Method for deficient bile replacement with external biliary drainage

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and describes a method for compensating a disturbed intestinal bile inflow in patients with the external biliary drainage. A method for the deficient bile replacement with the external biliary drainage consists in conducting a background therapy, prescribing a therapeutic formulation containing the following ingredients: ursodeoxycholic acid 12-15 mg/kg/day (up to 20 mg/kg) in 2-3 doses, Eslidin (soya lecithin phospholipids 300 mg; methionine 100 mg, soya oil up to 550 mg) 1 capsule 3 times a day at mealtimes; Milaif 0.2 g 3 times a day.

EFFECT: invention enables improving the patient's health condition and relieving a pain syndrome by a safe and technically easy method.

1 ex

 

SCOPE

The invention relates to medicine, in particular to surgery, Oncology, and in particular to methods of treatment of obstructive jaundice in the pathology and blockage of bile ducts.

Treatment of patients with mechanical jaundice is the actual problem in surgery of the biliary tract. To reduce the manifestations of liver failure and endotoxemia this is admittedly one of the outer discharge of bile.

In violation of the bile passage even in cases of a partial (less than 500 ml per day) or complete cessation of its receipt in the intestine are marked disorders of digestion, absorption of products of digestion of fats and fat-soluble vitamins - a, D, E, K.

The outer discharge of bile, especially when long-term existence leads to an increase in energy costs hepatic synthesis of bile acids and profound disturbances of homeostasis due to violations of the enterohepatic circulation of bile.

Evidence of the effectiveness of the deficiency of bile, resulting from its loss, no doubt.

ANALOGS

The literature describes a method of recovering recepter by collecting and extracorporeal purification of native bile (,And. Godovikov, L. A. igolkina, I. N. Klimovich. Theoretical background, rationale and factual information on the use of holesale alechenu hepatic failure in patients with mechanical jaundice // New technologies in surgical Hepatology: Mater. The third conference of surgeons-hepatologists. - SAT., 1995. - S. 416-417) with the subsequent return of her patient.

A similar method involves [the Application for the patent of the Russian Federation 94001617, AV 17/00, A61N 5/06] the return of bile after prior purification sorption on coal with ultraviolet irradiation and the addition of sodium hypochlorite solution.

In vitro clearance of bile along with the toxins removed a significant amount of bile acids, breaking their intestinal-hepatic circulation.

In addition, the conventional enteral route of administration through the mouth contains an element of estetichnosti hit, and bile in the stomach has ulcerogenic effect on the mucous membrane [Popov, A. N. et al. Syndrome Acholi in surgery of the biliary tract. Kazan: LLC "publishing house", 2003]. Oral bile is accompanied by inflammation of the gastric mucosa with the development of atrophic gastritis, negatively affects the production of hydrochloric acid [Kadyrov academies, Carotene T. A. Absorption of water, sodium chloride and glucose from the small intestine with prolonged loss of bile. In the book: Problems of physiology of human and animals in hot climates. Tashkent, 1965; 222-225].

PROTOTYPE

As a prototype we have used the recovery Method of violations of the enterohepatic circulation of bile acids by the use of geodesics alevai acid" [Application for patent of the RF No. 98106092, AC 31/575, OR 1/16]. The way the prototype is as follows: patient prescribed drugs chenodesoxycholic acid at a dose of 10-30 mg/kg twice a day. Apply depending on the amount of loss of bile twice a day, starting 3 days of decompression during the whole period of the external discharge of bile.

CRITICISM PROTOTYPE

However, the application of chenodesoxycholic acid is contraindicated in acute and chronic hepatitis, inflammatory diseases of the esophagus, stomach, intestine, malabsorption syndrome, liver and/or kidney failure, cholestatic syndromes and liver cirrhosis

The PURPOSE of the INVENTION

The goal of the proposed method consists in korregirovannye disturbed process of digestion and absorption of fats, resolution intrahepatic cholestasis, the suppression of bacterial overgrowth of intestinal bacteria, the restoration of the enterohepatic circulation of bile acids.

The INVENTION

85-90% of total bile acids in bile - bile acids, which are involved in enterohepatic circulation.

Deficiency of bile acids in the intestine leads to decrease of bactericidal bile and excessive bacterial growth in the intestine, the violation of the hydrolysis of lipids, slow motility of the biliary system and intestines.

