RU2440164C1 - Method of low-invasive treatment of pararectal fistulas - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely, to proctology, and is intended for low-invasive treatment of complete complex pararectal fistulas. Sinus tract is examined, its direction and presence of external and internal holes are determined. Successively, each sinus tract is treated through external hole, with obturation of external hole of untreated sinus tract, as minimum two times, with two-day interval. Treatment is carried out during 40-80 seconds by ultrasonic fluctuations with frequency 20-60 kHz with simultaneous supply of liquid phase. As liquid phase, used is alcohol solution in amount 10-20 ml, depending on sinus tract dimensions, which is supplied at rate 0.25 ml per second. As alcohol solution used is three percent alcohol iodine solution or seventy percent ethyl alcohol. ^ EFFECT: method is low-invasive, makes it possible to eliminate injury of anatomical structures of anal canal, reduce treatment cost, can be carried out on outpatient basis. ^ 2 ex, 2 dwg

Description

The invention relates to medicine, namely to proctology, and is intended for minimally invasive treatment of complete complex pararectal fistula containing epithelial and granulation tissue, preventing the self-healing of pararectal fistula.

A known method for the surgical treatment of complex pararectal fistulas, including the treatment of the fistulous course (see description of the patent of the Russian Federation No. 2150891, IPC A61B 17/00, A61B 18/20, A61B 18/22, A61N 5/067 from 03/20/1997, )

In the known method, the treatment consists in the thermal destruction of the inner membranes of the fistula using high-energy laser radiation, followed by suturing of the defect in the muscle and mucous membrane, as well as debridement. The treatment is carried out after examination of the fistulous course, in which its direction and volume of the sphincter muscle covered, the presence of sagging and cavities, the connection with the rectum, and cicatricial changes in the internal opening are determined.

The disadvantage of this method is the impossibility of effective laser processing of the mucosa in purulent sagging and cavities.

A known method of ultrasonic action on a blood vessel or cavernous body, adopted as a prototype, including the processing of ultrasonic vibrations with the simultaneous supply of the liquid phase and the subsequent evacuation of the liquid phase (see the description of the patent of the Russian Federation No. 2214193, A61B 18/00, A61N 7/00 dated July 6, 2001).

As the liquid phase in the known method using a sclerosing drug ethoxysclerol or thrombovar, which is fed into the blood vessel, both during ultrasound exposure and after its completion.

The main disadvantage of this method is the use as a liquid phase of an expensive and inaccessible preparation of ethoxysclerol or thrombovar, which increases the cost of treatment.

The technical task of the proposed method is to expand the functionality and reduce the cost of treatment.

The technical problem is solved by the fact that the method of minimally invasive treatment of complex pararectal fistulas includes ultrasonic vibrations with simultaneous supply of the liquid phase and subsequent evacuation of the liquid phase, while the fistulous course is studied first, determining its direction and the presence of external and internal holes, then each fistulous is processed sequentially stroke through an external opening, with obturation of the external opening of an untreated fistulous passage, at least twice, with an interval of two to, the treatment is carried out for 40-80 seconds by ultrasonic vibrations with a frequency of 20-60 kHz, and an alcohol solution in the amount of 10-20 ml is used as the liquid phase, depending on the size of the fistulous course, which is supplied at a speed of 0.25 ml per second .

As an alcohol solution, a three percent alcohol solution of iodine or seventy percent ethyl alcohol is used.

The proposed method of treatment consists in chemical ablation, namely burning out the surface of the fistula canal with a chemical agent, followed by sclerosis of the fistula, which eliminates damage to the anatomical structures of the anal canal and the development of incontinence. In addition, the method of treatment of complete complex pararectal fistula does not cause anatomical disorders that impede, if necessary, the surgical operation. A method of treating complete complex pararectal fistula can be performed on an outpatient basis, which does not affect the patient's ability to work.

A method for minimally invasive treatment of complex pararectal fistula is illustrated by drawings, where Fig. 1 shows a cross-reflex pararectal fistula; figure 2 - U-shaped extrasphincter pararectal fistula.

The proposed method is implemented as follows.

Before starting treatment, a patient is examined, the fistulous course 1 is examined, determining its direction and the presence of external and internal holes 2, 3 and 4, respectively, and also determine the volume of the sphincter muscle covered 5, the presence of purulent streaks 6 and cavities, connection with the rectum 7, cicatricial changes in the inner foramen.

For these purposes, well-known methods are used: staining of the fistula with a dye, radiopaque fistulography, probe examination, ultrasound, video fixation.

Then, a gauze swab is inserted into the rectum 7 through an anoscope or rectal mirror to absorb fluid. Then they are treated with ultrasonic vibrations, introducing the waveguide of the ultrasonic device directly into the fistulous passage 1 through the outer hole 2, and at the same time the liquid phase is fed into the fistulous passage 1. As the liquid phase, for example, a three percent alcohol solution of iodine or seventy percent ethyl alcohol is used.

