RU2736164C1 - Method for preventing adhesion in abdominal cavity after laparoscopic surgical operation in experiment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to intestinal surgery. Method for preventing adhesion in the abdominal cavity following a surgical procedure consists in administering Viscoplus 1 % artificial synovial fluid in an abdominal cavity in amount of 0.04 ml per 1 kg of body weight in 20 ml of physiologic saline once a week.

EFFECT: invention provides wound healing of the serous surface of the intestine by exposing proteins and increasing microcirculation in the intestinal wall.

1 cl, 2 tbl, 2 ex

Description

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

Known analogues: a method for the prevention of adhesion, proposed by M.I. Nesterov, M.R. Ramazanov (2534844 RU), which consists in the following: after laparotomy under anesthesia, a polyethylene tube with a diameter of 2 mm is inserted into the mesentery of the intestine. A solution containing 50 mg of proserin is injected through the installed tube. Additionally, synovial fluid is injected, 2 ml, dissolved in 10 ml of saline with an antibiotic.

This analogue has the following disadvantages: in case of joint inflammation, it is impossible to puncture the joint and collect articular fluid, after a joint puncture, it may become inflamed and take medications, pain syndrome after a joint puncture is not excluded, moreover, some patients refuse to puncture large joints.

The known method for the prevention of adhesion, proposed by R.A. Zhenchevsky (1989).

The prototype of the proposed method for preventing the formation of adhesions in the abdominal cavity after laparoscopic surgery is a method for the prevention of adhesions proposed by R.A. Zhenchevsky (1989), which consists in the following: fibrinolysin, trypsin, hydrocortisone, dissolved in hemodesis, are introduced into the abdominal cavity through a microirrigator.

Criticism of the prototype

The prototype method proposed by R.A. Zhenchevsky, has the following disadvantages:

1. Local use of fibrinolytic agents is categorically contraindicated after the formation of interintestinal anastomoses after bowel resection, since these agents counteract the healing of wounds of the serous integument of the intestine, in particular, the healing of interintestinal anastomoses.

2. After applying this method, good results were only in 77.4% of postoperative patients.

3. Possible intestinal atony, which contributes to the occurrence of adhesions.

Purpose of invention

The aim of the present invention is to prevent adhesion after laparoscopic surgery on the abdominal organs.

The essence of the invention.

In an experiment, laparoscopy was performed on 10 rabbits of the control group under general anesthesia. Intramural blood pressure in the wall of the small intestine was investigated in the norm according to the method of M.Z. Sigala (Sigal M.Z. Transillumination in operations on hollow organs. - Moscow, "Medicine", 1974, 183 p.) By the apparatus proposed by the patent RU2581266 dated 20.04.2016). Then the scarification of the serous surface of the small and large intestines was performed according to A.I. Bezhin et al. (2001). In the control group of rabbits, drugs to prevent adhesions were not injected into the abdominal cavity. The abdominal cavity was sutured and the rabbits were observed. All rabbits were found to have adhesions in the abdominal cavity in the postoperative period after 1 month with minimally invasive laparotomy. Investigated the blood pressure in the intramural vessels of the small intestine and the oxygen saturation of hemoglobin in arterial blood.

After the formation of adhesions in the intestinal wall, a statistically significant (P <0.005) decrease in blood pressure and oxygen saturation of arterial blood hemoglobin was established (Table 1).

In an experiment on 10 rabbits of the main group, laparoscopy was performed under general anesthesia, during which blood pressure in the intestinal wall and oxygen saturation were examined. Then scarification of the serous surface of the small and large intestine was performed according to A.I. Bezhin et al. (2001).

In order to prevent the formation of adhesions, artificial synovial fluid was used viscoplus. In the abdominal cavity was injected artificial synovial fluid viscoplus 1% 0.04 ml per 1 kg of animal weight, diluted in 20 ml of saline. Viscoplus was introduced through a microirrigator installed in the area of surgery. Artificial synovial fluid viscoplus in this dosage was injected into the abdominal cavity once a week.

In the postoperative period, intestinal contractions were examined with Sobakin's electrogastrograph, which showed sufficient physiological intestinal contractions. This confirms the effectiveness of the proposed method.

