RU2250109C1 - Method for treating adhesive abdominal disease in children - Google Patents

Abstract

FIELD: medicine, juvenile surgery.

SUBSTANCE: the method is characterized by the fact that 3 wk before surgical dissection of adhesions due to laparoscopy one should prescribe bifiform per 1 capsule and Hilak-Forte per 10-15 drops thrice daily. Moreover, 7 d before surgical interference it is necessary to conduct 7 seances of electrophoresis with irucsol and prescribe smekta sorbent per 1 packet thrice daily. Then comes laparoscopic dissection of adhesions, and after surgical interference one should perform electrophoresis with irucsol for 7 d. After appearance of intestinal peristaltics it is necessary to apply smekta per 1 packet thrice daily for 7 d. Since the 8^th after operation one should prescribe bifiform per 1 capsule and Hilak-Forte per 10-15 drops thrice daily for 1 mo. Then 1 mo after laparoscopy one should prescribe electrophoresis with collalysine up to 8-10 procedures at simultaneous abdominal massage and curative-physical culture complex for 8-10 d. The method enables to obtain antiadhesive effect in 92% cases of surgical dissection of adhesions due to complex impact upon pathogenesis of adhesive disease, at decreased number of relapses.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to pediatric surgery.

Currently, the problem of adhesive disease (SB) of the abdominal cavity is the most urgent in surgery. Joints after operations on the abdominal organs occur in 80-90% of cases and the number of diseases due to abdominal adhesions ranges from 12 to 64% of cases. Peritoneum SB in the form of acute and chronic intestinal obstruction occurs in 57% of cases. Among patients admitted to surgical hospitals with a diagnosis of acute adhesive intestinal obstruction (ASCI), the proportion of patients with adhesive-dynamic intestinal obstruction ranges from 45-87%.

SB in 50-75% is completed by OSKN, requiring emergency surgical intervention. Relapse of SB reaches 30-60% and, exacerbating the condition of patients, leads to death in 13-55% of cases.

An increase in the number of surgical interventions in the abdominal cavity and a growing number of adhesive complications posed a problem for surgeons - preventing the formation of postoperative adhesions.

Numerous proposed methods for the treatment and prevention of abdominal SB can provide an anti-adhesive effect in 20-65% of cases. However, the proposed treatment regimens have a disadvantage in the individual treatment of each case of SB.

The prototype of the proposed method, the author proposes a method for the treatment of adhesive disease of the abdominal cavity in children belonging to the group of “fast acetylators” with an average acetylation rate of 89.75 + 0.61% at a rate of 75% and with an inadequate cooperative cellular response (inhibition of macrophage output, increased number fibrin).

The essence of the method consists in the appointment, before laparoscopic separation of adhesions in the abdominal cavity, of complex therapy, including anti-inflammatory drugs, the use of complexing compound D - penicillamine at an age of 12-18 days in combination with phonophoresis of the proteolytic enzyme iruxol or electrophoresis of the proteolytic enzyme collalysine on the anterior abdominal wall. Then, laparoscopic separation of adhesions is carried out in a planned manner. The latter became loose, easily separated from the peritoneum, which ensured their safe separation during laparoscopy. Complex anti-adhesion treatment was performed only for children with adhesive disease of the abdominal cavity from the group of “fast acetylators”. In the group of “slow acetylators”, D - penicillamine was not treated; only endoscopic separation of adhesions was performed. All children - “fast acetylators” after complex treatment were monitored from 1 year to 4 years, no relapses of adhesive disease / Ivanova MN, Konovalov AK, Sergeev AV, Gordeeva IP , Solovieva E.I., Tsvetkova E.I., Alekseeva N.A. Pathogenetic treatment of adhesive disease in children. // Russian Bulletin of Perinatology and Pediatrics. - 1996. - Volume 41. - No. 4. - P.64 /.

