A method of treating bronchial wounds after reconstructive operations on the tracheobronchial tree

 

(57) Abstract:

The invention relates to medicine, and is intended for the treatment of bronchial tissue wounds in patients with various diseases of the bronchopulmonary system, underwent reconstructive surgery on the trachea and bronchi. Patients injected with antibiotics and advanced to the wound area affected by 4-5 times laser radiation of a wavelength of 0.63 and power at the fiber output of 3 mW. The irradiation time of 3 minutes the First laser action takes place during operation after suturing, the second in the 1st day after the operation, and the interval between each subsequent laser effects equal to the number of days selected in ascending order of the number of consecutive odd numbers beginning with unity. The method allows to accelerate the healing of bronchial tissue wounds, reduce postoperative complications by normalizing the content of histamine and DNA in tissues of the bronchial wounds and, consequently, accelerate the course of reparative processes. table 2.

The invention relates to medicine, namely to the treatment of bronchial tissue wounds in patients with various diseases of the bronchopulmonary system undergoing reconstructive plastic is I one of the most important sections of lung surgery, because permits to preserve lung tissue and to restore the lumen pneumatic paths. Despite the high demand in these operations, the attitude remains cautious due to the significant number of postoperative complications. All available methods of forming mazbrenguli anastomoses are not without drawbacks, and after surgery, some patients may develop serious complications (failure of the seams, stricture formation, proliferation of granulation, education bronchodilating fistula). As you know, the most threatening complication here is the failure of the tracheobronchial seams that when purulent-destructive lung disease reaches 50%. In this regard, the problem of finding effective measures for the prevention and treatment of this complication is extremely important. It is known that under favorable conditions the healing megrongalasara anastomotic leaks by type of initial tension, in adverse situations, the anastomosis heals by second intention, which leads to the accession of complications and sometimes death of the patient.

Know the use of laser radiation of various capacities in medicine. This so-called photodynamic consistent on antibacterial, anti-inflammatory and stimulating effects of laser radiation (see, for example, patent RU No. 2112569, IPC A 61 N 5/06).

However, the use of laser irradiation for the treatment of bronchial tissue wounds after reconstructive plastic surgery in pulmonary surgery to prevent postoperative complications is unknown, as is not known and the mechanism of such an effect.

Known methods of treatment of the tissue RAS pharmacological effects of antibiotics ("Wounds and wound infection"./Ed. by M. I. Kuzina, and others - M.: Medicine, 1981, 416).

Known methods of treating bronchial tissue wounds in patients undergoing reconstructive plastic surgery on the tracheobronchial tree, the pulmonary system, in which the conduct medication, such as reorganization of the tracheobronchial tree when performing thoracic surgery (patent RU No. 2145883, IPC And 61 In 17/00). However, in practice the application of such methods, in most cases, is not healing bronchial suture by first intention, and as mentioned above, the known methods of treatment of bronchial tissue wounds are aimed at achieving this healing. In some cases, as a result >is the most closest to the technical essence and the achieved result is a method of treating bronchial tissue wounds in patients with various diseases of the bronchopulmonary system after plastic operations on trachea and bronchi, which solves the problem of treatment, excluding the failure of the seams by medication effects on bronchial tissue wounds, namely the introduction of heparin and irrigation line of stitches contrical within 5-7 days after the operation (see patent RU No. 2065290, IPC And 61 In 17/00).

However, this method is in some cases also inefficient and does not allow you to significantly speed up the treatment.

The claimed invention solves the task of creating a method for the treatment of bronchial tissue wounds in patients with various diseases of the bronchopulmonary system after plastic operations on trachea and bronchi, allowing you to accelerate the healing of the bronchial suture.

The technical result of the invention is to accelerate the healing of bronchial tissue wounds, reduction of postoperative complications by normalizing the content of histamine and DNA in tissues of the bronchial wounds and, consequently, accelerate the course of reparative processes.

