aim of our study
was to develop a new effective way to prevent postoperative
adhesions of the abdominal cavity and its validation in terms of surgical
experiment.
In the literature, most
Authors are unanimous that the main etiopathogenetic factor in the disease
peritoneal mesothelium is damaged and inflammation with a predominance of its proliferative
phase (Cherenko MP, 1988; Zhenchevsky RA, 1989; Makshanov IJ, Karpik AI
Polynsky AA, 1992, Osipov VI, 1992; Bezhin AI, Lipatov, VA, Gridasov JA,
2000; Thompson, J., 1998; Hooker GD, Taylor BM, Driman DK,
1999).
Given the literature data
and data of their research, we believe it is not enough respect for
Principles gentle attitude toward the peritoneum during the operation, since in some cases
deserozirovaniya and loss of peritoneal mezoteliotsitov unavoidable.
In this regard, and most authors, and we believe a rational use of
additional resources aimed at prevention of postoperative
adhesions. In studying the literature we found a tendency in recent years: it is considered
that the most promising principle of providing high prophylactic
effect is the use of funds, uncoupling of the wound surface (Osipov
VI, 1992; Di Zerega GS, 1994; Alponat A, Lakshminarasappa
SR, Yavuz N, Goh PM, 1997; Baykal A, Onat D, Rasa K, Renda N, Sayek I., 1997,
Zerega G.S., 2001). Such divisive
prophylactics, let us classify the state of aggregation
(Fig. 1).
Fig. 1
surg1
most promising
in this area is considered to be solutions of dextran and membrane consisting
of cellulose ethers (methylcellulose, sodium carboxymethylcellulose) with
high biological inertness, (Onat D, Rasa K, Renda
N, Sayek I., 1997; Baykal A, Onat D, Rasa K, Renda N, Sayek I., 1997).
However, dextran solutions rapidly eliminated from the peritoneal cavity, which requires
their re-introduction, and the film is a mechanical irritant, capable of
cause aseptic reaction from both damaged, and from the
healthy peritoneum. In this regard, we believe prospective application of intra-abdominal
indifferent viscous substances in order to prevent postoperative adhesions
of the abdominal cavity. In the available literature we have not found ways to
prevention of postoperative adhesions by intraperitoneal injection of gels.
method was tested on a model of abdominal adhesions. In aseptic
conditions, two series of male rats of Wistar (30 animals in each) is reproduced
adhesions by trauma abdomen. And the first group was control,
and the second trial. After modeling the adhesive process of the last animal
Group deserozirovannye sites peritoneum treated with 3% methylcellulose gel.
Animals were removed from the experiment in 14 days by an overdose of ether
anesthesia. Before the withdrawal of experience to assess the overall state, produces
total blood count. Rats were subjected to autopsy, scastiny
abdominal assessment of severity of adhesions and visually
using the technique of semantic differential (Lipatov, VA, Grigoryan VV,
2000).
parietal peritoneum and abdominal organs were subjected to histological
Research by the standard technique with fixation in neutral formalin, filled
in paraffin, painting medium with hematoxylin-eosin, by Van Gieson, with impregnation
silver by Foot's method and staining with PAS-reaction. The research results are processed
statistically (calculated using average values, Student's criterion, the coefficient
conjugation, the methods used chi-square, linear regression and correlation).
statistically significant
differences in general status, indicators of clinical blood and indices
leukocyte counts between the control and experimental groups, we have not been found.
In the control group, adhesions occurred in all animals, the severity of adhesions
process by the method of semantic differential was 3,39 ± 0,18 points. In
experimental group in only four animals occurred podpaivanie gland
the median postoperative scar, and the severity of adhesions by
semantic differential was only 0,02 ± 0,001 points (Table 1).
Histologically
animals of the first group corresponded to morphological organization of adhesions deadline
removing the animal from the experiment. Evolution of the newly formed connective
tissue tended to further differentiation. The basis of her was ripe kallogenovaya
network with few elastic fibers. Cellular composition of the poor,
represented mainly by differentiated fibroblasts and fibroblast. Parietal
and the visceral peritoneum of animals first series of thickened, fibrotic change. In
of connective tissue adhesions is determined by degeneration of the muscular layer
intestine with symptoms of the disintegration of muscle fibers. This phenomenon was noted
and parietal region of adhesions. By that time, have a pronounced seam
vascular network, which already has an ordered stascture.
In the second series has been studied
Morphology of the peritoneum from the defect. By their histostascture peritoneum did not differ
from intact. Only in some preparations were determined by field focal fibrosis,
signs of inflammation in the peritoneum of the second series of animals were observed.
Table 1.
results of experiments to validate the use of methyl cellulose gel for
Prevention of postoperative adhesions of the abdominal cavity.
| 1 series (control) | 2 series (experimental) | P | |
| Number of animals | 30 | 30 | |
| general condition on a scale | 5 | 5 | > 0,05 |
| Number of leukocytes | 11,4 | 10,1 | > 0,05 |
| Erythrocyte sedimentation rate | 2,6 | 3,1 | > 0,05 |
| FRI | 0,76 | 0,66 | > 0,05 |
| MI | 1,68 | 1,65 | > 0,05 |
| Number of animals with the adhesive process of the abdominal cavity | 30 | 4 | <0,05 |
| Expression adhesions of the abdominal cavity using a semantic | 3,39 ± 0,18 | 0,02 ± 0,001 | <0,001 |
FRI - leukocyte index of intoxication (Kalf-Kalif, 1941).
MI - mielotsitarny index (GI Perekops'ka, Kolomogorova RV, 1985).
Thus, the use of methyl cellulose gel was significantly effective in reducing
experiment the probability of postoperative adhesions of the abdominal cavity
(P <0,001), which opens up prospects for its use in the clinic for the prevention of
postoperative adhesions and the complications associated with it.
Lipatov, VA On the prevention of postoperative adhesions
of the abdominal cavity. Proceedings of the Third International Scientific and Practical
Conference on Health and Education in XXI Century ", 29-31 March 2002, Moscow,
-C. 256-257.