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9INNOVATIVE 3D PRINTING PREVENTION ADHESIVE DISEASE
Sathanbayev A.Z.
Candidate of medicine, professor, head of the department of surgery, anaesthesiology and intensive care, International Kazakh-Turkish university named after K.A.Yasavi Annaorazov Y.A.
General surgical department, intern-surgeon, International Kazakh-Turkish university named after K.A.Yasavi
ИННОВАЦИОННАЯ ГЕЛЕВАЯ 3D ПРИНТЕРНАЯ ПРОФИЛАКТИКА СПАЕЧНОЙ БОЛЕЗНИ
Сатханбаев А.З., к.м.н., профессор, заведующий кафедры хирургии, анестезиологии и реанимации МКТУ им. Х.А. Ясави
Аннаоразов Ы.А., Хирург-интерн группы ХО-607 МКТУ им. Х.А.Ясави, Шымкентский Медицинский Институт, Факультет последипломного образования
АННОТАЦИЯ
«Инновационная гелевая 3D принтерная профилактика спаечной болезни» посвящена одной из актуальных проблем хирургического профиля. Совершенствование лечения и профилактики спаечной болезни, несмотря на появление ма-лоинвазивной хирургии не теряет актуальности и является постоянным объектом активного исследования и теоретического осмысления. При совершенствовании профилактики и лечения спаечной болезни важно использовать патогенетические методы и их упрощение при использовании в интраоперационном периоде. В данной работе авторы продвигают инновационную, патогенетически обоснованную, новую методику профилактики и лечения спаечной болезни распечатываемую с помощью 3D принтера.
ABSTRACT
«Innovative 3D printing prevention adhesive disease» is dedicated to one of actual problems of surgical profile. Improvements of treatment and prevent of disease, despite the emergence of minimally invasive surgery does not lose relevance, and is a constant subject of active research and theoretical understanding. In improving the prevention and treatment of adhesive disease is important to use methods of pathogenetic and simplification when used in the perioperative period. In this paper, the authors promote innovation, pathogenetically justified, a new technique for the prevention and treatment of adhesive disease printable using a 3D printer.
Ключевые слова: спаечная болезнь, профилактика спаечной болезни, противоспаечная 3D мембрана.
Key words: adhesive disease, prevent disease, anti adhesive 3D membrane.
Formulation of the problem: Over the period of abdominal surgery with an increase in surgical interventions on the abdominal organs, despite the minimization and transition to minimally invasive techniques, the problem of adhesive disease has not lost its relevance today.
Analysis of recent research and publications: Postoperative adhesions are the cause of abdominal pain in 30-33% of patients [1, 2].
Peritoneal adhesions associated with 40 to 75% of all cases of intestinal obstruction, and mortality in this complication still remains at a high level (5-10%) and does not tend to decrease [1, 3, 4].
From 20 to 75% of cases of infertility in women caused by postoperative adhesive process in pelvis [5, 6, 7].
Allocation of unsolved aspects of the problem: Frequent exacerbations adhesive abdominal and pelvic disease requiring hospitalization will eventually lead to a reduction in disability, emotional instability, sexual dysfunction, neuroticism personality, disability and a significant deterioration in the quality of life [2, 8, 9].
All of the above indicators reliably show not only the acute urgency of the prevention and treatment of adhesive disease, but also economically costly part of the problem.
Formulation of objectives: Adhesive disease - a concept used to refer to pathological conditions associated with the
formation of adhesions in the abdominal cavity of a number of diseases: traumatic injuries of internal organs, including the operative trauma. In most cases, adhesive disease is imminent defect is surgery, not a surgeon. Since the surgeon to save the patient from a deadly disease is a new disease in the patient abdomen. With the development of abdominal surgery, many surgeons with repeated laparotomy, began to notice the presence of a bonding between the abdominal organs.
Pathogenesis of adhesions: All research on the pathogenesis of adhesion formation to the present clearly opened up the formation of adhesions. By the pathophysiology of adhesion formation result:
- Reducing the level of plasminogen activator within the peritoneal injuries. organization of the fibrin occurs by the end of the first three days after exposure to the traumatic agent, and if during that time there are depression plasminogen activity and inhibition of local fibrinolysis, the formation of adhesions.
- Ischemic tissue damage during surgical exposure or by an inflammatory reaction of the peritoneum - a powerful factor depressing tissue fibrinolysis. The study of the parameters of fibrinolytic activity in the portal and ulnar veins showed that the intestine under physiological conditions is itself a modulator of the fibrinolytic activity.
