Method for improving functional results of low resection of rectum

FIELD: medicine.

SUBSTANCE: improving the functional result of a low resection of rectum in the patient suffering from rectum cancer is ensured by prescribing the drug preparation Laviocard+ 1 capsule 2 times a day with food for the pre-operative radiation course, one day before the operation and for 30 postoperative days to the extent of the low resection of rectum.

EFFECT: invention enables reducing a rate and degree of defecation and continence dysfunctions following the low resection of rectum and the radiation therapy.

1 tbl, 1 ex

 

The invention relates to medicine, in particular to surgery, and can be used to improve the functional outcomes of low resection of the rectum with radiation therapy.

25 - 46.5% of cases after a low resection of the rectum with the binding of the formed severe defecation disorders and continence syndrome low resection (SNR). Proven role of preoperative radiotherapy in the development of disorders of defecation in the "low" resection of the rectum. Radiation therapy has a dose-dependent effect primarily on the innervation and musculature sphincter apparatus of the rectum and pelvic floor. Lim J.F et al. (2005) notes the radiation damage of the sexual nerve, a Frykholm G.J. et al. (1996) - lumbar plexopathy after neoadjuvant therapy, which has a negative impact on the sensitivity of the reflex zones of the mucosa of the anal canal and violates the reflex mechanism of defecation and anal continence. During the reduction or formation neorectum the distal end of the reduced intestine and the reservoir are in the conditions of deficiency of blood supply, which also leads to activation of oxidative processes and, consequently, to the violation of anorectal function[6, 7, 8, 9, 10, 11, 12, 15, 16].

Known methods of prevention and treatment of CHP by surgical reconstruction of artificial pryamokishechnye vials: J, S, W, ileas endoecology tank etc. However, more than 30% of the cases, these methods are inefficient, because they do not affect the neuro-muscular system, participating in the tank and evacuation functions[1, 5, 14].

The functional result of low resection of the rectum and radiation therapy may be improved by supplementation of antioxidant action.

A method for improving functional outcomes low resection of the rectum and radiation therapy using medicinal product "Lavocat+". Dihydroquercetin is included in the composition of the medicinal product "Lavocat+", according to its antioxidant activity comparable with alpha-tocopherol and twice more active than beta-carotene [3, 4].

The technical result of the present invention is to reduce the incidence and severity of disorders of defecation and continence after a low resection of the rectum and radiation therapy is different from the previously used method.

This goal is achieved through the use of as a means to improve functional outcome low resection of the rectum and radiation therapy medicinal product "Lavocat+"because of the diverse factors influencing the development of CHP, play an important role in the damage to the neuromuscular apparatus of the rectum and pelvic floor during radiation therapy and bottom of the Oh resection of the rectum. Early methods of prevention and treatment of CHP include only methods of surgical restoration of lost the rectal ampulla without affecting the state of the neuromuscular apparatus of the pelvic floor and your saved items sphincter apparatus of the rectum.

The method is as follows.

Prescribed drug "Lavocat+" orally 1 capsule 2 times a day during meals during radiation therapy, the day before surgery and within 30 days after surgery in the volume of low resection of the rectum.

Performed clinical testing "Lavocat+" the selected category of patients. The patients were divided into two groups: the main receiving "Lavocat+", and control without the use of the drug.

In group consisted of 4 patients, statistically not different by gender and age, who underwent standard preoperative radiation therapy in the comparable ratio and the total radial load and operative treatment in the amount of "low" resection of the rectum with the formation of "neorectum" by transposition and dislocation reascending complex.

For an objective assessment of the effectiveness of the drug in preventing the development of CHP used clinical data characterizing the reservoir and the evacuation function of the lost direct kick is, questionnaires anorectal dysfunction [5], questionnaire Pomazkina VI [2].

According to the data presented in table 1, it is seen that in the main group evacuation and retention functions were significantly better.

Table 1
Clinical characteristics of defecation after 1 month after surgery
Retention of fecesControlMain
Full60%80%
The periodic Chelopechene underwear40%20%
Incontinence for liquid stool at night40%20%
Day20%0%
for hard stool0%0%
Sudden urge10%0%
Fragmentation of the chair (3 or more acts of defecation per hour)20% 20%
Painful bowel movements10%0%
Frequency/day on average (rankings.)5 (3-8)2 (1-3)

The questionnaire assessing the degree of anorectal dysfunction (2011), 1 month after surgery, the scores anorectal dysfunction in the control group was 4.5±1.8 points, i.e. the patients had an average degree of gravity of the violations, and in the main group was 2.8±0.6 points, i.e. mild anorectal dysfunction.

The questionnaire Pomazkina V.I. (2010) overall satisfaction with quality of life the main group after 1 month after surgery was 87±2.5%and the control group 65+2.8%, which was significantly lower.

During treatment in any case there was no marked side effects while taking the drug "Lavocat+".

