Liver surgeries are associated with the risk of bleeding and the development of adhesive disease. Sodium carboxymethylcellulose (Na-CMC) forms an elastic swelling gel and a “lattice” that holds the blood cells.The aim: determine the concentration of Na-CMC, which has the maximum hemostatic and anti-adhesive effect, during liver surgeries in the experiment.Materials and methods. The coagulating effect of Na-CMC (from 0.5% to 9%) was studied in vitro. In vivo experiment on 167 male Wistar rats weighing 185–250 g studied the bleeding time and the amount of blood loss, anti-adhesive activity in the model of liver surgery by cutting off the edge of the organ in the standard way: the depth and width of the wound is 1 cm; the height is 3 mm.Results. In vitro the minimum coagulating effect was obtained in 3% of Na-CMC. In vivo the maximum effect on reducing the bleeding time (–46% compared to the control, p < 0.01) and the amount of blood loss (–27% compared to the control, p < 0.01) had 6% Na-CMC. Then, according to the degree of decrease in the bleeding time, there were: 5% Na-CMC (–40%), 4% Na-CMC (–37%), 3% Na-CMC (–29%), 7% Na-CMC (–27%), 8% Na-CMC (–11%). For the amount of blood loss, a similar pattern of decreasing effect was observed: 5% Na-CMC (–21%), 4% Na-CMC (–14%), 7% Na-CMC (–12%), 3% Na-CMC (–11%), 8% Na-CMC (–5%). When comparing all the studied concentrations of Na-CMC gel with the control group in terms of bleeding time and blood loss, the differences are statistically significant: p < 0.01. Maximum anti-adhesive activity was observed for 6% Na-CMC on days 7 and 14 after surgery: the adhesive process was estimated at 0.497 [0.000–0.497] and 0.962 [0.000–1.301] points vs. 2.457 [2.118–2.457] and 4.071 [3.758–4.602] points in the control group (p < 0.01).Conclusion. The maximum hemostatic and anti-adhesive effect has 6% Na-CMC.

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The aim of this study was to develop a hemostatic agent with anti-adhesive properties and to study its effect on liver morphology, metabolic activity and hepatocyte regeneration in experimental liver injury. Methods. In 60 rats following experimental resection liver injury, the time of bleeding and the volume of blood loss were determined. Histological preparations were used to study the size of hepatocytes and their nuclei, the content of glycogen (PAS-reaction), the number of binucleated hepatocytes and the expression of Ki-67. Results. Compared with the control, an agent based on 6% sodium carboxymethylcellulose gel and 5% aminocaproic acid effectively and reliably reduces the bleeding time by 72% (217.91 s), the volume of blood loss by 74.7% (372.85 mg) (p ≤ 0.01) and the degree of blood filling of the sinusoid liver capillaries. In addition, the use of the novel gel prevents the adhesion formation. It stimulates mitotic activity of hepatocytes, accompanied by an increase in the number of binucleated hepatocytes and Ki-67 expression. By the 14th day, this activity significantly decreases. Hypertrophy of hepatocytes and their nuclei is observed by the 7th and 14th days of the experiment. This indicates both an increase in the metabolic activity of hepatocytes and intracellular regeneration. The use of the hemostatic gel does not alter the glycogen-storing function of hepatocytes, which indicates the lack of pronounced hypoxia due to effective control of bleeding. Conclusion. The local hemostatic gel based on 6% sodium carboxymethylcellulose gel and 5% aminocaproic acid can be recommended for local bleeding control in liver injuries and surgery.

Backgraund. Spleen surgery is mainly aimed to achieve effective hemostasis. The increasing popularity of topical hemostatic drugs is limited by their common side effect associated with the development of adhesions.The aim of study was to develop a new hemostatic drug with anti-adhesion activity. To achieve this, the authors have investigated 6% sodium carboxymethylcellulose gel with the addition of 5% aminocaproic acid. Materials and methods. The efficacy of the sample was studied experimentally in laboratory animals (rats, n = 87). The time of bleeding arrest, the amount of blood loss, the severity of the adhesion process, morphological and histological changes in tissues in the area of material implantation were assessed.Results. The study results evidenced that the new hemostatic drug reduced bleeding time by 68% (222.27 sec) and blood loss by 69% (285.6 mg) (p 0.01) after partial splenectomy, and prevented the development of adhesive process compared to the results obtained in the animals of the control group. On the 3rd day of the experiment application of the sample demonstrated that adhesions were completely absent, the coefficient of the severity of the adhesive process was 0 points; on the 7th and 14th days it was minimal - 0.481 and 0.486 points, respectively (p 0.05). A morphological study showed that the use of the new composite reduced the white pulp immunological reactivity associated with postoperative inflammatory processes, which is manifested by smaller lymphoid follicles and lower CD4 + T-lymphocytes expression.Conclusions. Thus, 6% sodium carboxymethylcellulose gel with the addition of 5% aminocaproic acid is an effective combined hemostatic and anti-adhesion agent that can be effectively applied in spleen surgery.