RU2039562C1 - Method for treating peptic ulcer - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: essence of this method resides in injecting about 25 to 30 ml of freshly isolated leukostock into zone affected by peptic ulcer a week after completion of ultraviolet treatment of autoblood and then carrying out reinfusion. EFFECT: comprehensive treatment of blood by ultraviolet radiation combined with transendoscopical administration of granulocyte concentrate ensures effective cicatrization of ulcerous defect to 96.0 98.6 percent and substantially shorter treatment period; cicatrization process involves no deformation of affected organ; ultraviolet treatment allows effective rearrangement of autoblood leukocyte receptor system and correction of humoral and cellular immunity.

Description

 The invention relates to medicine, in particular gastroenterology.

 A known method of treating gastric ulcer and duodenal ulcer by endoscopic administration of solcoseryl in the zone of peptic ulcer. However, this method has significant disadvantages, as it allows scarring to be achieved only in 51.2% of cases. In addition, using this method it is impossible to influence the pathological microflora and campylobacteriosis, as well as the indicators of humoral and cellular immunity, as well as microcirculation, which does not allow for clinical endoscopic remission in patients with long-term non-healing stomach ulcers and 12 duodenal ulcers .

 There is also known a method of treating gastric ulcer and duodenal ulcer by transendoscopic application of glue "gastrosol" or "diffusol" on the zone of ulcerous defect. However, this method has significant drawbacks: the technical difficulty of applying (only on a dry surface), performing the procedure once every three days, and the glue stays on the surface of the ulcer for no more than 12-14 hours and does not affect the pathological microflora and humoral and cellular immunity.

 A known method of treating gastric ulcer and duodenal ulcer, which consists in the fact that the patient through the endoscope in the area of the ulcerous defect is injected with freshly released leukomass in an amount of 25-30 ml after a week. However, with prolonged re-use of leukomass, a change in the receptor apparatus of leukocytes occurs, which significantly reduces local immunity in the form of a decrease in the synthesis of immunoglobulin, as a result of which the clinical effect is significantly reduced and the correction of humoral and cellular immunity does not occur again.

 The aim of the invention is to provide a more effective method of treating gastric ulcer and 12 duodenal ulcer.

 With the combined use of blood ultraviolet and local transendoscopic administration of granulocyte concentrate, it is possible to achieve scarring of the gastric ulcer in 96.8% of cases, ulcerative defect of the duodenal bulb in 98.6%. In addition, scar formation occurs without deformation of the stomach wall or bulb 12- duodenal ulcer. The use of this method of treatment can significantly reduce the treatment time to 28 ± 1.2 days for the localization of a ulcerative defect in the bulb of the duodenum and up to 32 ± 1.6 days for the localization of ulcers in the stomach. The effectiveness of this treatment method is confirmed by a halving of the frequency of recurrence compared with known treatment methods.

 The essence is that in the method of treating gastric ulcer and duodenal ulcer, including endoscopic administration of freshly released leukomass in the amount of 25-30 ml to the ulcerous defect zone, reinfusion of autologous blood irradiated with ultraviolet rays in the amount of 2- 3 sessions with an interval of 3-5 days, and leukomass is administered after 4-7 days.

 It has been established that the use of ultraviolet radiation contributes to the restructuring of the receptor apparatus of autologous leukocytes and, in the future, indicators of humoral and cellular immunity in the form of increased T-lymphocytes, decreased suppressor and increased helper function, as well as improved synthesis of secretory immunoglobulin A by the gastric mucosa in the ulcer zone. Pre-irradiation of blood with ultraviolet radiation promotes the generation of active oxygen forms by the leukocytes, which contribute to the bactericidal effect, improves microcirculation in the ulcer zone, and the introduction of donor leukocyte mass contributes to the pronounced effect on the pathological microflora and campylobacter infection in the ulcer zone.

The method is as follows. After puncture of the ulnar vein, the patient is taken 500 ml of blood in a sterile plastic container "Gemakon 500/300" with a blood preservative of sodium citrate 50.0, heparin 1500 IU. Then, through the source of ultraviolet irradiation "Isold", the patient is reinfused with blood at a speed of 56-80 drops in 1 min. At the end of the procedure, an aseptic pressure dressing is applied to the patient at the puncture site. In the first session of the Ural Federal District, 150 ml of blood is taken and reinfused, then, if there are no allergic reactions, the dosage increases to 450 ml of blood, the interval between sessions is 3-5 days. After the procedure, the cuvette of the Isold apparatus is washed, then soaked for 12 hours in a solution of chrompeak, then washed with running water, then washed twice with distilled water. Next the cuvette was sterilized in a hot air oven for 45 minutes at a temperature of 160 ° ^C. After 3-5 days after the ultraviolet irradiation to the patient during fibergastroscope with a special needle produce obkalyvanie ulcer at three points odnogruppnoy Freshly donor buffy coat (storage period of not more than a day) with obligatory blood test of the donor and recipient for HIV infection. During the session, 25 to 30 ml of leukomass is administered. With an interval of a week, re-chipping is performed according to the same method until the scarring effect is achieved.