An example of clinical application

Patient M., 64 years (no history 9879), was admitted to the Department of Coloproctology of Amur oblast clinical hospital with Ds. Colorectal cancer 7 see T4N0M0 Chronic intestinal obstruction, stabskompanie (Histology No. 14453 - well-differentiated adenocarcinoma). A course of preoperative radiation therapy in which the patient received "Lavocat+" 1 capsule 2 times a day. During radiation therapy, the patient any anorectal dysfunction were noted. Operated (Protocol operation No. 472) - performed anterior resection of the rectum with the reduction reascending complex. Mobilization of the caecum and ascending colon of about 20 cm with preservation a. Ileocolica and right bending. Crossed the ileum. Imposed elevateddiagnostics using a circular stapler 25 mm Made the reversion of the ascendant and the caecum after appendectomy, formed ileosigmoid and eccentrically anastomoses. The day before surgery, on the day of surgery and within 30 days of the postoperative period the patient received "Lavocat+" 1 capsule 2 times a day in combination with standard therapy. The postoperative period is typical, uncomplicated. Discharged 14 days after surgery in satisfactory condition. The statement is a good functional result is the retention of solid and liquid feces, stool 1-2 times, fragmentation defecation not notes. Overall satisfaction with quality of life 78% (pomaski V.I., 2010). The degree of anorectal dysfunction - 2.7 points.

As can be seen from the above, the purpose of the drug "Lavocat+" per os 1 capsule 2 times a day during meals during the course of radiotherapy, the day before surgery, on the day of surgery and for 30 days after operational vmichael the STV in the volume of low resection of the rectum leads to normalization in the antioxidant defense systems of the body, reducing damage to the neuromuscular regulation of rectal stump, pelvic floor and sphincter apparatus of the rectum, which in turn leads to a decrease in the degree of manifestation of the syndrome low resection of the rectum.

Sources of information

1. Jerlov G.K., Bashirov CF. Tank and sphincterotomies technology in surgery of rectal cancer // Novosibirsk: Nauka. - 2008., - 184 S.

2. Pomaski VI evaluation of the quality of life of patients after operations on the rectum // RZHGGK, 2010, No. 5, P.85-91

3. Satyr N.A., Yanova CENTURIES Antioxidants in treatment of mastitis // VI of the far Eastern regional Congress "Man and medicine: proceedings // Pacific medical journal. - 2009. No. 4. -Application. - S-138.

4. Anninsky A.A. et al. Biochemistry of flavonoids and their importance in medicine. - Pushchino, 2007 - s.

5. Yanova CENTURIES, Anikin SV Syndrome low resection of the rectum and its correction // Bulletin of the East-Siberian scientific center of the Siberian branch of the Russian Academy of medical Sciences, 2012. №4 (86), part 1, S.11-13.

6. Birnbaum E.N., Myerson R.J., Fry R.D., Kodner I.J., J.W. Fleshman Chronic effects of pelvic radiation therapy on anorectal function // Dis Colon Rectum 1994; 37:909-15.

7. Canda A.E., C. Terzi, Gorken V, Oztop I. Sokmen S. et al. Effects of preoperative chemoradiotherapy on anal sphincter function and quality of life in rectal cancer patients // Int J Colorectal Dis., 2010, 25(2):197-204.

8. Dahlberg m, Glimelius Century, Graf W, Pahlman L. Preoperative irradiation affects functionalresults after surgery for rectal cancer: results from a randomized study // Dis Colon Rectum, 1998,41, p. 543-551.

9. Dehni n, Pare R. Colonic J-pouch-anal anastomosis for rectal cancer // Dis Colon Rectum., 2003, Vol.46, N.5, P.667-675.

10. Frykholm G.J., Sintorn K., A. Montelius et al. Acute lumbosacral plexopathy during and after preoperative radiotherapy of rectal adenocarcinoma // Radiother Oncol 1996; 38: 121-30.

11. Gervaz p, Rotholtz N., M. Pisano et al. Quantitative short term study of anal sphincter function after chemoradiation for rectal cancer // Arch Surg 2001; 41: 543-51

12. Kollmorgen C.F., Meagher A.P., Wolff B.G., Pemberton J.H., Martenson J.A. et al. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function // Ann Surg 1994; 220:676-82.

13. Lim J.F., Tjandra J.J., Hiscock R., Chao M.W.T, Gibbs P. Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency // Dis Colon Rectum 2005; 49: 12-9.

14. M. von Flue, Harder F. A new technique for pouch - anal reconstruction after total mesorectal excision. Dis Colon Rectum 1994: 37: 1160-1162.

15. Mulsow, J., Winter D.C Sphincter preservation for distal rectal cancer - a goal worth achieving at all costs? // World J Gastroenterol 2011; 17(7): 855-861.

16. Van Duijvendijk p, We J.F., Taat CW et al. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy // Am J Gastroenterol 2002; 97: 2282-9.

A way to improve the functional result of low resection of the rectum in patients with rectal cancer, characterized in that the prescribed drug "Lavocat+" orally 1 capsule 2 times a day during meals during the pre-operative radiation therapy, for the day before surgery and within 30 days after surgery in the volume of low resection of the rectum.



 

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