By finding the most effectiveimplementation to replace the bile, we assumed that adequate substitute is the use of tertiary bile acids, harmless to the body, and mixtures of lecithin with vitamin-amino acid-mineral composition.

In the available literature there are no reports of deficit reduction bile at its outer lead of these drugs.

Technical result is achieved by the proposed method, which includes the compensation of the deficit of bile through the proposed composition containing: ursodeoxycholic acid at a dose of 12-20 mg/kg/day in 2-3 doses, slidin 1 capsule 3 times a day during meals, milif 0.2 g×3 times a day.

With regular intake of the drug ursodeoxycholic acid is the main bile acid in plasma, accounting for about 48% of the total amount of bile acids in the blood. The drug significantly delays the progression of fibrosis, reduces the concentration of toxic bile acids, stimulates the production of pancreatic secretions and bile, has a hepatotropic immunomodulatory and antioxidant action.

As an important component of bile is phosphatidylcholine (lecithin), when the deficit reduction bile we decided the necessary connection of alidina (phospholipids from soya lecithin 300 mg, methionine 100 mg soybean oil, 550 mg).

The choice of drug milif (preparation plant about the convergence - biomass of mycelium monocultures of the fungus Fusarium sambucinum) due to the fact that the formula contains a complex of vitamins and trace elements, amino acids, fatty acids and has metabolic, tonic, adaptogenic, regenerating, detoxifying, hepatoprotective, immunomodulatory and antiviral action.

Drug milif registered health Ministry: registration certificate No. 97/292/9 from 03.10.1997,; P No. 000880/01-2001 from 06.12.2001,; No. 2000/260/1 from 14.07.2000, the Certificate of state registration №77.99.23.3..9505.8.05 from 18.08.2005, and # 77.99.23.3..9506.8.05 from 18.08.2005 was Patented in England, France, Germany, Switzerland, Liechtenstein, USA, Japan, and Russia.

EXAMPLES of CLINICAL APPLICATIONS

Example No. 1. Patient S., 72,, no history 2916. Hospitalized after 7 days after onset of the disease with complaints of pain in the right hypochondrium, yellowness of the skin. The state of admission heavy, the skin is intensely jaundiced. Bilirubin 223,4 µmol/L. ultrasound: gallbladder size 88×35 mm, wall thickness 6 mm, in a cavity defined concrements sizes up to 6 mm, 3-4 pieces, choledoch in diameter up to 10 mm, determine the concretions, 3 mm, 2 mm Pancreas size 36×16×16 mm

Clinical diagnosis of choledocholithiasis, complicated by mechanical jaundice. Concomitant diagnoses: coronary heart disease, atrial depict RDI, permanentny form, normokalemia. Gastritis.

In the dynamics noted the worsening condition of the patient, skin itching became more bilirubin 323,8 µmol/l Operated in case of emergency, imposed decompression holetsistitah. The amount of bile, separated by drainage for days 400-500 ml. Produced fistulography is determined by the extension of the choledochus up to 16 mm in the distal ureteral stones with a diameter of 10 mm

The patient in addition to primary treatment assigned, offered by us, medicinal composition containing: ursodeoxycholic acid 12 mg/kg/day in 3 divided doses, slidin 1 capsule 3 times a day during meals, milif 0.2 g × 3 times a day. At the same time was a moderate improvement in motor function of the intestine with the positive dynamics of biochemical indices of peripheral blood. The observed decrease skin itching, General weakness, the patient became active.

After reducing the numbers of total bilirubin up to 75 µmol/l produced retrograde papillosphincterotomy, remove stone choledochus. Obstructive jaundice resolved. On the control fistulography choledoch not expanded freely pass, contours precise, admission to 12-p. K-ku satisfactory. Due to the fact that there comorbidities and high-risk surgery, the patient is not made cholecystectomy. Cholecystectomies pipe is dropped. Written under the supervision of a surgeon of the clinic.

Example No. 2. Patient U., 62,, no history of the disease 437. Diagnosis: the disease of the choledochus, complicated by stricture and mechanical jaundice. Concomitant diagnoses: cicatricial narrowing of the anal canal, superficial gastritis.

