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INVENTION
Patent of the Russian Federation RU2082413
The method of treatment of duodenal ulcer of the duodenum
The name of the inventor: Okhotin IK; Lukanov A.D .; Zubeyev PS
The name of the patent holder: Nizhny Novgorod State Medical Institute; Lukanov Andrey Dmitrievich
Address for correspondence:
Date of commencement of the patent: 1993.06.30
The invention relates to the field of medicine, namely gastroenterology, and can be used to treat duodenal ulcers. The task is to shorten the duration of treatment. New in the method is that the ulcerative defect is treated with lysozyme in a dose of 100-150 mg, then solcoseryl or actovegin in a dose of 4-5 ml, irrigate the ulcer with sea buckthorn oil, and the points of administration are changed with the subsequent procedure. The procedure is carried out every other day, for a course of treatment of 3-5 procedures.
DESCRIPTION OF THE INVENTION
The invention relates to the field of medicine, namely gastroenterology and can be used to treat duodenal ulcers.
Treatment of long-term non-healing ulcers of the duodenum is a complex and unsolved problem of modern gastroenterology. Therefore, the search for methods and drugs for the treatment of duodenal ulcers is an urgent problem in the treatment of this disease.
A method of endoscopic treatment using the preparation "Proposol" in the complex therapy of duodenal ulcers is known [1] The preparation contains propolis and is administered through the endoscope on an empty stomach three times a week, every other day. Through the Teflon catheter, carried out on the biopsy channel of the endoscope, 3 ml of the drug are applied to the surface of the ulcer. Simultaneously, conventional antiulcer therapy is performed. In 84.3% of patients, the ulcerative defect is epithelialized within a period of up to 18 days, which required 6 8 therapeutic endoscopies. Ineffective treatment was found in 6.1% of patients.
Known is a method for treating peptic ulcer with the help of film-forming drugs. Of a large number of glutinous substances NS. Fokin et al. (1980) [2] settled on a glue MK-6, which has antimicrobial activity, is not toxic, biocompatible and, upon contact with tissues, rapidly polymerizes. During an endoscopic examination, a teflon catheter is placed over the ulcer. Ulcerative defect and mucosa around the ulcer is treated with 8 10 ml of 96 ° , ethyl alcohol. On the ulcer, including 0.5 cm of the mucous membrane around it, 1 -2 ml of glue is applied depending on the size of the defect. The subsequent adhesive applications are made with an interval of 4 -5 days. Total for the course 8 10 applications. Timing of scarring of ulcers with the use of glutinous applications in combination with general therapy of peptic ulcer with duodenal ulcers was 33.2 ± 3.2 days.
A method for treating peptic ulcer of the stomach and duodenum with the help of the aerosol film-forming preparation "Statisol" is known, which affects the metabolic processes in the mucosa of the digestive tract, providing prolonged, reparative action in the area of the pathological focus, protecting the ulcer from further exposure to gastric acid-resistant contents The environment of the stomach. "Statisol" is applied to the ulcer via a catheter through the biopsy channel of the endoscope during fibroadastroduodenoscopy after preliminary "drying" with a mucous membrane of 96 o alcohol (3 5 ml), the glue was applied to the ulcer and up to 1 cm around it. 10 applications were applied to the course of treatment. As a result of complex therapy of peptic ulcer with the use of the film-forming preparation "Statizol" after 2 3 weeks healing of the ulcer is noted. With duodenal ulcer, the healing time was 20.7 ± 2.4 days [3]
The disadvantages of all described methods is the rapid removal of any drugs from the surface of the ulcer, through gastric juice and food and the impossibility of prolonged exposure to their local application to the ulcer.
The closest to the proposed method and accepted for the prototype is the known method for treating peptic ulcer of the duodenal cat by ulcer oxyferiscrobonom sodium and amigluracil followed by application of film-forming preparations to the ulcer: glue MK 6, MK 7 [4] Sodium oxyferisorbone exerts reparative, anti-inflammatory and Decongestant action. Amigluracil, a drug produced on the basis of methyluracil, belonging to the group of pyrimidine derivatives, has a reparative, anti-inflammatory and proteolytic effect. When fibrogastroduodenoscopy with a special needle injector at 2 -3 points at a distance of 0.5 0.8 cm from the edges of ulcers, 15-30 mg of oxyferisurbone sodium are submucosally administered, and 0.25 0.5 mg amigluracil at the bottom (at 1-2 points). Then, after "drying" (0.8 1 ml of acetone), 1 - 2 ml of medical glue MK-6 or MK-7 is applied to the ulcer, with a capture of 0.5 0.8 cm surrounding the mucosa through a Teflon catheter. Repeated fibrogastroduodenoscopies with a therapeutic purpose are performed at intervals of 4 to 5 days, an average of 3 6 times per course of treatment. In 1/3 patients with duodenal ulcer treated with this method the healing time of the ulcer is 12-15 days. In 2/3 patients the healing time is from 16 to 48 days. Clinical recovery occurred in 97.4% of patients.
