RU2525530C1 - Method of recovering functions of intestinal tube in case of short bowel syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: magnetic anastomosis is formed between the adducent and abducent parts of the small intestine with the application of magnetic dies. After formation of the magnetic anastomosis the stoma area is subjected to an impact of impulse laser radiation with a frequency of laser impulse repetition of 5 Hz, 50 Hz and a variable frequency of 0-250 Hz for 60 sec at each frequency. After formation of the anastomosis and coming off of magnetic dies, intestinoscopy with further magneto-laser impact in the zone of the formed anastomosis is performed with a value of a magnetic field induction 30-40 mT and power of infrared radiation in an impulse of 8-50 W for 60-120 sec. A cryo-electrostimulating impact on reflexogenic zones in the intestine projection is realised. Simultaneously a magnetic, an impulse-laser impact and an impact with incoherent radiation of infrared light diodes is realised on the anterior abdominal wall in the area of the navel, right iliac region, right mesogastric region, epigastrium region and left mesogastric region with a frequency of laser impulse repetition of 5 Hz, 50 Hz and a variable frequency of 0-250 Hz with radiation power 8-50 W in an impulse and an induction value of 30-40 mT for 30-60 sec. Deleting of the stoma, sewing the tube in an end-to-end way and its submergence into the abdominal cavity are carried out.

EFFECT: method makes it possible to increase efficiency of recovering functions of the intestinal tube in case of the short bowel syndrome due to acceleration of reparation improvement in the anastomosis zone, recovery of secretary function and suction function in abducent parts of the intestine, reflex enhancement of peristalsis.

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Description

The invention relates to medicine, in particular to the field of abdominal surgery, and can be used to restore the functions of the intestinal tube in case of short bowel syndrome.

Known surgical methods for restoring the functions of the intestinal tube, aimed at increasing the time of passage of the chyme along the small intestine, increasing absorption and based on the use of electrical stimulation of the small intestine (ed. St. USSR No. 2001401 according to class G01N 33/483 from 10/15/1993; ed St. USSR No. 1560231 according to class A61N 1/36 dated 04/30/1990, dated 04/30/1990).

Surgical methods are also known for restoring the functions of the intestinal tube, aimed at restoring the valves of the small intestine (ed. St. USSR No. 1701294, A61B 17/00 of 12/30/1991).

The disadvantage of the above methods is the relatively low efficiency of restoring the functional usefulness of the intestinal tube and the complexity and duration of operations when using small intestine stimulation.

The closest technical solution for the combination of essential features is a method of restoring the functions of the intestinal tube used in the treatment of double-barreled intestinal fistulas (RF patent No. 2018266 according to class A61B 17/00 from 08/30/1994).

This method involves the formation of a magnetic anastomosis by introducing magnets into the lead and discharge loop of the intestine, followed by suturing of the stoma.

The disadvantage of this method is the relatively low efficiency of the anatomical and functional viability of the anastomosis, causing purulent complications in the abdominal cavity.

The problem to which the claimed invention is directed, is to increase the efficiency of restoration of the functions of the intestinal tube in short bowel syndrome.

The problem is solved due to the fact that in the method of restoring the functions of the intestinal tube in the case of short bowel syndrome, including the formation of a magnetic anastomosis between the adducting and adducting sections of the small intestine using magnetic dies, the subsequent elimination of the stoma, suturing the tube end to end and immersing it in the abdominal cavity that after the formation of a magnetic anastomosis, the stoma area is affected by pulsed laser radiation with a laser pulse repetition rate of 5 Hz, 50 Hz and a variable frequency (0-250 Hz) for 60 seconds at each frequency, after the formation of the anastomosis and the exit of the magnetic dies, an intestinaloscopy is performed, followed by magnetic laser exposure in the zone of the formed anastomosis with a magnetic field induction value of 30-40 mT and an infrared laser radiation power of 8-50 W per pulse for 60-120 sec then carry out a cryoelectrostimulating effect on reflexogenic zones in the intestinal projection, simultaneously carry out a magnetic, pulsed-laser exposure and exposure to incoherent infrared radiation LEDs on the anterior abdominal wall in the navel, right iliac region, right mesogastric region, epigastric region and left mesogastric region with a laser pulse repetition rate of 5 Hz, 50 Hz and a variable frequency (0-250 Hz) at an output power of 8-50 W in a pulse and an induction value of 30-40 mTl for 30-60 seconds, after which the stoma is eliminated, the tube is sutured end to end and immersed in the abdominal cavity.

