Endoscopic method of treating giant gastric and duodenal ulcers

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to intraluminal endoscopic surgery of stomach and duodenum, and can be used in treating the patients with giant gastric and duodenal ulcers. An ulcer surface is exposed to endoscopic therapy by punctual noncontact surface monopolar coagulation with a centripetal argon plasma flame at flow rate 2.2 l/min starting in a 'SPRAY' mode at flow intensity 44 Wt, exposure length 2-3 seconds for each point. After a 30-second pause, the ulcer surface is treated with the argon plasma flame in a 'COAG' mode at flow intensity 44 Wt, exposure length 2-3 seconds for each point. 5 days later, the 'SPRAY' mode treatment of the ulcer surface is applied once more at flow intensity 40 Wt, exposure length 2-3 seconds for each point. If after 7 days following the second treatment, the monitoring fiberoptic gastroduodenoscopy shows a maximum ulcer diametre exceeding 1.5 cm, the third 'SPRAY' mode ulcer treatment is required at flow intensity 40 Wt, exposure length 2-3 seconds for each point. General coagulation time for the entire ulcer surface area in each treatment session makes 20-30 seconds.

EFFECT: method allows better treatment optimisation and improved conservative therapeutic effect in giant gastric and duodenal ulcers, as well as prevention of potential complications development.

2 ex

 

The invention relates to medicine, namely to intraluminal endoscopic surgery of the stomach and duodenum and can be used in the treatment of patients with giant gastric ulcer and duodenal ulcer.

There is a method of treatment of ulcers of the stomach and duodenum, including intragastric application to ulcers oil "Ozonic" in the amount of 3 ml a day (see RF patent №2147877, AK 31/19, publ. 27.04.2000, bull. No. 12). The disadvantage of this method is that the procedure of the application is carried out through the day, which is exhausting for the patient, and the fact that oil solution due to low adhesion ability can slide by the mucous membrane of the stomach, reducing the effectiveness of the treatment.

Known endoscopic treatment of gastroduodenal ulcers and daily by sea buckthorn (see Akhmetov R.A. and other Endoscopic method in treatment of peptic ulcer and erosive gastroduodenitis in children. Pediatrics, - 1990, No. 12, s-80), including irrigation through the catheter biopsy channel and ulcerative colasuonno the surface of sea buckthorn (single dose of 5 ml) with applique solkoserila (single dose of 2 ml). The procedure is carried out through the day. Treatment includes from 5 to 11 endoscopic irrigation daily by and buckthorn.

The disadvantage of this method of treatment are long the Outpost pain syndrome - up to 10 days, owing to the fact that medication is applied superficially on the skin surface ulcers and gastric mucosa and consequently they do not have time to be absorbed in the tissue, and through gastric juice and food are rapidly removed from the place of application, reducing the effectiveness of the treatment.

Also known "Method of treatment of peptic ulcer of the duodenum" (see RF patent №2082413, publ. 27.06.87. Bull. No. 18), wherein after the introduction of the endoscope in the bottom of the ulcer is cleaned with a special brush away food debris and plaque fibrin and the edge of the ulcer first cut away the lysozyme at a dose of 100-150 mg, and then daily by or Actovegin at a dose of 4-5 ml After injections ulcer irrigated with sea buckthorn oil (5 ml), and the point of introduction of change in the following procedure. Procedure carry out through the day when the treatment course of 3-5 treatments. The disadvantages of the method are the complexity of its implementation, including around a special needle-injector edges of the ulcer through the endoscope, which can increase swelling and duration of the procedure, tiring of the patient, because you want to work separately two drugs and to conduct surface treatment of ulcers of sea buckthorn oil. All of the above methods are of limited use when the plagues of giant size.

The objective of the invention is to improve the optimization of treatment and Ulu is the solution results of conservative therapy of giant gastric ulcers and duodenal ulcers, preventing the development of possible complications, to avoid surgical treatment.

