Method of hemostasis at adenomectomy

 

The invention relates to medicine, namely to urology. Enter Epsilon-aminocaproic acid palcapsule infiltration 10 ml in each fraction of the prostate. When expressed, the average share in it enter another 5-10 ml of Epsilon-aminocaproic acid. The method allows to increase the effectiveness of local hemostasis at adenomectomy prostate cancer. 1 C.p. f-crystals, 1 table.

The invention relates to medicine, and urology. The closest technical solution is a method of hemostasis at adenomectomy by introducing Epsilon-aminocaproic acid (hereinafter EACH) intravenous and oral (Debbas N. M. The use of an inhibitor of fibrinolysis Epsilon-aminocaproic acid for the removal of benign prostatic hyperplasia. Abstract. Diss... Kida. the honey. Sciences, M, 1970). Its disadvantages are: 1) lack of local gemostaticescoe actions as entering the bloodstream, the drug for 1 hour at 50% excreted from the body, not having time with the blood flow to actively accumulate in the place of postoperative bleeding, resulting in no long-term local hemostatic effect; 2) the need for additional administration of a drug for the implementation of the thromboembolic complications in patients with risk groups (the elderly), subjected to this operation.

The goal of our development was to increase the efficiency of local hemostasis, reduced drug load on the patient's body and the exclusion of the risk of thrombohemorrhagic postoperative complications when using EACH.

The proposed methodology is as follows.

After the autopsy and revision of the bladder during the operation of adenomectomy syringe with a long needle with a volume of 20 ml palcapsule was administered 10 ml EACH in every fraction of cancer, and as expressed by the average share another 5-10 ml into it depending on its severity, then made blunt bimanual husking benign prostatic hyperplasia. The volume of injected drug experienced picked up based on the ratio of volume/efficiency.

Comparative analysis of the methods used with the prototype shows that the inventive method differs from the known fact that for hydraulic cavity tissue and simultaneous implementation of local hemostasis is used EACH.

This goal is achieved intraoperative podkapsulnaya introduction EACH with infiltration of its capsule adenoma of the prostate and surrounding tissues that long holds in postoperative blood, and urine enzymes that promote the lysis of blood clots, significantly reducing the activity of the latter. This is especially important for the wound surface after adenomectomy, located on the border of environments, blood/urine.

EACH known as pharmacological drug approved for use in Russia, which is low-toxic substance, inhibiting fibrinolysis method of blocking plasminogen activators and partial inhibition of the action of plasmin, providing specific hemostatic effect in surgical interventions, which increased fibrinolytic activity of tissues, including when adenomectomy. Currently, it is used to stop bleeding of various origins techniques of intravenous and oral administration (Mashkovsky, M. D., M., 1986, S. 36-37).

At the present time, neither the patent nor in the scientific literature is not known application EACH for infiltration of local hemostasis at adenomectomy, combined with hydraulic preparation of tissue that allows to make a conclusion on the conformity of the proposed technical solution the criterion of "novelty". The features distinguishing the claimed from the prototype, not detected during the study of this and related areas of technology and to sleazing the following: hydraulic preparation of tissues, allowing less traumatic with simultaneous compression of the distal vessels injected into the tissue under the pressure of the drug to produce adenomectomy that allows to significantly reduce intraoperative blood loss, combined with local infiltration method of hemostasis allows to achieve an effect greater than expected from a simple summation of effectiveness that allows you to evaluate it as a "sverhsummarny the effect of the proposed method.

At the same time using this method EACH acquires new properties as hemostatic, actively influencing enzymes urine with fibrinolytic property with a significant reduction in their activity, which allows to consider the use of this technique with respect to the input palcapsule drug (AACC) as giving her "new property" in comparison with the conventional methods (intravenous and oral).

Example 1 Patient D. , 72 years old, diagnosis: benign hyperplasia (adenoma) of the prostate. When entering coagulogram fibrinolytic activity (FA) is reduced to 1.15 times, prothrombin increased by 7%, other values are within normal limits, in the clinical analysis of blood hemoglobin - 143 g/l P. the ora of novocaine. Intraoperative blood loss was 165 ml In the postoperative period while maintaining the patient on free drainage without tamponade bed adenoma blood loss was $ 225 ml, the increase in FA 1.4 times, a moderate decrease of prothrombin and hemoglobin 72 g/l, which required, in addition to active haemostatic measures (introduction EACH intravenously in the amount of 300 ml), blood transfusion in the volume of 425 ml in spite of subsequent hemostatic and infusion therapy hematuria was observed for 9 days, and microhematuria is 14 days.

Example 2 Patient M , 71 years, the diagnosis: benign hyperplasia (adenoma) of the prostate. When entering coagulogram FA - within normal limits, prothrombin 102%, other indicators are within normal limits, in the clinical analysis of blood hemoglobin - 132 g/L.

Produced Transbaikalia adenomectomy typical way after preliminary infiltration-podkupolnogo introduction EACH in a volume of 25 ml Intraoperative blood loss was 62 ml In the postoperative period in the conduct of the patient on the drains without tamponade bed adenoma blood loss amounted to 97 ml, makrogematuriya ceased by the middle of the 3 day, microhematuria - 5 su is not significantly changed. Conducted standard infusion therapy first 2 days, transfusion and intravenous hemostatic was not required.

The data of the foregoing examples are summarized in table.

Application EACH based on the fact that it is a specific hemostatics inhibit the action of thrombolytic enzymes as blood (see above), and urine. Sufficient to provide a clear hemostatic effects are small doses of the drug in the use of local infiltration: 20-30 ml EACH, as shown in the study, while the standard dose for achieving the primary hemostatic effect - 0.1 g/kg of body weight or 100-150 ml of a 6% aqueous solution, which can lead to thrombohemorrhagic complications. In addition, standard hydraulic preparation of tissue requires the introduction of 30-40 ml solution of novocaine, which is an additional drug load on the patient's body, which avoids the proposed method.

The proposed method is simple, convenient to use, effective and cheap.

Given the wide prevalence operations adenomegaly, use EACH in the clinic, its low cost and availability, high efficiency in this method, a CR is an increase.

Claims

1. The way local hemostasis at adenomectomy, including the use of Epsilon-aminocaproic acid, characterized in that the Epsilon-aminocaproic acid is injected palcapsule infiltration 10 ml in each fraction of the prostate.

2. The method according to p. 1, characterized in that when expressed average share in it enter another 5-10 ml of Epsilon-aminocaproic acid.

 

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