Method for the treatment of gastroduodenal ulcers


(57) Abstract:

The invention relates to medicine, namely to a gastroenterologist, and can be used for the treatment of gastroduodenal ulcers. When fibrogastroduodenoscopy cut away along the perimeter of the ulcer defect in 4 points. For this purpose, 2 ml (100 mcg) of Sandostatin in breeding with 8 ml of 0.25% solution of novocaine. The chip is carried out 1 every 2 days for 14 days. The method can reduce the secretory activity and enhance regeneration of the gastric mucosa. This reduces the possible scarring ulcers. 1 C.p. f-crystals, 2 tab.

The invention relates to medicine, namely to a gastroenterologist, and can be used for the treatment of gastroduodenal ulcers.

The problem of ulcers takes a Central place in modern gastroenterology. This is due to its prevalence, and social significance. If since the mid 70-ies of the monograph dedicated to peptic ulcer, published with a frequency of one monograph in 10 years, in the next 20 years - with a frequency of one monograph in 2-3 years. This is due, primarily, with technological progress, which greatly accelerates the period of accumulation of knowledge and new data, the call is on, L. C. Maslovsky "peptic Ulcer disease", M, 1995).

Peptic ulcer and duodenal ulcer is observed in the 0.4 - 10% of the population. According to A. L. Grebneva (Modern advances in the diagnosis and treatment of diseases of the digestive system. In kN. New in gastroenterology. M, 1995), on the territory of the former USSR in 1989, only registered patients with peptic ulcer of stomach and duodenum was about 10 million, the Increasing incidence, which reaches 5.7 per 1000 population, chronic relapsing course, long-term scarring, frequent complications requiring complex surgical procedures, long term disability and disability of patients, can be attributed to the pathology of a number of important medical and social problems. So for the period from 1971 to 1985 frequency SUD increased 1.8 times, the mortality rate was 11.4%, with forecasts for the period 1986 to 2010 is expected to further increase in the incidence of still 1.8 times.

The present work is devoted to the practical issues of peptic ulcer. Basically, today, conservative treatment of peptic ulcer disease associated with drug therapy. Current views on the etiology and pathogenesis of p. pain and dyspeptic phenomena; the healing of ulcers; reducing signs of acute gastritis and duodenitis (meaning, primarily, forms, called pyloric Helicobacter populating); normalization of gastroduodenal motility; preventing the aggravation or extension of the period of remission.

Gastroduodenoscopy, having direct access to the plague, has opened up new possibilities in the treatment of this disease. This method allows the introduction or application of a drug for ulcerative defect, while the parenteral method of administration access to the limited ulcer inflammatory shaft, granulation tissue, impaired microcirculation in periultseroznoy area.

There are several ways local impact on the ulcer by endoscopy (O. N. Minushkin, I. C. Animals, A. Elizaveta, L. C. Maslovsky "peptic Ulcer disease", M, 1995):

1. Machining ulcer crater with biopsy forceps, brushes or wash in a strong jet of fluid through the catheter.

2. Treatment of the ulcer liquid substance through the catheter. Offer to clean the ulcer alcohol, collargol, 5-10% solution of silver nitrate, rosehip, sea buckthorn oil, solkoseril (BHT, solcoseryl gel on the base).

4. The application of film-forming substances. Apply aerosol medications (liphuzol, gastrosil, statical) and medical adhesives (BF-6, MK-6, MK-7, MK-8, CL-3, propolicy glue).

5. Treatment of ulcer crater and periultseroznoy zone with application of high frequency currents.

6. Phototherapy with low - and high-energy laser radiation.

7. Transendoscopic ultrasound therapy.

8. Around the ulcer, periultseroznoy zone, the gastroduodenal area of drug drugs. This method is the introduction of drugs with anti-inflammatory action (hydrocortisone, heparin), improving the regeneration (methyluracil, solcoseryl, oxyphenisatin, dalargin, etc). According to most authors, using methods of local impacts on the ulcer through the endoscope, such treatment can significantly reduce the possible scarring ulcers of the stomach and duodenum.

The nearest proposed method of local treatment of ulcers is around the ulcer Dalargin (O. A. Kargin, Local use of Dalargin and electrostimulation during endoscopic who, however, it is possible the formation of a rough scar, the drug has no effect on the level of secretion of hydrochloric acid, to accelerate healing time.

The objective of the invention is to increase the effectiveness of treatment of gastroduodenal ulcers-drug, which provides a complex effect on the ulcer by reducing the secretory activity of the mucous membrane, by increasing the regenerative activity due to possible impacts on the HP factor.

Our data suggest that this drug is Sandostatin, which is imposed on this invention in the region of the ulcer.

