RU2233123C2 - Method for treating intestinal fistula - Google Patents

Abstract

FIELD: medicine, gastroenterology.

SUBSTANCE: one should carry out the drainage and medicinal therapy. Distal end of drainage should be applied at the distance of 0.2-1.0 cm against the fistula to perform an impact onto intestinal fistula through this distal end. One should affect with air-gaseous flow of nitrogen monoxide for about 2-3 min daily.

EFFECT: improved tissue regeneration.

1 ex

Description

The invention relates to medicine, in particular, to methods for treating mainly delimited peritonitis with intestinal fistulas.

Treatment of intestinal fistulas presents great difficulties and requires complex therapy due to the violation of the water-electrolyte balance, the presence of an inflammatory process in the abdominal cavity, the insufficient effectiveness of the use of antibacterial therapy, antiseptic and immune preparations. Tamponade of intestinal fistulas and their surgical closure depends on the time of occurrence, the shape of the fistula, its maturity and is not always effective (Yu.F. Isakov, E.A. Stepanov, T.V. Krasovskaya. “Abdominal surgery in children.” - M. : Medicine, 1998, p. 170-177).

The disadvantage of these methods is that the long-term use of antibacterial therapy, antiseptic solutions and regenerating ointments can lead to the development of hypergranulations and resistance of microorganisms, and the long-term existence of fistulas leads to water-electrolyte disturbances and a decrease in the regenerative abilities of the body. Carrying out tamponade of the intestinal fistula can be accompanied by the formation of a delimited cavity and abscess, which requires surgical debridement of the purulent process and increases the functioning time of the fistula.

A known method of treating unformed fistulas, including obturation of the cavity, drainage with connection to a vacuum pump (RF Application for the invention 98103534/14, publ. 01.27.2000).

The disadvantage of this method is that when creating a vacuum in the fistulous course, the contents enter through the drainage and it is possible to increase the size of the fistulous course, increasing the loss of fluid and electrolytes, which will further lead to the formation of a lip-shaped fistula, a longer infusion preparation and an increase in the volume of surgical intervention.

Currently, the most common method of treating intestinal fistula (for example, delimited peritonitis with intestinal fistula) is a method that includes the installation of drainage, drug therapy (G.A.Bairov. Emergency surgery of children. - L .: Medicine, 1983, p. 286- 291, prototype).

But the treatment of intestinal fistulas presents great difficulties due to the presence of a common adhesive and inflammatory process in the abdominal cavity, difficulty in surgical intervention, insufficient effectiveness of the use of drug therapy, including antibacterial, antiseptic and immune preparations. Long-term use of antibacterial therapy, antiseptic solutions and regenerating ointments can lead to the development of hypergranulations and resistance of microorganisms.

The task set by the authors is to eliminate these shortcomings, improve tissue regeneration, increase the effectiveness of treatment, the exclusion in some cases of surgical intervention.

For this, in the method of treating the intestinal fistula, including the installation of drainage, drug therapy, it is proposed to install the distal end of the drainage at a distance of 0.2-1.0 cm from the fistula, to effect through it on the intestinal fistula with an air-gas stream of nitric oxide (NO-therapy) ) from the apparatus “PLAZON” in a therapeutic mode for 2-3 minutes daily for a course of 6-10 sessions.

The proposed installation of drainage allows a metered effect of nitrogen monoxide without loss on dispersion of the intestinal fistula, eliminates the formation of a cavity and trauma to the intestinal tissue. There is a quick significant improvement in regeneration in the wound and intestinal wall, which allows you to successfully deal with intestinal fistulas. The effectiveness of this treatment regimen is confirmed by a reduction in the closure of intestinal fistula and inpatient treatment.

The method is as follows.

Installation of drainage can be carried out during the initial operation with rehabilitation and delimitation of the intestinal fistula from the free abdominal cavity. With a formed intestinal fistula, a laparoscope can be used to establish drainage with determining the exact distance to the entrance to the intestinal fistula. Without surgical intervention, drainage through the fistulous passage is carried out under radiological control.

The distal end of the drainage is installed in the immediate vicinity of the intestinal fistula (0.2-1.0 cm) and from the apparatus “PLAZON” (“Scalpel-coagulator-stimulator air-plasma SCSWP / NO) in the therapeutic regimen of 1000-3000 mg / m ³ , the exposure time is determined by individual indications from 2 to 3 minutes, the number of sessions is selected depending on the clinical effect from 6 to 10.

Immediately before a NO-therapy session, a medicinal effect is carried out with a 0.5% dioxidine solution or any other antiseptic drug.

Example 1

Irina X., 7 years old, medical history No. 4662.

Diagnosis: Intestinal obstruction, condition after intestinal intubation, multiple perforations of the small intestine, small intestinal fistula.

Upon receipt, the condition is serious. Clinic of partial intestinal obstruction, it is impossible to remove a naso-institutional probe. After preoperative preparation, an operation was performed: relaparotomy, revision of the abdominal cavity, suturing of multiple perforated openings of the small intestine (14 perforations from 0.2 × 0.3 to 0.5 × 2.0 cm), sanitation and drainage of the abdominal cavity according to the method described above .

On the 7th day after the drainage operation, intestinal discharge appeared, with fistulography there is a small intestinal fistula delimited from the abdominal cavity.

Traditional treatment: antibiotic therapy, immunotherapy - human immunoglobulin for intramuscular injection 1.0 No. 3. Local treatment: lavage of the fistulous passage with a 0.5% solution of dioxidine, dressings with a hypertonic solution, physiotherapy are not effective.

Through the fistulous passage into the silicone drainage, tissue and intestinal wall regeneration was stimulated with the PLAZON apparatus by exposing the patient to a therapeutic gas flow through the drainage for 3 minutes. After the first session of nitric oxide therapy, the discharge from the fistula decreased, and after 8 sessions it completely stopped. A total of 10 sessions were conducted. Fistulography was performed, its communication with the intestine is absent, drainage is removed. Complete wound healing on day 22.

This example shows the high effectiveness of nitric monoxide in the treatment of intestinal fistula.

According to this technique, a group of patients was treated, clinical observation showed high efficiency of the method using the indicated treatment parameters with individual selection of the time of exposure to NO-therapy and the number of sessions. The method allows to reduce the time of inpatient treatment, to avoid disability of the patient and conducting repeated rehabilitation courses.

Claims (1)

A method of treating an intestinal fistula, including the installation of a drainage, drug therapy, characterized in that the distal end of the drainage is installed at a distance of 0.2-1.0 cm from the fistula, and an intestinal fistula is exposed through an air-gas stream of nitrogen monoxide from the Plazon apparatus "in a therapeutic regimen for 2-3 minutes daily, for a course of 6-10 sessions.