Preventive method of intraperitoneal adhesions formations caused by surgeries of bowels

FIELD: EFFECT: medicine; surgery.

SUBSTANCE: heparin solution dosed 150-200 units/kg of body weight is mixed with 1-2 ml of 0.9% sodium chloride solution. This solution is applied for intraoperative slow injection in neurovascular bundle tissue of mesentery the most proximally of surgical insult point. After that puncture point ligation is performed.

EFFECT: effective intravascular inactivation of blood thrombin; reduction of vascular walls permeability; reduction of adhesion formation.

6 dwg

 

The invention relates to medicine, abdominal surgery, and can be used for the prevention of postoperative intraabdominal of adhesions operations on the intestines.

The known method of prevention of postoperative adhesions operations on the abdominal organs, in which after performing the surgical intervention and rehabilitation of the abdominal cavity in it pour sterile phosphate-citrate buffer solution with a pH of 5.6 in the amount of one liter or washing of the abdominal cavity. Then a large part of it is removed, leaving in the abdominal cavity up to 200 ml (RU # 2252755, IPC AC 31/191, OR 41/00, publ. 27.05.2005,).

However, the method is tedious, time-consuming to conduct, is the inactivation of thrombin contained in the exudate in the abdominal cavity.

The technical result consists in the simplicity of the method, and that increases the efficiency of preventing the formation of adhesions in the abdominal cavity with the use of anticoagulant (heparin) during operations with the creation of a "depot" of the drug in the parabasal tissue mesenteric vessels of the intestine, which maintains its optimal concentration in the blood to inactivate thrombin and reduces the permeability of the vascular wall.

The technical result is achieved by the fact that the way the profile is Tiki the intra-abdominal adhesions during surgery on the intestines is what is a pre-solution of heparin at a dose of 150-200 u/kg of body weight mixed with 1-2 ml of 0.9% sodium chloride solution, the resulting solution was injected intraoperatively slowly, inkjet fibre in the neurovascular bundle of the mesentery of the bowel proximal to the location of the operative trauma with subsequent legirovaniem the puncture site.

Figure 1 shows the formation of small bowel anastomosis single-row suture anchor type "end-to-end"; figure 2 - scheme of ligation of the mesenteric vessels of the small intestine; figure 3 - ligation boundary mesenterina vessels two arcades of the superior mesenteric artery Powszechny intestine shutdown of blood flow 16-20 pairs of straight vessels of the body; figure 4 - injection site (proximal to the ischemic intestine); figure 5 - multiple adhesions between the parietal peritoneum, intestinal loops and a large gland in the area of the ischemic area of the intestine; figure 6 - single spikes in the area of the ischemic area of the intestine with soldered a fragment of the greater omentum.

The method is as follows.

To study the prophylactic effect of heparin on the process of postoperative adhesions in the abdominal cavity was used two groups of animals: animals (10 dogs) of the first group, which was not performed intraoperative heparin, and the animal is (10 dogs) of the second group, who underwent intraoperative injection of heparin. Under typeinternational anesthesia (40-45 mg/kg body weight) after the middle of the laparotomy wound was withdrawn proximal section of the ileum. Produced the formation of small bowel anastomosis single-row suture anchor type "end-to-end" (figure 1). Then on the same sections of the ileum was luigirules regional mesenteric vessels (figure 2) within two arcades of the superior mesenteric artery so that blood flow was turned off 16-20 pairs of straight vessels of the body (model operating injury with impaired blood flow to the area ileum) (figure 3). Of the venous vessel, directly adjacent to itemizedoverlay section of the small intestine, after 20 minutes after you create a model of disturbed blood supply to the organ was performed bloodletting in the amount of 1-2 ml so that the blood fell on the mesentery of the small intestine. Then from the same blood vessel was performed blood sampling with subsequent study of a number of indicators of coagulation-lytic system of blood clotting time of blood by the Lee-white, prothrombin time and prothrombin relationship, activity of anti-thrombin III. After taking blood from the venous vessel was last tie.

Pre-solution of heparin at a dose of 150-200 IU/kg body mass cm is stirred with 1-2 ml of 0.9% sodium chloride solution. The resulting solution was administered intraoperatively slowly, inkjet fibre in the neurovascular bundle of the mesentery of the bowel proximal to the location of the operative trauma (figure 4). The puncture site was carefully luigirules. Then surgical wound is sutured in layers. In the postoperative period of treatment the animals were not conducted.

After the operation was performed monitoring the General condition of the animals, their behavior, appetite, nature and frequency of stools. Timing observations of the animals up to 1 month. After 7, 20, 30 days the animals were made poddarkennel relaparotomy with subsequent study of postoperative changes in the abdominal cavity. This drew attention to the nature, prevalence and severity of adhesions, the presence of exudate in the abdominal cavity, especially pathological changes in the investigated section of the intestine. Produced photographs of the studied object.

In the early postoperative period were killed 2 dogs from the first group. Cause of death in both cases was thrombosis of mesenteric vessels of the small intestine.

Research has shown that in animals of the first group 20 minutes after ligation of the vessels in the investigated area of the authority recorded a slight change of parameters of the blood coagulation system, and the difference between them was misleading the. Thus, the clotting time of venous blood were increased only 4.6% (P>0,05). Prothrombin time and prothrombin ratio was not significantly different from the control data. However, increased Universiada activity of venous blood, as evidenced by the significant increase in the activity of anti-thrombin III - 19.4% (P<0,05).

Animals of the second group 20 minutes after the ligation of mesenteric vessels, an increase in the venous blood coagulation 1.9 times (P<0.05), and increased activity of anti-thrombin III 23.2% (P<0,05), which was associated with the diffusion of heparin from parabasal tissue of the mesentery of the small intestine into the bloodstream.

After relaparotomy animals of the first group in the abdominal cavity in the majority of cases was found significant adhesions. The latter was represented by multiple adhesion between the parietal peritoneum, intestinal loops, especially in the area of the ischemic zone of the body, and the greater omentum covering this part of the intestine (figure 5).

Animals of the second group adhesions was presented single spikes, and in almost half of the cases was not determined. Most dogs adhesions were found in the area of the ischemic zone of the ileum, which was soldered greater omentum (6).

Thus, unlike the method of intra-abdominal injection of sterile phosphate-citrate buffer solution with a pH of 5.6, which boils down to the inactivation of thrombin contained in the exudate in the abdominal cavity, the introduction of intraoperative heparin solution in the specified proportions in parabasal tissue mesenteric vessels of the intestine proximal to the location of the operative trauma with the creation of a "depot" of the drug and its consequent gradual transition in the blood can more effectively influence the process of reduction of adhesions in the abdominal cavity due to intravascular inactivation of thrombin in the blood and reduce the permeability of the vascular wall. Furthermore, the method is simple to implement, does not require much time for it.

The way to prevent the intra-abdominal adhesions during surgery on the intestine, which consists in the fact that the solution of heparin in a dose of 150 to 200 units/kg of body weight mixed with 1-2 ml of 0.9%sodium chloride solution, the resulting solution was injected intraoperatively slowly, inkjet fibre in the neurovascular bundle of the mesentery of the bowel proximal to the location of the operative trauma with subsequent legirovaniem the puncture site.



 

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