Method for early postoperative prevention of acute gastroduodenal ulcers in patients suffering colorectal cancer

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for the early postoperative prevention of acute gastroduodenal ulcers in patients with colorectal cancer. That is ensured by the preoperative detection of Helicobacter pylori infection. Then for 5-7 preoperative days, amoxicillin in daily dose 2 g and clarithromycin in daily dose 1 g are administered orally.

EFFECT: method provides the prevention of acute gastroduodenal ulcers in the declared group of patients regardless the presence of pathological changes in the upper gastrointestinal mucosa.

5 ex

 

The invention relates to medicine, namely surgery, and can be used, in particular, for the prevention of acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period.

From the practice of medicine, namely surgery, there is a method of preventing acute gastroduodenal ulcers by assigning antisecretory drugs. In particular, the use of the intravenous introduction of H2gistaminoblokatorov in the postoperative period under the control of intragastric pH (Scriabin O.N., Verbitsky V.G., M. Kabanov, N. Asanov. Current views on the pathogenesis of acute gastroduodenal ulcers and ways to improve their prevention // Russian journal of gastroenterology, Hepatology, Coloproctology. - 1995. No. 1. - p.36-39).

The disadvantages of this method are:

Used drugs are not effective enough and, according to some researchers, do not reduce the incidence of this complication (Faisy S., Guerot e, Diehl J-L., Iftimovici E., Fagon J-y Clinicaly significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer profylaxis // Intensive Care Medicine. - 2003, - vol.29. No. 8. - P.1306-1313).

The use of drugs that suppress gastric secretion, is associated with the development of a number of complications, which is the most frequent nosocomial pneumonia (Messori a, Trippoli s, Vaiani m, Gormi M, Corrado V. Bleeding and pneumonia in intensive care patients given rnitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. // BMJ. - 2000. - vol.321, P.1103-1106).

Thus, the described disadvantages do not allow to obtain a specific technical result is a reduction in the incidence of acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period.

Also known a method of preventing acute gastroduodenal ulcers, the essence of which is that patients enter into 100 ml of 40% glucose solution once a day and 200 ml of aminacrine twice a day during the first 3-5 days after surgery (Corigin A.A., Baranchuk, VN, Scriabin O.N., Osipov I.S., Verbitsky VG, Shevchuk IM the Prevention and treatment of stress ulcers // journal of surgery. - 1990. No. 9. - p.41-46).

The disadvantage of this method is the following:

Ingestion of 500 ml of fluid in the first 3 days after surgery on the colon contributes to the development of paresis of the intestine, increases the risk of insolvency intestinal fistula, which does not allow to apply the known method in the postoperative period in individuals with inter-intestinal anastomosis and makes it impossible to use this method in patients with colorectal cancer in the early postoperative period.

These shortcomings do not allow to obtain a specific technical result is a reduction in the incidence of acute gastroduodenal ulcers in patients with colorectal Raco is in the early postoperative period.

The closest method to the present invention is a method of preventing acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period in patent No. 2274455, consisting in the fact that sick for 5-6 days before surgery injected ozonized physiological solution with a single dose of ozone is 42.8 μg of 3 treatments in one daily basis.

The disadvantages of this method are:

the high frequency of acute erosive-ulcerative lesions of the mucous membrane of the stomach and duodenum in patients with colorectal cancer in the postoperative period when using the known method (10%);

- the need to use special medical equipment (medical ozonator "Medozons-BM"), which reduces the availability of this method.

These shortcomings do not allow to obtain a specific technical result is a reduction in the incidence of acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period.

The similarity of the proposed method with the well-known is that they both belong to the surgery and is based on the introduction of drugs into a patient.

The present invention will solve the main task - to reduce the frequency of acute gastroduodenal ulcers in patients with colorectal cancer is the early postoperative period. The essence of the invention is expressed by a set of essential features that are sufficient to provide the technical invention of the result.

The solution of this problem lies in the fact that identify patients infected with Helicobacter pylori, followed by the introduction of them oral amoxicillin at a daily dose of 2 g and clarithromycin daily dose of 1 g for 5-7 days before surgery.

