Method for endoscopic treatment of erosive-ulcerous lesions of gastroduodenal mucosa in angiocardiosurgical patients

FIELD: medicine, angiocardiosurgery, gastroenterology.

SUBSTANCE: the present innovation deals with endoscopic treatment of gastroduodenal ulcers in angiocardiosurgical patients. One should endoscopically apply gel containing 3%-aqueous solution of sodium carboxymethyl cellulose and 5%-oxymethyl uracil upon the ulcer. Single dosage corresponds 5-10 ml, the course - about 3-4 seances every 1-2 d. The innovation provides polycomponent impact of the mentioned medicinal preparation and, thus, shortened terms of pre-surgical preparatory procedures in angiocardiosurgical patients upon the main disease, the prevention of the development of its complicated forms.

EFFECT: higher efficiency of therapy.

3 ex

 

The present invention relates to medicine, namely to endoscopy of the gastrointestinal tract, and can be used in the treatment of erosive-ulcerative lesions of the mucous membrane of the stomach and duodenum.

Erosive-ulcerative lesions of the mucous membrane of the stomach and duodenum at the present time there are more and more often due to different causes of their increase, being one of the most urgent tasks surgery and resuscitation. Until recently, no single concept of treatment of such patients. In these conditions one of the important stages in the preparation of patients with cardiovascular disease to surgical treatment is a diagnostic and therapeutic fibroesofagogastroduodenoscopia (peggs), since the presence of erosive and ulcerative lesions of the mucosa of the upper digestive tract is a contraindication for carrying out of angio-cardiac operations with the use of anticoagulant therapy. Unfortunately, for various reasons, none of the applied methods of treatment does not guarantee against the development of complications - bleeding, to avoid which in the postoperative period is not always possible. The incidence of erosive and ulcerative lesions of the upper section of the gastrointestinal tract in patients with various cardiovascular sabol what there is from 20 to 38%, acute lesions are observed in 16-20% (Rostowski MB, Volkov S., bldg E. the Frequency and nature of pathology of the mucous membrane of the upper parts of the gastrointestinal tract in patients with acquired heart diseases and blood vessels in the preoperative stage. - //In thoracic and cardiovascular surgery.// - 2001. No. 5. - P.42-46).

A known method of endoscopic treatment of gastroduodenal ulcers by coating on ulcerative defect autofinancing promoting wound-healing rate 3-7 treatments a day (Sataev VU "Endoscopic application of the FSA in the duodenal ulcers in children" Autorepair. dis... Kida. the honey. of Sciences, Ufa, 1998. - P.15-16).

The prototype of the present invention is a traditional method of treatment of erosive and ulcerative lesions of the mucosa of the upper parts of the gastrointestinal tract drug solcoseryl (Murashko CENTURIES, Chejemova PM "Solcoseryl in the treatment of peptic ulcer" of Owls. Medicine. - 1979. No. 2 - S-99; Tsarev NI, Red A.M., "a Method for the treatment of gastroduodenal ulcers" 1989. Patients with established endoscopic diagnosis after prior purification of the bottom of the ulcer from fibrinous plaque was injected 2.0 ml solkoserila in the edge of the ulcer and 2 ml sighting was applied to the surface. The introduction of this drug were carried out in 2 days from 3 to 5 sessions. After 11-12 days at the place of ulcerative defect is in the course of the scar visualized glybki granulation tissue and inflammation of the mucous. The disadvantage of this method is the injection of a medicinal product, long term healing of ulcers.

The technical result - multicomponent effects of drugs, reducing the duration of preoperative angio-cardiac surgery patients by primary diagnosis, the prevention of the development of complicated forms of the disease.

This technical result is achieved by the fact that applied a gel containing 3% aqueous solution of sodium carboxymethyl cellulose and 5% auximetilurazil in the amount of 5-10 ml, the rate of 3-4 sessions 1-2 days.

The proposed method is as follows.