The method is as follows.

At the initial stage, anastomosis is formed between the leading and outlet sections of the “double-barreled” small intestine using magnetic dies, at the end of which the passage of the chyme along the intestine is restored.

To accelerate and improve repair in the anastomotic zone, the stoma area is exposed to pulsed laser radiation with a laser pulse repetition rate of 5 Hz, 50 Hz and a variable frequency (0-250 Hz) for 60 seconds at each frequency.

After the formation of the anastomosis and spontaneous discharge of the magnetic dies with the help of a fibroscope, an intestinal microscopy is performed. Through the leading section of the “double-barreled barrel, clogging the stoma of the leading section, the area of the formed anastomosis is inspected, during which the correct form of the anastomosis and its formed edges are checked. In addition, a biopsy of the mucous membrane of the abdominal tract in the area of 0.5-1 cm from the anastomosis is taken.

Then, in the zone of the formed anastomosis, a magneto-laser effect is carried out with a magnetic field induction value of 30-40 mT and an infrared laser radiation power of 8-50 W per pulse for 60-120 sec, then a cryoelectrostimulating effect on reflexogenic zones in the intestinal projection is performed, at the same time magnetic, pulsed laser exposure and exposure to incoherent radiation of infrared LEDs on the anterior abdominal wall in the navel, right iliac region, right mesogastric area, epigastric region and left mesogastric region with a laser pulse repetition rate of 5 Hz, 50 Hz with a variable frequency (0-250 Hz) at a radiation power of 8-50 W per pulse and an induction value of 30-40 mT for 30-60 sec, after which carry out the elimination of the stoma, suturing the tube end to end and immersing it in the abdominal cavity.

The specified magneto-laser therapy allows to exclude zones of atrophy while preserving the secretory function of absorption of the intestinal discharge. After magneto-laser therapy, a cryoquantum effect on the reflexogenic zones in the intestinal projection is performed, and immediately after the cryoquantum effect, a magnetic and pulsed laser action and incoherent radiation of infrared LEDs are applied to the anterior abdominal wall in the navel, right iliac region, right mesogastric region, epigastric region and the left mesogastric region with a laser pulse repetition rate of 5 Hz, 50 Hz pulses per second and a variable frequency (0-) 250 Hz at powerfully radiation of 8–50 W per pulse and an induction value of 30–40 mT for 30–60 s.

The cryoquantum effect on reflexogenic zones in the projection of the intestine causes a reflex enhancement of peristalsis, and the magnetic effect, pulse-laser irradiation and exposure to incoherent radiation of infrared diodes subsequent to the cryoquantum accelerates the repair in the zone of the forming anastomosis.

The final stage of all the above effects is a cavity operation to eliminate the stoma and restore the intestinal tube by immersing it in the abdominal cavity.

The proposed method for restoring the functions of the intestinal tube in the case of short bowel syndrome allows reducing the lifetime of the non-functioning intestine, which ultimately improves the parietal enzymatic processing of food, the absorption of nutrients, the movement of chyme, the formation of feces and their elimination from the body.

Clinical example No. 1

Patient Victor Sergeevich O., 75 years old, medical history No. 20584/11.

Diagnosis

Primary: Disorder of mesenteric circulation, multiple perforations of the small intestine. Adhesive disease of the abdominal cavity.

Concomitant diseases: Condition after a past myocardial infarction. IHD, PEAKS (1991) CHF1. Hypertensive disease 3 Art., The risk of CCO4 Art. Peptic ulcer 12 p.k., remission. Chronic pancreatitis. Chronic hypomotor colitis.

Received August 6, 2011, a day after the onset of the disease, with complaints of bloating, an increase in the size of the abdomen, abdominal pain, nausea, vomiting, and stool and gas retention. An ultrasound scan shows signs of intestinal obstruction. On the survey radiograph upon admission, pathology was not detected. The severity of the condition was hospitalized in the intensive care unit and intensive care with hypovolemia. Beginning mesenteric thrombosis is suspected. Indications for emergency surgery. Resection of the small intestine conglomerate, excretion by enterostom was performed. On the histology of the removed conglomerate of the small intestine - a violation of mesenteric circulation.