- Antigenic similarity of E. coli and tissues that make up the bowel wall, proves that the leading factor in the genesis
of adhesions - sensitization of the organism to the intestinal microflora. Thus, the confirmed data on immunobiological reactivity of the organism and an allergic predisposition to the development of the PRSP.
- Intestinal paresis in the postoperative period.
- Physical damage to the walls of the abdominal cavity in intraoperative period.
- Aseptic inflammation that result from left abdominal tampons, drainage tubes, resorbable or not resorbable suture is long, the pieces of gauze, with the glove talc; due to hemorrhage and hematoma peritoneum as a result of blunt (not traumatic) needles;
- Injury to the peritoneum during dissection, trapping her tools, getting wet and wiping dry gauze; defects peritoneum sites when performing surgery;
- Drying peritoneal air, exposure to high temperatures when using electrocautery, laser, plasma scalpel, hot solutions;
Basic material: The methods and results of this work are based on a study of statistical data of 250 patients with surgical department Сentral Hospital of Kentau city, 15 surgical patients from Emergency Care hospital of Shymkent city, 60 patients of the Regional Necropsy bureau South Kazakhstan region and 430 surgical patients General Clinical hospitals of state Massachusetts during the period 2010-2014 years.
Examination of the patient begins with an explanation of the complaints, anamnesis of injury and history of life, objective and specific research methods.
Depending on the severity of the condition and the estimated amount of damage suffered referring physicians distribution post: in the operating department by passing the receiver, by passing the emergency room reception, admission department.
Difficult in most cases contact with the victim (combined trauma, shock, alcohol or drugs) forces take the lead role in the diagnosis of lesions instrumental methods.
Instrumental methods of diagnosis included: ultrasonography (US), X-ray, computed tomography (CT) of the abdomen.
The aim of the study was to ultrasound: detection and localization and assessment of the amount of free fluid in the abdominal cavity; assessment of parenchymal organs; detection, localization and definition of the scope of the retroperitoneal hematoma. In the absence of indications for emergency surgery patients compulsorily perform dynamic ultrasound. The time interval between the studies was determined individually, depending on the data obtained during the initial ultrasound: a suspected injury to abdominal organs ultrasound study performed every 0.5-1 hours. Even in the absence of clinical and instrumental data for possible damage to abdominal ultrasound study was repeated without fail after 12-24 hours after the initial investigation.
To patients with abdominal trauma, we did polypositional performed X-ray examination of the abdominal cavity. In the overview image of the abdominal cavity (in the supine position) determines the possibility of an inflammatory background, as well as signs of free liquid. To exclude the perforation of a hollow organ performed plain radiography of the abdominal cavity in a standing position, or in severe patient's condition -laterogramma (right side up).
Computed tomography was performed in patients with closed abdominal trauma in which clinical and ultrasound data was not possible to eliminate the injury parenchymal organs or traumatic pancreatitis.
The paper videolaparoscopic equipment and tools are mainly produced in Germany were used. To create and automatically maintain a predetermined amount used pneumoperitoneum insufflator «Stryker» Endoscopy 16L HIGH FLOW INSUFLATOR. To create a luminous flux used cold light source «Stryker» Endoscopy QUANTUM-LIGHTSOURCE 4000 with a capacity of 250W halogen lamp. fiberglass fibers 250 cm long companies have been adapted with him «Storz» or «Dufner». To obtain an image and transfer it to the screen using the camcorder «Stryker» Endoscopy 597T Medical video camera. The paper used 10 mm Laparoscopes only 30 deg., Company «Dufner» and «Storz». The image was transferred to the screen color monitor with a diagonal size of 15 inches «LEMKE» XR-140 15 «.
All existing methods to prevent disease despite the effectiveness have many disadvantages. For this we put forward the use of pathogenetically substantiated hyperfine anti adhesive (AA) gel membrane instantly printed in any period of operational and other interventions 3D printer after a set of individual patient parameters which delimits the operating field thereby reducing the synthesis of collagen and inflammatory mediators. The active ingredient is denatured animal collagen containing glucocorticosteroids and any kinds AA drugs based on individual needs and tolerability, after determining the sensitivity of the conventional method.
After determining sensitivity, tolerability and effects of AA drugs preoperative patient typed parameters and the parameters of the membrane (size, density, etc.) of the printer after filling display necessary means to the desired period of operation. Ready printer instantly prints dense Gel Substance (GS) by warming and adhesion molecules of the tool. After printing, the GS is applied to the desired area of the wound. Heavy contact with the abdominal cavity and the outside of the low temperature film forms a membrane that acting elements adhesions reduces the formation of adhesions and then sucked into the abdominal cavity.