In our opinion, this method has some drawbacks: it is not applicable to all children with adhesive disease of the abdominal cavity, but only to children in the group of “fast acetylators”, to identify this group of children, an additional laborious laboratory examination is necessary, the complexing compound D - penicillamine is toxic - possible: leukopenia, thrombocytopenia, agranulocytosis, proteinuria, hematuria, upset gastrointestinal tract, myalgia, arthralgia, pruritus, urticaria. When applying it, one should control the morphological picture of blood after 3 days, measure body temperature, control the content of copper in the urine / Mashkovsky M.D. Medicines A guide to pharmacotherapy for doctors. - 1988. - Part 2. - P.187-188 /.

The author proposes a method for treating adhesive diseases of the abdominal cavity in children, including laparoscopic dissection of adhesions, normalization of intestinal biocinosis with probiotics bifiform and hilak forte, the appointment of sorbents in the form of smecta, physiotherapy in the form of electrophoresis with proteolytic enzymes iruxol and collalysine, massage of the abdomen and exercise therapy in the form of abdominal and physical therapy walking - half-crouching, and then raising his knees high; kneeling - sit between the heels and to the sides; lying on your back - do a bicycle with your feet, raise your pelvis, sit with your knees bent and pressed to your stomach, swinging on your back; lying on his stomach - rocking on his stomach (boat), alternately with his hand to get the opposite leg, raise raised legs to raise, lower and lower.

The implementation of the method is as follows.

3 weeks before surgery in the abdominal cavity, probiotic bififorms are prescribed 1 capsule 3 times a day and hilak-fort 10-15 drops 3 times a day in order to normalize the intestinal microflora. 7 days before laparoscopy, the child undergoes electrophoresis with the proteolytic enzyme iruxol on the anterior abdominal wall of the abdomen in order to hydrolytically break down the protein components of adhesions and prevent bacterial infection, and a sorbent smectum is administered 1 packet 3 times a day for enterosorption to prevent microbial autosensitization of the body. Then, surgery is performed on the abdominal cavity in the form of laparoscopic dissection of adhesions. In the postoperative period, on the first day after the operation, electrophoresis with the proteolytic enzyme iruxol is prescribed on the front wall of the abdomen for 7 days; from the 2nd or 3rd day, when intestinal motility appears, a sorbent Smecta is administered orally 1 packet 3 times a day for 7 days, from the 8th day after the operation, probiotics are prescribed - bifiform 1 capsule 3 times a day and hilak-fort 10-15 drops 3 times a day for 1 month. Then, a month after laparoscopy, electrophoresis with the proteolytic enzyme collalysine is prescribed on the front wall of the abdomen for up to 8-10 procedures for lysis of connective tissue (adhesions) with simultaneous massage of the abdomen and exercise therapy in the form of walking - half squatting, and then highly understanding the knees; kneeling - sit between the heels and to the sides, lying on your back - do your feet with a bicycle, understand the pelvis, sit with your knees bent and pressed to your stomach, swinging on your back; lying on his stomach - swinging on his stomach (boat), alternately with his hand to reach the opposite leg, raise raised legs to raise, lower and lower - for 8-10 days.

For practical evidence of the effectiveness of the proposed method was treated 16 children with adhesive intestinal obstruction after previously undergoing surgical interventions on the abdominal organs. After 6 months, the diagnosis of SB was removed in 15 children. Relapse occurred in 1 child. With a follow-up of 1 year to 2 years, there is no relapse of SB in cured children. All children treated the treatment well; no side effects were noted.

The inventive method for the treatment of abdominal SB in children leads to recovery in 92% of cases and a decrease in relapse to 8%, non-invasive, available for outpatient conditions, economical, as laparoscopic intervention significantly reduces hospitalization.

Clinical examples

1. Patient U., 15 years old, examination card No. 8, complained of periodic, paroxysmal abdominal pain. From the anamnesis it is known that in 1992 there was a laparotomy for a closed abdominal injury.

