Prevention of peritoneal pelvic adhesion formation in women of reproductive age

Abstract

The objective: a prevention of the peritoneal pelvic adhesions formation in women of reproductive age in the postoperative periodMaterials and methods. 132 women with tubal infertility were examined: І group – main one (n=68) and ІІ group – comparison group (n=64). In the postoperative period, the patients of the main group received treatment and prevention measures according to the developed approach (intraoperative administration of anti-adhesion gel 50 ml and 1 suppository of the tiotriazolin a day rectally from the 1st day after surgery for 14 days), and the comparison group – according to the traditional approach. 30 healthy women were examined as a control group.The level of fibrinogen, fibrinogen /fibrin degradation products (FDP), protein-bound hydroxyproline and free hydroxyproline were studied in blood. Pain syndrome was assessed on a 10-point scale.Results. An increase in fibrinogen and FDP levels in the plasma of all examined women were found. But in the main group the concentration of FDP from 4 hours after intervention was significantly higher (5.31±0.24 mg/l) compared to the comparison group (4.53±0.17 mg/l). The level of protein-bound hydroxyproline in the blood serum of the examined women demonstrated its significant increase in the comparison group 12 hours after surgery, with a maximum after 24 hours and maintaining the concentration in 1.9 times higher after 3 days (p<0.05). The level of free hydroxyproline in the main group was significantly (in 1.4–1.6 times) higher than in the comparison group.The increase of the fibrinolytic capacity (p<0.05) in the peritoneal fluid was found during postoperative period. The period of hyperemia in II group lasted 2 times longer than in I group. Also, II group predominates in the number of patients with hyperthermia for more than 3 days – 10 (15.6 %), compared with I group – 4 patients (5.8 %). The duration of stay in the hospital dominated in II group with a standard treatment regimen in the postoperative period – 3.1 %, compared with I group – 1.9 %.The patients after operation in I group evaluated postoperative pain on average by 1.8 points (p=0.00), in II group – at 3.6 points (p=0.06). Synthetic opioid analgesics and nonsteroidal anti-inflammatory drugs were administered intramuscularly for analgesia. The patients in II group required more injections per patient.Conclusions. The proposed approach is effective, pathogenetically reasonable and can be used as a pathogenetic prevention of adhesions formation in women of reproductive age.