Method of programmed stimulation of repair regeneration in suturing line of anastomoses of hollow organs of gastrointestinal tract

FIELD: medicine.

SUBSTANCE: offered invention refers to medicine, namely to surgery, and can be used for prevention of inconsistency of anastomoses of hollow organs in gastrointestinal tract surgery. That is ensured by the oral introduction of 5-oxymethyluracil pills of the weight 1.5 g and diameter 7-7.5 mm on the 2nd postoperative day in the following proportions: 5-oxymethyluracil - 0.5 g, 5 % spirit-acetone acetylphthalylcellulose - 3 layers, 10 % hexane solution of low-molecular polyethylene - 1-3 layers, biological adhesive Sulphacrylate - 1-3 layers.

EFFECT: introduction of 5-oxymethyluracil in said dosage form provides stimulation of repair regeneration ensured by selective maximum concentration of the preparation in gastrointestinal segments where the anastomosis has been created, and reduced ischemic disorders.

1 ex, 1 dwg

 

The present invention relates to medicine, namely to surgery of the gastrointestinal tract, and can be used for resection of hollow organs (stomach, small intestine, colon). While there are different ways of forming anastomoses: "end - to-end", "side by side", "end - side, using both single-row and multi-row manual or mechanical joint.

Regardless of the option chosen, none of them gives a full warranty from the development of insolvency seams anastomosis. The causes of insolvency, different, but the main ones are ischemic changes in the area of the seam strip anastomosis, resulting in failure recovery action potential reparative tissue regeneration, dysfunction of cellular membrane walls of hollow organs in the area of the seam strip (Chibis O.A. Surgical suture. M., 1987). This is due to the inevitable crossing of the arteries of the mesentery of the intestine mobilization of mesenteric edges. It is proved that at a distance of 1.5-2 cm from the last saved artery intramural blood flow to the intestinal wall is reduced to 15% from the norm, which inevitably leads to ischemic changes on the edge of the resected intestinal wall (Delaney, S.P., E. Grim Collateral blood flow to a devascularized segment of small intestine. // Surg. Ginecol. Obst. - 1993. - Vol.116. No. 4).

In surgery of the gastro-intestinal tract is and continues the search for new approaches to solving this problem. One of them is the use of stimulants reparative regeneration, accelerating full structural tissue repair anastomosing bodies.

The prototype of the present invention is a method of preoperative prevention of insolvency of the anastomosis of hollow organs in surgery of the gastrointestinal tract, namely, that in addition to cleansing enemas for 5 days before surgical intervention orally administered 5-oxymethylphenyl dose of 50 mg/kg twice a day (Patent RF № 2304973, 2007).

5-oxymethylphenyl - pyrimidine derivative, is a "minor" basis, is found in large quantities in the transport of RNA and DNA and performs a significant role in the functioning and metabolism of these polymers. Marked by its high activity as an immunostimulant. In addition immunostimulating, OMO identified other important properties: anti-toxic, anti-oxidant, anti-inflammatory, as well as the ability to stimulate reparative regeneration. Polivalentes steps 5-auximetilurazil as representative of pyrimidines is a natural result of the fact that they intervene in the most fundamental life processes, such as synthesis of nucleic acids and protein" (Alekhine E.K. 2006).

In 2002 allowed the use of 5-auximetilurazil in image quality is as stimulator of immunogenesis and reparative regeneration (the Fund 42-0415-2777-02) under the trade name "Immoral".

The objective of the invention was to develop a way to prevent the insolvency of the anastomosis of hollow organs of the gastrointestinal tract.

The technical result when using the invention, the stimulation of reparative regeneration due to selective maximum concentration of the drug in those segments of the gastrointestinal tract, where was formed the anastomosis, reducing them in ischemic disorders.

The proposed method is based on the use of postoperative treatment tablets containing 500 mg of 5-auximetilurazil for delivery to the generated anastomosis and creation in this segment of the gastrointestinal tract, the maximum concentration of the drug.

The proposed method is as follows. Starting with 2 days of the postoperative period, when the appearance of a clear peristalsis and the absence of diarrheal illness in patients administered orally 1 tablet 2 times a day for 3-4 days.

Medicinal tablets contain the active substance 5-oximetery, 5% alcohol-acetone solution acetylcellulose (AFC), the solution of low-molecular-weight polyethylene (NMPA) in hexane 10%, medical adhesive Sulfacrylate in the following ratio of components, on 1 pills weight 1.5 g diameter 7-7,5 mm:

5-Oxymethylphenyl0.5 g
5% Alcohol-acetone solution AFC3 coats
The solution of NMPA in hexane 10% -1-3 layer
Medical adhesive Sulfacrylate -1-3 layer.