The essence of the proposed method for the treatment of giant gastric ulcers and duodenal ulcers is that perform endoscopic treatment of peptic ulcer surface by a point contactless surface monopolar coagulation torch argon plasma with a flow rate of 2.2 l/min, from the center to the periphery, starting work in the "SPRAY" with the power flow 44 W, affecting 2-3 seconds on each point with a total exposure time on the entire area of the ulcer surface 20-30 seconds, after 30 seconds ulcer surface is treated with argon plasma torch mode "COAG" power flow 44 W, affecting 2-3 seconds at each point, after 5 days in the treatment of peptic ulcer surface of repeat mode "SPRAY" with the power flow 40 W, acting on each point for 2-3 seconds, if 7 days after the second treatment with the control fibrogastroduodenoscopy maximum diameter of ulcers greater than 1.5 cm, produce a third treatment of the ulcer in the "SPRAY" with the power flow 40 W, affecting 2-3 s at each point, the total coagulation time, the entire area of the ulcer surface in each treatment is 20-30 seconds.

The number of points depends on the size of the ulcer and may ACTIGALL 8-10. The number of sessions reprocessed in the "SPRAY" is determined by the initial size of the ulcer, as well as visual reduction zone after the first treatment. If after 7 days after the second treatment (control EGD) the maximum diameter of the ulcer is more than 1, 5 cm, it is recommended to hold the third session of the AIC.

The total exposure time is about 20-30 with due to the fact that the number of points of treatment can vary (8-10), depending on the size of the ulcer, the exposure time at each point with 2-3 (enough for the formation of necrosis in the treatment area). Pause 30 seconds between switching from one mode to another due to the fact that this time is necessary for the formation of sufficiently strong coagulation film over the entire treated peptic ulcer surface before transition to the next mode of COAG" to prevent perforation of the body. Re-processing is carried out with less power (40 W) with the aim of reducing the depth of the tissue and the formation of a more superficial coagulation of the film.

Argon plasma coagulation (PGA) ulcer surface first in the "SPRAY", and then "COAG" forms a dense coagulation whitish film that prevents perforation of the body and provides optimal conditions for healing of ulcers under the "scab", the flow of argon is lazmi eliminates the effect of sticking of tissue to the electrode, therefore there is no danger of rejection scab.

Method APK for about 20 years, used in open surgery, laparoscopy and thoracoscopy in the first place to stop extensive superficial bleeding. Since 1991, the AIC is used in flexible endoscopy. The main areas of its application are removing adenomas, recanalization of the lumen cancer and stop bleeding (continued bleeding (FIA-FIB), including the recurrence of the bleeding to stop bleeding; a state of unstable hemostasis (FIIA-FIIC), with the aim of preventive anti hemostasis). For the treatment of uncomplicated and giant ulcers that had not been used.

The method is as follows. Perform fibrogastroscopy (FGDs), in which diagnose ulcerative defect, its location and size, produce a biopsy from the edges of the ulcer for histological study. For endoscopic treatment of giant gastric ulcers and duodenal ulcers with the help of the device Echuca-01 - "Photek use the probe-type Side-Fire ARS-probe 2200 a, the diameter of 2.3 mm, length 2.2 m, with item recognition tool, the end of the probe with the scale. ARS-probe conducted through the biopsy channel of the endoscope. Start processing ulcerative point of the surface by noncontact surface monopolar coagulation torch arg is a new plasma with a flow rate of 2.2 l/min from the centre to the periphery in the "SPRAY" with the power flow 44 W, acting on each point for 2-3 seconds with a total exposure time of 20-30 seconds and a pause of 30 seconds between switching to the next mode "COAG". The impact in the "SPRAY" from the subsequent 30-second pause allows you to create on the surface of the ulcer coagulation film that prevents perforation of the organ during further processing of the ulcer surface. Then spend processing ulcer surface in the "COAG, providing increased depth of coagulation, with the power flow 44 watts and speed of 2.2 l/min, affecting 2-3 seconds on each point with a total exposure time of 20-30 seconds. As a result, dense coagulation film whitish color that provides optimal conditions for healing of ulcers under the "scab". From the first day appointed traditional antiulcer therapy. Control EGD performed after 5 days of repeated endoscopic treatment of peptic ulcer surface in the "SPRAY" when the power flow of the argon plasma 40 watts and a speed of 2.2 l/min, affecting 2-3 seconds on each point with a total exposure time of about 20-30 seconds. The diameter of the point of impact is 3 mm, the number of points depends on the size of the ulcer and reaches 8-10. The number of repeated sessions of endoscopic treatment in the "SPRAY" is determined by the initial size of the ulcer, as well as visas is crucial decrease of the area of the ulcer after the first treatment and is 1-2 times depending on the condition of the ulcer. If after 7 days after two-time processing when the control fibrogastroduodenoscopy the maximum diameter of the ulcer is more than 1, 5 cm, it is recommended to hold the third session of the AIC.