Using anti adhesive membrane and all kinds of AA drugs only possible with laparotomy. This reduces the use of AA membrane thereby improving adhesion formation. The solution to this problem is to use endoscopic introduction of the membrane using a 3D printer that prints the membrane in place.
This method proposed by us is under development in cooperation with a research-based, physician general clinical hospital Rolon Andrew Clark - surgeon of the highest category, which is the co-author of the research
Conclusions and prospects: Adhesive disease is more common in females as compared to the male sex. The reason is the frequent damage to the pelvic organs.
Adhesive disease is more common in young people, which is the cause of hyperactivity, and susceptibility to injury.
Postoperative adhesions are a major cause of adhesive abdominal and pelvic disease.
To prevent the development of peritoneal fibrosis in patients who need an early elimination of the inflammatory process.
For this purpose, the amount of therapeutic measures should include a method of using ultrathin AA membrane. After applying the membrane is expected to significantly decrease in the formation of adhesions, reduced vascularization existing adhesions, which will lead to improved health of patients suffering from adhesive disease.
Introduction AA membrane using a 3D printer will enable the use of a membrane in minimally invasive interventions that will significantly reduce the adhesive disease and enable the use of AA membrane in hard to reach places and for critically ill patients who are contraindicated heavy operations, including laparotomy.
The ability to control the amount, concentration and size of the membrane dialing parameters for each patient and makes it possible to effect the treatment and prevention of the Security Council and the Security Council opens a new perspective of treatment.
Use of domestic resources for printing membrane significantly reduces the price. But most importantly, it gives the start and development of domestic medicine the opportunity to predominance in the development of prevention and treatment of the Security Council.
References:
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2. Kovalchuk VI, Derkacheva LV .. septic complications in patients with adhesive intestinal obstruction and ways to reduce mortality in them // Urban scientific and practical conference «Actual problems of septic infections»: Abstracts. -St. Petersburg, 1994. - P. 27-28.
3. VI Sazonov KN Gamzatov HA, Goleman JN .. Postoperative complications in patients with acute intestinal obstruction and methods for their prevention // Vestn. hir. -1995. - № 4-6. - P.141.
4. Oreshko LS, Abdel Haleg. Adhesive intestinal obstruction as a surgical problem // Urban scientific conference «Actual problems of prevention and treatment of common diseases»: Abstracts. - St. Petersburg, 1997. - P. 187-188.
5. KN Sazonov, Gamzatov HA, Borsak I.I .. High-insufflation of medicinal aerosols in the complex treatment of acute peritonitis // Urban Conference «Provisions on human health and the effectiveness of treatment»: Abstracts. - St. Petersburg, 1998. - S. 145.
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8. Oreshko LS .. Pathogenic adhesive disease prevention // All-Russia Anniversary conference of young scientists and specialists, dedicated to the 200th anniversary of the Military Medical Academy: Abstracts. - St. Petersburg, 1998. - S. 132.
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CLINICAL EXPERIENCE OF HERNIOPLASTY PROLENE IN EMERGENCY SURGERY
Sathanbayev A.Z.
Candidate of medicine, professor, head of the department of surgery, anaesthesiology and intensive care, International Kazakh-Turkish university named after K.A.Yasavi Tulemissov K.Zh. Lecturer of the Department of Surgery, Anesthesiology and Intensive Care, International Kazakh-Turkish University named K.A.Yasavi
КЛИНИЧЕСКИЙ ОПЫТ ПРОЛЕНОВОЙ ГЕРНИОПЛАСТИКИ В ЭКСТРЕННОЙ ХИРУРГИИ
Сатханбаев А.З., к.м.н., профессор, заведующий кафедры хирургии, анестезиологии и реанимации Международного казахско-турецкого университета им. Х.А. Ясави
Тулемисов К.Ж., Преподаватель кафедры хирургии, анестезиологии и реанимации Международного казахско-турецкого университета им. Х.А. Ясави
АННОТАЦИЯ
Опыт лечения больных с грыжами в отделениях хирургии, больницы скорой медицинской помощи г. Шымкент, Казахстан.
ABSTRACT
Experience in the treatment of patients with hernias in the departments of surgery, emergency hospital in Shymkent, Kazakhstan. Ключевые слова: грыжа, герниопластика, пролен, Шымкентская городская больница скорой медицинской помощи (БСМП).
Key words: hernia, hernia repair, prolene, Shymkent Hospital Emergency Medical Services (SHEMS).
