Method for conservative treatment of external colonic fistulas

FIELD: medicine.

SUBSTANCE: patients keep a diet with reducing an amount of liquid taken up to 1.5l a day that is compensated by the intravenous administration of solutions an amount and composition of which depends on a degree of water-electrolyte disturbances. Additionally, after bandage removal, the wound and edges of the fistulous passage is 5% potassium permanganate, which is then washed with 3% hydrogen peroxide. A mouth of the fistula and the wound edges are dried. That is followed by an aeration of the mouth of the fistula with a cooled plasma flow of nitrogen monoxide at a depth of 0.5cm in the therapeutic mode of 2000 mg/m3 and exposition of 1.5min. The mouth of the fistula and the wound edges are treated with a plasma flow of nitrogen monoxide in the concentration within the contact area with the wound surface of 1500 mg/m3 and time of exposure of 20 seconds per each 1 cm2 of the surface. The mouth of the fistula and the wound edges are dried. The mouth is packed with the gauze swab. The fistulous wound is exposed to EHF waves with the pure noise spectrum and the provided integral power on the wound surface of 1.5 mcWt along the perimeter of the mouth at 15mm from the fistulous passage for 30 minutes. The swab is removed. The mouth and the surrounding skin is treated with zinc paste and covered with gauze swabs. The further bandages are performed in the similar way as the bandage wets with the intestinal contents, but no more than 2 times a day and at least once every 3 days.

EFFECT: safe and effective conservative treatment of the intestinal fistulas at any phase of the wound process that enables avoiding risks of surgical intervention and general anaesthesia by rapid reduction of skin maceration and perifocal inflammation surrounding the mouth and prevents them, stimulates the growths of granulocyte tissue and epithelisation of the fistuous wound.

 

The invention relates to surgery, and in particular to methods of treatment of intestinal fistula.

Despite advances in modern medicine, the treatment of external intestinal fistulas remains a topical problem in abdominal surgery [Vicin B. A., Blagica E. M. Formed and unformed external intestinal fistulas. - Novosibirsk: Nauka. - 1983. - 142 S.; Makarenko, T. P., Bogdanov, A. C. Fistulas of the gastrointestinal tract. - M.: Medicine. - 1986. - 144 S.; Bazayev A. C. Optimizing the treatment of patients with external intestinal fistulas. Dis. ... Dr. med. Sciences. - N. Novgorod, 2004. - 322 S.; Kanshin N. N. Immature intestinal fistula and purulent peritonitis (surgical treatment). - M.: Profile, 2007. - 160 S.].

Persons with this pathology are one of the most difficult categories of patients. The vast majority of them have signs of serious disorders of homeostasis, there are significant violations of water-electrolyte balance and acid-base balance, anemia, hypoproteinemia, wound exhaustion, failure of the immune system. Against this background, in many cases, there is persistent, finally docked abdominal inflammatory process. As a result of prolonged antibiotic therapy is the selection of the existing microbiota, marked activation and growth vysokochastotnoi nosocomially, in the wound develops a biofilm process. These moments determine the very limited effectiveness of a number of actions on prevention of surgical infection, including use of antibiotics, antiseptics and sanitizing procedures. This increases the risk of any reconstructive interventions aimed at closure of the fistula, as well as General anesthesia.

As with most surgical diseases, the complex treatment of patients with intestinal fistula includes General and local therapeutic measures. In the basis of total treatment (in addition to compliance with the basic modern principles of treatment of purulent-septic diseases) is the struggle with developing due to the loss of intestinal contents disorders of water, electrolyte and protein metabolism, maintain homeostasis using infusion therapy, reinforced parenteral and enteral nutrition. Local treatment involves the reduction of inflammatory process in the tissue surrounding the fistula, protect them from exposure to intestinal discharge, reduction, or termination of losses intestinal contents [Bogomolov N. And., Smolyakova N. Y., Bogomolov N. N., Smolyakov Y. N. Device for blocking and treatment of intestinal fistula. A. C. RF 2224554 C1, CL AM 27/00, AM 31/00. Appl. 1.06.02. Publ. 27.02.04; Kanshin N. N. Immature intestinal fistula and purulent peritonitis (surgical treatment). - M.: Profile, 2007. - 160 S.].