The proposed method is illustrated in the drawing, which shows a block diagram of drops with 5-oxyethylation.

All components included in the pills that are allowed for medical use. 5-oximetery (Fund 42-0415-2777-02). Low-molecular-weight polyethylene with a molecular mass of 1500-5000 (TU 6-05-18-3782). Acetylcellulose (FS 42-1263-79). Acetone (GOST 2603). Ethyl alcohol 95% (FS 42-3072-94). Medical adhesive Sulfacrylate (A.S. No. 1005455 from 16.10.82). Hexane (TU 6-09-3375). As a result of experimental studies, it was found that AFC, NMPA, having a high adhesion to the surfaces provide a secure fit 5-auximetilurazil, which are then rolled and take the form of spherical drops.

Making medicinal product form pills provide convenience, and hygiene applications, the storage stability. Medical adhesive Sulfacrylate used as a fixative, in addition, it is used in surgery gastrointestinal symptoms such is on tract to seal the seams of the anastomosis of hollow organs. The above components in the appropriate proportions allow you to get a new composition and a new dosage form 5-auximetilurazil as medical pills, with the shell having a temporary destruction.

Produce coated tablets as follows. Pre-prepare a 5% alcohol-acetone solution AFC based: AFC 5,0; mixture of acetone and ethyl alcohol 95% (9:1) -95 ml Ready engine load in the drageeing boiler with forced warm air for drying in the process. Drive the drageeing boiler, the rotation speed of 40 rpm, the angle of 0-90°, and the kernel is uniformly moistened with the solution prepared binders using sprinklers. After 3 single coating solution UFC they roll a layer of fine powder auximetilurazil. The knurled areas spend up to a diameter of the sphere 7 mm. Then continue to build up in the drageeing boiler to obtain the correct spherical shaped mass of 1.5 g and a diameter of 7-7,5 mm Obtained spheres cover 1-3 layers of NMPA in hexane 10% and continue to rotate the drageeing boiler some time to remove the solvent and obtain spheres with shiny, smooth and even surface. They are then dried for one hour at room temperature and is applied as a protective covered the I layer of medical adhesive Sulfacrylate by means of a spray and dried each layer for one hour at room temperature. Received therapeutic agent is a sphere correct spherical shape, weight 1.5 g, diameter 7-7,5 mm, with smooth and even surface of uniform white or slightly yellowish tinge (drawing).

The proposed method preliminary experimental studies, after which the method was tested and applied in clinical practice. This method is applied in 52 cases, the formation of anastomoses in different segments of the gastrointestinal tract, including the imposition of anastomosis in acute intestinal obstruction.

The proposed method is illustrated by the following example.

Sick So 49 years old, was admitted to the hospital with a diagnosis of Acute abdomen. After clinical examination and preoperative preparation of the patient underwent emergency surgery - median laparotomy. During inspection of organs in the abdominal cavity to 700,0 ml of serosanguineous effusion, the loops of the small intestine is inflated to 4 cm, contain liquid contents. If further revision is detected stenoziruyuschaya tumor of the cecum.

Diagnosis: Blastoma the caecum. Acute obstructive small bowel obstruction. Diffuse serous-hemorrhagic peritonitis.

Done right hemicolectomy, open decompression of the bowel. Formed an inter-intestinal anastomosis end - to-end. Abdominal is alost drained, drained, median wound was sutured in layers tightly.

On the second day was held postoperative prevention of insolvency seams anastomosis with the use of pills, 1 pill 2 times a day.

The postoperative period without complications. The function of the gastrointestinal tract fully recovered in 4 days. The patient was discharged from the hospital with recovery on the 10th day. At the control examination performed after 1 month, the patient was in good condition, no complaints, disorders of the gastrointestinal tract is not marked.

The way to prevent insolvency of the anastomosis of hollow organs in surgery of the gastrointestinal tract by oral administration of 5-auximetilurazil, characterized in that it is administered on the 2nd day after surgery in the form of pellets weighing 1.5 grams and a diameter of 7-7,5 mm in the following ratio of components:

5-Oxymethylphenyl0.5 g
5% Alcohol-acetone solution
acetylcellulose3 coats
The solution of low molecular weight polyethylene
in hexane 10%1 - layer
Medical adhesive Sulfacrylate1-3 layer

1 pill 2 times within 3-4 days.



 

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