This tehnicheskiiy on the tracheobronchial tree by medication effects on bronchial tissue wounds as medications used antibiotics, after the operation is advanced to the wound area affected by 4-5 times laser radiation of a wavelength of 0.63 and power at the fiber output of 3 mW for 3 minutes, and the first laser action takes place during operation after suturing, the second in the 1st day after the operation, and the interval between each subsequent laser effects equal to the number of days selected in ascending order of the number of consecutive odd numbers beginning with unity.

The use of the proposed method is complete healing of the bronchial suture primary intention, it also normalizes the content of histamine and DNA in tissues of the bronchial wounds, which accelerates the flow of reparative processes and ensures reliable prevention of postoperative complications.

Using the proposed method and its advantages are illustrated by research. We observed 31 patient in age from 17 to 69 years with diseases of the bronchopulmonary system, which were performed reconstructive surgery on the tracheobronchial tree (the average age of the patients was 44.6±2,4 years). One of them men was 43 (70,5%) and 18 (29.5%of the island was affected by the introduction of antibiotics in accordance with conventional methods, as well as 4-5 times laser radiation of a wavelength of 0.63 and power at the fiber output of 3 mW for 3 minutes, and the first laser irradiation was carried out during the operation after suturing, the second in the 1st day after the operation, and the interval between each subsequent laser effects equal to the number of days selected in ascending order of the number of consecutive odd numbers beginning with unity, that is, 3-th, 7-th day. According to the testimony irradiation could also be held on the 13th day after the operation.

As the radiation source used for domestic helium-neon laser LG-75 with a wavelength of 0.63 and power at the fiber output of 3 mW. Laser irradiation was performed through the working channel of the endoscope company “Olympus” during surgery after suturing and at 1-, 3-, 7 -, and 13th days of the postoperative period for 3 minutes.

Monitor the effectiveness of remedial measures carried out by clinical data, fibrobronchoscopy research, as well as using histological and histochemical techniques.

The fibrobronchoscopy was used to monitor the condition of the mucosa of the bronchus in the wound. Studies were performed on endosomal the content of histamine in tissues. Quantitatively the concentration of histamine in the structures of the bronchial mucosa was evaluated using cytotechnologists carried out on a fluorescent microscope using microfluorimetric attachment FMAL. Observations were conducted on the voltmeter at a voltage of 800 volts with probe 0,5 mm

Color acridine orange for quantitative studies of DNA was performed according to R. Rigler (1966) modification b.p.Karnaukhova (1985). Dewaxed sections were fixed in a solution of Carnoy. After phosphate-citrate buffer with a pH of 4.2 was stained in acridine orange. After signing in paraffin sections were examined under a fluorescent microscope with the length of the exciting light of 435 nm (filters FS, SES, BS) and blocking filters LGL-18-0,5, the filters 8, 9 and 15.

Paint hematoxylin-eosin for P. Romas were used to estimate the depth of the damaged tissues and healing in the postoperative period. Painting by van gieson was used to determine the degree of infestation of elastic elements in the mucous and submucous membranes of the bronchial suture.

The concentration of histamine and the intensity of the luminescence DNA in tissue structures was expressed in conditional egineer developed the program “Statistics” on the IBM PC-compatible - Pentium 166 MMX Microsoft office (Word and Excel). The statistical reliability of the obtained data was determined by student's criterion.

The postoperative period in patients who received treatment in accordance with the claimed method, has been fairly easy, cough with sputum was observed rarely, like fever, weakness. Bronchoobstructive syndrome was of short duration (1-3 days) and minor, faster stabilized blood tests. The normalization of the General condition was observed already after 7-10 days. Complications occurred in 1 patient (3.3%) as pneumonia.

In the study of bronchoscopic paintings line the bronchial suture in the 1st day postoperative edema of the mucosa was less pronounced, although there was hyperemia and applying fibrin.

On the 3rd day after surgery edema of the mucosa was insignificant, fibrin met in places a thin layer, clearly traced the line of anastomosis.

On the 7th day postoperative period bronchoscopically in the area of the weld line has been a slight hyperemia of the mucous membrane, the absence of fibrin, slightly stood out the seam line.

By the 13th day was observed full recovery of mucosal suture line was not determined.

T the macroscopic healing process bronchial wounds in the way the prototype was completed mainly to 13 days whereas after endobronchial laser exposure is almost complete healing of the bronchial suture was observed on the 7th day postoperative period.

