RU2279882C1 - Endoscopic method for treating patients for gastroduodenal ulcers with derinate preparation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves endoscopically introducing Derinate into submucous layer at a dose of 3-5 ml in at least 2 points on the background of anti-ulcer therapy. The total treatment course is 2-3 sessions long with 3-4 days long pauses. Delayed Derinate absorption conditions from ulceration defect zone are to be created.

EFFECT: enhanced effectiveness of treatment; accelerated Helicobacter pylori eradication.

Description

The invention relates to medicine, namely to endoscopy.

Despite significant progress in the treatment of gastric ulcer and duodenal ulcer with the use of a variety of schemes and techniques, the incidence remains high. In hospitals in Moscow, about 2017 patients were treated for peptic ulcer, of which 650 were children. 558 adults have died.

The introduction into clinical practice of endoscopes with fiber optics has opened up great opportunities to influence the pathological focus (Bricis, 1974; Vasiliev, 1976; Buyanov et al., 1978; Ermolov et al., 1996). The first use of local treatment of chronic gastroduodenal ulcers in our country was made in 1974 by F. Bricis. et al., as well as Vasiliev Yu.V. (Cryogenic method for the treatment of gastric ulcer and duodenal ulcer. In the book: Actual issues of diagnostic and therapeutic endoscopy for diseases of the digestive tract. M., publ. MMSI-1989. - P. 16 -twenty). So, H.P. Akimov and A.A. Peretyanov reported compensation for microcirculation disorders in peptic ulcer by introducing heparin into the edge of the ulcer (Endoscopic use of heparin in the complex treatment of gastroduodenal ulcers Surgery. - 1983. - No. 2. - P. 18- 19). V.Yu. Deripasko reported about treatment with chipping of a ulcer defect with coenovocaine, Yu.E. Berezov et al. advised to introduce oxyferriskarbon. The method of introducing an alloplant ulcer into the region taking into account its regenerative ability (Zaripov Sh.A. 1997 Cand. Dissertation. Endoscopic application of an alloplant in the treatment of peptic ulcer of the stomach and duodenum) was widely used.

In order to increase cellular immunity, they suggest using thymogen or tactivin. This technique is the prototype of the invention (Yarema I.V., Popov Yu.P., Kolontarev B.A., Derkachev P.V., Antyukhov A.V. Pathogenetic therapeutic endoscopy in case of chronic duodenal ulcer. In the book: Actual questions of diagnostic and therapeutic endoscopy in diseases of the digestive tract. - M .: ed. MMSI, 1989. - S.105-113).

When using endoscopic methods of treatment, claims are made to the drug, taking into account all its features, both characteristic for most drugs and its inherent individual ability. In the proposed method, the drug Derinat is used, which has a wide spectrum of action: reparative, immunomodulating, capable of rapidly eradicating Helicobacter pylori.

The technical result is a reduction in treatment time, acceleration of reparative processes, an increase in the period of remission.

The specified technical result is achieved by the fact that Derinat is administered periulcerously in the submucosal layer, departing 2 cm from the edges of the ulcer, in a dose of 3-5 ml at least at 2 points, and the course of treatment is 2-3 sessions in 3-4 days.

The proposed method is as follows. The patient is prescribed traditional antiulcer therapy. 15 minutes before the diagnostic treatment, the patient is injected with a solution of 1 ml of Atropine Sulfate 0.1% intramuscularly and irrigated the oropharynx with 2 ml of 2% Lidocaine solution. Produce the appropriate preparation of the stomach, which consists in moderate inflating it with air. Through an endoscopic injector into the submucosal layer to a depth of 0.5 cm periulcerosis, departing 2 cm from the edges of the ulcer, inject 1.5% Derinat solution of 3-5 ml of the drug. It is enough to introduce it at least at two points. An average of 3 treatment sessions is carried out every 3-4 days.

This method was used in 64 patients. As a result of treatment, a positive clinical effect was noted in all patients, consisting in the disappearance of pain, heartburn, dyspeptic disorders. There were no complications associated with the application of this technique. With control fibrogastroduodenoscopy, a pronounced reparative effect was noted. Complete healing of ulcers on the 10th day was observed in 88% of cases. In the control group, where Timogen was used as the drug for endoscopic treatment, healing occurred in 55% of cases. Upon repeated immunological studies, the level of subpopulation of T-suppressors decreased. The coefficient of T-helpers / T-suppressors, initially lowered, significantly increased after treatment. The main group noted not only an acceleration of the repair process, but also a reduction in the duration of treatment, an increase in the period of remission.

Sodium deoxyribonucleate or Derinat is a highly purified sodium salt of native deoxyribonucleic acid depolymerized by ultrasound, dissolved in a 0.1% aqueous solution of sodium chloride. Derinat is a biologically active substance isolated from the milk of sturgeon fish. The drug is approved for medical use by order of the Ministry of Health and Medical Industry of the Russian Federation No. 316 of August 1996. A distinctive feature of Derinat is its longer absorption, which it is endowed with due to its oily consistency. Based on this property, it is injected not under a peptic ulcer, but about 2 cm away from the edges of the ulcer, which prevents leakage from the injection site and facilitates easier penetration into the submucous layer, without creating excessive ischemia.

Clinical example. Patient K., 43 years old. Suffers from duodenal ulcer for 5 years. Earlier, 4 months ago, he was treated inpatiently according to a three-component scheme (De-nol, Trichopol, Tetracycline). When handling, it presents characteristic complaints of heartburn, epigastric pain. On FGDS: ulcer of the bulbar part of the duodenum along the front wall of 8 mm in diameter, medium depth, against a background of cicatricial deformity. Conducted a comprehensive treatment. 3 sessions of endoscopic administration of Derinat to the periulcerous zone in the submucosal layer were performed, 2 cm from the edges of the ulcer, with an interval of 4 days. 3-5 ml of Derinat was consumed per session. At the time of the third session, marked repair and scarring of the ulcer was noted. Clinical signs disappeared on the 3rd day after the first session. Control for HP (initial seeding ++) on the 10th day revealed complete eradication (HP-). The control immunogram showed an increase in the “immunoregulatory compass” due to a decrease in T-suppressors and an increase in T-helpers. Persistent remission for a year and a half. When re-applying to the FGDS, there was no ulcerative defect.

Thus, the developed method for the endoscopic treatment of gastroduodenal ulcers with Derinat is quite effective and safe, which makes it possible to recommend its use both in the hospital and on an outpatient basis.

Claims (1)

A method for endoscopic treatment of gastroduodenal ulcers by administering a drug into the periulcerous zone against antiulcer therapy, characterized in that Derinat is injected into the mucosa, 2 cm from the edges of the ulcer, at a dose of 3-5 ml, at least 2 points, and the course treatment is 2-3 sessions after 3-4 days.