Method for treatment of extensive peritonitis

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly to abdominal surgery, and applied to treatment for extensive peritonitis. To do it during operative intervention the peritonitis source is eliminated, and abdominal cavity sanation is performed. Then 3% methylcellulose gel, preliminary saturated with 1200 mg/l sodium hypochlorite solution in proportion 3:1, is introduced.

EFFECT: preventing of parietal and visceral peritoneum mesothelium injury by microbial exo- and endotoxins, anti-microbial effect prolongation of sodium hypochlorite, and preventing inactivation of sodium hypochlorite by peritoneal toxic effluent.

1 ex

 

The invention relates to medicine, namely to abdominal surgery, and can be used in the treatment of common forms of peritonitis.

There is a method of treatment of widespread peritonitis. namely, what is the median laparotomy, eliminating the source of peritonitis, peritoneal cavity washed with sodium hypochlorite solution at a concentration of 0.06 to 0.12% in the amount of up to 800-1200 ml is adequate drainage and closure of the abdominal cavity (Postyshev VK, N.M. Fedorovsky Indirect electrochemical detoxification in the complex treatment of purulent diseases in surgery /Surgery. - 1994. No. 4. - P.48-50).

The main disadvantages of this method are: 1) short-term antimicrobial activity of sodium hypochlorite, limited time sanation of abdominal cavity and rapid inactivation (10-20 minutes); 2) the damaging effect of sodium hypochlorite on mesotheli peritoneum causes adhesions, which can further lead to the development of adhesive intestinal obstruction and adhesive disease.

Object of the invention is the prolonged antimicrobial action of sodium hypochlorite and prevent the development of adhesions in the abdominal cavity during peritonitis.

This object is achieved in that during the execution of surgical intervention after the IP address is the source of peritonitis and sanitation of the abdominal cavity in it enter 3% methylcellulose gel. pre-saturated solution of sodium hypochlorite at a concentration of 1200 mg/l (0,12%) in the ratio 3:1. The solution in the hands of the surgeon is evenly distributed across the surface of the peritoneum.

Sodium hypochlorite is a universal antiseptic, which is produced by the electrolysis of 0.9% sodium chloride in the apparatus EDO-4.

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, insoluble in hot water. Aqueous solutions of methylcellulose stable at pH 2-12, storage racks and is not exposed to microorganisms. The gel based on methylcellulose pseudo-plastic, physiologically inert and has no toxicity.

Technology of production of sodium hypochlorite solution in the gel methylcellulose is the following. Take 8 mg of methylcellulose powder, pour 100 ml of purified water heated to 80-90°C. the Mixture is left to swell. After lowering the temperature of the mixture up to 18-20°add 100 ml of purified water having room temperature, mix thoroughly until smooth. P is obtained gel is filtered and bottled in bottles of 150 ml, sealed and sterilized at 120°C for 8 minutes and Then 150 ml of 3% methylcellulose gel add 50 ml of 0.12% of sodium hypochlorite solution. The concentration of sodium hypochlorite in the resulting solution is reduced to 0.03% and corresponds recommended for intracavitary applications.

When making prepared solution into the abdominal cavity ensures a constant and gradual release of the sodium hypochlorite within 24-48 hours and thus prolong its antimicrobial effect. In addition, the solution acts as a temporary artificial "barrier" between damaged serous surfaces, ensuring their efficient separation, reduces the adhesion of the surfaces of organs and tissues, contributes to the preservation of their mobility and prevents the formation of adhesions.

The method is as follows.

After performing a laparotomy with peritonitis, address underlying causes of the pathological process and sanation of abdominal cavity with antiseptic solutions in all of its divisions entered the prepared sodium hypochlorite solution in the gel, methyl cellulose, which is equally distributed over the entire surface of the peritoneum.

An example of the experimental run.

To study the effect of methylcellulose gel, saturated solution of sodium hypochlorite mixed with methylcellulose, on the course of RA is postroennogo peritonitis was used in two series of Wistar rats of 50 animals each. Peritonitis was simulated standard needle introduction into the abdominal cavity of 10% fecal suspension. After 24 hours under sterile conditions was performed laparotomy under ether anesthesia. In the first group (control) sanation of abdominal cavity was performed with sodium hypochlorite. In the second group after rehabilitation in the abdominal cavity was injected with sodium hypochlorite solution in methylcellulose gel. Surgical wounds were usuals tightly.

