The method of surgical treatment of idiopathic thrombocytopenic purpura in children

 

(57) Abstract:

The invention relates to medicine, namely to Hematology, and can be used for the treatment of idiopathic thrombocytopenic purpura in children. Remote spleen decapsulator, divided into fragments HH cm and placed in a preservative solution. Stand in it with 1 to 2oWith 7 days, then crushed to 3 mm in diameter. Enter through the conductor in the number 50-6 ml in the pocket of the transverse abdominal muscles and strands omentum on the supply leg. The method allows to terminate immunosuppression. This increases the efficiency of treatment of the disease. 1 C.p. f-crystals, 2 Il.

The invention relates to the field of medicine and will find application in the treatment of idiopathic thrombocytopenic purpura (ITP).

ITP - primary hemorrhagic diathesis due to quantitative and qualitative insufficiency of platelet hemostasis. Characteristic symptoms of the disease are purpura (bleeding into the skin and mucous membranes) and bleeding of mucous, until perfusing bleeding. The most frequent nasal, uterine, less melena, hematuria and other bleeding. 2 - 4% of cases are bleeding th anemia. In this disease have a low number of platelets in the peripheral blood, normal or increased number of megakaryocytes in the bone marrow, splenomegaly.

The danger of this disease consists in the following: bleeding, often intractable, with subsequent anemia, hypovolemia; bleeding in vital organs, the brain.

Conducted research on the medical-scientific and patent literature identified various ways to treat ITP.

In the work Shabalova N. P. "Pathogenesis, clinical features, differential diagnosis and treatment of ITP in children (author's abstract on competition of a scientific degree of the doctor of medical Sciences, Leningrad, 1977) described a method of prednisonetherapyhy. The disadvantage of this method is that therapy prednisolone inhibits the function of the adrenal cortex, the immune system, causing abnormal weight gain, hypertension, syndrome Itsenko-Cushing syndrome, and is often ineffective.

Surgical treatment for ITP is splenectomy. The method described by Pugachev, A., and A. Generalov I. in the book "Surgery of blood diseases", M, Medicine, 1973 , S. 141. The disadvantage of this method is that the loss of the child's body a large number limmie data show, after splenectomy in this group of patients there is a decrease in phagocytic activity of lymphocytes, ISF, properdin, complement, T-lymphocytes, immunoglobulins. It should be emphasized that the immunosuppression that have a morphological basis, cannot be correct medication and in rare cases, the latter has a temporary effect.

Closest to the technical nature of the decision is "Way autotransplantation of splenic tissue that is protected by copyright N 1507340, A 61 B 17/00, BI N 34, 1989 (Babich I. I. non-indigenous, I.). This method includes splenectomy, grinding splenic tissue into pieces of 2 to 3 mm and autotransplantation homogenate on spongy transverse muscle of the abdomen followed by peritonealis strand omentum on the supply leg. The authors indicate that the histological structure of the graft in some time after the operation is fully consistent with the normal histostain spleen. The disadvantage of this method is that you can use it for the treatment of ITP is not possible, because the growth of the "new" spleen will certainly lead to relapse.

The aim of the invention is the election deansplanet.com canned splenic tissue, that eliminates persistent immunosuppression in this group of patients.

