RU2085951C1 - Method for prognosticating relapses of polyp formation and large intestine cancer after polypectomy - Google Patents

Abstract

FIELD: medicine; proctology. SUBSTANCE: expected relapses of polyp formation and large intestine cancer after polypectomy are prognosticated as function of level variations of peak acid production of patient's stomach. If acid production level is equal to, and less than, 5 mole/h, development of relapse and metachronous tumors is prognosticated. EFFECT: early detection and treatment of relapse and metachronous large intestine tumors. 1 tbl

Description

 The invention relates to medicine, namely to proctology.

 Known methods for predicting the recurrence of polypo formation and colon cancer after polypectomy based on the determination of the sizes of polyps, the number of polyps, the degree of their villous transformation (Fedorov V.D. Militarev Yu.M. Khakhanova M.V. Treatment results for patients with benign colon tumors. Klin.med. 1977, N 1, p. 87 95).

 However, the known methods are based on the idea of the essence of colorectal polyps as a purely local process, out of their connection with other diseases of the digestive system, which leads to the use of only local treatment. Thus, the described methods do not allow adequate prevention of recurrence of polypo formation and colon cancer, in addition, they do not differ in high information content and statistical reliability.

 The proposed method for predicting the recurrence of polypo formation is characterized in that the level of the maximum acid production of the stomach is determined and 5 mol / hr or less is predicted for the development of relapse polypo formation and colon cancer after polypectomy.

 The objective of the invention is the earlier detection and treatment of recurrent and metachronous tumors.

 The level of maximum acid production of the stomach of 5 mol / h or less as a parameter for predicting the recurrence of polypo formation and colon cancer after polypectomy is absent in the known methods for this purpose. This indicator (in the value of 5 mol / h or less) was used by Fishson-Ryss Yu.I. as one of the criteria for deep atrophy of the gastric mucosa (Fishson-Ryss, Yu.I. Modern methods for the study of gastric secretion. L. Medicine, 1972, p. 106 127). However, in the literature there is no information on the relationship between the level of maximum acid production and tumor diseases of the rectum and colon.

 Comparative characteristics of various methods for predicting the recurrence of polypo formation and colon cancer after polypectomy are given in the table.

 Statistical processing of the data showed that the significance of differences between the indicator in the last group (the maximum acid production of the stomach is 5 mol / h or less) and the corresponding indicators in the previous 3 groups is p <0.01, that is, the differences are statistically significant. Therefore, the proposed method is more informative and reliable than the previously described methods for predicting the recurrence of polypo formation and colon cancer after polypectomy.

 The method is as follows.

,
где
E общая кислотность в каждой порции желудочного сока (в титрационных единицах);
V объем каждой порции сока (в мл);
n количество порций (в период максимально стимулированной секреции 5, 6, 7, 8 порции);
MAO максимальная кислотная продукция желудка (в моль/ч).The probe method is used to perform fractional sampling of 4 servings of gastric juice during basal secretion (after 15, 30, 45 and 60 minutes). Then, a secretion stimulator is injected subcutaneously for the maximum stimulation. A solution of pentagastrin is used at a dose of 6 μg per kg of patient’s body weight (according to Klassen). Again, through the probe, 4 portions of gastric juice are taken (after 75, 90, 105 and 120 minutes). The volume of each serving of juice (in milliliters) and the concentration of hydrochloric acid (total acidity in titration units) are determined by the unified method of titration of gastric contents in one serving according to Michaelis using 0.1 normal sodium hydroxide and an indicator of phenolphthalein and dimethylamidobenzene. The total acid production during the period of maximum stimulated secretion is determined by the formula:

,
Where
E total acidity in each portion of gastric juice (in titration units);
V volume of each serving of juice (in ml);
n number of servings (during the period of the most stimulated secretion of 5, 6, 7, 8 servings);
MAO is the maximum acid production of the stomach (in mol / h).

 The last indicator reflects the functional capabilities of the gastric glands, since it directly depends on the number of parietal cells (Kozlovskaya L.V. Nikolaev A.Yu. Textbook on clinical and laboratory research methods. M. Medicine, 1984, p. 207 221; Fishzon-Ryss Yu.I. Modern methods for the study of gastric secretion (L. Medicine, 1972, p. 106 127). The level of maximum acid production of 5 mol / h or less allows predicting the recurrence of polypo formation or colon cancer after polypectomy.

 Clinical example 1. Patient Z.V.A. 60 years. Clinical diagnosis: adenomatous polyp of the rectum. Chronic gastritis with reduced secretory function. From the anamnesis: 02/10/89 the rectal polyp was removed (number 1, size - 0.8 x 0.8 cm, histologically adenoma). The maximum acid production of the stomach is 2.9 mol / h. 09/13/90 removed recurrent polyp of the rectum (single, 2 x 2 cm, histologically adenoma). After repeated surgery, the patient received preparations of gastric juice. With further observation (until 1994), there were no signs of relapse. Thus, the prognostic criterion for relapse was the value of the maximum acid production indicator of less than 5 mol / h, in the absence of prognostic criteria determined by existing methods.

 Clinical example 2. Patient K.T.N. 61 years old. Clinical diagnosis: group adenomatous polyps of the rectum. Chronic gastritis with reduced secretory function. From the anamnesis: 08/07/89 removed group polyps of the rectum (number 2, size 0.4 x 0.4 and 0.7 x 0.7 cm, histologically - adenoma). The maximum acid production of the stomach is 6.6 mol / h. I did not receive preparations of gastric juice. With follow-up until 1994, there were no signs of relapse. Thus, despite the presence of the prognostic criterion of relapse (the number of polyps 2) determined by the existing method, no relapse occurred, while there are no prognostic signs of relapse according to the claimed method (the level of maximum acid production of the stomach is more than 5 mol / h).

Clinical example 3. Patient B. K. I. 73 years. Clinical diagnosis: villous polyp of the rectum. Chronic gastritis with reduced secretory function. From the anamnesis: 06/24/90 removed the villous polyp of the rectum (number
1, dimensions 4.5 cm, histologically villous polyp). The maximum acid production of the stomach is 5.52 mol / h. I did not receive preparations of gastric juice. With follow-up until 1994, there were no signs of relapse. Thus, despite the presence of prognostic criteria for relapse (polyp size more than 1 cm, villous transformation) determined by existing methods, no relapse occurred, while there are no prognostic signs of relapse according to the claimed method (maximum acid production of the stomach is more than 5 mol / h).

 The proposed method for predicting, being more informative, considers polyps of the rectum as a result of deep functional and morphological changes that occur in the gastrointestinal tract as a whole, in their inextricable relationship with diseases of other digestive organs. Therefore, the proposed method allows for earlier diagnosis of recurrent and metachronous tumors, comprehensive prevention of recurrence of polyps, which consists in adequate replacement therapy for secretory insufficiency of the stomach.

Claims (1)

 A method for predicting the recurrence of polypo formation and colon cancer after polypectomy, characterized in that the level of the maximum acid production of the stomach is determined and 5 mmol / h or less is predicted to develop a relapse of polypo formation and colon cancer after polypectomy.

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