The drawback of the prototype is the duration of treatment of patients. The timing of healing of ulcers is close to the treatment of duodenal ulcers by other methods of complex action. In 2/3 patients the healing time is from 16 to 48 days, which does not satisfy modern gastroenterology.
The object of the invention is to shorten the duration of treatment.
Delivered by the fact that in the known method of treating duodenal ulcer by splitting ulcers with medicines, lysozyme and reparant are injected into the edges and under the ulcerative defect at different points, and the surface of the ulcer is irrigated with sea buckthorn oil, and the injection points are changed with the subsequent procedure. The procedure is carried out every other day, for a course of treatment of 3 5 procedures. Single dose of lysozyme 100 150 mg. 4 5 ml of sea buckthorn oil 5 ml. As a reparant, use solcoseryl or actovegin.
Lysozyme is an enzyme of protein nature. Get it from the protein of a chicken egg. It is an antibacterial drug that has the ability to stimulate nonspecific immunity. Lysozyme in surgery is used to treat severe surgical infection, while stimulating the body's immune forces. Lysozyme stimulates phagocytosis, proliferation of T and B lymphocytes. Without stimulation of the body's immune forces, it is impossible to strengthen reparative processes in the mucous membrane of duodenal ulcer with the help of only oxyfericurcon sodium or other reparants. 100 150 mg of the drug per injection This dose, which is administered intramuscularly to the patient with a severe, purulent infection of the abdominal cavity (purulent appendicitis, peritonitis) with a single injection. By creating a lysozyme depot in the submucosal layer of the ulcer, and then splitting the ulcer with a solution of solcoseryl or actovegin, stimulate local immunity processes and enhance reparative processes in the area of the ulcer, thereby conducting pathogenetic treatment of duodenal ulcer.
The method is carried out as follows:
An empty stomach in the position on the left side after irrigation of the pharynx with a 1% solution of dicain produces fibrogastroduodenoscopy in which duodenal ulcer is detected. The bottom of the ulcer is cleaned with a brush from food debris and fibrin plaque. After that, injecting the injector into the ulcer, the needle is ejected from it 0.5-0.8 cm. Making an injection into the edge of the ulcer in order that the infiltration shaft from the mucous membrane is formed when the medicine is administered. Injection inject lysozyme at a dose of 100-150 mg at one point, at the other point on the border of a healthy and affected mucous ulcer, solcoseryl or actovegin is injected at a dose of 4-5 ml. When lysozyme is administered, local immunity is stimulated, regeneration processes are activated upon introduction of the reparant. Creating a submucosal infiltrational shaft from drugs, they are deposited for a longer period, which increases their therapeutic effect, and brings the edges of the mucous by mechanical means, thereby accelerating the adhesion of the edges of the ulcer and its healing. After injection of lysozyme and solcoseryl or actovegin, sea-buckthorn oil is applied to the ulcer through the fluoroplastic catheter. When the oil is applied, the surrounding ulcer is seized by the mucous membrane. The procedure is repeated every other day. The course of treatment 3 5 procedures. Each subsequent procedure is performed at a new point along the perimeter of the ulcer. Treatment is terminated after cicatrization of the ulcer to a tender red rumen, sometimes by the mucous membrane at the site of the crater of the ulcer, depending on its depth.
Examples of specific performance are given in the form of an extract from the case histories.
The patient Vodopyanov AI 56 years old, ist.N 588, suffers peptic ulcer of the duodenum for 5 years. In February 1993, the patient has another exacerbation of peptic ulcer of the duodenum, which manifests itself in epigastric pains, aching, and muscle growth. With fibrogastroduodenoscopy from 20.02.1993 revealing exacerbation of peptic ulcer of the duodenum. I entered the therapeutic department for conservative treatment. The patient was treated: vikalin, gastropharm according to 1 table.x3 times a day, almagel for 1 d.l. X 3 times a day HBO therapy. 19.02.93 1 treatment endoscopy was performed. After irrigation of the pharyngeal ring, a 1% solution of dicain produced fibrogastroduodenoscopy. Esophagus and cardia freely passable. In the stomach on an empty stomach a lot of mucus, the mucous membrane is hyperimposed, the folds are thickened, edematous. In the antral section there are many surface erosions. The porter is symmetrical, he will close. In the bulb of the duodenum on the anterior medial wall a deep ulcer, 1.5 x 1.0 cm in size. Its bottom is filled with fibrin, the walls around are infiltrated, the folds are thickened, edematous. The bottom of the ulcer is cleared with a brush from fibrin. The ulceration was made with the creation of an infiltrative shaft with a solution of lysozyme 100 mg. From one point. From the second point on the border of the mutable and healthy mucosa, the ulcers were sacrificed with a solution of solcoseryl 5 ml. After that, irrigation of the ulcer with sea-buckthorn oil of 5 ml was carried out through the Teflon catheter. The patient was given 5 sessions of medical endoscopy according to the described method. After the second session, the patient had epigastric pains. During the 3 sessions, a decrease in the size of the ulcer was diagnosed, as well as its depth, the bottom was cleared of fibrin. During the 5th session, it was revealed: on the anterior-medial wall of the bulb of the duodenal ulcer, a pink-colored ulcer of 0.6 x 0.8 cm in size. The mucosa around the rose. Edema of folds and deformities of the bulb is not noted.