The method is as follows. The patient is fibrogastroduodenoscopy lying on left side. After examination of the stomach and duodenum, assess the condition and size of the ulcer, with the help of the endoscopic injector drawn through the instrument channel of the endoscope, is around the ulcer, 4 points around the perimeter at a distance of 1 cm from the edges of the ulcer, with the introduction of a solution of Sandostatin in the submucosal layer. Manipulations are performed once every two days. All 7 sessions. For injections ispolzuetsia, i.e. 2 ml of Sandostatin diluted in 8 ml of novocaine.

Clinical example 1

Patient C., 36 years old, was admitted to the hospital with complaints of pain in the epigastric region without a clear connection with food intake, nausea. For 11 years, suffering from gastric ulcer with annual exacerbations. Described in the complaint occurred two days ago. When admitted to hospital, General condition closer to satisfactory HELL 120/75 mm RT. century, the heart rate is 80 beats per minute, blood haemoglobin 125 g/l At esophagogastroduodenoscopy revealed a mucosal defect in the anterior wall of the antrum of the stomach, up to 0.8 cm in diameter, surrounded by inflammatory shaft with perifocal hyperemia of the mucous performed fibrin. Started by local treatment by the proposed method. After the first session on the second day reached the relief of pain, symptoms of dyspepsia. On the third day, repeat the procedure and the lack of perifocal hyperemia of the mucous. During the next session of the local treatment of endoscopically ascertained reducing the size of the ulcer to 0.4 cm in diameter, the beginning of epithelialization, the surface location of the ulcer. On the ninth suck Inoi C., 27 years. History of peptic ulcer disease duodenal ulcer within 3 years. Complaints received at a aching epigastric pain, left upper quadrant with radiation to the lumbar region, nausea, lack of appetite, loose stools. The General state of moderate severity: body temperature to 37.8oC, flushing of the face, abdomen moderately swollen, with marked tenderness to palpation in the epigastrium. Blood leukocytosis, 10.2 thousand Moderate increase in the level of diastase in the urine. In conclusion, ultrasound - reactive pancreatitis. During esophagogastroduodenoscopy in front of the bulb of the duodenum revealed rounded ulcerative defect: deep, up to 1.0 cm, the bottom of which is covered with fibrin and necrotic masses. For local treatment to 6 days recorded cleansing, reducing the depth of the ulcer, and 9 day - pronounced edge epithelialization, reduced to 0.3 see Clinically is the absence of pain, subsidence of the clinic pancreatitis, ultrasound improved the condition of the pancreas. On the 12th day endoscopically showed complete epithelialization of ulcers.

To evaluate the effectiveness of the developed method, we have conducted with the treatment of the developed method (n1= 12). In the first control group included patients who were treated using a method prototype endoscopic injections ulcer solution of Dalargin (n2= 12). The second control group consisted of patients who were around the ulcer 0.25% solution of novocaine, without Sandostatin, according to the method and in the amount stipulated in the treatment developed by the proposed method (P3= 10).

In all groups, patients were assigned to diet, recommendations for diet. Patients in all groups comparable in age, sex, ulcer history, the size of the ulcers. The average age of patients in group 1, 42 years old, in the first control - 41.5 years, in the second control group for 42 years. The ratio of men and women in all groups of 3:1. The average duration of ulcer history in the main group was 7.5 years, in the first control - 6.9 years, in the second control group is 7.6 years. Patients in all groups of complications in history was not. The size of the ulcer at admission in all groups - from 0.7 cm to 1.3 cm (PL. 1).

We have analyzed the results of treatment in the main and control groups. It has also been found earlier by mensentaal - for 12 hours, respectively. Terms of ulcer healing by 100% in the main group - 9 days, 1 control for 12 hours, and in 2 control group time exceed 15 days. In addition, identified earlier reduction of perifocal inflammation, lymphoplasmacytic infiltration in the main group compared to the control. In the main group recorded the beginning of epithelialization in 6 days, while 1 and 2 control groups, 9 and 12 days respectively. The relief of pain, dyspepsia events in the main group in the period up to 3 days, in the control - 6-9 days. Cytologic evaluation noted sanitizing effect in the main group compared to HP. The results of comparative studies are reflected in the table. 2).

Thus, local application of sandostatin in the treatment of gastroduodenal ulcers by the developed technique has a pronounced reparative and clinical effect.

1. Method for the treatment of gastroduodenal ulcers, including around the submucosal layer around the perimeter of the ulcer with a solution of a drug in therapeutic fibrogastroduodenoscopy, characterized in that as a medicinal PRA of novocaine.

2. The method according to p. 1, characterized in that the chip is at 4 points around the perimeter of the ulcer, with a frequency of 1 every 2 days for 14 days.


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