The patient with cardiovascular disease in the preoperative period conduct standard endoscopic examination of faggs (Olympus CIF XQ-30). When the presence of the ulcer gastroduodenal zone is carried out to obtain biopsy material and assign antiulcer therapy. When therapeutic esophagogastroduodenoscopy clean the surface of the ulcer, filled with detritus and fibrinous plaque by sighting irrigation with 3% hydrogen peroxide solution and 2 ml of sterile distilled water 4 ml, after which produce evacuation of the contents. Then in compliance with the rules antiseptics sighting applied on the ulcer defect of mucous membrane of 5-10 ml of gel containing 3% aqueous solution of sodium is karboksimetilcelljulozy and 5% auximetilurazil. Multiplicity of 1 time per day for 1-2 days. The treatment course of 3-4 sessions. Time of treatment: in the morning on an empty stomach. In the proposed method applies a product containing 3% aqueous solution of sodium carboxymethyl cellulose and 5% auximetilurazil with high biological stability and allows you to increase the time of contact of the surface of the ulcer with the medicinal product.

Oximetery - pyrimidine derivative, is a "minor" basis, is found in large quantities in the transport of RNA and DNA and plays an important role in the functioning and metabolism of these polymers. The observed high activity of Karega" as immunostimulant. In addition immunostimulating "Karega" identified other important properties: toxic, anabolic, antihypoxic, hepatoprotective, as well as the ability to stimulate reparative regeneration. Polivalentes actions of Karega" as the representative of pyrimidines is a natural result of the fact that they intervene in the most fundamental life processes, such as synthesis of nucleic acids and protein" (Navrathri). The anabolic effect of karega underlies cellular regeneration.

In 2002 allowed the use of auximetilurazil as a stimulator of immunogenesis (Fund 42-0415-2777-02) trading under the name "Immoral".

Clinical example 1: Patient W., 53, height 172 cm, weight 88 kg, was admitted to the hospital with complaints pressing pain in the chest with little exertion. On the basis of complaints, anamnesis, inspection, data of additional methods of research established clinical diagnosis of Ischemic heart disease. Angina voltage. FC 3.

The GSP.: HSN 1. FC 2. SOP.: Hypertension 3, 2, risk 4. Planned surgical treatment - Coronary, mammarocoronary bypass surgery in terms of IR in a planned manner. The patient also showed characteristic complaints of heartburn and slight pains in epigastrium. On stage, preoperative preparation was carried out standard diagnostic faggs (Olympus CIF XQ-30) and revealed a deep chronic ulcer antrum of the stomach along the lesser curvature of 8 mm in diameter with robovie changes and inflammation around the shaft. Produced biopsy from the ulcer edge. Assigned antiulcer treatment in combination with local endoscopic treatment. The patient received 4 sessions of endoscopic injection of gel containing 3% aqueous solution of sodium carboxymethyl cellulose and 5% auximetilurazil. One session was spent 5 ml. Clinical signs disappeared on the 3rd day after the first session. At the time of the fourth session noted a pronounced scarring ulcers - stage red scar, the status of the patient is satisfactory, complaints from the digestive tract does not impose, disorders of the gastrointestinal tract is not marked. Routinely performed surgical treatment on the principal diagnosis. When you re-inspection after a year on faggs the ulcer was not detected.

This method was used in 18 patients.

Clinical example 2: Patient A., 57 years old, height 169 cm, weight 82 kg, case history No. 1162. Admitted with complaints to the Department of surgery of shortness of breath when walking 50 meters, burning pain in the chest, weakness, sweating, palpitations, and headaches. Clinical diagnosis of Atherosclerotic autocarriers. Valvular aortic stenosis, FKZ, HSN 2A. Ischemic heart disease. Angina FC. Stenosis of the anterior interventricular branch of the left coronary artery. Comorbidities: Hypertension 3 tbsp., 3 risk 4. At the stage of pre-made a standard diagnostic algorithm, including faggs.

In the preoperative period, the patient complained of abdominal pain at night and in 1.5-2 hours after a meal. The rhythm of pain type Moynihan - hunger-pain-relief of pain after eating, nausea. Conclusion faggs: Mirror duodenal ulcer sizes 13×7 mm and 15×8 mm Acute erosive duodenitis. Scar-ulcer deformity of the duodenal bulb. Produced bi PSIA from the edges of the ulcer.

