RU1771762C - Method of acute cholecystitis treatment 9240, ,0221 method of preventing explosion in discharged tank and in discharging granulated polymer 9240, ,0222 device for feeding fire-extinguishing composition in fire-extinguishing system - Google Patents

Abstract

Usage: in medicine, in particular for abdominal surgery, and can be used to treat acute cholecystitis with hepato-choledochal syndrome. The essence of the method consists in the fact that a fiber is introduced through the drainage into the lumen of the choledochus and a laser is exposed to the bile duct and liver tissue at a wavelength of 630-1600 nm and a power density of 0.06-0.1 W / cm2 for 10- 15 min, starting from the first postoperative day, daily for 5-7 days. The positive effect of the method: easy to implement, reduces the duration of treatment and the number of complications.

Description

The invention relates to medicine, and more specifically to abdominal surgery, is intended for the treatment of hepatocholedochal syndrome in the postoperative period in patients with acute cholecystitis, due to the fact that in more than 30% of patients with acute cholecystitis, the course of the disease is complicated by the development of hepato-choledochal syndrome from the current postoperative period, one of the urgent problems is the need to develop new and improve known methods of treating this severe donkey Ears.

A known method of treating hepato-choledochal syndrome in patients with acute cholecystitis involves performing cholecystectomy of external drainage of the common bile duct, followed by sanitation of the biliary system with antibacterial and anti-inflammatory drugs.

The disadvantages of the above method are the difficulty of sanitizing the biliary system with antibacterial and anti-inflammatory drugs, primarily due to their limited penetration through the biliary tract, their rather weak anti-inflammatory effect on liver tissue, the cost and scarcity of drugs

The purpose of the invention is the prevention of postoperative complications and the reduction of treatment time. To do this, laparotomy, cholecystectomy and choledoch drainage are performed. The choledochus is drained by a polyvinyl chloride tube with the direction of its lumen towards the liver and is discharged through a separate incision on the anterior abdominal wall. This drainage is intended for decompression of the biliary tract and the passage of the fiber to expose the laser radiation to the choledochus and liver tissue in the postoperative period.

Our research includes 65 observations of laser therapy

H

M

X O KZ

patients with acute cholecystitis with hepato-cholecheal syndrome. It was found that with a decrease or extension of the laser wave, a decrease in the power density of the laser radiation and exposure compared with the data cited, the therapeutic effect is also significantly reduced. And an increase in the power density of laser radiation above 0.1 W / cm2 and exposure to laser radiation for more than 15 minutes does not lead to a noticeable improvement in the therapeutic effect - (P 0.05).

It is important to note that after 3-4 sessions of laser therapy, not only an improvement in the general condition of patients was observed, but also a marked tendency to improve laboratory criteria (clinical blood count, proteinograms, amino acid composition of plasma, levels of ACT, trypsin, trypsin inhibitor, cal blood lycrein-kinin and coagulation systems, serum immunoglobulin level A.S. M) P 0.05 or P 0.05.

Examples:

1 Patient G.L.B. 70 years old was hospitalized in the clinic for acute cholecystitis with hepato-choledochal syndrome. A cholecystectomy was performed with drainage of the common bile duct of the Vishnevsky-Robson type. In the postoperative period, hepatopathy-choledochal syndrome was treated by laser irradiation at a wavelength of G30 nm with a laser radiation power density of 0.1 W / cm, the duration of the session was 15 minutes. Six laser irradiation sessions were performed through a fiber through drainage. After a second session of laser therapy, the patient noted a clear improvement in general condition. After the third session, normalization of the pulse and arterial pressure was noted, the proteolytic activity of blood serum decreased by more than 1.5 times. Mild leukocytosis was noted. After 4 sessions, the patient was active, expanded enteric nutrition, and there was stool. After the fifth and sixth sessions, the patient's condition is satisfactory. The postoperative period was uneventful. Sutures were removed on the 9th day of the postoperative period. The wound healed by primary intention. In satisfactory condition, was discharged home on the 15th day from the moment of admission to the clinic.

2. Patient P.S.I. 64 years old was hospitalized in a clinic for cholecystitis with hepato-choledochal syndrome. An operation was performed for cholecystectomy, external drainage of the common bile duct type Vishnevsky-Robson. In the postoperative period, starting from the first day after the operation, laser irradiation of the liver was performed through

the fiber was used to drain the common bile duct at a wavelength of 1600 nm, the laser power density was 0.06 W / cm and the session duration was 10 minutes. Completed 7 sessions of laser therapy. An obvious therapeutic effect was observed after the third

session. The general condition of the patient significantly improved. Active peristalsis appeared, the gases departed. Evening temperature was within normal limits. After 4 sessions, the patient is active, body temperature, hemodynamic parameters within normal limits. Progeolytic blood serum activity decreased by 80%. The postoperative period was uneventful. Sutures are removed on day 9. The wound healed by primary intention. In satisfactory condition, the patient was discharged on day 14 from the moment of admission to the clinic.

