Therapy of acute obturative cholecystitis

FIELD: medicine.

SUBSTANCE: therapy involves exposure on acupunctural points of gall bladder in combination with conventional conservative therapy. Exposure on acupunctural points implies laser radiation of frequency 1425-1575 Hz, wavelength 0.83-0.89 mcm, unit impulse power 5-6 Wt, unit impulse duration 110-160 ns. Acupunctural points are tonic by exposure within 4-6 seconds, while sedation is ensured by exposure within 16-18 seconds. Then right hypochondrium is exposed to pulse magnetic field of induction 22.5-37.5 mTl, frequency 49.5-50.5 Hz, duration 20-25 minutes. The epigastrium is exposed to variable magnetic field of induction 22.5-37.5 mTl, frequency 49.5-50.5 Hz, and duration 20-25 minutes. The therapeutic course is 10-12 days.

EFFECT: method reduces fatal outcome rate ensured by exacerbation management and elective surgery.

2 ex, 3 tbl

The invention relates to medicine, namely to surgery, and can be used in the treatment of acute obstructive cholecystitis, including in elderly and senile age.

Known conventional conservative therapy edema attack of acute cholecystitis, including bed rest, hunger, ice on the belly, and the appointment of antispasmodics, infusion therapy, antibiotic. However, such treatment is often not effective enough to completely relieve the attack.

There is a method of treatment of acute cholecystitis in elderly and senile age, namely, that spend laparoscopy and drainage of the gallbladder, then carried out the reorganization of the gallbladder antiseptic solution, optionally containing imsim activity 150-250 PE (patent RU 2115357, IPC⁶A61B 1/00, A61K 38/43, A61M 27/00). There is a method allows to arrest the acute inflammatory process in the gall bladder for 5-10 days, however, it requires special equipment and therefore can be used only in specialized medical institutions.

There is a method of treatment of acute cholecystitis, including puncture of the gall bladder under control and the introduction of antibiotics, which is carried out after the impact on the entire surface of the gallbladder helium-neon laser (patent RU 1672640, IPC 6A61N 5/06). The known method is quite complicated to implement, requires special equipment and may be used only in specialized medical institutions.

There is a method of treatment of acute obstructive cholecystitis, including puncture of the gall bladder under control of the ultrasonic scanning and rehabilitation of the cavity with a solution of NaClO through the puncture needle is introduced along a certain trajectory in accordance with the invention, and subsequent laser irradiation cavity through the monofilament fiber is introduced through the same puncture needle (patent RU 2146883, IPC⁷A61B 17/00 A61N 5/067). However, the known method requires not only special equipment and high qualification of the attending surgeon.

In practice, to perform puncture cholecystostomy (as well as diagnostic laparoscopy and endoscopic cholecystectomy way) requires special expensive equipment and sufficient qualified personnel, and it is not always possible, especially in the Central district and district hospitals. In this situation, the tactics of the surgeon will be to conservative therapy, and in case of its failure to perform open cholecystectomy for urgent reasons. Mortality after open cholecystectomy performed in the acute period of the disease, n is much higher compared to elective surgery (as an open, and laparoscopic).

Also known is a method of treatment of acute cholecystitis by acupuncture (acupuncture), according to which the exercise effect on the acupuncture points of the gall bladder. To do this, use the F8 point qu-Quan, F14 qi-men, IG4 WAN-GU, IG8 Xiao-Hai, R3 tai-si, V17 GE-Shu, V18 Gan-Shu, V19 tribute-Shu, V23 Shen-Shu, VB24 Gy-ye, VB34 Yang Ling Quan, VB38 Yang-fu, VB41 zu Lin qi, VC4 Guan-yuan (table 1) (luvsan, Traditional and modern aspects of Eastern reflexology. M.: Nauka, 1992, str, 364 - prototype). However, the use of acupuncture has a number of disadvantages associated with the special technique of the implementation of the acupuncture and the probability of infection of a patient by means of injury from needles. In addition, the method is not sufficiently high effectiveness in the relief of acute obstructive cholecystitis.

The objective of this invention is to provide a simple, noninvasive, effective enough method of treatment of acute obstructive cholecystitis.

The technical result is the relief of obstruction of the gall bladder, the restoration of the passage of bile from its cavity.

This is achieved by the fact that in the treatment of acute cholecystitis, including the effect on the acupuncture points of the gall bladder on the background of the conventional conservative treatment (bed rest, hunger, ice on the belly, and the e appointment antispasmodics, infusion therapy, antibiotics), the effect on the acupuncture points provide laser radiation frequency 1425-1575 Hz, the wavelength of 0.83-0.89 microns, the power of a single pulse 5-6 W, the duration of a single pulse 110-160 NS exposition 4-6 for toning acupuncture points and exposure 16-18 for sedately acupuncture points, and then perform the pulsed magnetic field with induction of 22.5-of 37.5 MT, frequency of 49.5-50.5 Hz with a duration of 20-25 minutes on the area of the right hypochondrium, and an alternating magnetic field with induction of 22.5-3 to 7.5 MT and a frequency of 49.5-50.5 Hz on the epigastrium with a duration of 20-25 minutes, treatment 10-12 days.

The proposed method is as follows.

