The way to stop bleeding from gastroduodenal ulcers

 

(57) Abstract:

The invention relates to medicine, in particular to a gastroenterologist, and can be used to stop bleeding from gastroduodenal ulcers. When the endoscopic study produced around the submucosal layer around the perimeter of the ulcer with a solution of sandostatin 50 mcg at four equidistant points. The method stops gastroduodenal bleeding due to regulatory effects on mesenteric blood flow, and leads to an increase of the regenerative process by reducing secretion of hydrochloric acid in the affected area. 1 C.p. f-crystals, 1 table.

The invention relates to medicine, namely to a gastroenterologist, and can be used to stop bleeding from gastroduodenal ulcers.

The problem gastroduodenal bleeding remains one of the urgent. Bleeding from gastroduodenal ulcers one of the severe complications, occurring in 15 -20 % of patients with peptic ulcer in 5% of cases is threatening their life character. About 1/3 of all ulcer patients operated on for bleeding. (Stanulis A. I., Kuzeev R. E. "Current issues medicinales bleeding, the researchers aim to improve the ways conservative stop bleeding and translation situations in the planned mode of preparation of the patient for surgery. Now to solve this problem, there are techniques such as the application of medicines thick consistency (BHT. solcoseryl); application of film-forming solutions, liphuzol, statical, gastrosil, medical adhesives (MK-6, MK-7, MK-8, CL-3); electrocoagulation; laser photocoagulation; around the ulcer contrical, dalargin, 96% solution of ethyl alcohol (E. C. Lutsevich, and coauthors, 1990, Y. C. Sinev and co-authors. 1985 and others) Closest to the proposed method, local hemostasis is around the ulcer 96% ethanol solution (Gibralta O. T."Problems of diagnosis and treatment of peptic ulcer 12 SC in the surgical clinic". 1992) the Disadvantages of this method are the frequent recurrence of bleeding, the lack of purposeful epithelization of the defect.

The purpose of the invention is to stop the bleeding from the ulcer, prevention of rebleeding, promoting epithelialization of the ulcer. Our data suggest that those who STN ways monofactorial impact on bleeding ulcer this method not only focuses on the effective stop of gastroduodenal bleeding, but will also perform the role of starting point in the healing of ulcers and, as a consequence, prevention of rebleeding. This is due to the integrated effects, including reduction in mesenteric blood flow by more than 30% (C. I. Emel'yanov and coauthors, 1997), decreased secretory activity of the gastric mucosa, increasing the regenerative activity of the epithelium of the stomach and 12 SC Method is carried out as follows. After examination of the stomach and duodenum, assessment and sizes of the source of bleeding, as well as its intensity ulcer crater washed with ice-cold water. Then make injections of sandostatin 50 mcg into the submucosal layer at four equidistant points at a distance of 1 cm from the edge of the ulcer. The procedure is carried out simultaneously. In case of recurrent bleeding procedure is repeated. After stopping the bleeding patient is prescribed an anti-ulcer therapy. The proposed method has a number of advantages.

Clinical example. N1.

Sick Black A. P. 31 year History N 4230, entered may 26, 1997 at 1 H. O. CCB IPU them. Semashko with a diagnosis of Exacerbation of peptic ulcer 12 SC , complicated by bleeding. From the anamnesis: the extent of condition for 3 days, when there are "hungry" night of pain in the epigastric region. may 26 morning was single vomiting "coffee grounds ", after which the patient was delivered at CCB IPU them. Semashko.

Objective: clear Consciousness, the active position. Skin and visible mucous membranes pale, moderate humidity. In the lungs vesicular breathing is carried out in all the departments of the chest, wheezing no, the breathing frequency was 23 minutes HELL-130/70 mm RT. Art., pulse 96 beats per minute, heart sounds clear, rhythmic. Tongue coated white bloom, the abdomen is not swollen, soft, slightly painful in the epigastric region. Symptom resurrection positive. Symptom of peritoneal irritation negative. Blood test: HB-102 g/l, HT-45%.