The histological pattern of the tissues of the bronchial suture in 3-, 7 -, and 13th days of the postoperative period corresponded to macroscopic changes.

Dynamics of the content of histamine in tissue structures of the bronchial suture patients are shown in table 1.

After endobronchial laser therapy during surgery and in the postoperative period the content of histamine in the tissues of the bronchial suture increased in 1 day at 40% and amounted to 0.060±0.002 services.ed. The greatest amount of this amine was also observed in the epithelium, in its own record mucous it was uneven.

By the 3rd day after the operation, the level of histamine was increased in all the structures of the wound surface by 75% compared with the original values and corresponded 0,077±0,004 srvc.ed. The increase in the content of the amine, obviously, was associated with a gradual increase in acute inflammatory process.

To 7th days of its contents were returned to the preoperative level in all the structures of the mucosa (0,048±0,007 usenew vascular permeability, increasing perforirovannoi basal membrane and pedestrianonly epithelium. In this situation, remaining around the wound tissue structures and the remains of substances entering the blood and through it was eliminated from the body. In addition, histamine is involved in the reaction of the antigen-antibody”, promoting the differentiation of T-lymphocytes, pushing them to the plasma cells. On the remains of the tissues in the area of the wound was concentrated plasma cells and the corresponding antibodies, which were associated with antigens. These complexes were reported in the blood, and through it was eliminated from the body. Pure bronchial wounds. After cleansing the wound inflammatory response was quiet, histamine levels were decreased. The healing process in these patients we observed already on the 7th day.

Research data histamine allow to conclude that the use of the inventive method leads to a rapid bronchial cleansing wounds and keeps immunologic processes, harmonizing the content of histamine in tissues.

Changes in the luminescence intensity of DNA in the tissues of the bronchial wounds reflected in table 2.

The intensity of the luminescence DNA structures mucosa bronchiale the s content of this compound was observed in the epithelium. In its plate mucosa luminescence DNA was increased only in the seam areas. On the 3rd day the degree of luminescence her in all the structures of the wound surface was reduced to 1.04±0,020 srvc.ed., although higher than the original values (0,86±0,009 srvc.ed.). To 7th days of luminescence DNA was again increased to 1.13±0,030 srvc.ed., and the 13-th day has fallen back to pre-operative values and was 0,79±0,020 srvc.ed.

In studies it was found that after laser irradiation in the bronchial tissues of the wound destruction of DNA was not observed, the protein synthesis was more intensively, while without laser exposure, the tightening action of the inflammatory process, as a rule, there has been a violation of this synthesis.

Thus, it was established that the use of the proposed method reduces the intensity of the inflammatory reaction of the tissues, improves microcirculation in the damage zone, stimulates reparative-regenerative processes and, thereby, prevents the formation in the damage zone of rough scar and the development of postoperative complications.

The inventive method of treatment helps to normalize the content of histamine in the tissues of the bronchial suture without led skorea reparation processes, providing complete healing of the bronchial suture primary tension already by the 7th day after surgery, reducing the number of postoperative complications in 3 times.

The effectiveness of the proposed development is also illustrated by the following clinical examples.

Example 1. Extract from the medical history of the patient C., 54 years. Enrolled in thoracic surgical Department of the RSC No. 1 with complaints of cough with sputum containing an admixture of fresh blood, pain in the lower left half of the chest in the back, fever, weakness, sweating. Considers himself ill in the next 15-20 years since then, as had a bilateral pneumonia. Exacerbations were frequent, after a light snow. Repeatedly hospitalized in therapeutic patient received antibiotics and symptomatic treatment. In the last 2-3 years marks the appearance of streaks of blood in sputum. This deterioration in about a week binds with hypothermia. Hemoptysis is the second day.

When inspecting a state of moderate severity. Skin pale. Thorax correct form, both halves of the symmetric breathing. The NPV of 28 per minute. Percussion of the lung, muffled heart sounds, rhythmic. The pulse is 70 / min. AD - 160/100 mm RT.article The abdomen is soft, painless. The liver stands out from the edge of the rib arc 1-2 cm, elastic consistency. Spleen not palpated. The kidneys are not changed, the symptom of Pasternack negative on both sides. Physiological functions are normal.

