The way to prevent intraoperative drying of the peritoneum during operations on the organs of abdominal cavity

 

(57) Abstract:

The invention relates to medicine, in particular to surgery, and can be used for the prevention of intraoperative drying of the peritoneum during operations on the abdominal organs. After opening the abdominal cavity in the visceral and parietal peritoneum in the area of the proposed intervention are 1% methylcellulose gel. The method prevents the development of adhesions.

The invention relates to medicine, in particular to abdominal surgery.

Closest to the claimed solution is a method of preventing the drying of the peritoneum with the help of her shelter wipes, which is pointed out by many authors and is widely used in practical surgery: at various stages brunobeast operations loop of intestine large wrap sterile pad soaked in saline solution or furatsilina. (Handbook operating and dressing sisters. Edited by Komarova B. D. - M., 1985. - S. 245).

The main disadvantage of this method is quick drying abdominal integument of abdominal cavity and the abdominal wall, the development of adhesions.

The objective of the invention is esoterist, resulting from drying of the abdominal integument.

This object is achieved in that after opening the abdominal cavity, peritoneal cover in the area of the alleged interference is treated with 1% methylcellulose gel.

Methylcellulose is a simple water-soluble cellulose ether and methyl alcohol. It is a white, slightly yellowish powder granulated or fibrous product is odorless and tasteless, soluble in cold water, benzyl alcohol, methylsalicylate, in mixtures of lower alcohols with water, hot glycols, glycerine, polyglycols and their ethers, and not soluble in hot water. Aqueous solutions of methylcellulose stable at pH 2-12, have good surface-active properties.

Manufacturing technology of gel on the basis of methylcellulose is the following. The calculated amount of methylcellulose pour purified water heated to 80-90oSince, in the amount of 1/2 of the mass of methylcellulose. The mixture is left to swell. After lowering the temperature of the mixture up to 18-20oTo add the remaining water is purified with a room temperature, mix thoroughly until smooth. The resulting gel was filtered>/P>The gel based on methylcellulose pseudo-plastic, has no toxicity, resistant to the action of chemical reagents, organic solvents, has biological stability, physiologically inert.

When the gel methylcellulose on the peritoneal covering of authorities, he, having good wetting ability, covers the abdominal organs and the inner surface of the abdominal wall, preventing them from drying out during the operation.

The method is as follows.

In progress laparotomic operation after opening the peritoneum, the revision of the abdominal cavity and determine the extent of surgical intervention on the peritoneum of those bodies that will be subject to drying during surgery, apply sterile 1% methylcellulose gel. In the wound appears organ or part, which is expected to be operational techniques and the peritoneum which will be exposed to traumatic agents (including drying). The peritoneum is processed soaked in gel "loose" topfarm (cloth etc), with a spatula, etc.

An example of a specific implementation.

To study the protective effect of methylcellulose gel of Ilatov experiments were performed hygienic studies of microclimate parameters operating, influencing the evaporation of liquids from biological tissues, including drying of the peritoneum (temperature, humidity and air velocity), which do not exceed the allowable temperature 23oC, relative humidity 46,62%, air velocity of 0.03 m/s To determine the criteria for evaluating the severity and extent of adhesions mathematical modeling of phenomena and proposed automated assessment of severity of adhesions by the method of semantic differential.

At the first stage in the acute experience under ether anesthesia, rats were Manterola intestinal loops in laparatomy the wound and examined the drying time intact visceral peritoneum, peritoneum, covered with a damp cloth, and peritoneum, treated with 1% methylcellulose gel. In the first case it was 6,40,5 min, in the second 18,73,6 min, and in the third 53,04,1 minutes And after visually defined drying of the gel film is formed, covering the peritoneum. Film of methyl cellulose protects the peritoneum from drying out, which is confirmed histologically.

At the second stage in sterile conditions under ether anesthesia, rats were performed a median of laperla was maintained outdoors operating within 30 minutes. In the first series was produced only drying loops (control). In the second series misteriously the intestine was wrapped in sterile gauze moistened in saline solution. In the third series misteriously loop of intestine were processed with 1% methylcellulose gel and also was positioned outdoors for 30 minutes. Then the intestinal loop was upravljalci in the abdominal cavity, which was usuals tightly. Deaths during and after operations in none of the series was not observed.

The animals were sacrificed experiment in 14 days by overdose of ether anesthesia. Before the conclusion of the animals was performed blood sampling for the overall analysis. Was conducted the autopsy of the animal. Opened the abdominal cavity, assessed the severity of adhesions visually (the distribution process, the deformation of organs, bowel distention, presence of effusion in the abdominal cavity) and using the automated method of semantic differential (on a scale). Produced photographing of the object under study. The abdominal organs were subjected to histological examination according to the standard technique with a fill of drugs in paraffin, colouring slices geneticheski: calculated average values (arithmetic mean, mode, median), defined by the maximum and minimum value, standard deviation, reliability of results.

The severity of adhesions, which was estimated by the method of semantic differential in points, in the first series was 3,880,21; in the second series 1,80,61; and in the third 0,090,02. This indicates a pronounced protective effect of methylcellulose gel in relation to the peritoneum. The General condition of the animals, the results of clinical blood analysis, indexes leukocyte all runs were within the normal reaction, and statistically significant differences of these parameters between the control and experimental groups, we have not recorded. Histological examination authentically revealed reduced proliferative and infiltrative processes. From the first to the third series decreases infiltration by histiocytes and fibroblasts and polymorphonuclear leukocytes. Decreases the number of threads of fibrin and "young" connective tissue fibers in slices prepared from total drugs abdominal cavity complexes and separate adhesions.

The results of the research indicate a significant protective effect of gel methylcellulose the odik shelter peritoneal wipes which are to contact the peritoneum with wet gauze, drawing on the abdominal organs and the parietal peritoneum of methylcellulose gel not only protects the peritoneal cover from drying out, mechanically without damaging it, but it also has other protective properties (mechanical protection from damage, adsorption of pathological fluids, aggressive mediators, reducing the intensity of pulsation with interoreceptors peritoneum, and so on); 2) gel-based methyl cellulose retains its effects and after intervention; 3) 1% methylcellulose gel has protection against drying and trauma peritoneal properties as well as high bioinert.

Advantages of the proposed method are ease of use, reliable prevention of damage to the peritoneum drying and the absence of trauma. In addition, this method has several other advantages over other ways of preventing the drying of the peritoneum.

Therefore, the proposed method for the prevention of intraoperative drying peritoneum allows to significantly reduce the intensity of postoperative adhesions and complications associated with the development of adhesive disease.


 

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