Method for antibacterial therapy in gastric cancer perforation

FIELD: medicine.

SUBSTANCE: upon completion of the surgical intervention, before the abdominal wall closure, microirrigators are inserted through counteropenings into the hypochondria. An end of the right microirrigator is fixed with an interrupted catgut suture to a stump of the resected stomach; an end of the left microirrigator is fixed at an upper level of the abdominal cavity with the interrupted catgut suture. Drain tubes are inserted through the counteropenings in the iliac regions into the small pelvis. The surgical intervention is terminated with treating the whole abdominal cavity with 50 ml ozonised normal saline 1000 mcg/l. Then 10 minutes later, the abdominal cavity is treated with metronidazole 100 ml. From the 1st to 5th postoperative day, metronidazole 200 ml is administered in the form of 24-hour infusion through a portable infusion device via the right microirrigator. Through the left microirrigator, 50 ml ozonised normal saline 1000 mcg/l is administered once a day. A course of standard intravenous antibiotic therapy is prescribed into the patient.

EFFECT: reducing an incidence rate of postoperative infectious-inflammatory complications in the given category of patients due to the specific regimen of the antibacterial therapy and the ozone therapy.

2 ex

 

The invention relates to medicine, namely to Oncology, and can be used in the surgical treatment of gastric cancer complicated by perforation of the tumor, to reduce the number of infectious-inflammatory complications in the postoperative period.

The frequency of perforation of gastric cancer ranges from 0.4 to 7.6% of the total number of patients with gastric cancer. The method of choice in complicated stomach cancer is the implementation of radical or palliative resection or gastrectomy. However, perforation of the tumor is threatening complication, which leads to a large number of infectious-inflammatory complications in the postoperative period, often ending in death. In connection with that used various combinations of antibiotics that are not effective.

Known "Method of combined antibiotic therapy when conducting emergency operations on the stomach and the colon in complicated forms of cancer of these localizations" (Petrov, D. S. Intraoperative injection of antibiotics on autoplasma when urgent surgery in patients with cancer of the gastrointestinal tract: author. dis. ... candles. the honey. Sciences. Rostov n/a, 2006), consisting in the introduction of intraoperative antibiotics on their own plasma of patients in a dose exceeding the daily therapeutic 3-4 times, then on the 4th day after surgery Antibes is otice was introduced to the autologous blood. The method allowed the author to reduce the number of septic complications: the main group - peritonitis - 20%, suppuration of wounds and 17.1%, pneumonia - 11,4% (p<0,05). In the control of these complications occurred in 56% 44,20%, respectively (p<0.05), and postoperative mortality was higher in 2 times (28% compared to 11.4%). However, this method involves the fence autologous blood from patients in a serious condition in connection with threatening complication of gastric cancer - perforation of the tumor, patients often are in a state of shock, not allowing them to harvest autologous blood. Thus, the method may be used in a limited number of patients.

Known "Method of prophylaxis of septic complications in reconstructive operations for cancer of the colon" (Goncharov, I. C. Prophylaxis of septic complications in reconstructive operations for cancer of the colon: author. dis. ... candles. the honey. Sciences. Rostov n/a, 2004), consisting in the introduction of intraoperative antibiotics autologous blood of patients combined with post-operative prolonged endolymphatic antibiotic therapy. The method allowed the author to reduce the number of septic complications after reconstructive operations to 7.2%, as compared to 29.8% (p<0.05) in the control group due to the menichini frequency of complications of surgical wounds (3 times) and prevent insolvency seams anastomosis. However, the proposed method does not reduce the number of peritonitis requires a fence autologous blood, which is impossible in urgent situation. The application of this method is possible only in a planned surgery.

Pashkov S. A. et al. (Pashkov S. A., places centuries, Murysev E. M. Intraperitoneally translocation of bacteria and antibiotic therapy in acute adhesive intestinal obstruction // Kazan medical journal. 2004. So 85. No. 5. S. 346-350) recommended intraperitoneal antibiotic therapy. However, the developed scheme intraperitoneal antibiotic therapy, not the analysis of the effectiveness of intraperitoneal antibiotics.