When examining the ultrasound of the abdominal cavity - on the right in the area of the postoperative scar (the location of the drainage), a loop of the intestine soldered to the aponeurosis is visualized; and in the epigastrium - the solder bowel to the postoperative scar. Considering the clinic and the data of the US, the diagnosis was made: Adhesive intestinal obstruction (SB). 3 weeks before surgery, bifiform probiotics were prescribed 1 capsule 3 times a day and Hilak Fort 15 drops 3 times a day. 7 days before laparoscopy, electrophoresis was prescribed with the proteolytic enzyme iruxol on the front wall of the abdomen and inside the sorbent smectum 1 packet 3 times a day. After this, laparoscopy with the separation of adhesions was performed. In the postoperative period, electrophoresis was prescribed on the first day with iruxol on the anterior abdominal wall for 7 days, from the 2nd day, smecta was administered orally 1 packet 3 times a day for 7 days, from the 8th day after the operation, bifiform was prescribed 1 capsule 3 times a day and Hilak-Fort 15 drops 3 times a day for 1 month. A month after laparoscopy, electrophoresis was performed with collalysine on the front wall of the abdomen in the form of 10 procedures and within 10 days - massage of the abdomen and exercise therapy - walking with high legs; kneeling - sit between the heels and to the sides; lying on the back - raising the pelvis, swinging on the back, “bicycle”, sit with bent knees; lying on his stomach - rocking (boat) and breeding, meeting and lowering the raised legs. During the follow-up examination 6 months after laparoscopy, the child does not show any complaints, and according to the control ultrasound scan, no adhesions were found in the abdominal cavity.

2. Patient K., 15 years old, examination card No. 12, was admitted as planned with complaints of periodic pain in the lower abdomen. From the anamnesis it is known that in October 2001 a laparoscopy was performed for torsion of the left ovarian cyst. An examination of the child revealed an adhesion process in the abdominal cavity. Preparations for planned laparoscopy, adhesiolysis have begun. 3 weeks before surgery

interventions prescribed bifiform 1 capsule 3 times a day and hilak-fort 15 drops 3 times a day. 7 days before laparoscopy, electrophoresis with Iruxol was prescribed on the front wall of the abdomen and inside the smect 1 packet 3 times a day. After this, laparoscopy was performed with the separation of adhesions and additional excision of the old postoperative scar with the subsequent application of an intradermal suture. The postoperative period was uneventful, from 1 day after the operation, electrophoresis was prescribed with Iruxol on the anterior abdominal wall for 7 days; from the 2nd day, smecta is prescribed in 1 packet 3 times a day for 7 days; from the 8th day after the operation, bifiform 1 capsule 3 times a day and hilak-fort 15 drops 3 times a day for 1 month are prescribed. 1 month after laparoscopy, an electrophoresis course was performed with collalysine on the front wall of the abdomen in the amount of 8 procedures and for 8 days a massage of the abdomen, and exercise therapy - walking half squat, lying on your back - lifting the pelvis, swinging on the back, bike legs; lying on his stomach - swinging (boat), getting the opposite leg with his hand, breeding, mixing and lowering the raised legs. During the follow-up examination after 3 and 6 months after laparoscopy, the child did not show any complaints, and according to the US data, adhesions in the abdominal cavity were not revealed.

Claims (1)

A method for treating peritoneal commissural disease, including surgical intervention in the form of laparoscopic adhesion separation, electrophoresis of proteolytic enzymes on the anterior abdominal wall, characterized in that 3 weeks before laparoscopic dissection of adhesions prescribe probiotic bifiform 1 capsule and hilak-fort for 10-15 drops 3 times a day, 7 days before surgery, spend 7 sessions of electrophoresis with iruxol and appoint a sorbent smect 1 packet 3 times a day, conduct a laparoscopic dissection of the spa k, after surgery, electrophoresis with iruxol is carried out for 7 days, after the appearance of intestinal motility, a sorbent Smecta is prescribed in 1 packet 3 times a day for 7 days, from the 8th day after the operation, bifiform 1 capsule and hilak-fort are prescribed 10-15 drops 3 times a day for 1 month, 1 month after laparoscopy, electrophoresis with collalysin is prescribed for up to 8-10 procedures with simultaneous abdominal massage and a physiotherapy complex for 8-10 days.