Repeatedly 10.08.11 and 16.08.-18.08.11, in connection with sluggish peritonitis, a reorganization relaparotomy was performed. 08/18/11 - during the operation, the ileostomy was removed to the jejunum enterostomy zone. Subsequently, the condition stabilized, losses through the enterostomy were compensated by enteral nutrition through a probe, by infusion therapy.

09/01/11 Protein - 61. Potassium - 3. Sodium - 137. Hemogl - 77.

09/02/2011 Magnetic dies were applied. 2 magnetic plates (magnetic induction of each field - 180 mT) were introduced into the adducting and outlet sections of the small intestine in order to create entero-enteroanstomosis and restore the passage of intestinal contents through the intestinal tube.

In the postoperative period, a quantum effect was made on the area of the enterostomy in the dressings and through a transparent colostomy bag to improve the repair and prevention of secondary complications with a laser pulse repetition rate of 5 Hz, 50 Hz and a variable (0-250 Hz) for 60 seconds at each frequency during dressings or through a transparent kalopriemnik No. 5.

09/07/2011 magnetic dies spontaneously departed. Passage of intestinal contents was adjusted slowly due to sluggish peristalsis of the outlet section.

On September 11, 2011 an intestinal examination was performed to examine the area of the formed anastomosis, during which it was established that the anastomosis has the correct shape and thin edges formed without a scar. In addition to visual examination, a biopsy sample of the mucous membrane of the intestinal outlet in the area of 0.5-1 cm from the anastomosis was taken for comparison. In a histological examination, the material was compared with that taken for surgery (during resection) and with the plates taken from the abducting zone taken before installation. It was stated that the mucous membrane does not have zones of inflammation and necrosis (as in the first case) and zones of atrophy with a violation of secretory function and absorption function (as in the second). These effects were achieved due to the beneficial effects of a powerful magnetic field (induction 150-300 mT) and quantum exposure (15 watts per pulse infrared laser influence). Due to the insufflation of air, with inflating the intestine, the motility of the sluggish peristaltic discharge section of the small intestine increased.

09/12/11, a quantum and electric pulse action was started, including a pulsed laser (with a wavelength of 890 nm) affecting the anterior abdominal wall in the navel, right ileal region, right mesogastric region, epigastric region and left mesogastric region with a laser pulse repetition rate of 5, 50 Hz and a variable (0-250 Hz), with a radiation power of 15 W per pulse, and an induction value of 35-40 mT at an exposure time of 60 seconds per point, as well as the use of light from infrared LEDs with a wavelength of 860-960 nm and electrical stimuli yats. The impact was carried out using a medical installation "RIKTA-ESMIL-02". Enhanced peristalsis is determined using the auscultatory method through the anterior abdominal wall and using ultrasound. To restore a full passage of intestinal contents through the intestinal tube, a pressure bandage was applied to the stoma area.

11/09/11 Surgery was performed to remove the stoma and restore the intestinal tube with immersion in the abdominal cavity.

In the postoperative period, the area of skin sutures was affected by the energy of the RIKTA-ESMIL-02 medical device with a pulse repetition rate of 1 kHz. Primary healing. Sutures were removed on the 10th day. Discharged in satisfactory condition.

Clinical example No. 2

Patient Julia K., 75 years old, medical history No. 19864/11.

Primary: Condition after imposing a jujunostoma regarding complications of surgical treatment of obesity from May 2011. Water-electrolyte disturbances.