The diet of patients with intestinal fistula should include enteral (if kupirovannom paresis of the intestine), parenteral nutrition. The principles of enteral nutrition are the predominance of mechanically gentle, easily digestible, high-calorie food with restriction of carbohydrates. Recommend to seek alternation during the day, relatively dense a protein rich meals with low-calorie liquid meals, inhibiting the secretion of gastric glands and the pancreas and not exciting bile formation and bile.

To protect the skin from the action of intestinal detachable use of physical, mechanical and biochemical methods.

Known methods of treatment of intestinal fistula, including the use of topical dressings, temporary obturation of the fistula and the application of active aspiration in order to relieve the purulent-destructive processes in the wound, eliminating the maceration around her. However, these methods are not always effective and have several disadvantages. Introduction to the fistulous passage of the obturator increases the size of the defect of the intestinal wall. The use of active suction systems increases the size of the fistulous course, the increased loss of fluid and electrical is Ritov, which further leads to the formation of Gorovenko fistula and expansion of the volume of surgical intervention.

Physical methods based on the application of paste of Lassara, glue BF-2, BF-6, silicone pastes, polymer films and other means, are applied to the skin around the external opening of the fistula [Kanshin N. N. Immature intestinal fistula and purulent peritonitis (surgical treatment). - M.: Profile, 2007. - 160 S.; Ishchenko O. C. Use of fibrin glue in the treatment of patients with immature intestinal fistula. Abstract. dis. ... candles. the honey. Sciences. - M., 2011].

There is a method of treatment of immature fistulas, including obturation cavity or wound with fistula polymeric material [Reschen offers excellent opportunities for Days, the Rationale of treatment in patients with postoperative external intestinal fistulas in its formative stages. Dis. ... candles. the honey. Sciences. - Saratov, 2003. - 162 C.]. The disadvantage of this method is that the obturator prevents the overgrowth of granulation tissue and narrowing of the fistulous course, which further leads to the formation of Gorovenko fistula, which requires complex surgery.

There is a method of treatment of immature fistulas, including the use of vacuum aspirator [Bazayev A. C. Optimizing the treatment of patients with external intestinal fistulas. Dis. ... Dr. med. Sciences. - N. Novgorod, 2004. - 322 S.].The disadvantage of this method is the fact, when establishing the vacuum in fistulous course content is delivered through drainage, therefore, may increase the loss of fluid and electrolytes. In some cases recommend the return of the intestinal contents are evacuated through the drain-foam system, and a vacuum suction device into the lumen of the colon through performed distal to the fistula probe [Bazayev A. C. Optimizing the treatment of patients with external intestinal fistulas. Dis. ... Dr. med. Sciences. - N. Novgorod, 2004. - 322 S.].

Known therapeutic efficacy of exogenous nitric oxide (NO) in the treatment of several diseases, which is based on the properties of endogenous NO as polyfunctional physiological regulator and is as follows:

- normalization of microcirculation due to vasodilation, antiplatelet and anticoagulant actions NO;

- bactericidal activity as their own, and mediated by peroxynitrite, formed in the tissues in the interaction of NO with superoxide anion;

- induction of phagocytosis of bacteria by neutrophils and macrophages;

activation of antioxidant protection;

- improvement of nerve conduction (neurotransmission);

- regulation of specific and nonspecific immunity;

direct induction of proliferation of fibroblasts, growth of blood vessels, collagen synthesis, formation and maturation of granulation tissue, proliferation of the epithelium;

- modulation of apoptosis and prevention of pathological scarring.

When using the apparatus "Plason" therapeutic effect is carried out by supplying to the biological tissue gas streams of different temperatures, but with the same content in a stream of nitrogen oxide (NO) [Kruglov, E. E., Nalivkin A. E., Mashkov, A. E., Nasedkin A. N., Golubovsky, A. a Method for the treatment of intestinal fistula. A. C. RF 2233123 C2, CL AV 17/00, A61K 33/08, OR 1/00. Appl. 12.09.02. Publ. 27.07.04; Sweden) O. C. I. Klimenko, Physical methods in complex treatment of purulent diseases of soft tissues. // Sibir. the honey. review. - 2009. No. 5. - S. 55-58].