In the analysis of blood from 30.08 - moderate leukocytosis. Urine analysis without features. VK and atypical cells in sputum is not detected. In coagulogram - moderate hypercoagulation. Blood sugar, biochemical tests, protein fractions of the blood unchanged.

Spirogram from 01.09: Light violations ventilation obstructive type.

Kineticenergy from 01.09: Pulmonary hypertension of 1 degree.

ECG from 01.09 without features

The fibrobronchoscopy from 06.09: When the LDP examination revealed the presence of grey thick sputum in the lower lobe of the right lung, the deformation of the proximal bronchus on the right. Left on spore upper lobe bronchus detected the presence of “plus”fabric.

Clinical diagnosis: tumor of the upper lobe bronchus on the left. Essential hypertension.

The operation took place resection of the upper lobe on the left with a wedge resection of the bronchus. Imposed mazbrenguli anatomo grozdeva hemangioma.

The postoperative period smooth: within 7 days remained low grade fever, cough with little sputum mixed with blood, weakness, pain in the surgical wound. The healing of the wound by first intention.

Bronchoscopy in the 1st day in the right bronchial tree was determined purulent secret, to the left along the line of anastomosis pronounced swelling and bright hyperemia of the mucous membrane, the line of anastomosis through a light conducted through the working channel of the bronchoscope, irradiated by the laser for 3 minutes. On day 3 in the right bronchial tree, there was a moderate amount of mucopurulent sputum, to the left along the line of anastomosis was determined by the presence of fibrin (roller type) yellowish. Swelling of the anastomosis was insignificant. Uninstalled mucus and fibrin, after which the line of anastomosis through a light conducted through the working channel of the bronchoscope, irradiated by the laser for 3 minutes. On the 7th day in the right bronchial tree small amount of sputum. Left anastomosis pass, no swelling, line anastomosis can be traced into the lumen of the bronchus is not. Segmental bronchi without features. Bronchi washed with a solution of Kahn the postoperative period the patient received ristomycin. Discharged on the 14th postoperative day in good condition.

When the control turnout 1.5 months changes in the anastomosis was not detected. All subsequent years continued to work at the same place, pulmonary hemorrhage was not observed. As can be seen from the history of the disease, the patient C. was performed resection of the upper lobe on the left with a wedge resection of the bronchus for benign tumor of the bronchus. In the postoperative period in addition to traditional therapy he had been exposed to low-intensity helium-neon laser with a wavelength of 0.63 and power at the fiber output of 3 mW for 3 minutes (4 sessions). Healing of the bronchial suture was observed on the 7th day after the operation.

Example 2. Patient M., aged 57, was on treatment in thoracic surgical Department of the Republican clinical hospital №Ministry of health of the Czech Republic concerning tuberculosis cirrhosis of the upper and middle lobes of the right lung with small cavities.

Cough disturbs more than 20 years (the smoker). During the month of observed temperature increase up 38-38,5°C, weakness, dyspnea, increased cough. The radiological examination revealed a decrease in the volume of the right lung, the presence for the ome, was determined inhomogeneous darkening of the upper and middle lobes, areas of the enlightenment, the presence of additional shade in the root.

Transaction top bilobectomy right. With the aim of preserving the lower lobe produced imposition megrongalasara anastomosis. Before applying the last of the seams anastomosis irradiated by the laser. The lower the share included in the ventilation air. Anastomosis sealed. The pleural cavity is washed with furatsilina, put 1.0 g of kanamycin. Drainage of pleural cavity 3 and 7th intercostal space. The wound is sutured in layers.

Schedule laser effects:

1) on the operating table immediately after operation;

2) on the 1st day of the postoperative period;

3) on the 3rd day post-operative period;

4) on the 7th day postoperative period;

5) on the 13th day of the postoperative period.

The postoperative period without complications. The primary healing. Was discharged in good condition on the 17th day after the operation.

