Method for prevention of suppurative-septic complications in patients with acute gangrenous cholecystitis in minimal access surgery

FIELD: medicine.

SUBSTANCE: ronkoleukin is administered in a dose of 500,000 units in a 0.9% physiological saline 20.0 ml. The prepared solution in an amount of 10.0 ml is administered into a round ligament of the liver through a catheter inserted under visual control. The rest amount of 10.0 ml is introduced into incisional wound edges on the 1st and 3rd postoperative days.

EFFECT: method provides stimulating local immunity in both the incisional wound, and the hepatoduodenal region ensured by a separate effect of cytokines on various groups of lymphatic nodes.

1 ex

 

The invention relates to medicine, namely to surgery, and can be used in emergency abdominal surgery.

There is a method of treatment with interleukin-2 in advanced bacterial infections (German patent No. 3910011, AK 37/02, 1990). In this way the introduction of Il-2 intravenously, subcutaneously, intraperitoneally, intramuscularly leads to increased non-specific cellular response that will reduce the number of bacteria in the peritoneal cavity and reduction of endotoxins in the blood plasma. The method according to the patent may be used by injection of interleukin-2 in a dose of 1-3,5-106 U/kg in the postoperative period, the state after a serious injury, a common gram-positive and gram-negative infections, peritonitis.

The use of high doses of interleukin-2 can cause the development of toxic reactions and is very expensive.

The well-known "Method of adaptive immunotherapy for the treatment of patients with purulent-septic processes, patent RU No. 2098125 C1, A61K 38/20, AK 38/00, which emit mononuclear cells, cultured them with interleukin-2 and return parenteral patient, and available purulent cavity is washed with a solution containing a combination of cytokines obtained by culturing mononuclear cells with inteleukin-2.

This method has been applied t is like in combination with intravenous and not used as an independent method only local citicentre. The method of preparation of the complex autologous cytokines requires high technical support and material costs, as well as the time factor. When the washing solution is not absorbed and does not provide enough long-term impacts on local tissue, requires a higher concentration of the drug, frequency and duration of use, leading to increased treatment time.

The known method antibacterial prophylaxis of infectious complications in surgery of the liver, gall bladder and biliary tract. The antibiotic must be entered before skin incision, that is, until bacterial contamination, so that a bactericidal concentration was maintained in the tissues during the entire operating period. Antibacterial medication should be 10-15 minutes intravenous or for 30-60 minutes intramuscularly before skin incision. The drugs of choice are:

1. Cefazolin 1.2 g/

2. Cefuroxime 1.5 g/

3. Amoxicillin is known to be/clavulanate 1.2 g/C.

However, the operation performed for acute gangrenous cholecystitis, belongs to the class of "dirty" operations that involve the carrying out of antibacterial therapy. Abdominal surgical infection Ed. Savelyeva B.C., Gelfand BYR - M - 2011. S-85.

The disadvantage of this method is the fact, h is about to date, the majority of microorganisms, antibioticresistant and the use of antibiotics, for the prevention of septic complications, is less effective than the proposed method.

The closest is the way of antibacterial therapy through a catheter in the round ligament of the liver under visual and palpatory control in patients with acute destructive cholecystitis during the operation of the mini-access (Shevela A.I., Morozov V.V., Kuznetsov A.V. Antibacterial therapy through the round ligament of the liver in patients with acute cholecystitis during operations from mini-access // Fundamental research. - 2006. No. 1 - p.40-41).

The disadvantage of this method is a local antibiotic therapy in the upper floor of the abdominal cavity and prolonged standing of the catheter.

The present invention is improving the efficiency of the method of prophylaxis of septic complications in patients with acute gangrenous cholecystitis during the operation of the mini-access by enhancing specific immune response in the operating wound in the upper floor of the abdominal cavity.

This object is achieved by a method of prophylaxis of septic complications in patients with acute gangrenous cholecystitis during the operation of the mini-access, including the introduction of the drug in the round ligament of the liver through a catheter into it under visual control. Inject Roncoleukin dose of 500,000 IU per 20,0 ml physiologists the definition of the solution of sodium chloride 0,9%, with 10.0 ml of solution is injected into the catheter and 10.0 ml of the solution into the edges of the surgical wound in the 1st and 3rd day postoperative period.

