Method for treating mallory-weiss syndrome

FIELD: medicine.

SUBSTANCE: at performing curative endoscopy one should apply pneumoapplication of granulated sorbent - diovine at the quantity of 0.2 g, the pressure being 15 atm. at the distance of 1.5 cm against the defect onto the surface of bleeding rupture of gastric mucosa. Diovine's coarse-grained structure enables to keep the integrity of mucous-bicarbonate barrier due to providing normal vapor exchange and moisture medium in the defect. Moreover, diovine's antimicrobial action helps to suppress gram-positive and gram-negative microflora that enables to shorten terms for defects healing and decrease the frequency of repeated hemorrhages.

EFFECT: higher efficiency of therapy.

1 ex

 

The invention relates to medicine, in particular to surgery, can be used in the treatment of syndrome Mallory Weiss.

Known method of electrocoagulation used to stop gastroduodenal bleeding. Electrocoagulation is produced by high frequency current, resulting in a defect area is created coagulation scab. This provides a hemostatic effect (Panzeri, Y.M., Gallinger SCI Surgical endoscopy of the gastrointestinal tract. - M.: Medicine, 1984. - P.67-72).

However, during electrocoagulation is not possible to accurately control the depth of coagulation, and therefore often there are cases of iatrogenic trauma lower fabrics. Reliable hemostasis is carried out with parabasal coagulation throughout the vessel, so the square of burns of the esophagus and stomach are significant, which lengthens the duration of treatment. In addition, when electrocoagulation is dense adhesion of biological tissues to the electrode, and often occur with a scab for discharge electrode, which causes re-bleeding. Rejection of coagulation scab within 3-5 days after endoscopic hemostasis in this group of patients may be accompanied by recurrence of hemorrhage.

The known method of laser photocoagulation, which consists in absorbing and t is informatsii light energy of the laser beam into heat, with the consequent increase of the temperature of the tissue around the defect and the coagulation of a bleeding vessel (Lutsevich EV, Astapenko V.G., Belov I. Guide to gastrointestinal endoscopy. - Minsk: Visas. HQ., 1990).

However, the high cost of laser equipment and not completely reliable hemostatic results make this method ineffective.

Known injection method of endoscopic hemostasis, including the introduction of adrenaline, ethanol-mixture of procaine, 70% ethanol and other drugs in the area of the defect (Paunov VA and other Diagnostic and therapeutic endoscopy syndrome Mallory Weiss, - Actual problems of modern surgery: proceedings of the Congress. - Moscow, 2003. - P.7).

However, this method often gives the recurrence of bleeding and is not always technically fulfill syndrome Mallory Weiss.

A method of stopping bleeding are also endoscopic applications and injections of film-forming substances and adhesive substances (Panzeri, Y.M., etc. Is urgent endoscopy in acute gastrointestinal bleeding. - Actual emergency surgery. - M., 1994. - P.56-60).

However, the adhesive composition does not have sorption properties, and are water-repellent effect. The rejection of the polymer film from the defect occurs within the first hours after application, so the time of its therapeutic effects are severely limited. In addition, film-forming polymers are not oblad the Ute local hemostatic properties, and the technique of therapeutic procedures has certain difficulties.

Closest to the claimed method is the treatment of syndrome Mallory Weiss using Glavina (Batkaev A.R. Application of endoscopic sorption therapy in patients with the syndrome Mallory Weiss. - Abstract. Dis ... Kida. the honey. Sciences. - Voronezh, 2002. - 25).

The main disadvantage of this prototype include the following: endoscopic treatment elevina syndrome Mallory Weiss is a way to prevent re-bleeding, and not a method of endoscopic hemostasis; when cracks cardioesophageal region with ongoing bleeding monotherapy elevina is not applied, the hemostatic effect of the sorbent can be manifested only in combination with other methods of endoscopic hemostasis, which requires a large number of therapeutic procedures; treatment elevina deep defects cardioesophageal zone is not possible to avoid the resumption of bleeding.

The technical result of the invention is to improve the reliability of hemostasis, reducing the risk of recurrent bleeding and reducing the number of medical purposes.

The technical result is achieved by pnevmopochtoy Divina on the bleeding defect in the amount of 0.2 g under a pressure of 15 ATM from a distance of 1.5 cm from the gap during which rosedene therapeutic endoscopy.