The method is as follows: for contact impact on biologically active points used semiconductor laser Pattern-AND-2K" nozzle "B-1", the length of the radiated wave of 0.83-0.89 microns, a pulse frequency 1425-1575 Hz, the power of a single pulse 5-6 W, the duration of a single pulse 110-160 NS, the exposure time for one corporeal point with the purpose of toning is 4-6, with the aim of sedation is 16-18 with the dual points of impact begin on the left. Patient is in sitting position effect of biologically active points in the following order: 4-6 (tone) F8 qu-Quan, V23 Shen-Shu, VI 8 Gan-Shu; 16-18 (Seda is irout): VB34 Yang Ling Quan, V17 GE-Shu, V19 tribute-Shu, IG8 Xiao-Hai. In the supine position: 4-6 (tone): R3 tai-si, VC4 Guan-yuan, F14 qi men; 16-18 (seatrout): VB38 Yang-fu, VB41 zu Lin qi, IG4 WAN-GU, VB24 LM-task. Then the biologically active zone (right hypochondrium, epigastrium) contact method exposed by the device for low-frequency magnetotherapy AMT-02 "Magniter". On the epigastrium affected by varying magnetic field 22,5 of 37.5 MT with a frequency of 49.5-50.5 Hz within 15-20 min, in the right hypochondrium - pulsed (pulsed) magnetic field 22,5 of 37.5 MT with a frequency of 49.5-50.5 Hz within 20-25 minutes After the session is complete, the impact of a semiconductor laser and magnetic-infrared laser therapeutic apparatus to the patient spend the conventional conservative therapy edema attack of acute cholecystitis: bed rest, hunger, ice on his stomach, antispasmodics, infusion therapy, antibiotics. If the patient after the first treatment of acute obstructive cholecystitis claimed process within 24 h there is a positive dynamics of the disease by ultrasonography obturation was stopped, the flow of bile from the gall bladder recovered (gall bladder decreased in size by palpation is not detected), then in the following days he spend another 9-11 sessions daily in the morning (8-9 am). Just 10-12 sessions over 10-12 days. The control effect is vnesti treatment carried out according to objective examination, General blood analysis, biochemical blood analysis, ultrasound (the main criterion for the effectiveness of therapy). If the background of therapy the patient within 24 h is not observed positive dynamics, according to the U.S. obturation of the gallbladder was not stopped, the passage of bile from its cavity is not recovered (gall bladder by ultrasound increased in size, detected by palpation), then the patient needs surgery.

Example 1

Ill Il s (N 11232), 65. Was admitted to the surgical Department 27.12.2006, On the basis of complaints, objective data and ultrasound diagnosed with acute obstructive cholecystitis. Concomitant diagnosis: ischemic heart disease. Held laser on biologically active points and low-frequency (alternating and pulsed) magnetic field on biologically active zones, conservative therapy in accordance with the claimed method of treatment. After 8 hours after admission, the patient due to the size reduction of the gallbladder is identified by palpation, and reducing the intensity of pain syndrome was decided ultrasound. Ultrasound: the size of the gallbladder decreased signs of obturation was absent, choledoch not extended (4 mm). Later the patient was held 10 sessions without istia on biologically active points and zones and conservative therapy. On the background of complex treatment of positive dynamics edema attack of acute inflammation in the gallbladder. The patient was discharged on the 12th day after receipt and holding of the first session of laser-puncture, low-frequency magnetic therapy. The dynamics of changes in blood parameters and body temperature of the patient in the treatment process of the claimed method are presented in table 2.

Example 2

Sick N s (N 136), 61. Was admitted to the surgical Department 13.08.2006, On the basis of complaints, objective data and ultrasound diagnosed with acute obstructive cholecystitis. Concomitant diagnosis: ischemic heart disease. The impact of the laser on biologically active points and low-frequency (alternating and pulsed) magnetic field on biologically active zones, conservative therapy in accordance with the claimed method of treatment. After 10 h after admission of the patient in view of reducing the size of the gallbladder, identified by palpation, and reducing the intensity of pain syndrome was decided ultrasound. Ultrasound: the size of the gallbladder decreased signs of obturation was absent, choledoch not extended (6 mm). Later the patient was held 9 sessions impact on biologically active points and zones and conservative therapy. On the background of the integral treatment of the positive dynamics in the short-attack of acute inflammation in the gallbladder. The patient was discharged on the 11th day after receipt and holding of the first session of laser-puncture, magnetic-infrared laser and conventional conservative therapy. The dynamics of changes in blood parameters and body temperature of the patient in the treatment process of the claimed method are presented in table 3.

The claimed method applied in 98 patients. In 92 patients (93.9 per cent) were able to avoid surgical intervention, subsequent all of them were successfully operated in a planned manner, and to perform elective surgery recurrence of obstruction was not one of the patients. It was found that treatment of acute obstructive cholecystitis claimed process is more effective in patients addressed during the first days of disease onset. Thus, the use of laser influence on biologically active points of the gall bladder and the impact on biologically active zones of the right hypochondrium and epigastrium - low-frequency alternating and pulsating magnetic field allows to achieve edema attack of acute obstructive cholecystitis without surgery (including laparoscopic), which is especially important for patients of elderly and senile age with multiple comorbidities and a high degree of operational figure is a, at impossibility of the needle cholecystostomy.

This method is simple, accessible, does not require expensive equipment and highly skilled surgeon. So it can be used at any branch of surgery (specialized and General profile, including district hospitals. The use of the claimed method of treatment of obstructive cholecystitis will significantly reduce the mortality from this disease.