The pathogenesis of acute erosive-ulcerative lesions of the esophagus stomach and duodenum is currently under consideration with the position of the imbalance between the local factors of aggression and protection of the mucous membrane of the digestive tract (Kubyshkin VA, Shishin C.V. Erosive-ulcerative lesions of the upper parts of the gastrointestinal tract in the early postoperative period // Surgery. Consilium medicum. - 2004. No. 1. - P.17-20). Doubtless aggressive factor is Helicobacter pylori. The factors ulcerogenesis due Helicobacter infection include: persistent increase of acid, the development of local inflammatory reactions that damage the gastric mucosa, damage to the endothelium of the microvasculature of the stomach, the change in the number and composition of mucus, slow healing of erosions and ulcers of the mucous membrane of the stomach and duodenum.

Given the above, individuals infected with Helicobacter pylori, are, in glad authors, more susceptible to the formation of acute gastroduodenal ulcers in the early postoperative period, compared with uninfected patients. In connection with this offer in the preoperative period among patients with colorectal cancer to identify patients infected with Helicobacter pylori and carry them with antibacterial treatment as a method of preventing acute gastroduodenal ulcers in patients with colorectal cancer.

The proposed method is as follows. In the preoperative period in patients with colorectal cancer perform esophagogastroduodenoscopy with biopsy. Taken material sent for cytological and histological examination in order to detect Helicobacter pylori. Color cytological preparations Romanovsky-Giemsa. Color histological preparations also perform Romanovsky-Giemsa. In addition, all patients spend immunochromatographic detection of antibodies to Helicobacter pylori in serum. On the basis of three conducted studies of patients infected with Helicobacter pylori. Infected patients per os administered amoxicillin 1 g × 2P per day and clarithromycin 0.5 g × 2P for 5-7 days before surgery.

The proposed method allows to reduce the incidence of acute gastroduodenal ulcers and erosions in the early postoperative period in patients of color is the mental cancer to 5.6% compared to the prototype (10%), does not cause adverse reactions and additional complications.

Just on the subject of Helicobacter pylori infection surveyed 54 people on the basis of immunological laboratory research Institute for the study of leprosy UNIVERSITY. These patients were hospitalized in goose Astrakhan oblast Oncology dispensary in 2007-2008, All examined persons in the preoperative period esophagogastroduodenoscopy was performed to exclude peptic ulcer disease and taking biopsy material. Diagnosis of Helicobacter pylori was performed 3 methods - immunochromatographic detection of antibodies to Helicobacter pylori in serum, cytological and histological examination of biopsy specimens of the gastric mucosa and duodenum. Infected were 36 patients, which accounted for 66.7% of the total surveyed persons From prevention to patients infected with Helicobacter pylori, was administered per os amoxicillin 1 g 2 times a day and clarithromycin 0.5 g 2 times within 5-7 days before surgery. 18 patients without signs Helicobacter infection preventive treatment was not performed. All examined patients at 3 and 7 days of the postoperative period esophagogastroduodenoscopy was performed to identify acute erosive-ulcerative lesions of the esophagus, stomach and duodenum and evaluation effectively.providing preventive treatment. The control group consisted of 123 patients operated in goose Astrakhan oblast Oncology dispensary about colorectal cancer in the period from 2006 to 2007 In the preoperative period, all patients in the control group conducted a survey of the stomach. Data from patients prophylactic treatment is not received.

In the studied group of patients, among whom was identified patients infected with Helicobacter pylori, and held them prophylactic treatment in accordance with the scheme, severe erosion of the stomach was diagnosed in 3 patients, which was 5.6%. Acute gastroduodenal ulcers in patients of this group were not found. In the control group the frequency of erosive and ulcerative lesions of the upper parts of the gastrointestinal tract was 9.8%. Of these erosion was diagnosed in 7 patients and 5.7%, gastroduodenal ulcers - 5 patients (4.1 per cent). However, 6 patients (4,9%) acute gastroduodenal lesion was complicated by bleeding or perforation. Mortality in the control group, due to these complications, was 4.0%, i.e died 5 patients.

The proposed method was successfully tested on 54 patients were examined on the basis of immunological laboratory UHF NEIL UNIVERSITY and operated on for colorectal cancer in goose Astrakhan oblast Oncology dispensary in 2007-2008

Below are the results of the probation.