 PRI me R 1. Patient A., 42, was admitted to the hospital with a diagnosis of peptic ulcer with localization of an ulcer in the antrum, non-scarring. Complaints of intense pain after eating after 1.5-2 hours, heartburn, belching sour. These complaints appeared in the patient over the past three weeks. He was treated with almagel, ranitidine, H-prostil, without effect in the 3rd Central Clinical Hospital. A.A. Vishnevsky. Discharged after 34 days with a non-healed ulcer of the antrum in lesser curvature 1 by 0.8 cm. Referred to the clinic for treatment: gastrofibroscopy from September 6, 1990: the esophagus is freely passable, its mucosa is not changed, the mucosa of the antrum is actively hyperemic and swollen , at the angle of the stomach along the lesser curvature, a peptic ulcer 1 x 0.8 cm, rounded, covered with fibrin, the pylorus of the correct form, with peristalsis, the intestinal contents are thrown into the cavity of the stomach. The mucosa of the duodenum and the descending section are not changed. The patient received a blood sampling III gr. RH (-) in an amount of 500 ml, and reinfusion was performed through the Isolde apparatus in an amount of 150 ml, reactions and complications were not observed. Three days later, reinfusion through the Isolde apparatus was repeated 450 ml of blood without reactions and complications. On September 13, 1990, during gastrofibroscopy, 30 ml of group III granulocyte concentrate, RH (-) N 33-34 (donor Ovsyannikov V.A.) was introduced into the ulcer zone at four points. A biopsy was taken from the edge of the ulcer. Three days later, the patient noted a significant decrease in epigastric pain. Repeated gastroscopy from 09/20/90, the dynamics showed a significant decrease in peptic ulcer up to 0.5 x 0.4 cm, edema and hyperemia of the edges of the ulcer significantly decreased, 30 ml of leukocyte mass was reintroduced into the edges of peptic ulcer N 4 (205-206 ) Group III, RH (-) (donor Frosin S.S.), HIV negative. Control gastrofibroscopy from 09/27/90, compared with the previous study, shows a whitish scar of 1 x 0.3 cm tree shape on the site of the former ulcer, a biopsy from the rumen was taken. Morphological studies of the gastric mucosa from the edges of the ulcer defect in dynamics showed a significant reparative activity of the integumentary epithelium, a decrease in edema and stromal infiltration. Thus, the use of ultraviolet radiation and leukomass in a short time (22 days) allowed to achieve scarring of a long non-healing ulcer of the antrum.

 PRI me R 2. Patient E. 34 g, was hospitalized in the clinic for exacerbation of peptic ulcer with localization in the bulb of the duodenum. Peptic ulcer occurs with frequent relapses (up to 3-4 times a year). In 1989, he was treated three times at the hospital of the Ministry of Railways No. 3 for exacerbation of peptic ulcer. Last hospitalization in April 1989, when he was treated with phosphalugel, ranitidine, local application of MK-8 glue, local administration of solcoseryl without effect. Discharged from a non-healed ulcer of the duodenal bulb. He was hospitalized in the clinic on April 28, 1989 with severe pain, "nightly" and "hungry" pains, heartburn and belching after eating. According to Gastrofibroscopy data dated April 29, 89, it was noted that the esophagus is not changed, the cardia outlet closes completely, the mucous membrane of the body of the stomach is not changed, the antrum is moderately hyperemic and edematous, the pylorus is freely passable, the bulb of the duodenum 12 is deformed due to the anterior wall, there is also a round ulcerative defect of 1 x 1.5 cm, the caret is hyperemic and edematous, the bottom is covered with fibrin, the mucous membrane of the duodenal bulb is hyperemic and edematous with multiple erosions, the descending section is not changed.

 The patient received a blood sampling of group I, RH (-) in an amount of 500 ml and reinfusion through an Isold apparatus in an amount of 150 ml was carried out, allergic reactions and complications were not observed. Three days later, reinfusion through the Isolde apparatus was repeated 450 ml of blood without reactions and complications. On 05.05.89 g, medical gastrofibroscopy was performed: 25 ml of the leukocyte mass of group I, RH (-), N 3 / 38-39 of 05/04/89 were injected at three points with an injection needle. Five days later the pain syndrome stopped. A control gastrofibroscopy dated 05/12/89 was observed in dynamics along the front wall in the bulb of the duodenum 12, an epithelial ulcer of 0.5 x 0.3 cm, and erosion in the bulb of the duodenum was not determined. Repeatedly, 28 ml of leukocyte mass of group 1 N 2 / 28-29 from 05/11/89 were chipped through an endoscope. Control gastro-fibroscopy from 05/19/89 g: in comparison with the previous study, a fragile tree-like scar, the mucous membrane of the bulb 12 are determined at the site of the former ulcer the duodenum is focal hyperemic. Complete clinical and endoscopic remission was achieved by irradiating the blood of the Ural federal district and twice administering the donated leukocyte mass, and ulcer scarring was achieved in 21 days, compared with previous hospitalizations, when scarring was not successful.

Claims (1)

 METHOD FOR TREATING ULCER OF THE STOMACH AND DUODENAL GUT, by introducing freshly released leukomass into the zone of the ulcer defect 25-30 ml 1–3 times in a week, characterized in that reinfusion of autologous blood irradiated with ultraviolet rays is preliminarily performed 5–3 times, 3–3 times with an interval of 3 and 4-7 days after that, leukomass is administered.