Known "Method of intraperitoneal chemotherapy in ovarian cancer patients" (Stepura L. A. Prolonged intraperitoneal neoadjuvant and adjuvant chemoimmunotherapy in the complex treatment of ascitic form of ovarian cancer stage III-IV disease: author. dis. ... candles. the honey. Sciences. Rostov n/A., 1998), selected as a prototype. The method consists in intraperitoneal administration course doses of cytostatics, diluted ascitic fluid, combined with intraperitoneal introduction of Tactivin. Then patients underwent surgical treatment. Shows less toxicity, high efficiency of this method, which allows to significantly increase the percentage of regression, operability and resectability of the tumor is, as well as the life expectancy of patients with ascitic form of ovarian cancer stage III-IV disease (16-26%) compared with other methods of treatment.

However, the method provides for chemotherapeutic treatment of patients with ascitic form of ovarian cancer, aimed at preoperative preparation of patients, increasing operability and resectability of the tumor and not on reducing the frequency of infectious and inflammatory complications.

The aim of the invention is to reduce the frequency of infectious-inflammatory complications in the postoperative period after surgical treatment of gastric cancer complicated by perforation of the tumor.

This objective is achieved in that when the operation completes before closure of the abdominal wall set through contraditory in podrebarac microirrigation, the right end of microirrigation fixed hub catholisim seam to the cult of the resected stomach, the left end of microirrigation fixed in the top floor of the abdominal cavity anchor catholisim seam, drainage pipes installed through contraditory in the iliac regions in the pelvis. Operation complete processing of the entire abdominal cavity 50 ml of ozonated (1000 g/l) saline solution, after 10 minutes a solution of metronidazole 100 ml With 1 to 5 day post-operative period through right microirrigation enter cher the C portable infusion device solution metronidazole 200 ml in 24-hour infusion. Through left microirrigation 1 time per day injected 50 ml of ozonated (1000 g/l) saline solution. Intravenous patient receives the standard course of antibiotic therapy.

The invention "Method of antibiotic therapy with perforation gastric cancer" is new, because it is unknown in the medical field for surgical and antibiotic treatment is complicated by malignant tumors, reducing the number of infectious-inflammatory complications in the postoperative period.

The novelty of the invention lies in the fact that when the operation completes before closure of the abdominal wall set through contraditory in podrebarac microirrigation, the right end of microirrigation fixed hub catholisim seam to the cult of the resected stomach, the left end of microirrigation fixed in the top floor of the abdominal cavity anchor catholisim seam, drainage pipes installed through contraditory in the iliac regions in the pelvis. Operation complete processing of the entire abdominal cavity 50 ml of ozonated (1000 g/l) saline solution, after 10 minutes a solution of metronidazole 100 ml With 1 to 5 day post-operative period through right microirrigation administered via a portable infusion device solution metronidazole 200 ml in 24-hour infusion. Through left microirrigation 1 time per day in which W ill result in 50 ml of ozonated (1000 g/l) saline solution. Intravenous patient receives the standard course of antibiotic therapy.

Thus, intraoperative and postoperative intraperitoneal antibiotic therapy and ozone therapy can help reduce the number of infectious-inflammatory complications in the postoperative period when the perforation of gastric cancer.

The invention "Method of antibiotic therapy with perforation gastric cancer is industrially applicable, as may be used in health care, hospitals cancer profile, dispensaries, cancer research institutes.

Examples of specific applications of the Method of antibiotic therapy with perforation of stomach cancer on patients.

Patient C., born in 1945, history 1847/b, was admitted to the Department of General Oncology, RNII 21.05.12. diagnosed with a stomach tumor, stage 3, clinical group 2, the perforation".

After a short preoperative preparation 21.5.12 urgent testimony was operated, the operation - distal Subtotal gastrectomy. When the operation completes before closure of the abdominal wall was installed through contraditory in podrebarac microirrigation, the right end of microirrigation recorded hub catholisim seam to the cult of the resected stomach, the left end of microirrigation recorded is in the top floor of the abdominal cavity anchor catholisim seam, drainage pipes were installed through contraditory in the iliac regions in the pelvis. The operation has finished processing all of the abdominal cavity 50 ml of ozonated (1000 g/l) saline solution, after 10 minutes a solution of metronidazole 100 ml With 1 to 5 day post-operative period through right microirrigation was administered via a portable infusion device solution metronidazole 200 ml in 24-hour infusion. Through left microirrigation 1 time per day was introduced 50 ml of ozonated (1000 g/l) saline solution. Intravenous patient received a standard course of antibiotic therapy by Meronem 1 g 3 times a day.