The novelty of the invention:

- inject Roncoleukin dose of 500,000 IU per 20,0 ml of physiological solution of sodium chloride 0,9%;

to 10.0 ml of solution is injected into the catheter and 10.0 ml of the solution into the edges of the surgical wound in the 1st and 3rd day postoperative period.

This allows you to quickly create a higher concentration in areas of interest, which increases the efficiency of action of the drug. In addition, the introduction of Roncoleukin stimulates production of interleukin-2, which significantly improves local immunity.

The subcutaneous route of administration, in contrast to intravenous, intramuscular and the application allows you to quickly create a higher concentration of the drug in the area of interest, which considerably increases the efficiency of action. The drug is injected directly into the surgical wound, where and formed local immune response and increase the immunological reactivity, allowing you to more efficiently sanitize the source of the infection.

For the first time in surgical practice used combined Loco-regional therapy for the prevention of septic complications in patients with acute gangrenous cholecystitis during the operation of the mini-access.

Sosaku is of essential features can significantly increase local immunity, as in the area of the wound, and hepatoduodenal region, which greatly improves the prevention of the development of wound and intra-abdominal septic complications in acute gangrenous cholecystitis.

The method is as follows.

When performing cholecystectomy from mini-access, using the apparatus "mini-assistant" for acute gangrenous cholecystitis, after performing the main stage of the operation, on the middle line of the abdomen above the navel 1-2 cm and 1 cm to the right produce vcol needle perpendicular to the skin. The needle is injected deep, piercing the broad aponeurosis of the abdominal muscles until you feel a failure. Needle inside the round ligament of the liver, controlling the needle position visually. The lumen of the needle enter the conductor and establish a polyethylene catheter. Inject Roncoleukin dose of 500,000 IU per 20,0 ml of physiological solution of sodium chloride at 0.9%. 10.0 ml of solution is injected into the catheter and 10.0 ml of the solution into the edges of the surgical wound. Perform skin puncture needle at a distance of 1.0 cm from the incision and enter 5.0 solution in the subcutaneous tissue on each side in the 1st and 3rd day postoperative period.

Clinical example 1

Woman, 55 years old (case history 216) received emergency surgery Department at CCH 1 core 18.01.13 with a diagnosis of JCB. Acute calculate the cholecystitis.

Since the receipt was a complex conservative therapy of acute cholecystitis: infusion, antispasmodic therapy. Despite ongoing therapy, the patient remained without positive dynamics.

19.01.13 performed surgery: cholecystectomy from mini-access, catheterization of the round ligament of the liver. Installed intraoperative diagnosis: ECB. Acute gangrenous cholecystitis. Local serous peritonitis.

1st day after the operation, the moderate, moderate pain. The body temperature of 38.4°C.

The prepared solution of Roncoleukin dose 500000 database of 20.0 ml of physiological solution of sodium chloride at 0.9% was injected 10.0 ml in the catheter and 10.0 ml of the solution into the edges of the surgical wound. Perform skin puncture needle at a distance of 1.0 cm from the incision and enter 5.0 solution in the subcutaneous tissue on each side in the 1st and 3rd day postoperative period.

After the end of therapy according to the proposed method the patient's condition has improved, the temperature was normalized, improved appetite, the patient became active, due to cancellation pain abdominal pain syndrome is not worried. Laboratory tests: the normalization of leucoformula, ESR, ultrasound-control: accumulation of fluid in the bed of the gallbladder no. 26.01.13 patient was discharged in satisfactory condition on the preamble is Torno aftercare.

Thus, the method has allowed to prevent the development of septic complications.

The use of the proposed invention increases the efficiency of the method of prevention of septic complications in patients with acute gangrenous cholecystitis during the operation of the mini-access, by increasing the specific immune response in the operating wound in the upper floor of the abdominal cavity.

The way to prevent septic complications in patients with acute gangrenous cholecystitis during the operation of the mini-access, including the introduction of the drug in the round ligament of the liver through a catheter into it under visual control, characterized in that the injected Roncoleukin dose of 500,000 IU per 20,0 ml of physiological solution of sodium chloride at 0.9%, and 10.0 ml of solution is injected into the catheter and 10.0 ml of the solution into the edges of the surgical wound in the 1st and 3rd day postoperative period.



 

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