients with a surgical profile / Derbenev DP, Zhukov SV, Kolgina N.Yu., Korolenko MK, Rybakova MV, Rogachevskaya AS, Rogachevsky V.I., Sadov D.V., Sokolova O.N., Samoilova N.Yu., Shatokhina N.A. // Certificate of registration of the computer program RUS 2018660196 07/16/2018

5. A method for predicting postoperative complications after hernia repair in the distant postoperative period // RF patent for the invention No. 2644938 dated 02/14/2018

6. A method for predicting the occurrence of postoperative complications // RF patent for the invention No. 2170934 from 07.20.2001

Claims (1)

A method for assessing the risk of cosmetic defects in the area of a postoperative wound in surgical patients with connective tissue dysplasia, which consists in determining the level of matrix metalloproteinase I and the level of matrix metalloproteinase IX, characterized in that the study is carried out a week before surgery and a week after surgery, with a decrease in the level matrix metalloproteinases I and levels of matrix metalloproteinases IX after surgery reveal a high risk of cosmetic defects in the postoperative area wounds, otherwise the risk of cosmetic defects in the area of the postoperative wound in surgical patients with connective tissue dysplasia is negligible.