Some peculiarities of surgical treatment

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Preoperative examination and preparation of patients for surgery. A thorough anamnesis gathering and refining of complaints of the patient already mentioned. However, the survey is time-consuming, and some important details (localization, radiation of pain, and so on) can elude the attention of the operating surgeon. So it was he, and not just ward doctor before the operation should talk with the patient, again to produce vaginal-pryamokishechnye examination, study programme, data over and other studies. This will help to solve the question of the forthcoming operation, the necessity of participation of urologists and surgeons, if the operating gynecologist not able to use the technique of operations in the bowel or urinary system, the procurement of the required number of blood or its components, mixtures, preparations to replenish energy deficiency and correction vodno-elektrolitnogo balance.
Preliminary preparation of the intestine to the operation facilitates its revision, intervention and post-operative period.
The timing of the operation. We refused from operations for endometriosis before menstruation. This was done 20 years ago with the aim of ensuring a more radical removal of endometriosis [B. N. Baskakov, 1966]. Observations subsequent years showed that the changes of tissues, caused by endometriosis, can detect it not only before, but also after a period. Remain cicatricial inflammatory transformation, dense nodes with fine-mesh structure at the cut.
Observations are made indicate the absence of the need to operate the patients on the eve of the month in the pursuit of radical destruction of endometriosis. If to consider increased bleeding tissue in the area of operation, especially on the eve of the month, it becomes apparent uselessness of our previous recommendation about timing operations before menstruation.
So, to operate on patients it is after month, after 3-4 days from the date of their graduation.
Anesthesiological assistance. Advantages endotracheal narcosis does not cause doubts. Better when anesthetic allowance holds a specialist in gynecologic hospital, understanding the peculiarities of operations deep in the pelvis and the need to ensure good relaxation for the whole operation.
Epidural anesthesia and blockade (catheter into the epidural space is set before surgery or immediately after surgery) are extremely useful when performing major surgery for endometriosis, especially in patients with common cicatricoadhesive process of organs of small pelvis and abdomen, resection of ulcers, and after operations on the occasion of festering endometrioid ovarian cysts in other situations when you need early and good recovery of intestinal peristalsis.
To restore the motor-evacuative bowel function, except prolonged epidural blockade trimekainom or lidocaine, be sure to create in the body of the patient conditions Eugenie (introduction of such quantity of the liquid, which the body needs in the moment, to avoid hyperhidrosi and gobohide tissues) to support all life functions and water and electrolyte balance. The prerequisites for the prevention of postoperative enteroparesis and recovery of motor function is the elimination of the deficit of potassium and sodium (introduction polyionic solution or ringer's solution with the addition of Panangin and 1 % solution of potassium chloride and so on), correction of KOS and timely and adequate reparation blood loss, especially if the operation was performed at analizirovali patient.
The following indispensable conditions of recovery of motor function of intestines and a good regeneration of tissues are replenishing of energy resources and deficit of plastic materials with account of preoperative preparation (insufficient caloric probe diet for 3-4 days before surgery) and the lack of enteral nutrition during 6-7 days after the operation. With this purpose, the patients are applied:
1) intravenous administration of 20% glucose solution-1500 - 2000 ml with an adequate amount of insulin;
2) sorbitol (20 % solution) - 250-400 ml;
3) of amino acid solutions and complexes of amino acids (aminomethyl, clarified hydrolysis 500-1000 ml, aminosol - 500 ml, amino - 500 ml, Albazin - 500 ml, VAMIN-fructose - 500 ml, moriamin - 500 ml, gepstein a and b), in combination with albumin (5-10-20 % solution) -up to 500 ml and protein;
4) fat emulsion (lipofundin or intralipid 500 ml) with geparinom;
5) vitamins.
Each day the patient should receive 2000-2500 kJ.
When you are unable to make long epidural blockade, we can apply the peripheral sympathetic blockade by the following method. On the day of surgery during then the patient is injected intramuscularly benzogeksony -2,5 % solution with 0.5 ml of the Second injection of the drug at the same dose is produced during the operation (after 3 h after the first injection), and in the future benzogeksony introduces every 6 hours for 5-6 days. With 2 days to blockade and receptors of the small intestine enter piroxin - 1 % solution of 1 ml and obzidan - 0.5 ml (to blockade R-receptors of the colon). Both drugs are recruited in one syringe and administered intramuscularly 2 times a day at intervals between injections benzogeksony. With 3 days to the benzogeksoniya, pirroksana and obsidianu add neostigmine - 0.05 % solution, 0.5 ml, 2 times a day intramuscularly. The introduction of drugs continues until a chair, aided by the ingestion of mineral oil 1 tablespoon (30 ml) 3-4 times a day, starting from the 6-th day after operation. Especially positive effect on recovery of motor function of the intestine HBO that we start the morning after surgery.