When esophagogastroduodenoscopy: found a bleeding ulcer defect sizes up to 0.7 cm, located in the bulb 12 SC Was made laundering ulcer ice water, after which the edges of the ulcer into the submucosal layer was put on 50 mg sandostatin four vzaimodestvie point. The bleeding stopped in the process direction, the clot formed after 3 minutes. He was appointed antiulcer therapy. When the control fibrogastroduodenoscopy after 1 day visible tightly adjacent sgus the venous defect epithelials, not leaving a rough scar-ulcer strain. The patient was discharged with recovery.

After 6, 12 months during follow up recurrence of the ulcer was not found.

Clinical example N2.

Sick Of Danchuk N. Century, 43 years history N9516 received December 10, 1997, 1 H. O. with a diagnosis of exacerbation of peptic ulcer 12 SC When receiving complaints of weakness, discomfort in the upper abdomen. Vomiting type "coffee grounds" multiple loose stools "melena".

From the anamnesis: suffering from peptic ulcer disease since 1985 Repeatedly treated on this occasion, CCB them Semashko IPU. Last exacerbation 2 years ago. This deterioration from 9 December, when he felt discomfort in the upper abdomen. At night the patient had multiple liquid black stools, and vomiting eaten food. In the morning the condition worsened - there was a sudden weakness, increased pain, and was once vomiting "coffee grounds". These complaints patient was taken to the CCB them. Semashko MEAs.

Admission: HB-106 g/l, NT-46%, Leucocytes - 8.8. The state average severity of the Skin and visible mucous moderately pale. In the lungs vesicular breathing, wheezing no. Heart t is ut, soft to palpation, moderately painful in the epigastric region. Peritoneal symptoms are not present. Liver, spleen not palpable. By rectal examination on the glove feces "black" color - melena. When fibrogastroduodenoscopy found in the stomach of a small amount of content-type "coffee grounds", mucous moderately hyperemic, peristalsis uniform. In the bulb 12 SC on the back closer to the upper third of the detected ulcerative defect 0, 5 cm from the clot, and oozing blood. The clot was washed with ice water. Produced by injections of sandostatin 50 mcg into the submucosal layer at four equidistant points. The bleeding stopped. He was appointed antiulcer therapy. The patient was under observation. After one day in the control fibrogastroduodenoscopy on ulcerous defect detected tightly adjacent the clot. After 17 days in the control fibrogastroduodenoscopy ulcerative defect completely epithelials. In the observation after 6, 12, 18 months recurrence of the ulcer was not found.

To evaluate the effectiveness of the developed method, we have made a comparative study of two groups: primary (28 patients) which included what's been used around the ulcer 96% ethanol solution. All patients assigned to antiulcer therapy, and recommendations on the diet. Patients in both groups comparable in age, sex, duration of disease, size, and localization of ulcers. The average age of patients in both groups 41. The ratio of men to women in the control and main groups of 1:3. Complications history are present in both groups. The size of the ulcer of 0.8-1.2 in the main and in the control of 0.8-1.2. In terms of relief of pain syndrome: the main group - 4 days control 7 days; term relief of dyspeptic syndrome: the main group - 7 days control 10 days; the timing of the reversal of the ulcer to 50% of core group - 10 days, control respectively to 16 days. Epithelialization occurred on average in the main group on day 18, whereas in the control on day 22. The number of patients with remission for more than 6 months in the core 28, and 21 in the control, respectively. The number of patients with remission over 12 months - 28 in the primary and 19 in the control. The number of patients with remission more than 18 months - 21 in the main and 17 in the control. The number of complications within 6 months after the treatment in the main group no control 4. Duration of ulcer history in about the lnyh the group to reduce the time of the initial stop bleeding relieving pain and healing of the ulcer.

Thus, local application of sandostatin to stop bleeding from gastroduodenal ulcers opens new possibilities in the treatment of dangerous complications of peptic ulcer.

1. Method for the treatment of gastroduodenal ulcers, comprising the administration of a medicinal product in the area of the ulcer when conducting fibrogastroduodenoscopy, characterized in that as a drug use sandostatin, which is injected into the submucosal layer at the perimeter of the ulcer no further than 1 cm from the edge of the ulcer, the introduction is carried out simultaneously using 200 MGK sandostatin, which is injected 50 μg in four equidistant points.

2. The method according to p. 1, characterized in that in the case of rebleeding introduction of sandostatin repeat.

 

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