For processing using ultrasonic vibrations with a frequency of 20-60 kHz. The amount of liquid phase 10-20 ml and the exposure time of 40-80 seconds depends on the size of the fistulous course 1.

In the presence of fistulous passages 1 (see FIG. 2), more than one treatment with ultrasonic vibrations is performed sequentially of each fistulous pass 1, with the obturation of the untreated external opening 3 of the fistulous pass 1.

Ultrasonic vibrations ensure the passage of purulent-mucous coatings into the liquid phase with an outflow through the inner hole 4 and, at the same time, due to the cavitation process, impregnation of the liquid phase into the membrane (wall) of the fistula up to 0.3 mm.

Then the tampon is removed from the rectum.

As a result of processing, chemical ablation of the membrane of the fistulous passage 1 and rejection occur. On the surface of the fistulous passage 1 there is a reparative process, as well as stimulation of fibroblasts. The fistulous course 1 is abliterated by granulations passing into fibrosis.

Reprocessing of fistulous passage 1 with ultrasonic treatment is carried out similarly after two days, after which the patient is prescribed a second visit after a month.

At the second visit, an examination of the fistulous course 1 is carried out and, if necessary, the treatment is repeated, carrying out ultrasonic treatment of the fistulous course 1 and the application of a female suture on the inner opening 4 of the fistula.

Example 1

A patient with a diagnosis of cress-reflex pararectal fistula, the external opening 2 of which is 8 cm from the anus at 10 hours, while the fistulous course 1 is curved 10 cm long and goes to the front crypt at 12 hours at a depth of 2 cm, covering 50% of the sphincter 5.

Treatment begins with the introduction of a gauze swab into the anal canal 7 to absorb the sclerosant liquid phase and the waveguide into the fistulous canal 1 through the external opening 2 for ultrasound exposure. After that, the liquid phase 1, three percent alcohol solution of iodine or seventy percent ethyl alcohol is fed into the fistula 1, and at the same time an ultrasound effect is performed. The liquid phase in an amount of 10 ml in the fistulous course 1 with the above parameters is injected at a speed of 0.25 ml per second, and the exposure time is 40 seconds. After the end of the exposure, the gauze swab with the absorbed three percent alcohol solution of iodine is removed from the anal canal 7 to exclude a chemical burn. After two days, the treatment is repeated.

Example 2

A patient with a diagnosis of U-shaped extrasphincter pararectal fistula with purulent drip. At 5 and 7 hours, four centimeters from the anus there are external fistulous openings 2 and 3, connected at a depth of four centimeters, where there is an internal hole 4. There is a purulent nodule 6 by 3 cm into the retrorectal space. From the junction of the fistulous passages, the passage passes into the back crypt, covering the entire sphincter 5, and at the junction there is an internal hole 4.

Treatment begins with the introduction of a gauze swab 7 into the anal canal to absorb the sclerosant liquid phase. The waveguide is first introduced into the fistulous passage 1 through the outer opening 2 at 5 hours and a three-percent alcohol solution of iodine is supplied at a rate of 0.25 ml per second for 20 seconds (5 ml), while the outer opening 3 at 7 hours is closed .

Then the waveguide is introduced into the outer hole 3 at 7 o’clock and a three percent alcohol solution of iodine is supplied at a speed of 0.25 ml per second for 20 seconds (5 ml), while the outer hole 2 is closed at 5 o’clock.

Then the waveguide is introduced into the cavity of the purulent drip 6 and a three-percent alcohol solution of iodine is supplied at a speed of 0.25 ml per second for 20 seconds (5 ml), while hole 2 is opened for 5 hours to excrete excess three-percent alcohol solution of iodine.

After processing the fistulous passages 1 and purulent drip 6 and the end of the exposure, a gauze swab with an absorbed three percent alcohol solution of iodine is removed from the anal canal 7 to exclude a chemical burn. After two days, the treatment is repeated.

Claims (3)

1. A method for minimally invasive treatment of complex pararectal fistulas, including ultrasonic treatment with simultaneous supply of the liquid phase and subsequent evacuation of the liquid phase, characterized in that the fistulous passage is examined first, determining its direction and the presence of external and internal openings, then each fistulous passage is sequentially processed through the outer hole with the obturation of the outer opening of the untreated fistulous course at least twice, with an interval of two days, processing for 40-80 with ultrasonic vibrations of a frequency of 20-60 kHz and in the liquid phase using an alcoholic solution in an amount of 10-20 ml depending on the size of the fistulous which is fed at a rate of 0.25 ml per second. 2. The method according to claim 1, characterized in that a 3% alcohol solution of iodine is used as an alcohol solution. 3. The method according to claim 1, characterized in that 70% ethyl alcohol is used as the alcohol solution.

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