Method for preventing recurrent dacryocystitis after dacryocystorhinostomy

 

(57) Abstract:

The invention relates to medicine, ophthalmology. Perform irrigation of the nasolacrimal canal. The first three days for washing use eubacteria. Then within four days of the lacrimal-nasal canal washed with collagenase QC. The method improves anatomical and functional characteristics of dacryocystorhinostomy.

The invention relates to medicine, namely to ophthalmology, and can be used for prevention of recurrent dacryocystitis after previously held dacryocystorhinostomy, especially in patients with severe purulent process.

The recurrence rate of chronic dacryocystitis depending on the type of surgical approach and type of the operation varies from 1.0 to 15.0% in Andon-screen operations and from 0.6-25,0% - outer access (Tarbet K. J. et all //Ophthalmology. - 1995. - Vol.102. No. 7 - R. 1065-1070). According to the Ufa research Institute of eye diseases, after the laser transcanalicular endoscopic dacryocystorhinostomy relapses were noted in 4.4% of the total number of transactions (Aznabaev MT, Aznabaev B. M., Fattakhov B. T., Claflin R. R.//Russ. oftalmol. Journe. - 2001. No. 1. - S. 10-12). Anatomical and morphological manifestation of the failure of dacryocystorhinostomy t all. - 1997. - Vol.104. No. 1. - R. 86-91). Therefore, relapse prevention given a topical issue.

Over the last 10-15 years in periodicals published a number of works whose authors with the purpose of preventing a recurrence of the obstruction of the lacrimal ducts after dacryocystorhinostomy apply various modifications.

One of the most widely used in clinical practice, is the total intubation of the nasolacrimal duct is a tube of silicone. However, endotracheal material may be properly selected according to the thickness and elasticity. With a long stay in lacrimal passages silicone may cause irritation phenomena to form ulcers in the lacrimal bone. Another problem is the lack of washing lacrimal passages in the first days after surgery (within 3 weeks). (B. F. Chirkunov // Diseases of the lacrimal organs. Samara, 2001. S. 274-280).

The most effective and closest to the technical essence is a way to prevent a recurrence of the disease after dacryocystorhinostomy, consisting in the introduction of gauze swab into the cavity side anastomosis through the middle of the bow with extraction at 4-5 days after the surgery and subsequent didanosine of lachrymal when sarasinee lacrimal passages. Kishinev, 1974. S. 48-49). However, sulfacetamide in some cases when used in high doses cause tissue irritation. The drug is contraindicated if history of toxic-allergic reactions to sulfonamides. (A. D. Mashkovsky // Medicines. M., 1987. Ch. II. S. 282). Hydrocortisone anti-inflammatory, desensitizing and anti-allergic effects. However, it does not prevent the development of scar process and is contraindicated in viral diseases of the eye. (A. D. Mashkovsky // Medicines. M., 1987. H. I. S. 566).

The technical result of the invention is to improve anatomic and functional parameters after dacryocystorhinostomy.

The technical result is achieved by way of the prevention of relapse given after dacryocystorhinostomy, which consists in washing the nasolacrimal canal antibacterial drug, characterized in that as an antibacterial drug in the first 3 days use eubacteria followed by washing of the nasolacrimal canal within 4 days by collagenase KK.

Eubacteria polyvalent purified liquid (hereinafter eubacteria) is a mixture of feralization staphylococci is of metabolites. Eubacteria is intended for the treatment of purulent-septic and enteric diseases caused by staphylococci, streptococci, Proteus, Pseudomonas aeruginosa and Escherichia coli, and Klebsiella. Antibacterial effects of the drug, due to the specific lysis of pathogenic bacteria in inflammation under the action of bacteriophages. The drug is used in the form of irrigation, lotions, and also for introduction into the cavity wounds, abscesses. Eubacteria helps to reduce the inflammatory process and accelerate it subsided, stimulates the healing of wounds.

Collagenase CC (registration number 96/252/21) selectively acts on collagen - the main component of connective tissue, causing its destruction. When purulent wounds collagenase QC promotes rapid evacuation of non-viable tissue and exudate, early manifestation of granulation tissue, epithelialization. Its use prevents the development of coarse (type keloid) scars, while retaining the mobility of the skin and soft tissues. Collagenase QC is a complex of proteases containing at least three collagenolytic of proferment.

The invention consists in the following.