Were investigated the results of the method for the prevention of adhesions. After 1 month, a minimally invasive laparotomy was performed under anesthesia and blood pressure in the vessels of the intestinal wall and saturation were examined. In the postoperative period of the main group (10 rabbits), which were injected with Viscoplus, a statistically significant increase in blood pressure in the vessels of the intestinal wall and in the oxygenation of hemoglobin of arterial blood was established (Table 2). The goal of the present invention was achieved: the intestinal motility improved significantly and the amplitude of intestinal contractions on the enterogram increased.

Features of the invention that differ from the prototype

1. With the proposed method in the abdominal cavity injected artificial synovial fluid viscoplus 1% 0.04 ml per 1 kg of animal weight, dissolved in 20 ml of saline in the area of surgery once a week. This drug promotes sliding in the abdominal cavity of intestinal loops and healing of intestinal wounds due to the protein content, in contrast to the method of R.A. Zhenchevsky, in which the enzymes trypsin, fibrinolysin are introduced, which counteract the healing of intestinal wounds due to the destruction of the scar along the suture line.

2. With the proposed method for preventing adhesion, the introduction of artificial synovial fluid viscoplus into the abdominal cavity improves microcirculation of the suture strip, since this artificial synovial fluid increases intramural blood pressure and oxygenation of arterial blood hemoglobin in the intestinal wall in the area of interintestinal anastomosis, in contrast to the prototype. According to the prototype method R.A. Zhenchevsky, enter the enzymes trypsin, fibrinolysin, which does not increase the intramural pressure of the intestine.

According to the method of R.A. Zhenchevsky, postoperative paresis is possible, since drugs that reduce the intestine are not administered. On the contrary, with our proposed method, postoperative paresis is not observed, since viscoplus increases blood pressure in the intramural vessels of the intestine and promotes peristaltic bowel movement.

Artificial synovial fluid viscoplus promotes healing of wounds on the serous surface of the intestine, which is not observed with the method of R.A. Zhenchevsky. On the contrary, trypsin and fibrinolysin, which are used according to the prototype method, destroy scars in cases of formation of an interintestinal anastomosis.

Examples of specific execution of the method

Example # 1 from Experimental Research Journal # 3.

Laparoscopy was performed on a 5 kg French Sheep rabbit under general anesthesia, and blood pressure in the vessels of the small intestine was examined, as well as saturation with a device developed by us. At the same time, normal blood pressure in the intramural vessels of the small intestine was found to be 56/42 mm Hg. at a systemic pressure of 115/70 mm Hg, and the oxygen saturation of arterial hemoglobin was 86%. Then scarification of the serous surface of the small and large intestine was performed according to A.M. Bezhin et al. (2001).

In the area of wounds in the abdominal cavity, a microirrigator with a diameter of 2 mm is installed. The tube is fixed with polysorb No. 3 absorbable suture material.

The other end of the microirrigator is brought out to the anterior abdominal wall and is fixed to the skin with an interrupted suture.

The laparoscope has been removed. Stitches on the wound.

Artificial synovial fluid viscoplus in the amount of 1% -0.04 ml per 1 kg in the composition of 20 ml of physiological solution was introduced once a week through a microirrigator into the abdominal cavity to the place where there are small intestine wounds.

For anesthesia in the postoperative period, 0.3 ml of 50% analgin solution and 0.3 ml of 1% diphenhydramine solution were injected intramuscularly twice a day. 50 ml of 5% glucose solution was introduced under the skin for the purpose of parenteral nutrition.

There were no complications after the operation. The rabbit has recovered. After 1 month, a minimally invasive laparotomy was performed again under anesthesia, and the blood pressure in the wall of the small intestine was examined, which was 68/52 mm Hg. at a systemic pressure of 120/70 mm Hg, and the oxygen saturation of arterial blood hemoglobin is 90%.

Here is an example # 2 from Experimental Research Journal # 2.