The animals were sacrificed experiment by overdose of ether anesthesia at 1, 4, 7, 10 and 14 days after surgery. Before the conclusion of the experiment was performed blood sampling for General analysis and counting of leukocyte index of intoxication. Opened the abdominal cavity. Estimated amount and nature of the effusion. The exudate was taken for bacteriological inoculation by counting the number of microorganisms in 1 ml of effusion. The severity of adhesions was evaluated visually (distribution of adhesions as a whole and for each type of adhesions separately, the deformation of the bodies, flatulence) and using the method of semantic differential (on a scale). Produced photographing of the object under study. The parietal peritoneum and abdominal organs were subjected to histological examination according to the standard technique involving the use of drugs in neutral formalin, fill in arafin and painting sections were hematoxylin-eosin and van gieson (picro-fuchsin). The data are processed statistically: calculated average values (arithmetic mean, mode, median), minimum and maximum value, standard deviation, reliability of results.

In the study of indicators of the General analysis of blood found that normalization of leukocytosis and leukocyte index of intoxication (LII) in the experimental group was already observed on the 4th day after surgery, while in the control - only 7-E. in Addition to 1 day post-operative period there was a statistically significant decrease LEAH 33.9% with the introduction of sodium hypochlorite solution in the gel methylcellulose (1,68±0,34 against 2,54±0,42 in control).

Bacteriological examination of the number of microorganisms in 1 ml of exudate from the abdominal cavity in the 2nd group on the 1st day after surgery was significantly decreased by 20.8%, and for 4 days by 43% compared with the control group (experimental group-1 day - 65 800±300 CFU/ml, 4-th day - 19650±2840 CFU/ml control 1-e day - 52100±3650 CFU/ml, 4 days - 11200±2350 CFU/ml).

The severity of adhesions, which was estimated by the method of semantic differential in scores in the control group was on the 10th day of 4.38±084; 14-th day - br4.61±1,06, in the experimental group 2,6±0,21 and 1.9±0,18 respectively (p<0,05). Thus, the formation of adhesions using R. the range of sodium hypochlorite in methylcellulose gel was reduced by more than 40%.

Histological examination reliably detected decrease as infiltrative inflammatory and proliferative processes. In the experimental group decreased infiltration due to both polymorphonuclear leukocytes, and at the expense of histiocytes and fibroblasts, decreased the number of threads of fibrin and immature connective tissue fibers in slices prepared from total abdominal cavity complexes and separate adhesions.

Postoperative mortality in the 1st group was 34%, in the second group 22%.

Example clinical implementation.

Patient S. 48 years, the case history No. 14844, was admitted to the Department of purulent surgical infection MUSES GB NSR gburski 10.11.06 with the clinic widespread peritonitis. After preoperative preparation of the operated urgently 11.11.06. Intraoperatively after midline laparotomy in abdominal cavity revealed about 1000 ml fibrinous-purulent effusion, marked adhesions. Loops of small intestine inflated, hypermonogenic will not peristaltic covered with fibrin. When the division of adhesions revealed multiple meritline abscesses. Further revision of the abdominal cavity of the source of peritonitis is not revealed. Intraoperative diagnosis of cryptogenic common fibrinous-purulent peritonitis, severe abdominal sepsis. Operation: laparotomy,intestinalis, the opening abscesses, abdominal resection of part of the small intestine and the large area of the packing, nasointestinal intubation of the small intestine, sanitation and drainage of the abdominal cavity, laparostomy. After sanation of abdominal cavity 8 l of 0.02% solution of furacin, it osushivaniya and drainage glove-pipe the drains of the four standard points (both podrebarac and both iliac regions) drains blocked. Into the abdominal cavity through laparotomic wound introduced 200 ml of the prepared solution of sodium hypochlorite in the gel, methyl cellulose, which are evenly distributed in the abdominal cavity. Superimposed laparostomy with zipper. Conduit drains above open in 3 hours. 13.11.06 and 15.11.06 ran landmark rehabilitation programmed relaparotomy, during which the abdominal cavity was injected with sodium hypochlorite solution in methylcellulose gel in a volume of 200 ml with the aforementioned method. The phenomenon of peritonitis were stopped. During rehabilitation relaparotomy noted rare easily separated by spikes. P/o period was uneventful. The patient was discharged in satisfactory condition, 8.12.06.

Thus, the survey results indicate a high anti-inflammatory and protivospaechnyj activity of sodium hypochlorite solution in methylcellulose gel. Advantages of the proposed method is the fast ease of use, effective relief of inflammation in the abdominal cavity and reliable prevention of adhesions with peritonitis. Therefore, the proposed method can improve the results of treatment of widespread peritonitis.

The method of treatment of widespread peritonitis, characterized in that during the execution of surgical intervention after elimination of the source of peritonitis and sanitation of the abdominal cavity in it enter the 3%methylcellulose gel, previously saturated solution of sodium hypochlorite at a concentration of 1200 mg/l in the ratio of 3:1.



 

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