Patient Semenova NP East. N 889, 61 years suffering from peptic ulcer of the duodenum for 3 years, when the ulcer was first detected. Pain in epigastric seasonal, muscular nature disturbed the patient before. With exacerbation of duodenal ulcer 12 the patient was hospitalized in the therapeutic department of hospital No 28, where she underwent conservative treatment: vikalin, gastropharm according to 1 table. X 3 times a day, Almagel 1 d.l. X 3 times a day. Spasmolytics in / m 25.02.1993 with fibrogastroduodenoscopy revealed that the esophagus and cardia freely passable. In the stomach on an empty stomach there is no content, pink mucous, the folds are not thickened. The porter is symmetrical, he will close. In the bulb of the duodenum on the anterior and posterior walls two ulcers, 0.8 x 0.5 cm in size, their bottom covered with fibron, folds somewhat thickened. Mucous is hyperimposed. Diagnosis: peptic ulcer of the duodenum in st. Exacerbation. Kissing ulcers of the bulb of the duodenum. A therapeutic endoscopy was performed: an injector was injected into the ulcer on the back wall of the bulb, the ulcer was chopped with a solution of lysozyme 150 mg. On the opposite side of the ulcer, the ulceration of the ulcer on the border of healthy and affected with solcoseryl solution of 4 ml was performed. After that, the ulcer was irrigation with a solution of sea buckthorn oil of 5 ml. He received 5 sessions of medical endoscopy. During the second session, there was an improvement in the form of a decrease in the size of the ulcers and a beginning scarring along the edges. The pain syndrome disappeared by the 3rd procedure. By 5 procedures, ulceration of the ulcers is diagnosed.
Comparison of the proposed method with the prototype made it possible to reveal the following positive effect:
By splitting the ulcer with a solution of lysozyme and creating its depot in the submucosal layer, local immunity increases.
Subsequent ulceration of the ulcer with a reparant against the background of injected lysozyme creates the most favorable conditions for ulcer healing by reducing the number of procedures to 3 5 per course of treatment.
Thus, the treatment time was reduced to 6-10 days.
12 patients were treated with the method described. All have clinical endoscopic positive dynamics during the ulcerative process. All patients had cicatrization of the ulcer after 3 5 endoscopic clefts.
An excellent result was obtained in 92.31% of patients. Satisfactory in 7.6% of patients, which allows us to recommend a method for introduction into wide practice.
BIBLIOGRAPHY
1. Kabanov A. N. Suvorov A.M. Medical endoscopy in selection of patients with duodenal ulcer, subject to surgical treatment / / Wedge. Hir.-1986. -N8.-p.39 41.
2. Fokin N.S. Bastatsky V.G. Ponomarev V.G. And others. The use of glue MK-6 in the treatment of gastroduodenal ulcers with a fibroscope // Sov. Med.-1980-N2. -P.61 63.
3. Tsarev N.I. A.B. Krasnykh Application of the film-forming glue "Statisol" in the treatment of stomach and duodenal ulcers // Vestn. Hir. -1986.-N1. -FROM. 14 17.
4. Prototype. Berezov Yu.E. Fokin N.S. Bastatsky V.G. Local treatment of long-term non-healing gastroduodenal ulcers through a fibroscope // Sov.med. -1981.-N2.-P.26. 30.
CLAIM
1. A method of treating duodenal ulcer by peeling the ulcers with drugs, characterized in that lysozyme and a reparant are injected at different points into the edges and under the ulcerative defect and the ulcer is irrigated with sea buckthorn oil, the injection points being changed with each subsequent procedure, the procedure is carried out In a day, on a course of treatment of 3 5 procedures.
2. A method according to claim 1, characterized in that a single dose of lysozyme is 100-150 mg, reparant 4 5 ml, sea buckthorn oil 5 ml.
3. The method of claim 1. 1 and 2, characterized in that the reparant is solcoseryl or actovegin.
print version
Date of publication 28.03.2007gg
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