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INVENTION
Russian Federation Patent RU2233123
METHOD OF TREATMENT intestinal fistulas
Name of the inventor: Round EE (RU); Nalivkin AE (RU); Mashkov AE (RU); AN Nasedkin (RU); Golubovskii GA
The name of the patentee: Moscow Regional Research Clinical Institute
Address for correspondence: 129110, Moscow, ul. Shchepkina 61/2, Monica, Patent Group
Starting date of the patent: 2002.09.12
The invention relates to medicine, gastroenterology. Carry out the installation of drainage, drug therapy. The distal end of the drainage installed at a distance of 0.2-1.0 cm from the fistula. Carried out through his influence on intestinal fistula. Affect airborne nitrogen monoxide gas stream for 2-3 minutes daily. The method improves the regeneration of tissues.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, in particular, to methods for treating peritonitis delimited mainly with intestinal fistulas.
Treatment of intestinal fistula is very difficult and requires complex treatment in connection with the violation of water and electrolyte balance, the presence of inflammation in the abdominal cavity, the lack of efficiency of the use of antibiotic therapy, antiseptic and immune drugs. Tamponade intestinal fistulas and surgical closure depends on the time of origin, form a fistula, its maturity and is not always effective (Yu.F.Isakov, E.A.Stepanov, T.V.Krasovskaya "Abdominal surgery in children" -.. M. Medical, 1998, s.170-177).
The disadvantage of these methods is that long-term use of antibiotic therapy, antiseptic solutions and regenerating ointment can lead to hypergranulation and microbial resistance, and the continued existence of fistula leads to water-electrolyte disturbances and reduce the body's regenerative abilities. Carrying tamponade intestinal fistula can be accompanied by the formation of delimited cavity and an abscess that requires surgical sanitation of purulent process and increases the fistula operation.
A method of treating immature fistulas comprising obturation cavity drainage with connection to a vacuum pump (RF application for the invention 98103534/14, publ. 27.01.2000).
The disadvantage of this method is that when creating a vacuum in the course of fistulous contents enters through the drainage and possibly increase the size of the fistulous, increased fluid and electrolyte losses, which further leads to the formation of a fistula gubovidnogo, longer infusion preparation and the increase in volume of surgery.
Currently, the most common way to treat intestinal fistulas (eg, delimited peritonitis with intestinal fistula) is a process that includes the installation of drainage, drug therapy (G.A.Bairov Emergency surgery of children -.. L .: Medicine, 1983, s.286- 291, a prototype).
But the treatment of intestinal fistula is very difficult due to the presence of adhesions and widespread inflammation in the abdominal cavity, surgical difficulty, lack of efficiency of the use of drug therapy, including antibacterial, antiseptic and immune drugs. Long-term use of antibiotic therapy, antiseptic solutions and regenerating ointment can lead to development of microbial resistance and hypergranulation.
The objective set by the authors, is to eliminate these disadvantages, improving tissue regeneration, improving the efficiency of the treatment, with the exception, in some cases surgery.
For this purpose, a method for treating intestinal fistula, comprising a drainage unit, drug therapy, it is suggested to install a distal end drainage in the region of 0.2-1.0 cm from the fistula, through carry effects on intestinal fistula air-gas flow of nitrogen monoxide (NO-therapy ) from the unit "PLASON" in the therapeutic regimen for 2-3 minutes per day for the course of 6-10 treatments.
The proposed drainage installation allows dosed influence of nitrogen monoxide without loss dissipation on the intestinal fistula, eliminates the formation of cavities and trauma of bowel tissue. There is a rapid significant improvement of regeneration in the wound, and the intestinal wall, allowing you to successfully deal with intestinal fistulas. The effectiveness of this treatment regimen confirmed the reduction in timing closure and intestinal fistula hospital treatment.
The method is as follows
Installation of drainage can be conducted at primary surgery with debridement and delimitation of intestinal fistula from the free abdominal cavity. When formed intestinal fistula to install drainage may use a laparoscope to determine the exact distance to the entrance of intestinal fistula. No surgery is performed through the installation of drainage fistula under fluoroscopic guidance.
The distal end of the drain is installed in the immediate vicinity of the intestinal fistula (0.2-1.0 cm) from the unit "PLASON" ( "scalpel-coagulator stimulator air plasma SKSVP / of NO) in a therapeutic regime of 1000-3000 mg / m 3, exposure time is determined by the individual indications of 2 to 3 minutes, the number of sessions is selected depending on the clinical effect of 6 to 10.
Just before the session NO-therapy drug is carried out impact 0.5% solution dioksidina or any other antiseptic preparation.
example 1
X. The Irina, 7 years, medical history №4662.
Diagnosis: Intestinal obstruction, post-bowel intubation, multiple perforation of the small intestine, enteric fistula.
When a serious condition. Clinic partial bowel obstruction can not be removed nazoinstentsialny probe. After preoperative preparation operation is performed: relaparotomy, inspection of the abdominal cavity, suturing multiple perforated holes of the small intestine (14 perforations between 0.2 and 0.3 to 0.5 ґ ґ 2.0 cm) debridement and drainage of the abdominal cavity as described above .
On day 7 after surgery for intestinal secretions drainage appeared at fistulography there enteric fistula, delimited from the abdominal cavity.
Traditional treatment: antibacterial therapy, immunotherapy - human immunoglobulin for intramuscular administration 1,0 №3. Local treatment: washing fistulous 0.5% solution dioksidina, dressings with hypertonic saline, physical therapy is not effective.
A fistula in silicone drainage conducted stimulation and tissue regeneration of the intestinal wall unit "PLASON" by acting through a drain gas flow in the therapeutic mode for 3 minutes. After the first treatment session nitrogen monoxide discharge from the fistula has decreased, and after 8 sessions completely stopped. A total of 10 sessions were held. Spend fistulography, missing his message to the intestine, drainage removed. Complete healing wound for 22 hours.
This example demonstrates the high efficiency of nitrogen monoxide in the treatment of intestinal fistulas.
The above procedure was treated group of patients, clinical observation showed the high efficiency of the process when using these treatment options with individual selection of exposure time NO-therapy and the number of sessions. The method allows to reduce the time of hospital treatment to avoid disability and patient for repeated rehabilitation courses.
CLAIM
A method of treating intestinal fistula, comprising a drainage unit, drug therapy, wherein the distal end of the drain is set at a distance of 0.2-1.0 cm from the fistula, through exposure performed on the intestinal fistula air-gas stream from the nitrogen monoxide apparatus "Plazon "a therapeutic regimen for 2-3 minutes daily, a course of 6-10 treatments.
print version
Publication date 29.03.2007gg
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