Method for treating adhesive abdominal disease in children

FIELD: medicine, juvenile surgery.

SUBSTANCE: the method is characterized by the fact that 3 wk before surgical dissection of adhesions due to laparoscopy one should prescribe bifiform per 1 capsule and Hilak-Forte per 10-15 drops thrice daily. Moreover, 7 d before surgical interference it is necessary to conduct 7 seances of electrophoresis with irucsol and prescribe smekta sorbent per 1 packet thrice daily. Then comes laparoscopic dissection of adhesions, and after surgical interference one should perform electrophoresis with irucsol for 7 d. After appearance of intestinal peristaltics it is necessary to apply smekta per 1 packet thrice daily for 7 d. Since the 8th after operation one should prescribe bifiform per 1 capsule and Hilak-Forte per 10-15 drops thrice daily for 1 mo. Then 1 mo after laparoscopy one should prescribe electrophoresis with collalysine up to 8-10 procedures at simultaneous abdominal massage and curative-physical culture complex for 8-10 d. The method enables to obtain antiadhesive effect in 92% cases of surgical dissection of adhesions due to complex impact upon pathogenesis of adhesive disease, at decreased number of relapses.

EFFECT: higher efficiency of therapy.

2 ex

 

The invention relates to medicine, namely to pediatric surgery.

At the present time the problem of adhesive disease (SA) of the abdominal cavity is the most relevant in surgery. Adhesions after operations on the abdominal organs occur in 80-90% of cases and the number of diseases in the soil adhesions of the stomach varies from 12 to 64% of cases. SAT peritoneum in the form of acute and chronic intestinal obstruction occurs in 57% of cases. Among patients hospitalized in surgical hospital with a diagnosis of acute adhesive intestinal obstruction (oscn), the proportion of patients with spaece-dynamic intestinal obstruction varies 45-87%.

SAT in 50-75% completed oscn requiring emergency surgical intervention. Recurrence SB reaches 30-60% and exacerbating the condition of the patients, leading to fatal outcomes in 13-55% of cases.

The increase in the number of surgical procedures in the abdominal cavity and the growing number of adhesive complications challenged surgeons problem - to prevent the formation of postoperative adhesions.

Proposed numerous methods of treatment and prevention of SB abdominal cavity allow you to get antiadhesive effect in 20-65% of cases. However, the proposed treatment schemes have the disadvantage in the individual treatment of each case SAT.

The prototype of the proposed CSP is both the author proposes a method for the treatment of adhesive disease of the abdominal cavity in children, belonging to the group of “fast acetylators”, with an average speed of acetylation 89,75+0,61% at the rate of 75% and with inadequate cooperative cell response (braking output of macrophages, increased amounts of fibrin).

The method consists in assigning to laparoscopic division of adhesions in the abdominal cavity adjuvant therapy, including anti-inflammatory drugs, use of complexing compounds D - penitsillamin in a dosage of age 12-18 days in combination with phonophoresis proteolytic enzyme iruxol or electrophoresis proteolytic enzyme kulalisena on the anterior wall of the abdomen. Then is carried out in a planned manner laparoscopic division of adhesions. The latter has become friable, easily separated from the peritoneum that provide safe separation during laparoscopy. Comprehensive protivospaechnyj the treatment was performed only children with adhesive disease of the abdominal cavity from a group of “fast acetylators”. In the group of “slow acetylators” treatment D - penitsillaminom not performed, performed only endoscopic division of adhesions. All children are “rapid acetylators” after the complex treatment was under surveillance from 1 year to 4 years, recurrence adhesive disease is not checked / MARINA Ivanova, Konovalov, A., Sergeev A.V., Gordeeva I.P., who Solovieva H., Tsvetkova E.I. Alekseeva N.A. Pathogenetic treatment of adhesive disease in children.// Russian journal of Perinatology and Pediatrics. - 1996. Volume 41. No. 4. - P.64/.