Example 3. Patient P., 25 years old, and a/b No. 133/11, were treated in the surgical thoracic Department of the Republican clinical hospital No. 1 of the Ministry of health of the Czech Republic on povazay moved with pneumonia, concerned about a persistent cough, aggravated by the slightest hypothermia. When bronchographic study left in the bronchi basal segments revealed a saccular and cylindrical bronchiectasis. Focused on surgical treatment.

The operation took place resection of the lower lobe of the left lung (ascultam method). Part of the proximal bronchus exempt from hypertrophied lymph nodes to discharge reed bronchus. Produced by excision of the proximal walls of the bronchus to the bronchus reed segments. From an opening removed a large number of viscous sputum. Imposed nylon seams between the cartilaginous and membranous parts of bronchus, lung included in the ventilation. The pleural cavity washed furacin. When suturing produced by the irradiation of the tissue laser for 3 minutes. Performed drainage of the pleural cavity in the 7th intercostal space. The wound is sutured in layers.

Schedule subsequent laser exposure:

on the 1st day of the postoperative period;

on the 3rd day post-operative period;

on the 7th day postoperative period;

on the 13th day of the postoperative period.

The postoperative period without ologna day after the operation.

Clinical examples demonstrate the advantage of the claimed method over the known methods and the method of the prototype. When using the inventive method, the recovery occurs, as a rule, at 14-16 days, and in severe cases - 17-e day, while using the prototype method only on 19-20-E.

A method of treating bronchial tissue wounds after reconstructive operations on the tracheobronchial tree by medication effects on the tissues of the bronchial suture, characterized in that as the medications used antibiotics, and afterwards advanced to the wound area affected by 4-5 times laser radiation of a wavelength of 0.63 and power at the fiber output of 3 mW for 3 min, and the first laser action takes place during operation after suturing, the second in the 1st day after the operation, and the interval between each subsequent laser effects equal to the number of days selected in ascending order of the number of consecutive odd numbers beginning with unity.



 

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EFFECT: enhanced effectiveness of treatment.

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6 cl

FIELD: medicine.

SUBSTANCE: method involves filling vitreous cavity with perfluororganic compound. Two electrodes manufactured from platinum group metal are intravitreally, transretinally introduced into intraocular neoplasm. Electrochemical destruction is carried out with current intensity of 10-100 mA during 1-10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2 in perfluororganic compound medium. The transformed retina and tumor destruction products are intravitreally removed with perfluororganic compound volume being compensated with its additional introduction. Boundary-making endolasercoagulation of retinotomy area is carried out. The perfluororganic compound is substituted with silicon oil. The operation is ended in placing sutures over sclerotmy areas and over conjunctiva. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity. Platinum, iridium or rhodium are used as the platinum group metals.

EFFECT: complete destruction of neoplasm; reduced dissemination risk.

6 cl, 12 dwg

FIELD: medicine, applicable for stopping of pains of various nature.

SUBSTANCE: the device has a quantum-mechanical oscillator located in a casing, magnet, vessel for medicinal agent and a hollow cylinder. The magnet is installed between the oscillator and the vessel. Positioned in the vessel is a hollow cylinder having through holes on its surface.

EFFECT: quick and absolute anestesia.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves administering laser radiation therapy once a day using low intensity pulsating radiation of wavelength equal to 890nmand power density of 0.03 mW/cm2. Injured organ projection to frontal abdominal wall is exposed to radiation at the first laser therapy stage in two fields acting upon each field for 2 min with radiation pulse succession frequency equal to 80 Hz in applying stable contact-type method. Total treatment dose on two fields is equal to 0.008 J/cm2. The second laser therapy stage begins immediately after having finished the first one in applying radiation along the large intestine path using labile contact-type method in a way that radiation pulse succession frequency equal to 80 Hz is applied first during 1 min and then frequencies of 600, 150 and 300 Hz are applied also during 1 min, respectively. Total treatment dose is equal to 0.032 J/cm2 at the second stage. Total treatment dose is equal to 0.04 J/cm2 at both stages.

EFFECT: enhanced effectiveness in inhibiting dysbacteriosis; reduced frequency of postoperative complications.

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