SU1734708A1 - Method of surgical treatment of bronchial asthma - Google Patents

Abstract

The invention relates to medicine, namely cryosurgery, and can be used in the treatment of bronchial asthma. The goal is to reduce the morbidity and reduce the time of operation. Bifurcation of the common carotid artery and carotid glomerus is exposed. A gauze coupling applicator is applied to the sino-carotid zone and sprayed with a directed, flow of liquid nitrogen irrigates it until the walls of the arteries are frozen at (-120) - (-

Description

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The invention relates to medicine, namely cryosurgery, and can be used in the treatment of bronchial asthma.

The goal is to reduce the morbidity and reduce the time of operation.

Example 1. Sick I., 35 years old, was admitted to a surgical clinic with a diagnosis of bronchial asthma, infrarektsionno-allergic form, severe course, stage of unstable remission. Diagnosis. 1 tbsp of the lungs.

The disease has been suffering for 11 years, and for the last four years it has been in the 2nd group of disability due to this disease, which is characterized by a progressive course of exacerbations 5-6 times a year. He constantly uses various inhalation bronchodilators (berotek, becotide, salbutamol, etc.), for four years he takes prednisone courses

diminishing regimen with maintenance doses of 2.5-10 mg per day.

Upon admission, complains of choking, paroxysmal character, feeling of lack of air, dry cough, shortness of breath when walking, feeling of heaviness in the chest. An objective study notes the restriction of the excursion of the chest. Percussion is characterized by a clear, pulmonary sound with a box tone. Auscultation - dispersed dry rales on the background of hard breathing with elements of the bronchospastic syndrome.

Complete blood count 1 Hb - 144 g / l; era 4.5-U12; d 7700. e 4%; n 1%; from 56%; l 3%; ESR 12 mm / h. In other clinical and biochemical analyzes there are no changes.

X-ray examination of the lungs: chronic bronchitis, pulmonary emphysema.

Fiber bronchoscopy: bilateral diffuse catarrhal endobronchitis 1 tbsp.,

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CO 4S, VI O 00

allergic stack of the mucous membrane of the bronchial tree, Levage. Introduction of bronchodilators and antihistamines (drugs.

Spirography: impaired obstructive pulmonary ventilation capacity,

Taking into account the progressive nature of the course of bronchial asthma, the lack of effect of conservative therapy and focal pathology in the lungs, indications for surgical treatment have been set.

Cryoenervation of the sino-carotid zone. Under local anesthesia with a 0.25% solution of novocaine, an incision was made along the anterior margin of the difficult clavicle-mastoid. The common carotid artery and its branches were separated from the fascial bed by an acute route during the planned cryo-action and were taken on rubber turnstiles. From a two-layer gauze, a rectangular-shaped flap was cut with sides of 30 x 35 mm with two longitudinal cuts up to half of the rectangle in such a way that a narrow strip of 4-5 mm remained in the middle. The gauze applicator thus formed, having a wide base and three separate strips, was placed under the carotid artery and enveloped in them a common trunk, the inner and outer branches of the vessel in the form of a coupling. The middle strip was placed between the branches in the fork. The carotid artery was raised on the turnstiles without clamping the lumen and using the A.I. Shalnikov apparatus to irrigate its walls with liquid nitrogen through gauze, which creates a condition for the uniform glaciation of its walls. Monitoring the adequacy of cryogenics was performed by three thermocouples located in the freezing zone of the common carotid artery, bifurcation and both branches of the artery. The arithmetic mean value of temperatures measured using the readings of the indicated thermocouples was calculated from the results of four measurements of the temperature of the walls of the arteries located in the caudal and cranial sections from the junction of the artery, at each of the four freezing cycles, and amounted to -120 -123 ° C.

The average temperature of the crystallized glomerulus was -145 ° C. The subsequent thawing was carried out spontaneously at room temperature. The average irrigation duration of one cycle was 65 seconds. The freeze cycle - thawing was repeated four times a day, which was due to

high intensity of arterial blood flow. The operation was completed by drainage of the vascular bed with a rubber graduate and layer-by-layer suturing.

operating wounds. The duration of the operation 50 minutes The postoperative period was uneventful. Discharged on the ninth day in a satisfactory condition. Dyspnea attacks are single, rare and

0 can be easily stopped with inhalation baroteca. At the control examination after 6 months. the state of health improved significantly, the exacerbation of the disease was not, minimal maintenance doses of prednisone 2.5 mg, rarely used inhalant, shortness of breath occurs only when walking fast.

PRI mme R 2. Ill B., 32, was admitted to the hospital with complaints of attacks

0 suffocation, dry cough, shortness of breath with little exertion, feeling of lack of air. For five years, he suffered from asthma, an infectious and elologic form, an average

5 over. Diaznoz 1 tbsp. The last two years have marked a significant deterioration in health with an increase in the frequency of exacerbations 3-4 times a year. Asthmatic statuses occurred three times. Repeated old-fashioned treatment was unsuccessful, she used 5-6 times a day.

On physical examination, vesicular breathing is weakened. Hearing 5 double-sided dry musical rattles. Symptoms of nasal spasm (harsh breathing, difficult exit, dry rales heard at a distance) appear periodically. From the laboratory and

0 biochemical parameters of blood changes i | 8T

According to X-ray: chronic bronchitis, emphysema, Local organic pathology is not.

5 Fibrobronchoscopy: diffuse catarrhal endobronchitis 1 tbsp, allergic mucosal edema

Spirography: obstructive breathing dysfunction.

0Operating cryodestruction of the carotid-sinus zone. Produced under local anesthesia with a 0.2b% novocaine solution with a size along the anterior margin of the sternocleidomastoid muscle on the right.

5 Acutely exposed the common carotid artery and its internal and external branches, which were taken for turnstiles. A gauze patch in the form of a sleeve enveloped the artery for two centimeters from the bifurcation in the caudal and cranial directions, Snapped into the artery on the turnstiles, the cryodestruction of the blue-carotid zone was performed by the OI Shal'nikov apparatus in the freeze-thaw mode. According to the results of four measurements, the temperature of the artery walls in the areas on both sides of the fork was on average –121–125 ° C, the average temperature of the cryodestructive glomerulus was –145 ° C, and the average irrigation duration of one cycle was 59 seconds. The operation was completed by draining the vascular bed with a rubber graduate and stitching the surgical wound. The duration of surgical intervention was 60 minutes. The postoperative period is smooth. Wound healing by primary tension,

After the operation, the attacks of asphyxiation completely stopped, and shortness of breath, appearing during physical exertion, was easily stopped by a single use of a pocket inhaler with a berotok. At discharge, the patient's condition is satisfactory, dyspnea was observed when walking briskly. There was no wheezing in the lungs. At the control examination after 6 months. satisfactory condition

exacerbations of asthma was not. Rarely uses a pocket inhaler, the effect of the operation is satisfied.

The proposed method for the treatment of bronchial asthma is applied in 12 patients with an infectious-allergic form of the disease, moderate to severe course. In four patients, the effect of the operation was assessed as satisfactory - rare and easily relieved odyshechnye seizures, which indicates the restoration of sensitivity to drug therapy. In eight patients after surgery, the attacks stopped altogether.

The method is recommended in clinical practice.

Claims (1)

Invention Formula A method of surgical treatment of bronchial asthma, including denervation of the common carotid artery bifurcation, carotid glomerular devitalization, and in order to reduce trauma and shorten the operation time, the common juicy artery bifurcation is subjected to fourfold / cryogenic at 120-125 ° С with intermediate thawing, and carotid, 4 balls are cooled to -145 -155 ° С.