Postoperative histological analysis 78853-59: well-differentiated adenocarcinoma with invasion of all layers of the stomach wall, the collapse, the formation of perforating holes, cancer metastasis in lymph nodes no.

The postoperative period was uneventful, with no complications. The level of peripheral blood leukocytes did not rise above 10109/l; reaction temperature in the first 5 days was low, then normal. Symptoms of peritonitis, sepsis post-operative wound was not. Sutures were removed on the 14th day. The patient was discharged in good condition.

Patient M., born in 1961, history 1832/, he enrolled in the Department of General Oncology, RNII 17.01.13. with a diagnosis of opuholevogo, phase 3, clinical group 2, the perforation".

After preoperative preparation 17.01.13 urgent indications operation was performed - distal Subtotal gastrectomy. When the operation completes before closure of the abdominal wall was installed through contraditory in podrebarac microirrigation, the right end of microirrigation recorded hub catholisim seam to the cult of the resected stomach, the left end of microirrigation recorded in the upper floor of the abdominal cavity anchor catholisim seam, drainage pipes installed through contraditory in the iliac regions in the pelvis. The operation has finished processing all of the abdominal cavity 50 ml of ozonated (1000 g/l) saline solution, after 10 minutes a solution of metronidazole 100 ml With 1 to 5 day post-operative period through right microirrigation was administered via a portable infusion device solution metronidazole 200 ml in 24-hour infusion. Through left microirrigation 1 time per day was introduced 50 ml of ozonated (1000 g/l) saline solution. Intravenous patient received a standard course of antibiotic therapy by Meronem 1 g 3 times a day.

Postoperative histological analysis 6980-87/13: moderately differentiated adenocarcinoma with invasion of all layers of the stomach wall, the collapse, the formation of perforating holes, METAS the basics of cancer in the lymph nodes large and small glands.

The postoperative period was uneventful, with no complications. The level of peripheral blood leukocytes did not rise above 11109/l; reaction temperature in the first 5 days was low-grade, maximum of 37.8 degrees for 2 days after surgery, then normal. Symptoms of peritonitis, sepsis post-operative wound was not. Sutures were removed on the 13th day. The patient was discharged in satisfactory condition.

The proposed method treated 6 patients with gastric cancer. The use of intraoperative intraperitoneal antibacterial and ozone therapy has a high efficiency, strong antibacterial and anti-inflammatory effect.

Technical and economic efficiency "Method of antibiotic therapy with perforation gastric cancer" is that the method allows to reduce the incidence of infectious-inflammatory complications in the postoperative period after surgical treatment of perforation of stomach cancer, exhibit low toxicity, simple in execution. The method allows for highly effective antibacterial therapy in a short time, reduces length of stay of the patient in hospital and the cost of treatment of infectious-inflammatory complications.

Method antibacterial therapy in the perforation of gastric cancer, including surgery, antibiotic therapy day is, characterized in that when the operation completes before closure of the abdominal wall set through contraditory in podrebarac microirrigation, the right end of microirrigation fixed hub catholisim seam to the cult of the resected stomach, the left end of microirrigation fixed in the top floor of the abdominal cavity anchor catholisim seam, drainage pipes installed through contraditory in the iliac regions in the pelvis; the operation complete processing of the entire abdominal cavity 50 ml of ozonated 1000 g/l saline solution, after 10 minutes a solution of metronidazole 100 ml; 1 to 5 days post-operative period through right microirrigation administered via a portable infusion device solution metronidazole 200 ml as 24-hour infusion; left microirrigation 1 time per day injected 50 ml of ozonated 1000 g/l saline solution, with intravenous teach the standard course of antibiotic therapy.



 

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