Example No. 1. Patient A., 54 years old, medical history, No. 3643 Diagnosed with colorectal cancer Art. IV (T4NxM1). Metastases in the liver. Upon receipt of the executed esophagogastroduodenoscopy - erosive-ulcerative lesions not detected. When chromatography revealed antibodies to Helicobacter pylori in serum. The results of cytological and histological examination of the gastric mucosa for the presence of Helicobacter pylori positive. In the preoperative period initiated prevention of the introduction of oral amoxicillin 1 g × 2 times and clarithromycin 0.5 g × 2 times a day, so the daily dose of amoxicillin 2 g, clarithromycin - 1, Treatment was received within 5 days. Treatment discontinued due to the fact that on the 8 day stay in the hospital operated on an emergency regarding the perforation of the tumor. Performed sigmostomia, sanitation and drainage of the abdominal cavity. When a control gastroscopy in the postoperative period of acute erosions and ulcers of the upper gastrointestinal tract have been identified, which testifies to the effectiveness of the proposed method of prevention.

Example No. 2. Patient Century, 70 years, history of No. 6660. Diagnosis of cancer of the rectum Art. IV (T4NxM1). Metastases in the liver. During esophagogastroduodenoscopy in the preoperative period revealed no pathology. A survey on the subject of infection Heliobacter pylori according to the method set forth in example No. 1, is positive. Conducted preventive treatment according to the method described in example No. 1, but for 6 days before surgery. Operation - the imposition of double-barreled colostomy. When control esophagogastroduodenoscopy at 3 and 7 days after surgery erosive-ulcerative lesions of the esophagus, stomach and duodenum was not detected, indicating that the effectiveness of a preventive treatment.

Example No. 3. Patient S., 66 years old, medical history, No. 7696. Diagnosis of cancer of the rising of the Department of colon II In Art. (T4N0M0). During esophagogastroduodenoscopy in the preoperative period revealed no pathology. The results of the survey, according to the method described in example No. 1, concerning the infection of Helicobacter pylori positive. Conducted preventive treatment according to the method described in example No. 1, but within 7 days. Operation - right hemicolectomy with the imposition of retransportation. When a control gastroscopy at 3 and 7 days after surgery acute erosive-ulcerative lesions not detected, which indicates the effectiveness of the proposed method of prevention.

Example No. 4. Patient D., 55 years old, medical history, No. 3352. Diagnosis of cancer of the descending of the Department of colon II In Art. (T4N0M0). During esophagogastroduodenoscopy in the preoperative period revealed no pathology. The survey is and Helicobacter pylori infection, according to the method described in example No. 1, is positive. Received prophylactic treatment according to the method described in example No. 1, for 4 days. The operation is a left hemicolectomy. When a control gastroscopy on the 3rd day of the postoperative period revealed erosion of the duodenum, indicating no positive result.

Example No. 5. Patient E., 67 years old, medical history, No. 3061. Diagnosis of cancer of the rectum II And senior (T3N0M0). During esophagogastroduodenoscopy in the preoperative period revealed no pathology. Screening for Helicobacter pylori infection according to the method described in example No. 1, is positive. Received prophylactic treatment according to the method described in example No. 1, for 8 days. Operation - abdomino-perineal extirpation of the rectum. When a control gastroscopy on the 3rd day of the postoperative period revealed erosion of the antrum, which indicates no positive result.

The advantage of the proposed method is to reduce the frequency of acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period to 5.6%, compared with the prototype (10%). In addition, the proposed method is easy to use. Identification of patients infected with Helicobacter pylori, can be done in different ways, some of which are not Tr is required to endoscopic examination. The cost of preventative treatment is low. The proposed method involves oral medications that can be used at the outpatient stage during examination of the patient. In addition, by reducing the frequency of acute gastroduodenal ulcers in the early postoperative period in patients with colorectal cancer, the proposed method allows to reduce postoperative mortality.

Thus, the authors proposed earlier by anyone not offer a Method of preventing acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period, which can be recommended for use in specialized treatment facilities, providing surgical care to patients with malignant neoplasms of the colon, the country's health system.

A method of preventing acute gastroduodenal ulcers in patients with colorectal cancer in the early postoperative period by introducing medicines into the body of the patient, wherein identifying patients infected with Helicobacter pylori, followed by the introduction of them oral amoxicillin at a daily dose of 2 g and clarithromycin daily dose of 1 g for 5-7 days before surgery.



 

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