This goal is achieved as follows. After splenectomy the mid-transverse incision cut out the left descending strand of the greater omentum in the supply leg, which is in the form of duplicatory stitched to the transverse muscle of the abdomen in the region of the left lateral part and cut (Fig. 1). Formed in the cavity of injected conical silicon conductor (Fig. 2), the end of which is left under the skin. After this the wound tightly sutured in layers. Spleen decapsulated and divided into separate fragments by size 1 x 2 x 5 cm Pieces, placed in a sterile bowl and pour preservative consisting of heparin, 1 to 2 ml (5 to 10 thousand UNITS); obsidan 1 - 1.5 ml; kontrikala 1 - 3 ml (80 thousand UNITS); gentamicin 1 - 1.5 ml (80 thousand UNITS); cyclophosphamide 0.2 g; gemodeza 100 ml, prepared ex temporo in a volume ratio of spleen and preservative 1 : 5. The vessel is tightly closed and stored at temperatures of 1 to 2oC) within 7 days. On the 7 - 8th day in aseptic conditions splenic tissue is removed from the preservative, crushed to fragments 3 mm in diameter. Without anesthesia two loose skin suture in the left lateral part of the section. The end of the ml with full gradual removal of the conductor. Two loose skin sutures tighten. Thus, the homogenate canned splenic tissue is in a cavity, formed of strands of greater omentum on feeding pedicle and transverse abdominal muscles, with full organotropic location.

The claimed method of surgical treatment of ITP applied in child oncohematological center on the basis of the OEB, Rostov-on-don.

Example. The patient, Sasha P. , age 12, and/b N 1025/209. Complaints nasal bleeding, hemorrhagic rash on the lower extremities. Palpation of the abdomen found an enlarged spleen. HELL when entering 90/50 mm RT. Art., pulse 100 per minute, rhythmic, weak filling. Clinical and laboratory examination allowed to put the diagnosis of ITP, severe recurrence. The platelet count at admission - single, in the course of treatment is a gradual increase to 141 109/L. Immunological and immunological failure in T-suppressor type, lower concentrations of immunoglobulins. Patients received two courses of prednisonetherapyhy - starting with 3 mg/kg, with a gradual reduction of the dose within 3 months. After 6 months, the child comes again with recurrent disease, which was the indication for splenectomy. Spleen Hawai lateral part of the section by the method described above. The splenic tissue is suspended above a specified way. On the 7th day produced autotransplantation 60 ml of homogenate canned splenic tissue. The postoperative period was uneventful. The wound healed by first intention. The follow-up period 6 months: almost healthy. No complains. In a laboratory study of platelets corresponds to the age norm (310 109/l). The immunological - s - 6,2 109/l, lgA - 1,2; lgM - 1,03; lgG - 12,4; RTBL spontaneous - 4,5; FC - 6,6; ISF - 0,7; PHI - 70,3; E-ROCK - 22,4; T limp - 26,4%. Moved intercurrent infectious diseases are not marked. By palpation and ultrasound examination of the abdominal cavity in the left upper quadrant is defined by a dense formation of size 4 x 5 see the clinical-laboratory examination 1 year after surgery - similar data. Relapse IPT and immunodepressive not observed.

Thus, the claimed method of surgical treatment of ITP has the following advantages:

1. The simplicity and accessibility for Healthcare practice as a way of preservation and autotransplantation of splenic tissue.

2. In the process of conservation is irreversible denaturation of morphological components of the splenic TC is S="ptx2">

4. The absence of low-temperature aggression against lymphoid tissue in the process of conservation.

5. Use for delayed autotransplantation canned splenic tissue specialized guide that allows you to perform this manipulation without wide relaparotomy.

6. Radical reduction of the phenomena of thrombocytopenia in normalization of immune status.

Technical difficulties and complications associated with the use of the claimed method was not observed.

1. A method for the treatment of idiopathic thrombocytopenic purpura in children, involving surgery and preservation of the splenic tissue, wherein the remote spleen decapsulator, divide into pieces 1 x 2 x 5 cm, placed in a preservative solution and within 7 days maintained at 1 to 2oC, then crushed to 3 mm in diameter and is injected through the conduit in a quantity of 50 - 60 ml in a pocket formed from the transverse abdominal muscles and strands omentum on the supply leg.

2. The method according to p. 1, wherein the preservative solution comprises the following components: heparin 1 - 2 ml (5 to 10 thousand Units); obzidan 1 - 1.5 ml; contrical 1 - 3 ml (15 - 30 thousand Units);

 

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