Laparoscopy was performed on a White Giant rabbit weighing 6 kilograms under general anesthesia and a study of blood pressure in the vessels of the small intestine and saturation were carried out. The blood pressure in the intramural vessels of the small intestine was normally 55/40 mm Hg. at a systemic pressure of 118/70 mm Hg, arterial oxygen saturation - 88%. Then the small intestine was scarified according to A.M. Bezhin et al. (2001). A microirrigator with a diameter of 2 mm is installed in the abdominal cavity. The tube is fixed with polysorb No. 3 absorbable suture material.

The other end of the microirrigator is brought out to the anterior abdominal wall and is fixed to the skin.

Artificial synovial fluid viscoplus 1% 0.04 ml per 1 kg of animal weight in 20 ml of physiological solution was introduced into the abdominal cavity through a microirrigator once a week.

0.1 mg per 1 kg of weight of cefotaxime and 0.3 ml of 50% analgin and 0.3 ml of 1% diphenhydramine were injected intramuscularly for pain relief. 60 ml of 5% glucose was injected under the skin on the first day after surgery.

In the postoperative period, once a week, artificial synovial fluid Viscoplus 1% -0.04 ml per 1 kg of body weight was injected in 20 ml of saline into the abdominal cavity.

After 1 month in the postoperative period, a repeated minimally invasive laparotomy under anesthesia was performed.

Blood pressure in the wall of the small intestine and saturation were re-examined, which turned out to be higher than normal (65/50 mm Hg at a systemic pressure of 120/70 mm Hg, oxygen saturation of hemoglobin in arterial blood was 92%).

The advantages of the proposed method are as follows.

1. According to the proposed method, artificial synovial fluid, viscoplus, is introduced into the abdominal cavity, which promotes sliding in the abdominal cavity of intestinal loops and healing of wounds in the abdominal cavity due to the protein content.

2. According to the proposed method, postoperative paresis is not observed, since viscoplus increases blood pressure in the intramural vessels of the intestine and promotes peristaltic bowel movement.

4. Applied artificial synovial fluid viscoplus increases intramural pressure in the suture band and oxygenation of arterial blood hemoglobin, promotes healing of the anastomosis.

The proposed method for preventing the formation of adhesions was applied experimentally in 10 rabbits in the postoperative period after modeling the adhesion process according to A.I. Bezhin et al. (2001).

In the postoperative period, adhesion was not found in 10 rabbits of the main group.

Studies of blood pressure in the vessels of the intestinal wall and saturation of hemoglobin in arterial blood were carried out. These studies showed that after 1 month, blood pressure in the intestinal wall and blood oxygen saturation increased statistically significantly (P <0.005) (Table 2).

The pain syndrome of the knee joints in the patient is excluded, the inflammation of the joints in the patient is excluded, since the puncture of the joints is not performed.

Sources of information

1. Bezhin, A.I. Choice of a method for modeling adhesive disease / A.I. Bezhin, V.A. Lipatov, V.V. Grigoryan // Materials of the Second Russian Scientific and Practical Conference "Actual Problems of Ecology, Experimental and Clinical Medicine" / Ed. F.S. Avdeeva, I.A. Andreeva, P.A. Yakovleva. April 26-27, 2001 - Orel, 2001 .-- S. 52-53.

2. Zhenchevsky R.A. Adhesive disease. - M .: "Medicine", 1989. - S. 192 - prototype.

3. Nesterov M.I., Ramazanov M.R., Magomedov A.M., Aliev E.A., Abdurakhmanova Z.M. Patent "Apparatus for the study of vessels of hollow organs during surgical operations" RU 2581266 C2 from 20.08.2016. Bul. No. 23.

4. Nesterov M.I., Ramazanov M.R. Patent "Method for the prevention of adhesive disease in the abdominal cavity after surgery" RU 2534844 C2. Published on December 10, 2014, Bul. No. 34.

5. Sigal M.Z. Transillumination in operations on hollow organs. - Moscow: "Medicine", 1974. - 183 p.

Claims (1)

A method of preventing adhesion in the abdominal cavity after surgery, which consists in the fact that artificial synovial fluid viscoplus 1% is injected into the abdominal cavity in an amount of 0.04 ml per 1 kg of weight in 20 ml of saline once a week.