Received July 28, 2011

In May 2011, in the City Clinical Hospital No. 13 was operated on for diffuse peritonitis. According to the patient, she received perforation of the small intestine during surgery on the stomach for weight loss (abroad). Was on long-term inpatient treatment, small intestinal fistula was applied. There was sepsis, multiple organ failure syndrome. After discharge, the condition began to gradually worsen, abdominal pain and nausea bothered. Denies hyperthermia. 07/28/11 increased pain, vomiting. She took cerucal - without effect. Delivered by an ambulance team, was hospitalized in hospital No. 13 in serious condition. In consciousness, contact, adequate. The skin is pale. Breathing is weakened in the lower parts of the lungs. Heart sounds are muffled. Heart rate 110 bpm. HELL 80/40 mm Hg The abdomen is tense, painful in the upper sections. The severity of the condition is due to multiple organ failure syndrome and shock against the background of surgical sepsis, due to the consequences of the iatrogenic state (surgical treatment of obesity). On ultrasound in the abdominal cavity, fluid formation of inflammatory origin. Subsequently, she received conservative treatment (intensive, infusion-corrective therapy). The severity of the patient's condition was due to the syndrome of the "short intestine", which occurred against the background of the disconnection of the jejunum 80 cm below the ligament of the treitz. In this regard, a decision was made to form a junior anastomosis with the help of magnetic technology (applying magnetic dies).

08/04/2011 09:00 AM Installation of magnetic dies on the junction box. On the anterior abdominal wall on the left of the jujnome. After the introduction of Promedol 1.0 v / m, the leading and outlet parts of the jejunostoma were revised. At a distance of 3 cm from its edges, magnetic dies are superimposed. Quantum therapy was performed (Rikta apparatus, variable frequency, exposure - 120 sec, power 15 W (imp) in order to improve stimulation of reparative processes in the field of magnetic dies installation and reduce the risk of p / o complications.

Quantum therapy No. 5 on the stoma area was carried out in order to improve the repair and prevention of secondary complications. The exposure was performed using the Rikta-Esmil 02 apparatus with a frequency of 5 Hz, 50 Hz, a variable (0-250 Hz) - for 60 sec, a power of 15 W (imp). Removal of dies after restoration of passage through the jejunum.

08/11/2011 at 15.00 dies departed independently.

08/15/11, due to the presence of sluggish intestinal motility, quantum stimulation of the intestine was performed using the RIKTA-05 apparatus with a pulse repetition rate of 5 and 50 Hz and with a laser power of 50 W per pulse. Peristalsis increased during the session, which was confirmed by auscultation and by ultrasound.

08/26/2011 an intestinal examination was performed to examine the area of the formed anastomosis. The latter had a regular shape and thin edges formed without a scar. In addition to visual examination, a biopsy sample was taken of the mucous membrane of the intestinal discharge in the area of 0.5 cm from the anastomosis. It was stated that the mucous membrane does not have zones of inflammation, necrosis and atrophy. Due to the nosufflation of air, when the gut was inflated, the motility of the sluggish peristaltic discharge section of the small intestine increased. In the future, to restore a full passage of intestinal contents through the intestinal tube, a pressure bandage was applied to the stoma area.

10.27.11 Surgery was performed to remove the stoma and restore the intestinal tube with immersion in the abdominal cavity.

In the postoperative period, the area of skin sutures was affected by the energy of the RIKTA-ESMIL-02 medical device with a pulse repetition rate of 1 kHz. Primary healing. Sutures were removed on the 10th day. Discharged in satisfactory condition.

Claims (1)

A method of restoring the functions of the intestinal tube in the case of short bowel syndrome, including the formation of a magnetic anastomosis between the leading and exhausting parts of the small intestine using magnetic dies, the subsequent elimination of the stoma, suturing the tube end to end and immersing it in the abdominal cavity, characterized in that after the formation of the magnetic anastomosis the stoma area is affected by pulsed laser radiation with a laser pulse repetition rate of 5 Hz, 50 Hz and a variable frequency of 0-250 Hz for 60 seconds at each frequency, after the formation of the anastomosis and the discharge of the magnetic dies, an intestinal microscopy is carried out followed by a magnetic laser effect in the zone of the formed anastomosis with a magnetic field induction value of 30-40 mT and an infrared laser radiation power of 8-50 W per pulse for 60-120 sec, then a cryoelectrostimulating effect on reflexogenic zones is performed in the projection of the intestine, simultaneously carry out magnetic, pulsed-laser exposure and exposure to incoherent radiation of infrared LEDs on the anterior abdomen wall in the navel, right iliac region, right mesogastric region, epigastric region and left mesogastric region with a laser pulse repetition rate of 5 Hz, 50 Hz and a variable frequency of 0-250 Hz with a radiation power of 8-50 W per pulse and an induction value of 30 -40 mTl for 30-60 seconds, after which the stoma is eliminated, the tube is sutured end to end and immersed in the abdominal cavity.