After prologo channel's solution eubacteria (1012phage particles 10 ml), the next 4 days with a solution of collagenase QC (250 IU 10 ml). Proposed solutions lavage is carried out lacrimal tract through the lower lacrimal point.

Eubacteria provides sanitation channel from the bacterial flora of mucus, fibrin, items, gems, which contribute to the development of connective tissue, and collagenase QC increases the effect of preventing scarring holes created during the operation. Phased application of these drugs provides an effective improvement of the anatomical and functional results of dacryocystorhinostomy.

Example 1.

Patient M., aged 27, was admitted with complaints of watering for 1 year. An eye doctor on a residence diagnosed: OD - Chronic dacryocystitis. Conducted diagnostic irrigation of the lacrimal ducts - cross was absent. Admitted for surgical treatment.

R-graphy lacrimal tract contrast weight was determined in the lacrimal SAC size 23 mm in the nasal cavity contrast weight fails.

Held laser transcanalicular endoscopic dacryocystorhinostomy. In the postoperative period daily for 3 collagenase QC. Systematic antibiotic therapy is not shown due to the fact that the suppurative process is not pronounced. Patency of lacrimal passages restored. The patient was followed for 12 months and had no complaints, the patency of the nasolacrimal canal was preserved, tubular, bow (color), dual Allergology samples were positive. R-graphy lacrimal tract contrast mass in the lacrimal-nasal canal was not determined, was held in the nasal cavity.

Example 2.

Patient I., 43 years old, was admitted with a diagnosis of OD - Chronic dacryocystitis. Watering disturbed about 3 years of age, was treated as an outpatient at the optician at the place of residence (irrigation of the lacrimal ducts solution furacin 1:5000, disinfectant drops) without functional success. Admitted for surgical treatment.

R-graphy lacrimal tract contrast weight was determined in the lacrimal SAC size 68 mm in the nasal cavity contrast weight fails.

Held laser transcanalicular endoscopic dacryocystorhinostomy. In the postoperative period, taking into account the severity of purulent process and the large size of the lacrimal SAC on radiography assigned systemic antibacterial , after surgery washed lacrimal-nasal canal with a solution of eubacteria (1012phage particles 10 ml), in the next 4 days with a solution of collagenase QC (250 IU 10 ml). Patency of lacrimal passages restored. The patient was followed for 12 months and had no complaints, the patency of the nasolacrimal canal was preserved, tubular, bow (color), dual Allergology samples were positive. R-graphy lacrimal tract contrast weight was determined in the nasal cavity.

Example 3.

The patient Was 33 years. He admitted with a diagnosis of OD - Chronic dacryocystitis (relapse). A year ago was operated: OD - Dacryocystorhinostomy by Dupuy-Zutano. Six months later noticed aggravation, came tearing of the right eye. Upon receipt of the lacrimal-nasal route right impassable, which is confirmed radiographically.

Repeated operation OD - Dacryocystorhinostomy by the LTTE. The next day after surgery, the irrigation of the nasolacrimal canal solution of eubacteria. The procedure was carried out daily for 3 days. In the next 4 days lacrimal-nasal route was washed with a solution of collagenase QC. In connection with recurrent suppurative process at the same time the patient received antibiotics intramuscularly (gentamicin 80 mg 2 times a day) and sulfanilate the e-9 months patency of lacrimal tract was free, tubular nose (color), dual Allergology samples were positive. R-graphy lacrimal tract contrast mass in the lacrimal-nasal canal was not determined, was held in the nasal cavity.

Under the proposed method the treatment of 98 patients (104 eyes) aged from 21 to 63 years. Was well tolerated drugs. Complaints from patients was not, in any case not marked allergic reaction. Long-term (9 to 12 months) recurrence was not observed. The patency of the nasolacrimal canal in all the patients operated was free, functional tests were positive, the x-ray lacrimal tract contrast mass in the lacrimal-nasal canal was not determined.

Thus, the method of washing the nasolacrimal canal solutions eubacteria and collagenase ACS patients who are given after surgery dacryocystorhinostomy can improve anatomic and functional characteristics of dacryocystorhinostomy.

A method for preventing recurrence of disease after surgery dacryocystorhinostomy, which consists in washing the nasolacrimal canal antibacterial drug, characterized in that as antibact is the anal, within four days by collagenase QC.

 

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