There is a method of treatment of intestinal fistula, including the installation of drainage and drug therapy with exposure through the distal end of the drainage installed at a distance of 0.2-1.0 cm from the fistula, air-gas stream of nitrogen monoxide (NO therapy) from the apparatus "Plason" in therapeutic mode for 2-3 minutes daily for a course of 6-10 sessions [Kruglov, E. E., Nalivkin A. E., Mashkov, A. E., Nasedkin A. N., Golubovsky, A. a Method for the treatment of intestinal fistula. A. C. RF 2233123 C2, CL AV 17/00, A61K 33/08, OR 1/00. Appl. 12.09.02. Publ. 27.07.04].

The disadvantage of this method is the need for drainage of the fistula using x-ray control, it is impossible to perform in conditions of dressing, or laparoscopic method that cannot be used in the dressing daily, due to the bulkiness of the device is s and in some cases the lack of specially trained personnel.

It is known the use of EHF-therapy for the treatment of several diseases. The basis of the correction and restoration of impaired functions through the use of EHF-therapy on the principle of impact on its own information management system of the organism, the principle of "imposing" the body lost in the disease process of a healthy rhythm. Consider that under pathological conditions external EHF-radiation affecting arteriovenus the body, they mimic the signals produced by the body, helping it to quickly and efficiently resolve the alteration. Cells and organs weakened organism, not able to restore the disturbed homeostasis, can be normalized external EHF-radiation and continue to function normally. One of the mechanisms of action of waves EHF in the treatment of wounds is an increase in connective tissue, mainly due to the formation of collagen fibers.

There is a method of treatment of trophic ulcers of the lower extremities based on these principles, which hold local effects on waves EHF spectrum type of "white noise" for 10-15 minutes and an additional influence on biologically active points [Malchukov C. A., Polyakov, A. G., Anisimov, S. I., E. Efimov, I., Karnaukhov A. C. EHF-therapy of low-intensity noise radiation. N. Novgorod: Publishing house of the Nizhny Novgorod state University. N. And. Lobachevsky, 2002. - S. 68-69]. The total duration of the session up to 30 minutes, and the duration of the course depends on the effectiveness of treatment and includes 10-12 sessions.

The last two ways are taken as prototypes.

The aim of the present invention is a safe and effective treatment of intestinal fistula using only conservative methods, which avoid the risks of surgery and General anesthesia.

The goal is to reach a set of measures including diet, medication restorative therapy and local treatment - the treatment of the wound and the edges of the fistulous course of a 5% potassium permanganate solution and 3% hydrogen peroxide solution, processing and plugging fistulous stroke zinc paste, the effect on fistula exogenous nitric oxide (NO) is obtained by using domestic air plasma apparatus "Plason", and local irradiation fistulous wound millimeter waves EHF spectrum type of "white noise" in the frequency range 53,57-78,33 GHz using the "AMFIT-0,2/10-01").

The proposed method is as follows.

For the entire period of treatment of the patient with external colonic fistula prescribe a diet with restriction of the total volume of fluids you drink 1.5 liters per day, which compensate for intravenous R. the cross-sections, the number and composition of which depend on the extent of violations of water-electrolyte disorders. After removal of the dressing from the wound and the edges of fistulous stroke treated with 5% potassium permanganate solution, which is then washed with 3% hydrogen peroxide solution, dried up sinus tract opening and the edges of the wound, provide aeration fistulous openings at a depth of 0.5 cm cooled plasma stream of nitrogen monoxide using a commercially available apparatus "Plason" ("Scalpel-coagulator-stimulator air plasma SXIT/NO") in therapeutic mode 2000 mg/m3with an exposure time of 1.5 min, then treated fistulous opening and the wound edges plasma stream of nitrogen monoxide concentration in the zone of contact with the wound surface is 1500 mg/m3and the exposure time is 20 seconds for each 1 cm2surface drain fistulous opening and the wound edges, hole plugging gauze cloth, the region of the sinus tract wounds irradiated waves EHF spectrum type of "white noise" and provided integral power on the surface of the wounds of 1.5 µw along the perimeter of the fistulous openings at a distance of 15 mm from the edges of the fistulous course within 30 minutes after the horn nozzle using a commercially available apparatus "AMFIT-0,2/10-01", the cloth is removed, fistulous opening and the skin around it is treated with zinc pasta, cover with a gauze cloth and, subsequent ligation carry out exactly the same as getting wet dressings intestinal contents, but not more than 2 times per day and at least once in 3 days.