Patients received endoscopic application introduction to the ulcer gel 5%auximetilurazil in the amount of 10 ml treatment consisted of 4 treatments. After the first injection was observed disappearance in the dynamics of visually detectable inflammatory changes in periultseroznoy region, after the second cleansing of the bottom ulcers from fibrinous plaque. In the third period of the introduction of gel 5%auximetilurazil, on the 5th day from the start of treatment was observed creeping granulation tissue from the edges of the ulcer to the center. During this period endoscopically were observed complete healing of erosions, showed a clinical improvement, reducing the intensity and duration of abdominal pain, dyspeptic phenomena. On the 8th day, during the 4th infusion dynamics observed epithelialization of ulcers. When control faggs within 10 days from the beginning of the endoscopic treatment was noted stage "red scar". Routinely performed surgical treatment on the principal diagnosis. When you re-inspection after a year on faggs the ulcer was not detected.

Clinical example 3: a Patient Century, 53 years, height 168 cm, weight 78 kg, was admitted to the hospital with complaints pressing pain in the chest during physical activity. On the basis of complaints, anamnesis, inspection, data of additional methods of research has clinical diagnosis: Ishemic the Kai heart disease. Angina voltage. FC 3.

The GSP.: HSN 1. FC 2. SOP.: Hypertension 3, 2, risk 4. Planned surgical treatment - Coronary, mammarocoronary bypass surgery in a planned manner. On stage, preoperative preparation was carried out standard diagnostic faggs (Olympus CIF XQ-30). Conclusion faggs: Chronic ulcer antrum. Erosive duodenitis. Superficial gastritis. Catarrhal reflux esophagitis.

Revealed deep ulcerative defect antrum of the stomach along the lesser curvature of 8 mm in diameter, with inflammatory shaft around. Produced biopsy from the ulcer edge. Assigned antiulcer treatment in combination with local endoscopic treatment is the introduction of the gel containing 5% oximetery combined with a 3% aqueous solution of sodium carboxymethylcellulose. One session was spent 3 ml.

A full course of endoscopic treatment of ulcer size 8 mm amounted to 6 treatments. Amid held endoscopic ulcer treatment offered by the gel epithelial erosions of the duodenum was observed for 8 days. Only 12 days from the start of treatment endoscopically observed epithelialization of the ulcer in a stage of "red scar".

This example shows that when using 3-4 ml per procedure the effectiveness of healing ulcer Def is the manifested slightly, the period of epithelization was increased. When applied to the ulcer defect more than 10 ml at the size of the ulcer to 8 mm no significant changes compared with the application of the drug in a volume of 10 ml.

This method was used in 18 patients.

In the result of the treatment, all patients had a positive clinical effect, which consists in the disappearance of pain. Complications associated with the use of this technique. Endoscopic evaluation of reparative processes were evaluated in comparison with the first group receiving endoscopic treatment daily by. Patients who received a course of endoscopic treatment with a gel containing 3% aqueous solution of sodium carboxymethyl cellulose and 5% auximetilurazil, the healing of the ulcer was observed at 8-10 day with a strong regenerative effect.

Thus, the developed method endoscopic treatment gel containing 3% aqueous solution of sodium carboxymethyl cellulose and 5% auximetilurazil, when conservative complex therapy of gastroduodenal ulcers quite effective, can significantly improve the results of treatment, to prevent the development of complicated forms of the disease, reduce the healing time, and the timing preoperative cardiac surgery patients by primary diagnosis.

The way endoscopica the who treatment of erosive and ulcerative lesions of the gastric mucosa and duodenal ulcers in angio-cardiac surgery patients, characterized in that the gel is applied, containing 3%aqueous solution of sodium carboxymethyl cellulose and 5% auximetilurazil in the amount of 5-10 ml, the rate of 3-4 sessions 1-2 days.



 

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