In our opinion this method has some drawbacks: it is not applicable in all children with adhesive disease of the abdominal cavity, but only for children in the “fast acetylators”, to identify this group of children needed more time-consuming laboratory tests, complex-forming compound D - penicillamine toxic - possible: leukopenia, thrombocytopenia, agranulocytosis, proteinuria, hematuria, disorder of the gastrointestinal tract, myalgia, arthralgia, pruritus, urticaria. When it is used to monitor the morphological picture of the blood after 3 days, to measure body temperature, and control the content in the urine copper / Mashkovsky PPM Medicines. The textbook of pharmacotherapy for physicians. - 1988. - part 2. - S-188/.

The author proposes a method for the treatment of adhesive disease of the abdominal cavity in children, including laparoscopic dissection of adhesions, normalization biocenose intestinal probiotics by Bifiform and hilak-Forte, the purpose of the sorbents in the form of receiving smecta, physiotherapy in the form of elecrophoresis with proteolytic enzymes iruxol and collision, belly massage and exercise therapy in the form of walk - Proprieta, and then high in the accepting of the knees; kneeling to sit between your heels and sides; lying on your back is to make your feet the bike, raise the pelvis, to sit with legs bent and pressed against the belly knees, rocking on his back, lying on his stomach - swinging on the belly (the boat), alternately by hand to get the other foot, raised feet to breed, to bring and drop.

The implementation of the method is as follows.

3 weeks before surgery on the abdomen are assigned probiotics Bifiform 1 capsule 3 times a day and hilak-Forte 10-15 drops 3 times per day in order to normalize the intestinal microflora. 7 days prior to laparoscopy child electrophoresis is carried out with a proteolytic enzyme iruxol on the anterior abdominal wall of the abdomen, with the aim of hydrolytic decomposition of the protein components of adhesions and prevent bacterial infection and inside is assigned sorbent smecta 1 packet 3 times a day for enterosorption to prevent microbial autocannibalism body. Then performed surgery on the abdomen in laparoscopic dissection of adhesions. In the postoperative period on the first day after surgery assign electrophoresis with a proteolytic enzyme iruxol on the anterior wall of the abdomen for 7 days; from the 2nd or 3rd day, when you get to the intestinal peristalsis, n who appoints inside the sorbent smecta 1 packet 3 times a day for 7 days, from the 8th day after surgery, prescribe probiotics - Bifiform 1 capsule 3 times a day and hilak-Forte 10-15 drops 3 times a day for 1 month. Then a month after laparoscopy assign electrophoresis with a proteolytic enzyme collision on the anterior wall of the stomach up to 8-10 procedures for lysis of connective tissue (adhesions) with simultaneous belly massage and exercise therapy in the form of walk - Proprieta, and then realizing highly knees; on his knees to sit between your heels and sides, lying on his back doing legs the bike, to understand the pelvis, to sit with legs bent and pressed against the belly knees, rocking on his back, lying on his stomach - swinging on the belly (the boat), alternately by hand to get the other foot, raised feet to breed, to bring and drop - in for 8-10 days.

For empirical evidence for the effectiveness of the proposed method were treated with 16 children with adhesive intestinal obstruction after previous surgical interventions on the organs of abdominal cavity. After 6 months was filmed diagnosis SB in 15 children. Recurrence occurred in 1 child. During the observation period from 1 year to 2 years recurrence SAT at children treated there. All children treatment was well tolerated, side effects are not checked.

The inventive method of treatment SAT abdominal cavity in children leads to recovery in 92% of cases and reduce relapses d is 8%, non-invasive, available for in polyclinic conditions, economical, because laparoscopic intervention significantly reduces the length of hospitalization.

Clinical examples

1. Patient U., 15 years, survey map No. 8, has complained of periodic, paroxysmal pain in the abdomen. From the anamnesis it is known that in 1992 laparotomy was about closed trauma of the abdomen.