Example 1. Patient M., 53 years old was admitted to the surgical Department 22.01.09 year history No. 854 with a diagnosis of giant duodenal ulcer.

23.01.09 was performed EGD. It found the giant ulcer duodenal ulcer (ulcer size of 3.2×3.0 cm). Performed a biopsy of the edges of the ulcer and the treatment of peptic ulcer surface of the argon plasma.

With the help of the device Echuca-01 - "Photek and probe type Side-Fire ARS-probe 2200 a, the diameter of 2.3 mm, length 2.2 m, with item recognition tool, the end of the probe with the scale. ARS-probe providen through the biopsy channel of the endoscope. Performed point-contact handling ulcer surface monopolar coagulation argon plasma torch from the center to the periphery at a flow rate of 2.2 l/min, SPRAY with flow power 44 W by exposure for 2-3 seconds on each point with a total exposure time of 20-30 seconds and pause for 30 seconds. That helped to create the ulcer surface coagulation film that prevents perforation of the organ during further processing of the ulcer surface. Then carried out the treatment of peptic ulcer surface in the "COAG" increased depth of coagulation with the power flux is 44 W by exposure for 2-3 seconds on each point with a total exposure time of 20-30 seconds at a flow rate of argon of 2.2 l/min Thus was formed a dense coagulation film whitish color that create optimal conditions for healing of ulcers under the "scab". From the first day assigned to traditional anti-ulcer therapy: Omeprazole 20 mg 2 times daily + Clarithromycin 500 mg 2 times a day + Amoxicillin 1000 mg 2 times a day for 7 days.

Control of FGDs conducted 28.01.09 year (after 5 days): biopsy from the edges of ulcers and re-performed the endoscopic treatment of peptic ulcer surface in the "SPRAY" with the power flow 40 W by exposure for 2-3 seconds on each point with a total exposure time of 20-30 seconds at a flow rate of 2.2 l/min

Control EGD (after 7 days) 4.02.09 year: ulcer flat, diameter 1.0 cm, filled with granulations. The third session of the AIC is not required.

Control EGD 10.03.09 year: ulcerative defect is not detected (complete epithelialization).

Example 2. Patient N., 58 years old was admitted to the surgical Department 13.03.09 year history No. 1205.

14.03.09 was performed EGD. It found the giant gastric ulcer (ulcer size of 3.5×3.7cm). Performed a biopsy of the edges of the ulcer and the treatment of peptic ulcer surface of the argon plasma.

With the help of the device Echuca 140-01 - "Photek and probe type Side-Fire ARS-probe 2200 a, the diameter of 2.3 mm, length 2.2 m, with item recognition tool, the end of the probe with the scale. ARS zones is conducted through a biopsy channel of the endoscope. Held non-contact treatment of peptic ulcer surface monopolar coagulation argon plasma torch of 2.2 l/min from the centre to the periphery in the "SPRAY" with the power of 44 W for 2-3 seconds on each point with a total exposure time of 20-30 seconds and pause for 30 seconds before switching to the mode of COAG". That helped to create the ulcer surface coagulation film that prevents perforation of the organ during further processing of the ulcer surface. This was followed by treatment of peptic ulcer surface in the "COAG" increased depth of coagulation with a capacity of 44 watts for 2-3 seconds on each point with a total exposure time of 20-30 seconds with an argon flow of 2.2 l/min thus formed dense coagulation film whitish color that create optimal conditions for healing of ulcers under the "scab". From the first day assigned to traditional anti-ulcer therapy: Omeprazole 20 mg 2 times daily + Clarithromycin 500 mg 2 times a day + Amoxicillin 1000 mg 2 times a day for 7 days.

