Method of restoring obturative apparatus of rectum

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to proctology, and deals with correction of pelvic floor pathology, conditioned by congenital insufficiency of injury of muscular structures of obturative apparatus of rectum. For this purpose cell mass of autologous bone marrow punctate is introduced in injection form into soft tissues of paa-anal area and around rectum. Then after each introduction said areas are subjected to impact of bipolar symmetric fluctuating current, one electrode being placed on lumbar spine, the other - in region of anus. Current force is gradually increased to 5-10 mA until noticeable muscle contraction appears. Course consists of 10 daily procedures.

EFFECT: in short terms method ensures recovery of obturative apparatus of rectum similar to natural, is low-traumatic and simple in application.

2 ex

 

The invention relates to medicine, in particular to the correction of the pathology of the pelvic floor due to congenital deficiency or damage of the muscle structures of the locking device.

A known way to provide intestinal support, including installation within the scope of the intestine of the implant, made in the form of a longitudinal cut of a porous-permeable cylindrical sleeve from a super-elastic Nickel-titanium (U.S. Pat. application No. 99124445, CL A61F 5/00, 1999).

The disadvantage of this method is its limited capacity, due to the fact that the means used do not provide effective holding like a natural.

Closest to the present invention is a method of restoring the locking apparatus of the rectum, including the introduction of the graft in prianalnoy region (U.S. Pat. Of the Russian Federation No. 2194457, CL A61B 17/00, 20.12.2002)

This method includes setting the scope of the intestine of the implant, made of super-elastic Nickel-titanium, in the form of a cylindrical laminated sleeve. The intestine send down in the crotch and fixed to promontorium form anorectal and rectosigmoidal curves and set them in a cascade three implant.

The disadvantage of this method is the increased trauma caused by surgery in the field of neural devices is and rectum with a high probability of damage. In addition, the possibility of rejection entered a foreign body, causing a number of postoperative complications.

In accordance with this task, aimed at creating simple, low-impact way for the restoration of locking apparatus of the rectum, like the natural, which will create a satisfactory socio-psychological state of the patient, increase the comfort of his life.

To solve this problem in the method of restoring the locking apparatus of the rectum, including the introduction of the graft in prianalnoy area proposed as a graft to use cell mass autologous bone marrow punctate, you need to repeatedly enter the injectable soft tissue prianalnoy the area around the rectum, then after each injection to affect this region of the bipolar symmetric flucturion shock, with one electrode placed on the lumbar spine, and the second in the anus, the current strength gradually increase to 5-10 mA before the appearance of visible muscle contraction. This treatment should consist of 10 daily procedures.

The mechanism of action of cell autograft is associated with the known ability of stem, mesenchymal, and other immature cells show prolif the operational activity in the direction of the damaged tissue or tissue demanded by the body (in this case, the striated anal sphincter muscles).

When stem cell transplantation is necessary to connect an external effects for the formation of a feedback system.

Because muscle cells being interconnected with nervous apparatus, the formation of functional connections with the Central nervous system occurs under the influence of electric pulsation when working muscle tissue. In this regard, a further necessary condition for the development of sphincter and restore its function is the stimulation of the anal region. Given that each patient has a pulse frequency strictly individual proposed to realize the impact of bipolar symmetric flucturion current, which represents the randomly varying electrical impulses that may lead to the individual resonance frequency of the patient and will speed up the formation of muscle tissue from stem cells.

The method is implemented as follows.

After admission of the patient in the hospital it is examined by the diagnostic apparatus "Chronos" and define the zones of functional disorders. In addition, identify indicators of blood flow and the oxygen content in the blood using laser spectrophotometry. In the detection of pathology of the muscular structures kapitalnogo apparatus ASU is estlat the treatment by the proposed method. What the patient taking bone marrow by bone marrow puncture in the region of the iliac crest. The number of selected punctate is 40-60 ml Selected bone punctate centrifuged to separate cell mass from the whey. Then produce autologous cell mass by subcutaneous infiltration of soft tissue prianalnoy the area around the rectum. The amount of cell mass, intended for transplantation must be in the range of 10-50 ml depending on the patient's age. With the introduction of cell mass is carried out in 2-6 techniques with a break. Then after each introduction of cell mass on the affected area shall effect bipolar symmetric flucturion current with the same frequency and amplitude. When one electrode is placed on the lumbar spine, the second in the anus. The current strength is gradually increased up to 5-10 mA before the appearance of visible muscle contraction. The duration of the treatment 10 min, in the course of 10 daily procedures. The first results usually appear within 2-4 weeks. The patient notes the occurrence of a certain sensation in the anus, improving its tone. Reduced clomazone. Then there are non-existent previously weak urge to have a bowel movement and the ability to delay defecation nokorode time. These signs start working muscular anal area gradually increase. On electromyography recorded increase in the background activity of the muscles in 1,5-2,5 times. Clearly arbitrary increases muscle activity in patients in varying degrees.