3. Sick K.S.M. 52 years old was hospitalized in the clinic for acute cholecystitis with hepato-choledochal syndrome. Cholecystectomy, drainage of the common bile duct

type Vishnevsky. In the postoperative period, hepato-choledechal syndrome was treated with laser radiation at a wavelength of 1060 nm, a laser radiation power density of 0.08 W / cm2,

session duration 12 minutes 5 sessions of laser irradiation of the liver through a light guide conducted through drainage o6aiero of the bile duct were performed. A positive effect was found after the second session of laser therapy. The patient noted a decrease in abdominal pain, peristalsis appeared, and the gases moved away. After the third session of laser therapy, hemodynamic parameters and body temperature returned to normal. The serum proteolytic activity decreased by 45%. The postoperative period was uneventful. The sutures were removed on the 8th day after the operation, the wound healed by primary intention. In satisfactory

the patient was discharged home on the 13th day after admission to the clinic.

Therefore, the use of the method we developed for the treatment of hepato-choledechal syndrome in patients with acute

cholecystitis in the postoperative period allows to reduce the time spent by patients in the clinic by an average of 3.5 days, to reduce the number of complications.

As the experience of testing the developed method for the treatment of hepato-choledochheal syndrome with an increase in the laser power density of 0.1 W / cm and lengthening the exposure time does not improve the treatment of hepatocholechole syndrome.

4. Sick P.V.S. 51 years old was hospitalized in the clinic for acute cholecystitis with hepato-choledochal syndrome. An operation of cholecystectomy with drainage of the common bile duct was performed according to the type of Vishnevsky drainage. In the postoperative period, starting from the first day after the operation, laser irradiation of the liver was carried out through the drainage fiber, and laser radiation of 630 nm was used, the laser radiation power density was 0.15 W / cm2, and the duration of the session was 15 minutes. 5 laser irradiation sessions were performed. A positive effect was revealed after the second session of laser therapy. The patient noted improvement in general condition, abdominal pain decreased. After the third session, hemodynamic parameters were within normal limits, the temperature returned to normal, and there was stool. Enteral nutrition expanded. The postoperative period was masonry. The sutures were removed on the 9th day of the postoperative period, the wound healed by primary intention. In satisfactory condition, was discharged on day 13.

5. Sick Sh.S.M. 50 years hospitalized in a clinic for acute cholecystitis with hepato-choledochal syndrome. An operation of cholecystectomy with drainage of the common bile duct was performed according to the type of drainage of Wisniewski-Robson. In the postoperative period, hepato-choledochal syndrome was treated by irradiating the liver through a fiber through drainage. The wavelength of the laser radiation used was 630 nm, the laser power density was 0.1 W / cm2, and the session lasted 25 minutes. Six sessions of laser therapy were performed starting from the first day of the postoperative period. A positive effect was found after the second session of laser therapy. There was an improvement in general condition, a decrease in abdominal pain. After the third session, hemodynamic parameters and body temperature returned to normal.

There was a chair. The postoperative period was uneventful. The sutures were removed on day 9, the wound healed by primary intention. In satisfactory condition, the patient was discharged on day 14.

With a decrease in the laser power density of 0.06 W / cm2, a decrease in the duration of a laser irradiation session of 10 min, a decrease in length

laser radiation of 630 nm or an extension of 1600 nm, a decrease in the therapeutic effect of the use of laser radiation for hepato-choledochal syndrome in the postoperative period is observed.

Thus, our deep study of the possibilities of using laser radiation to treat hepato-choledochal syndrome in patients with acute cholecystitis in the postoperative period, its high efficiency, allows us to obtain a new therapeutic effect - reducing treatment time and the number of complications.

Changing the parameters of the dosages of laser radiation leads to a decrease in the therapeutic effect, which is manifested in the appearance of complications and lengthening the average length of stay of patients in the clinic.

It should be noted that our proposed method for the treatment of hepato-choledochal syndrome is simple to implement, does not require expensive and scarce drugs for its use, and does not cause complications.

Claims (1)

The claims A method for the treatment of acute cholecystitis by cholecystectomy and drainage of the cold followed by sanitation of the biliary system, characterized in that, in order to reduce the time of treatment and prevent complications of the hepatocholechole syndrome, the fiber is introduced into the lumen of the choledochus to drain and affect bile duct and liver tissue by laser radiation with a wavelength of 630-1600 nm and a power density of 0.06-0.1 W / cm2 for 10-15 minutes daily 5-7 days after surgery.