- Ultrasound of the gall bladder is not increased, the wall thickness of 5 mm in the cervical area is defined hyperechoic education, not giving acoustic shadow, 1 cm in diameter, choledoch 7 mm Conclusion: the polyp of the gallbladder?

Performed studies gastroscopy, duodenoscopy, fluoroscopy of the stomach and duodenum 12 organic pathologies it is not revealed. Due to the fact that there was increase in mechanical jaundice, the patient performed cholecystostomy. Daily loss of bile 500-750 ml of the Patient in addition to primary treatment assigned, offered by us, medicinal composition containing: ursodeoxycholic acid 12 mg/kg/day in 3 divided doses, slidin 1 capsule 3 times a day during meals, milif 0.2 g × 3 times a day

After declining numbers of bilirubin patient operated - there is obstruction of the distal choledochus surround process and narrowing of the lumen. Performed the dissection of adhesions, cholecystectomy, resection of the choledochus and hepaticojejunostomy for Ru on the drainage. Was discharged in good condition.

Example No. 3. Patient E., 1981, № history 9362. The hospital is new in the Department of surgery within 2 days of onset with a diagnosis of acute cholecystitis. Ultrasound of the liver and bile ducts, gall bladder size 91×41 mm, wall thickness 4 mm, in the lumen of the concretions size of 0.1; 0.2; 0.3 cm - a lot. Choledoch 12 mm, the lumen of the concretions is not revealed. Clinical diagnosis: JCB complicated flegmonoznami calculous cholecystitis and mechanical jaundice. Concomitant diagnosis of urolithiasis.

Operation - cholecystostomy. The amount of bile, separated by drainage for the day - 300-400 ml. Patient treatment composition 3 times a day with 3 days after cholecystostomy. The level of bilirubin in the serum normalized on the 7th day, the motility of the bowel has recovered fully on the 4th day. On the control fistulography choledoch not expanded freely pass, contours precise, admission to 12-p. K-ku satisfactory. Was discharged in good condition.

The POSITIVE EFFECT of the application of the METHOD

Clinical trials of the proposed method of treatment of obstructive jaundice showed its significant advantages in comparison with applied in practice.

In the process of the treatment for 3-5 days marked improvement in the General condition of the patient, the weakening pain, reduce itching. Revived intestinal peristalsis, the chair was painted. Positive dynamics of biochemical indices of blood in the process tera is AI: the increase in the content of total protein, the reduction of bilirubin, ALT, ACT.

The method is safe, simple in technical execution and easily tolerated by patients. After receiving the proposed pharmaceutical composition noted:

regulation violated process of digestion and absorption of fats, as evidenced by the appearance of colored feces;

- recovery of intestinal peristalsis, eliminates constipation and flatulence, improves appetite;

- lack of development of allergic reactions;

- improvement of psychological status, improved mood, reduced headaches;

- stimulation suppressed the regenerative capacity of tissues.

The proposed method to overcome the lack of bile has advantages in that the components are non-toxic, have a hepatoprotective effect, contribute to the restoration portal and biliary circulation of bile acids and digestive processes.

Sources of information

- Zabazniy N. P., Maksymchuk Y. C., Collar C. A., Zhuravlev, M. N., Groshev I. A., Dobrynin O. C. // Abstraction of bile with high tumor obstruction of extrahepatic bile ducts. Russian cancer journal, 2007. No. 4. - S. 32-34.

- Kondracke Y., Kupcinskas L., Subscene I. Comparative evaluation of the effectiveness of ursodeauxiholeva acid (Ursofalk) and cholestyramine in the treatment of intrahepatic cholestasis is eremennyh. Results of a randomized trial // Gastroboletus. - 2001. No. 4. - S. 11-13.

- Yakovenko A. C., Yakovenko, E. P. cirrhosis of the liver: treatment issues // Gastroenterology. Volume 08/No. 7/2006.

- The method of treatment of violations of the enterohepatic circulation of bile in patients with external drainage of the biliary tract [Application for patent of the RF No. 98106092, AK 31/575, OR 1/16] - prototype.

The way to overcome the lack of bile to the outside of her recordings, including the introduction of drugs: ursodeoxycholic acid of 12-20 mg/kg/day in 2-3 doses, alidina 1 capsule 3 times a day during meals, mylife 0.2 g 3 times a day.



 

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1 ex

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