Specific examples of the method

Example 1

Patient Murashov I., 16, East. Disease No. 18878.

Born with a VLOOKUP with high atresia of anus and rectum, for which in the first days of life imposed by transversostomas. Subsequently disappeared from sight for 12 years as outpatients was not observed, hospitalizations was not. In 2004 performed abdomino-perineal and zadnekamernye anorectoplasty on singing. In the postoperative period occurred stenotic disease of NEOBUS. In 2005 he was hospitalized for dilations (bougie until 16-17) on the background of weak muscles of the anus. Enrolled in a planned manner with a diagnosis of insolvency of the anus (the gaping anus, permanent clomazone).

If biografii identified: marked reduction of background and arbitrary bioelectric activity of the anal sphincter, the reflex activity of the sphincter is sharply reduced. Reflexogenic: marked venous congestion in the anal area, reducing elektrovojvodina muscle sacral area, their partial connective tissue degeneration.

The child spent treatment is their proposed method, when this cell mass autologous bone marrow punctate twice with a break in 2 days was administered by injection into soft tissue prianalnoy the area around the rectum, then after each injection impacted this area of the bipolar symmetric flucturion shock. One electrode was placed on the lumbar spine, and the second in the anus, the strength of the current was gradually increased up to 5-10 mA before the appearance of visible muscle contraction. The course of treatment was 10 daily procedures.

On the background of complex therapy Per rectum: the rectum is not gaping, appeared weak voluntary contraction of the muscles of the anus, is able to briefly hold the liquid in the ampoule rectum. According to the control myographic studies background and arbitrary bioelectric activity of the muscles of the anus increased (background with 6,63 µv to 7.10 MACs arbitrary 27, 8 µv to 34, 6 µv).

Example 2

Patient Zyryanov And, 10 years No. 2851, No. 18878 born with VLOOKUP: atresia of anus and rectum with rectvisible fistula. At the age of 4 years under the guise of salmostoma child performed anorectoplasty by Rizzoli. Subsequently, constant clomazone. The girl was treated by the proposed method. When this cell mass autologous bone marrow punctate three times with an interval of two days was administered by injection into soft tissues PA is analnoe the area around the rectum, then after each injection impacted this area of the bipolar symmetric flucturion shock. The course of treatment is 10 daily procedures. The patient also received complex myostimulating therapy.

Against this background, locking activity anal machine has improved, as evidenced by the decrease in the degree of clomazone and EMG studies: background cf. - 11,23 µv, after of 13.27 MACs arbitrary cf. - 26,18 µv, after 30,33.

Example 3

Sick Perevodchik D., 3rd year, No. 16193 born with multiple birth defects: atresia of anus and rectum, esophageal atresia, multicasts right kidney, obstructive megaureter left kidney. In the first days of life is made of plastic esophagus, colostomy, at the age of 2 years had anorectoplasty and antireflux surgery. Later stenotic disease of NEOBUS, incontinence of feces. The treatment in this way. When this cell mass autologous bone marrow punctate three were introduced by injection into soft tissue prianalnoy the area around the rectum, then after each injection impacted this area of the bipolar symmetric flucturion shock. Against this background, the clinical improvement. EMG: background average - 16,19 µv, after 18,7 MACs arbitrary bioelectric activity not assessed because of the age of the child.

Use on the frame of way in a short time will ensure the restoration of the locking apparatus of the rectum like a natural, that will increase the comfort of the patient's life.

The method of restoring the locking apparatus of the rectum, including the introduction of the graft in prianalnoy region, characterized in that the graft used-cell mass autologous bone marrow punctate, which is repeatedly injected into the injection into soft tissue prianalnoy area around the rectum, then after each injection affect this region of the bipolar symmetric flucturion current, one electrode is placed on the lumbar spine, and the second in the anus, current is gradually increased up to 5-10 mA before the appearance of visible muscle contraction, while the course of treatment is 10 daily procedures.



 

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