When examining CCS abdominal cavity to the right of the postoperative scar (location drainage) is visualized loop of intestine, papanna to the aponeurosis; and epigastric - papanna intestine to postoperative scar. Given the clinic and data CCS was diagnosed with Adhesive intestinal obstruction (SAT). 3 weeks before surgery were assigned probiotics Bifiform 1 capsule 3 times a day and hilak-Forte 15 drops 3 times a day. 7 days prior to laparoscopy assigned electropores with a proteolytic enzyme iruxol on the anterior wall of the stomach and into the sorbent smecta 1 packet 3 times a day. After that performed laparoscopy with division of adhesions. In the postoperative period on the first day appointed electrophoresis with iruxol on the anterior wall of the abdomen within 7 days from the 2nd day smectite inside 1 package 3 times a day for 7 days, from the 8th day after the operation n is meant Bifiform 1 capsule 3 times a day and hilak-Forte 15 drops 3 times a day for 1 month. A month after laparoscopy performed electrophoresis with collision on the anterior wall of the abdomen in the form of 10 procedures and within 10 days - belly massage and exercise therapy - walking with highly raised legs, kneeling to sit between your heels and sides; lying on the back - lifting pelvis, rocking on the back, “bike”, to sit with your knees bent; lying on his stomach - swinging (boat) and breeding, svidanie and lowering of the raised leg. At follow-up 6 months after laparoscopy child no complaints and according to control RCS adhesions in the abdominal cavity is not revealed.

2. Patient K., aged 15, map survey No. 12, enrolled in a planned manner with complaints of recurrent pain in the lower abdomen. From the anamnesis it is known that in October 2001 performed a laparoscopy in occasion of torsion of a cyst of the left ovary. During examination of the child revealed adhesions in the abdominal cavity. Started preparation for the planned laparoscopy, adhesiolysis. 3 weeks before hirurgicheskogo

intervention appointed Bifiform 1 capsule 3 times a day and hilak-Forte 15 drops 3 times a day. 7 days prior to laparoscopy assigned electrophoresis with iruxol on the anterior wall of the abdomen and inside smectite 1 packet 3 times a day. After that performed laparoscopy with division of adhesions and additional excision old is th postoperative scar with the subsequent imposition of intradermal suture. The postoperative period was uneventful, with 1 day after surgery scheduled electrophoresis with iruxol on the anterior wall of the abdomen within 7 days; 2 days appointed smectite 1 packet 3 times a day for 7 days; 8-th day after the operation assigned Bifiform 1 capsule 3 times a day and hilak-Forte 15 drops 3 times a day for 1 month. 1 month after the laparoscopy, the course of electrophoresis with collision on the anterior wall of the abdomen in the amount of 8 procedures and within 8 days - belly massage, and therapeutic exercise - walking Proprieta, lie on your back lifting your pelvis, rocking on the back, the bike legs, lying on his stomach - swinging (boat), the procurement arm opposite leg, dilution, mixing and lowering of the raised leg. At follow-up at 3 and 6 months after laparoscopy child had no complaints, and according to the CCS adhesions in the abdominal cavity is not revealed.

A method of treating adhesive disease of the abdominal cavity, including surgical intervention in the form of laparoscopic division of adhesions, electrophoresis of proteolytic enzymes on the anterior abdominal wall, characterized in that 3 weeks before laparoscopic dissection of adhesions prescribe probiotics Bifiform 1 capsule and hilak-Forte 10-15 drops 3 times a day, for 7 days before surgery conducted 7 sessions electrophore is and erukala and assign the sorbent smecta 1 packet 3 times a day, conduct laparoscopic dissection of adhesions after surgical intervention within 7 days of conducting electrophoresis with iruxol, after the appearance of intestinal peristalsis appoint sorbent smecta 1 packet 3 times a day for 7 days, from the 8th day after surgery appoint Bifiform 1 capsule and hilak-Forte 10-15 drops 3 times a day for 1 month after 1 month after laparoscopy assign electrophoresis with collision to 8-10 procedures with simultaneous massage of the abdomen and physical therapy complex for 8-10 days.



 

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