Control EGD 19.03.09 (after 5 days): biopsy from the edges of ulcers and repeated endoscopic treatment of peptic ulcer surface in the "SPRAY" with a capacity of 40 W for 2-3 seconds on each point with a total exposure time of 20-30 seconds, the flow of the argon plasma of 2.2 l/min

Control EGD (after 7 days) 26.03.09 year: ulcer flat, diameter is 1, 8 cm, filled with granulations. To stimulate epithelialization of the ulcer surface produced third endoscopic treatment of peptic ulcer surface in the "SPRAY" with a capacity of 40 W for 2-3 seconds on each point with a total exposure time of 20-30 seconds, the flow of the argon plasma of 2.2 l/min

Control EGD 29.04.09 year: stomach ulcer surface in the process of epithelialization.

Control EGD 10.05.09 year: ulcerative defect is not detected (complete epithelialization).

Only by this method were treated 5 patients with giant and trudnorazreshimoj ulcers of the stomach (3) and duodenal ulcer (2) at the age from 26 to 66 years. Two had completed two sessions of endoscopic treatment, the three took the third session. Complications during treatment of peptic ulcer surface of the argon plasma was not observed. All patients achieved complete epithelialization of ulcers on average for 28+-2,3 days.

The proposed method for the treatment of giant gastric ulcers and duodenal ulcers provides the following benefits:

1. Simple in execution and all patients report no discomfort during the treatment of peptic ulcer surface of the argon plasma.

2. Treatment of peptic ulcer surface in the "SPRAY", and then "COAG" forms a dense coagulation film balasaraswati, what prevents perforation of the body and provides optimal conditions for healing of ulcers under the "scab".

3. The flow of the argon plasma eliminates the effect of sticking of tissue to the electrode, and therefore there is no danger of rejection scab.

Endoscopic treatment of giant gastric ulcers and duodenal ulcers, characterized in that perform endoscopic treatment of peptic ulcer surface by a point contactless surface monopolar coagulation torch argon plasma with a flow rate of 2.2 l/min from the centre to the periphery, starting work in the "SPRAY" with the power flow 44 W, affecting 2-3 with on every point, after a 30-second pause ulcer surface is treated with argon plasma torch mode "COAG" power flow 44 W, affecting 2-3 with on every point, after 5 day treatment of peptic ulcer surface repeat mode "SPRAY" with the power flow 40 W, acting on each point 2-3, if 7 days after the second treatment with the control fibrogastroduodenoscopy maximum diameter of ulcers greater than 1.5 cm, produce a third treatment of the ulcer in the "SPRAY" with the power flow 40 W, affecting 2-3 s at each point, the total coagulation time, the entire area of the ulcer surface in each treatment is 20-30 C.



 

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FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and can be applied for treatment of giant post-operational ventral hernias. After dissection of aponeurosis of rectus muscles of abdomen, indenting 4-5 cm from hernial ring edge, hernial sac is opened. Intraabdominal stage of operation is performed. By means of two pararectal cuts from both sides dissected are skin, subcutaneous fat to aponeurosis of external oblique and transverse abdominal muscles. Tendon part of external oblique, internal oblique and transverse abdominal muscles is excised. Implants in form of mesh endoprostheses are sewn to external oblique, internal oblique and transverse abdominal muscles and rectus abdominal muscle from both sides. Aponeurosis is sutuired together without tension on medium line with continuous suture "joint-to-joint". Above sutured aponeurosis of rectus abdominal muscles third mesh endoprosthesis is implanted.

EFFECT: improvement of results of giant post-operational ventral hernia treatment and reduction of number of recurrences and complications.

1 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg

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