PubMed1998
One of the most frequent reasons of the intraperitoneal adhesions formation in young women is pelvic inflammatory disease and surgical operations of pelvic organs. The element of more complex activities against adhesion creation is to limit an inflammatory reaction in the area of operation by intraperitoneal and systemic pharmacotherapy. The system of activities put into practice in the Clinic of Gynaecology includes in the field of pharmacological prophylaxis a systemic and intraperitoneal use of dexamethasone and promethazine before, during and after the operation, in total doses respectively: 250 mg and 300 mg, as well as intraperitoneal dosing of 500 ml of dextran 70, just before closing the peritoneal cavity. Verification of the results of these activities during laparoscopy or laparotomy shows its high effectiveness. For many years we did not observe any complications of any wound healing after the operations. Due to existing reports about possible complications in the postoperation period, which are probably caused by the use of the above-mentioned pharmaceutics, I decided to investigate how dexamethasone, promethazine and dextran 70 influence the selected parameters of humoral resistance in women who were operated on due to mechanical infertility. The investigated group consisted of 30 women, while the control group comprised 10 women who had gynaecological operations of similar extent. The venal blood samples were collected before the operation and on the third, fifth and twenty first day after the operation. The levels of selected acute phase proteins were checked and the character as well as the dynamics of value changes were monitored in both groups. Because of great variability between the proteins the fractions were picked out focusing on the differences in dynamics of metabolism, half-life time and biological functions. Following proteins were investigated: C-reactive protein, alfa1-acid glycoprotein, haptoglobin, alfa1-antitripsin, ceruloplazmin, alpha2-macroglobin, hemopexin, immunoglobulins A, G, M, albumins, transferrin, alpha2-HS-glycoprotein. The analysis of the study results has indicated that the application of dexamethasone, promethazine and dextran 70 only exerts modulating influence on the course of acute phase reaction induced by the operations. In the group having been studied earlier (in 3rd postoperative 24-hours) significant changes were revealed concerning the level of particular proteins in accordance with their physiological character (increase or decrease of level) in the control group such changes appeared later (about 5th 24-hours) and were characterized by markedly smaller amplitude and dynamics (Tab. 1-2, Fig. 1-15). The levels of proteins defined prior to operation were reached faster by patients of the study group (up to 21st 24-hours after operation). It has been disclosed that the use of composed antiadhesion therapy with dexamethasone, promethazine and dextran 70 accelerates, intensifies and simultaneously restricts the duration of transformations defined as acute phase reaction, which result in reducing the number of intraperitoneal adhesions. This therapy does not impair the mechanisms of humoral immunity in patients operated on.