The described method was applied in the surgical Department of the branch №5 of FCGU "1586 Military clinical hospital of the Ministry of defense of the Russian Federation.

The present method was treated group of patients (n=12), clinical observation has shown high efficiency of the method when using the recommended treatment options. Complications were not, in all cases, were able to achieve closure of intestinal fistula using the proposed method, without the need to perform surgery and General anesthesia.

In the application of this method revealed the following advantages:

- fast relief processes of maceration of the skin and perifocal inflammation around the fistulous openings and further their prevention;

- stimulation of the growth of granulation tissue and accelerate epithelization fistulous wound;

- the possibility of application of the method at any phase of wound healing;

the method reduces the time of inpatient treatment and to avoid surgical intervention in this category of patients;

- how easily available, easy to perform, does not require large financial cost of implementing the method and the training of personnel.

a Method of conservative treatment of external colonic fistula, including the appointment of a special diet with restriction of the total volume of fluids you drink 1.5 liters per day, which compensate for intravenous solutions, the number and composition of which will depend on the extent of violations of water-electrolyte disturbances, characterized in that after removal of the dressing from the wound and the edges of fistulous stroke treated with 5% potassium permanganate solution, which is then washed with 3% hydrogen peroxide solution, dried up sinus tract opening and the edges of the wound, provide aeration fistulous openings at a depth of 0.5 cm cooled plasma stream of nitrogen monoxide using a commercially available apparatus "Plason" ("Scalpel-coagulator-stimulator air plasma SXIT/NO") in therapeutic mode 2000 mg/m3with an exposure time of 1.5 min, then treated fistulous opening and the wound edges plasma stream of nitrogen monoxide concentration in the zone of contact with the wound surface is 1500 mg/m3and the exposure time is 20 seconds for each 1 cm2surface drain fistulous opening and the wound edges, hole plugging gauze cloth, the region of the sinus tract wounds irradiated waves EHF spectrum type of "white noise" and provided integral power on the surface of the wounds of 1.5 µw along the perimeter of the fistulous openings at a distance of 15 mm from the edges of the fistulous course within 30 minutes cerebrospinal nozzle using a commercially available apparatus "AMFIT-0,2/10-01", the cloth is removed, fistulous opening and the skin around it is treated with zinc pasta, cover with a gauze napkins, subsequent ligation carry out exactly the same as getting wet dressings intestinal contents, but not more than 2 times per day and at least once in 3 days.



 

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15 cl, 12 dwg

FIELD: medicine.

SUBSTANCE: invention refers to hyperthermia equipment. An apparatus comprises an electromagnetic energy transmission facility for targeting the energy, comprising at least one conductive metallic electrode material in the form of a coating or a mesh wire; a flexible carrier surface is coated with the conductive metallic electrode material. The coated flexible carrier is porous and allows for a through water and sweat transport. The conductive metallic electrode material makes the flexible carrier in the form of the mesh wire; it is porous and allows for the through water and sweat transport via the flexible carrier. The metallic electrode material is not isolated from the skin; it is opposite to at least one counter electrode or one oppositely charged capacitor electrode, or the coated flexible carrier or mesh wire consists of the number of positive and negative sections or the number of positive and negative electrodes that represent an array of alternating positive and negative sections or an array of positive and negative electrodes. The electromagnetic energy transmission facility is attached to a radio-frequency source providing radio frequencies within the range of 10 kHz to 50 MHz.

EFFECT: using the invention enables higher and easier usability of the apparatus.

11 cl, 4 dwg

FIELD: medicine.

SUBSTANCE: preparatory, therapeutic and rehabilitation stages are performed. The preparatory stage involves analysing the previous medical history taken by at least three specialists: a psychologist, a psychotherapist and an ozone therapy specialist. The therapeutic stage involves a rational psychotherapy with feeding biological self-regulating system information in various forms and congestion, as well as in a strict sequence of brain activity rhythms. At the rehabilitation stage, the patient performs unassisted home psychotherapeutic sessions according to the individual program with the use of players.

EFFECT: method enables providing the higher therapeutic effectiveness by enhancing the individual patient's ability to recognise positive possibilities and rehabilitation in the line with the health lifestyle by the integrated treatment, activation of individual's ability training to rehabilitate.

16 cl

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