SU1816433A1 - Method of diagnostics of commissural process - Google Patents

Description

The invention relates to medicine, specifically to surgery, and relates to methods for determining the adhesive process that develops after operations, in particular on the organs of the abdominal cavity, in individuals with an individual tendency to adhesions.

The purpose of the invention is to reduce the morbidity of the diagnostic process and to increase its effectiveness.

The goal is achieved by indirect determination using a skin test of the individual characteristics of the vessels of the peritoneum in individuals prone to adhesions. In these patients, as a result of an operative trauma and due to its irritation of the sympathetic nerve, an infusion of relatively pronounced and prolonged spasm of the vessels, leading to ischemia, followed by clumping of its leaves and adhesions. The role of ischemia in adhesion formation is confirmed by the experimental clinical data of a number of researchers. Spasm of spread to blood vessels of the skin, innervated by the same sympathicus. The reaction of the vessels of the skin is determined by the following breakdown, which consists in determining the intensity and prevalence of hyperemia and a change in skin temperature at the site of determination.

Previously, the body temperature is determined at the sample site. For this, a universal electronic voltmeter V7-27A was used. The skin of the forearm from the inside at the border of the distal and middle third is treated with alcohol. In an 1-2 ml syringe with a thin (insulin) needle, an equal amount of a 0.9% sodium chloride solution is collected and distilled. water to obtain a 0.45% solution. 0.2 ml of solution is injected intradermally to form a crust. The skin puncture site is re-moistened with alcohol. After 3 minutes, the reaction is studied.

The degree of intensity of the vascular reaction is divided into four types.

1816433 A1

The first (weak). Around the lemon peel at a distance of 1.5 cm from its edge, a barely noticeable redness is determined. The temperature in this place does not exceed the initial temperature or it is below 6.1 ° C.

The second (moderate). Distinct redness at a distance of 2.5 cm. The temperature rises to 0.5 ° C.

The third (expressed). Distinct by. blushing at a distance of up to 3.5 cm. Separate foci of redness are possible (one or two). The temperature exceeds the initial temperature up to 0.8 ° C.

Fourth (pronounced). Intense redness at a distance of 3.5 cm. The formation of several separate foci is possible. The temperature rises to 1 ° C.

In patients with an accurately diagnosed (during repeated operations) diagnosis of commissural disease · in all cases, a skin test yielded results corresponding to the first or second type of vascular reaction. In patients in whom, despite the previous surgical interventions, repeated adhesions were not detected during repeated gluttony, the skin test gave data that allowed them to be attributed, as a rule, to the third and fourth type of vascular reactivity.

That. that the results of the skin test and the vascular reaction are independent of surgical interventions, but indicate the tendency to adhesions or their presence on the individual properties of the body, and pronounced or pronounced - the absence of tendency to adhesions or their absence.

PRI me R 1. Patient L., 1938 (I. 6. No. 4867) was admitted to the General Surgery Clinic for planned surgical treatment for peptic ulcer of the duodenum. A year ago suffered suturing. perforated ulcers. During the operation (resection of the stomach), a pronounced adhesion process was found. Before the operation, a skin test was performed. Around, the crusts at a distance of about 1.5 cm are barely noticeable redness with fuzzy edges. The skin temperature at the site of redness does not change10 obstruction of the tumor origin. A skin test was performed before discharge from the hospital. It was the same as for discharge after • an appedectomy (third type). Distinct redness at a distance of 3 cm with a temperature increase of 0.6 ° C.

Skin test results were studied in 44X patients with an established adhesive process. Of these, 38-adhesions were found in operations, in 6 - confirmed by studying the protocols of previous operations. Of the 38 operated in 8, the operation was performed for the first time or repeatedly for commissural intestinal obstruction;

30 were operated on for other diseases.

Another group of patients in the amount of 48 people who made the same test and studied its results - people who did not have adhesions. Of these, 31 patients, in whom the absence of adhesions was established during the repeated operation performed by us, and 17 patients who, after the previous operation, had no signs of adhesions · disease.

Two cases were assigned to a subgroup of 31 patients, where individual minor strata were found that did not violate intestinal motor function.

Mandatory conditions for the study of samples in patients of both groups were: a relatively satisfactory condition, normal temperature and hemodynamics. The asymmetry of the vascular reaction observed in about a quarter of the case does not go beyond the limits of the same type.

Of the 44 patients with adhesive disease, there were 21 men and 23 women. Age composition: 2 years old, 2, 30–18 people, 40–12, 50–10, and 60–2. ’

Results of a skin test in patients with adhesive disease: 18 patients had the first type of reaction, in 26 - the second.

Results of a skin test in individuals free of adhesions: in 4 - the second type, in 31 - the third, in 13 - the fourth.

Of the 4 patients with the second type of vascular reaction (three were from the subgroup (34 ° C). The first type was 50-17), in which the absence of a vascular reaction was suggested.

adhesions on the basis of the absence of any complaints from the abdomen after a previous operation. In one patient with a second type of vascular reaction, no adhesions were found with laparotomy.

The experience of studying the characteristics of the reactivity of skin vessels in patients with adhesions and without them, accumulated over several years, allowed us to come to the following conclusions. In patients with individual

PRI me R 2. Patient B., 1938 (and. 'B. No. 3782) was admitted to the clinic of general surgery with the phenomena of partial intestinal obstruction. Six months ago, he was operated on for appendicular diffuse peritonitis. Appedectomy with drainage of the abdominal cavity produced laparotomy for increasing intestinal obstruction. There is no adhesion process.

(3 tendency to postoperative adhesions in response to intradermal administration of 0.2 ml of a hypotonic 0.45% aqueous solution of sodium chloride, the vascular reaction, determined by the distribution, degree of redness and change in skin temperature, is insignificant. The severity of adhesions in 4 cases in the second the type of vascular reaction was greater than in 4 cases where the first type took place.In patients without an individual tendency to adhesions, the same test is usually accompanied by a relatively more pronounced vascular reaction according to the same parameters.

Thus, the practical value of the proposed test lies in the fact that its application makes it possible to determine the tendency of unoperated people to adhesions, as well as diagnose adhesions in those operated on the abdominal cavity. Therefore, with the help of the test, you can preliminarily determine the share of risk of gluttony, which does not depend on the morbidity, infection or repetition of ⁴ interventions. The importance of these factors in the development of adhesions is not negated.

Probably they, along with an individual inclination and in combination with it, determine the intensity of the adhesive process in each individual case. The pre-established tendency to adhesions should be taken into account when developing indications for surgery and the implementation of preventive measures to prevent the adhesion process. _t

The technique is simple, it can be used in every medical institution with the appropriate device for quick measurement of skin temperature.

Claims (2)

The claims A diagnostic method for adhesions, characterized in that, in order to reduce the invasiveness of the method, intracutaneous administration of 0.2 ml of a 0.45 ^ aqueous solution of sodium chloride is carried out on the palmar surface of the forearm, followed by analysis of the size of the redness of the skin ·. around the resulting crust, as well as skin temperature at the site of redness and with a diameter of redness from the edge of the crust, to 2.5 cm and a temperature gradient of up to 0.5 ° C - in comparison with the initial diagnose adhesion process. ·