Method of prevention of postoperative complications after laparoscopic surgery

 

(57) Abstract:

The invention relates to medicine. A method for prevention of postoperative complications after laparoscopic procedures, including introduction to the place of operative intervention of a 5% solution of Mexidol in the amount of 2-6 ml 10-20 ml of saline. The invention allows to reduce the frequency of fibrinous growths.

The invention relates to medicine and can be used in gynecology for the prevention of postoperative complications after endoscopic operations.

One of the ways to prevent postoperative complications in gynecology is antibiotic therapy. Apply broad-spectrum antibiotics, intramuscularly, within 5-7 days after surgery (Kulakov C. I., N. Seleznev.D., Krasnopolsky Century. And. Operative gynecology. M, Medicine, 1990).

However, in recent years received numerous reports about the insecurity of this type of pharmacotherapy. The use of antibiotics contributes to the emergence of antibiotic-resistant strains of microorganisms, reduces immunity, often causes allergic reactions.

Prevention Polop the technical solution of sodium chloride, preparations of cellulose. Solutions fail by irrigation in the abdominal cavity after the execution of the main phase of the operation.

These drugs have proved highly effective in the prevention of adhesions, but have some side effects. Dextrans often cause side effects (anaphylactic shock, prolonged blood coagulation, pulmonary edema, an increase in the frequency of infectious complications), which significantly narrows the indications for use of these funds. Isotonic solution of sodium chloride has no anti-inflammatory action, which also reduces its effectiveness. Drugs derived from cellulose that can accumulate in organs and tissues and lead to the development of atheromatous certificatie, the development of anemia and leukopenia, so the use of these drugs in the clinic is limited.

The essence of the invention is that a method for prevention of postoperative complications during operative laparoscopy, by means of a single irrigation place of operative intervention 5% solution of Mexidol in the amount of 2-6 ml 10-20 ml of saline.

Mexidol is a water - soluble antioxidant structural analoguevoltage activity due to the normalization of processes of lipid peroxidation, stabilization of cell membranes. This drug stimulates the immune system and improves microcirculation. The peculiarity of its effect on the intracellular metabolism is the stimulation energy and plastic processes, detoxification, phagocytosis, synthesis of hormones.

The Mexidol contributes to the acceleration of reparative processes in tissues by reducing the inflammatory response, increase local immunity and suppression of free radical oxidation in the wound, reducing the risk of postoperative complications and the formation of adhesions, which improves the efficacy of surgical treatment.

The amount of preparation depends on the volume of surgical intervention. Mexidol is available in ampoules of 2 ml

The method is as follows.

During laparoscopy, after the main phase of the operation and toilet abdominal cavity, depending on the extent of surgical intervention, bred 1-3 capsules (2-6 ml) of Mexidol in 10-20 ml of saline. The solution obtained using the irrigator is led to the place of operative intervention (fallopian tubes, ovaries, uterus) by irrigation once. Immersed in a liquid bodies MSS="ptx2">

Example 1. Sick Cousin T. A., 27 years old, was admitted to the Department of operative gynecology 31.12.1998, complaining of nagging abdominal pain in the last 2 days, a delay of a menses for 10 days, spotting from the genital tract within 3 days, weakness, dizziness.

From the anamnesis: menstruation is 15 years, 6 days 28-30 days, moderate, painless. Of diseases: acute respiratory infections, childhood infections, chronic gastritis, in 1994, the operation concerning a cyst of the right ovary produced laparoscopic resection of right ovary. The Department was held on bimanual examination, ultrasound of the pelvic organs and puncture of the abdominal cavity through the posterior vaginal fornix. On the basis of the survey was diagnosed with impaired tubal pregnancy on the right. The patient was urgently taken to the operating: made operative laparoscopy - tubectomy right. During the operation revealed adhesions in the pelvis 2 degree - of adhesions. After using the toilet abdomen place of operative intervention irrigated 5% solution of Mexidol in the amount of 2 ml, diluted in 10 ml saline. In the abdominal cavity bylany period was uneventful. Discharged from hospital on the 5th day. In 2000, the patient's pregnancy, which resulted in timely delivery.

Example 2. Fomin N. In., 28 years old, was admitted to the Department of operative gynecology 01.11.1999, complaining of menstrual disorders by type of optimizarea, the absence of pregnancy within 7 years of regular sexual intercourse without contraception.

From the anamnesis: menstruation of 14 to 5 days 28-160 days, painless. Illness: acute respiratory infections, childhood infections; in 1995, operative laparoscopy, surgical removal of the ovaries, salpingolysis about syndrome SKA, adhesions pelvic 1 tbsp., infertility. In 1997, operative laparoscopy, surgical removal of the ovaries about sclerochiton degeneration of the ovaries, infertility; within 2 years had received conservative therapy. The Department conducted bimanual examination, ultrasound of the pelvic organs, preoperative clinical examination. Based on the data of anamnesis, results of objective examination diagnosis: syndrome sclerochiton reborn ovarian relapse. Primary infertility.

03.11.1999, the patient made operative laparoscopy, surgical removal of the ovaries, chromosulfuric is a, diluted to 20 ml of saline. In the abdominal cavity left microirrigation. On the 3rd day after the operation was carried out control laparoscopy. The postoperative period was uneventful. Discharged from hospital on the 5th day. In 2000, the pregnancy ended timely delivery.

Results were examined and carried out by this technique in 70 patients. The control group consisted of 24 patients in the placebo group included 12 patients, which is similar to patients treated with Mexidol, to the place of operative intervention were summed saline.

The average age of the patients was 29.8 years. The indication for operative intervention were as follows: in 39 patients infertility tubal-peritoneal Genesis, 25 polycystic ovary syndrome, 10 uterine fibroids and 14 ovarian cysts, external genital endometriosis 18. The volume of endoscopic intervention depended on the nature of the identified pathology.

Any complications or adverse reactions in the form of drug intolerance of the examined patients was not observed.

The effectiveness of this drug has been evaluated on the basis of macroscopic assessment of the pelvic organs is IDA in the peritoneal contents. The studies were conducted before surgery, at 1, 3, 5 day postoperative period using early control laparoscopy. Revealed that under the influence of Mexidol signs of aseptic inflammation in the wound were less pronounced than in the comparison groups. Frequency of formation of fibrinous growths in the study group was significantly lower.

Data cytological examination of peritoneal fluid showed that in the main group on the 2 days before, had experienced a decrease in the number of cells. The increase in the number of macrophages and lymphocytes was higher in 24,26,0% than in the comparison group.

Under the influence of Mexidol marked decline in the level of malondialdehyde in 3 days, and in the control group and the placebo group in 5 days.

Thus, the use of Mexidol in endoscopic operations in gynecology is an effective way to prevent postoperative complications and formation of adhesions.

Method of prevention of postoperative complications after laparoscopic procedures, including a single announcement of a medicinal product to the place of operative intervention, characterized in that the quality of drug COI is

 

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