ezni annually in surgical wards previously treated with 1%
operated patients, intestinal obstasction in these patients develops
50-75% of cases, with mortality dostigaet13 - 55%. Many authors believe,
that after operations adgeziolizisa adhesions of the abdominal cavity (SPBP)
can not decrease, and even intensify. In this regard, we believe topical
studying different ways of division of adhesions during the operational
intervention.
Aim of our study was the choice of the optimal method adgeziolizisa.
At the first stage simulation SPBP on white intact Wistar
Wistar male rats, weighing from 100 to 120 g. The animals were divided into four
group (10 animals in each group). In sterile conditions, under ether anesthesia
median laparotomy was performed, parietal peritoneum and the ventral wall
inward facing side of the cecum deserozirovalis with
we developed the device until the "bloody dew." Wound sewed
layers.
In the second stage, after 14 days, relaparotomy was performed and the division of adhesions
using microsurgical techniques under magnification operating
microscope (OM-2) in various ways. In the 1-series, we used a blunt
adgeziolizis, in the 2 nd - acute in the third - electrotome in 4-th-the combination of blunt and sharp
adgeziolizisa.
Animals were removed from the experiment at 14 day by overdose of ether anesthesia
. Rats were subjected to autopsy. Severity of adhesions
assessed visually and by using the method of semantic differential.
parietal peritoneum and abdominal organs were studied histologically by
standard technique, sections were stained with hematoxylin-eosin and Van Gieson.
The results are processed statistically.
After opening at the 1-series in most cases visually determined
conglomerate, consisting of loops of small and large intestine, cecum, a small
their deformation, places him solder was greater.
A similar pattern was observed in 4-series. In the 2-series was the least SPBP
pronounced, with the conglomerate consisted of loops of intestine and blind
intestine, with no apparent strain. In some cases, the 1 st, 2 nd and 4 th series, noted
podpaivanie conglomerate to the scar after surgery. In the third series of conglomerate
formed the greater omentum, loops of small and large intestine, cecum,
in some cases, it involved the liver, stomach and spleen. Conglomerate
was Soldered to the ventral wall, while there were severe strain
bodies.
In the 1-series expression of adhesions by the semantic differential
was 2,15 ± 0,24 points in the 2 nd series - 1,75 ± 0,26 points; in the third series -
3,57 ± 0,23 points; in the 4-series - 2,25 ± 0,25 points. Significant difference
averages in all the series (p) was less than 0.0001.
Histological examination of the 1-series was determined
immature connective tissue with foci of fibrous tissue. In the 2-series observed weakly expressed
soedinitelnotkanye fiber cell reaction was absent. In the third series
noted strong development of coarse-fibered connective tissue, sometimes
observed foci of necrosis delimited from the surrounding tissue inflammation
shaft. In the 4-series was found mature connective tissue with signs of chronic inflammation
. Mostly identified areas of loose granulation tissue.
Thus, the best way adgeziolizisa is acute
method, in which the severity of adhesions was the lowest.
Satisfactory results were obtained after the application of blunt and
mixed adgeziolizisa. On the basis of the study found,
that used to divide adhesions cauterodyne impractical because it
application is expressed SPBP with necrotic foci in internal organs.
Glushenko IA Lipatov, VA . Romanova, ES Choice of optimal method
adgeziolizisa. Proceedings of the IV International scientific-practical conference
«Health and Education in the XXI century", Moscow, May 23-25, 2003-C. 153.