The method is as follows: during therapeutic endoscopy the fibergastroscope is set before a bleeding defect. In his instrumental channel is inserted a plastic tube (catheter)that is filled with divinam in the number of 0.2, the Distal end of the catheter is fixed at 1.5 cm from the defect. Subsequent blowing powder Divina on the bleeding surface is air jet insufflator under a pressure of 15 ATM.

Example: Patient K., 67 years old (case history No. 13068) received the order of urgent care in the surgical Department of the MUSES GKB №9 (SMP) , Voronezh 17.05.2004, 22 hours and 30 minutes with a diagnosis of syndrome Mallory Weiss. Unstable stopped bleeding.

From the anamnesis: the patient twice suffered a cerebral vascular accident, 15 years, suffering from hypertension 3 tbsp., ischemic heart disease with persistent forms of atrial fibrillation. This deterioration came 17.05.2004, about 18 hours, when the background of hypertensive crisis in a patient appeared vomiting at first light liquid, and then the blood clots. The patient was referred for an urgent esophagogastroduodenoscopy.

On emergency FGDS No. 768 dated 17.05.2004.: the esophagus pass on mucosa - blood smears. In the area of the esophago-gastric junction on the rear panel, there is a deep and broad defect Muco-submucosal layer in length and 3-4 cm, a width of 1.0 cm depth - to 0.3 cm; the bottom it is filled tightly fixed dark clot. At the time of inspection leaking fresh blood there. The stomach is full of dark blood with clots. A detailed inspection is impossible.

Conclusion: The Syndrome Mallory Weiss. Unstable stopped bleeding.

The clinical analysis of blood from 17.05.2004, HB - 71 g/l, erythrocytes - 2,12•1012/l Triglycerides admission: APTT - 41 sec, fibrinogen and 3.3 g/l, fibrinogen B -1, Ht - 44/56, thrombin time is 15 seconds, prothrombin index is 96%ethanol test - negative.

The patient was hospitalized in the intensive care unit, where he held: infusion-transfusion, haemostatic therapy, antiulcer (Almagell, quamatel) and symptomatic treatment.

Recurrent bleeding occurred in 11 hours from the moment of receipt: 18.05.2004, 9 hours and 30 minutes. The patient's condition deteriorated, appeared melena, single vomiting blood. On emergency FGDS №770 from 18.05.2004, In the posterior wall of the distal part of the esophagus in the esophageal-gastric transition has a defect length of 3.0 cm, width of 1.5 to 2.0, see the Bottom filled with a red clot, which marked the dripping blood.

The defect was pnevmopochtoy dry powder divine in the amount of 0.2 g under a pressure of 15 ATM from a distance of 1.5 cm from the defect. When observed within 10 minutes it was noted the, the bleeding stopped.

Conclusion: Recurrence of bleeding from the defect esophageal-gastric junction. Stop bleeding by Divina.

The next day, 19.05.2004, the patient's condition has improved, nausea and vomiting was not, hemodynamics stable. The patient continues to be common hemostatic and symptomatic therapy.

After 2 days, 21.05.2004, the patient's condition is stable. No complains. Nausea, no vomiting. Pulse - 85 tank/min, satisfactory qualities, arrhythmic; BP - 120/70 mm Hg complete blood count: HB - 98 g/l, erythrocytes - 3.04 from•1012/l, leucocytes - 7,0•109/HP

After another 5 days, 26.05.2004,: the condition of the patient is satisfactory. No complains. Skin and visible mucous regular color. The abdomen is soft, painless. Chair regular color.

FGDS No. 720 from 26.05.2004,: defect mucosal esophageal-gastric junction has a thin linear scar length of about 2 cm Mucous around him without signs of inflammation.

27.05.2004, the patient was discharged in satisfactory condition under the supervision of a physician at the place of residence.

Thus, the proposed method for the treatment of syndrome Mallory Weiss by pneumonopathy Divina on the bleeding defect makes it possible to increase the reliability of hemostasis, to reduce the treatment time and the number of therapeutic procedures,thus increasing the effectiveness of the treatment of syndrome Mallory Weiss.

A method of treating syndrome Mallory Weiss, including the use of pelletized sorbent in therapeutic endoscopy, characterized in that on the surface of bleeding defect produce pneumopericardium divine in the amount of 0.2 g under a pressure of 15 ATM from a distance of 1.5 cm from the defect.



 

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