RU2441675C1 - Decompensated pyloroduodenal stenosis treatment method - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: group of inventions is referred to medicine, namely - to gastroenterology and surgery and is meant for treatment of patients with decompensated pyloroduodenal stenosis. The method consists in endoscopic injections of the medicinal product in gastric mucosa sections, the medicinal product being Alloplant combined material that consist of connective tissue regeneration stimulator 35-45 mass %, phagocytosis stimulator 35-45 mass % and nervous structures regeneration stimulator 10-30 mass %. Alloplant injection is performed at the distance of 1.5 - 2.5 cm from the cicatrically changed tissue of the duodenal cap and pyloric canal of the stomach along the stomach perimeter. The injections shall be performed in cycles, 8-12 with an interval of 1 or 2 weeks, 4-12 injections for a cycle. ^ EFFECT: enhancing the non-invasive decompensated pyloroduodenal stenosis treatment; obtaining permanent clinical remission due to the Alloplant's indirect influence on the cicatrically changed tissue of the duodenum section via the formation of depot in healthy tissues due to the specific nature of stomach and duodenum blood supply. ^ 1 dwg, 2 ex

Description

The invention relates to medicine, namely to gastroenterology, and is intended for the treatment of pyloroduodenal stenosis resulting from long-term non-healing duodenal ulcers.

Uncompensated pyloroduodenal stenosis refers to the stage of the disease, when the mucosa of the duodenum turns into scar tissue, narrowing the lumen of the intestine to 0.3-0.4 cm. Under these conditions, passage of food and fluid is stopped and there is a need for surgical intervention. According to the source (Clinical Surgery, Reference Guide for Doctors. Edited by Yu.M. Pantsyrev. Moscow, MEDICINA, 1988, p. 227), there are three stages of this disease: Stage 1 - deformation of the pyloroduodenal canal with its narrowing clearance up to 1-0.5 cm; Stage 2 - the pyloroduodenal canal is narrowed to 1-0.3 cm due to sharp scar deformity; Stage 3 - a huge stomach, atrophy of the mucous membrane, pronounced narrowing of the pyloroduodenal canal.

A known method of resection of the duodenum with an ulcer complicated by stenosis and penetration, which produce transverse anterolateral seromyotomy, open the lumen of the duodenum, produce parietal mobilization of the posterior wall towards the pylorus. Then, a longitudinally scar-modified wall is dissected from two sides from the ulcer to the altered tissues, and it is excised circularly. Pyloroduodenoanastamosis is formed, while capturing the serous, mucous and submucous membranes of the pylorus, without capturing the muscle (patent of the Russian Federation No. 22240051, IPC A61B 17/00, published on November 20, 2004).

There is a method of surgical treatment of decompensated cicatricial and ulcerative stenosis of the duodenal bulb, in which stenosis is excised, the defect is sutured, and the dilated nonfunctioning pylorus is gradually removed from cicatricial adhesions, and transverse duodenotomy is performed through the area of bulbar stenosis. After that, the duodenal bulb affected by a scar or ulcer is excised and a single-row sulphur-muscular-submucosal suture is formed with a monolithic thread (RF patent No. 2336032, IPC A61B 17/00, published on October 20, 2008).

The disadvantage of surgical methods for the treatment of decompensated pyloroduodenal stenosis is the complexity and high percentage of complications and mortality in the postoperative period.

There is a method of preoperative endoscopic preparation of patients with complicated duodenal ulcer (RF patent No. 2279881, IPC A61K 31/713, publ. 07/20/2006), in which 2 ml of derinate is endoscopically injected 2 cm from the edge of the edge ulcers. Additionally, in a dose of 2 ml, it is introduced in the area of the stomach stump supposed for anastomosis into the submucous layer of the anterior and posterior walls along the greater curvature of the stomach body. The course is 2-3 sessions with an interval of 3 days. The method provides an improvement in cellular immunity, microcirculation of blood and lymph. However, it does not provide treatment for decompensated pyloroduodenal stenosis without surgical intervention.

There is a method of endoscopic chipping of an ulcer with dispersed Alloplant biomaterial, which is a stimulator of tissue regeneration (RF patent No. 2189822, IPC A61K 35/32, published on 09/27/2002). However, it does not provide non-surgical treatment of decompensated pyloroduodenal stenosis.

The objective of the invention is to increase the effectiveness of non-surgical treatment of decompensated pyloroduodenal stenosis due to the complex effect on scar tissue with Alloplant biomaterial combined with high regenerative abilities.

The problem is solved by a method of treating decompensated pyloroduodenal stenosis in case of duodenal ulcer by endoscopic injection of the drug into the gastric mucosa at a distance of 1.5-2.5 cm from the scarred tissue of the duodenal bulb and the pyloric stomach along the perimeter of the stomach, in which as a medicine, a combined Alloplant biomaterial is used, consisting of a stimulator of regeneration of connective tissues 35-45 wt.%, stim insulator phagocytosis 35-45 wt.% and stimulator regeneration of nervous structures 10-30 wt.%, wherein the injection is carried out in an amount of 8-12 courses with an interval therebetween 1-2 weeks 4-12 injections per course.

The proposed method is based on the indirect effect on the affected tissue of the duodenal bulb and the pyloric canal of the stomach through healthy sections of the mucous and submucous stomach. A feature of decompensated pyloroduodenal stenosis is the impossibility of endoscopic exposure directly to scar tissue due to the very small passage in areas affected by peptic ulcer. When developing the method of treatment, the author used the well-known specificity of blood supply to these organs (N.E. Chernekhovskaya. "Therapeutic esophagogastroduodenodenoscopy", Monograph, Moscow, "Med press-inform", 2009, p.14, 15, 22). In the stomach there is a large number of arterial and arteriovenous anastomoses. In addition, the subserous and submucosal networks of the lymphatic capillaries of the stomach connect to the lymphatic system of the duodenum, providing a single blood supply system. Such complex architectonics provides a rich vascularization of the stomach and duodenum. Given the specifics of the blood supply to these organs and the peculiarities of their rheology, one can explain the high bioavailability of drugs introduced into the gastric mucosa and submucosa for the duodenum.

The use of multicomponent Alloplant biomaterial provides a comprehensive effect on the reparative regeneration of the scar-modified mucosa, blood vessels, nerve endings and nerve fibers of the duodenum. A stimulator of regeneration of connective tissues contributes to the process of growth and differentiation of cells. The phagocytosis stimulator performs the function of resorption of scar tissue as a result of the release of the proteoglycan complex and the growth of the macrophage cell population. The stimulator of the regeneration of nerve structures due to the high content of neurotrophic factors restores the functions of the affected nerves.

The method is as follows.

Before treatment, esophagofibrogastroscopy is performed to determine the degree of scar damage and the stage of pyloroduodenal stenosis:

- compensated;

- subcompensated;

- decompensated.

With narrowing of the pyloroduodenal lumen ≤4 mm, stenosis is classified as decompensated. In this case, the patient is prescribed endoscopic injections using an Olympus NM-3K injector. Injections are carried out, retreating 1.5-2.5 cm from the scarred tissue of the duodenal bulb and the pyloric canal of the stomach along the perimeter of the stomach at 12-15 points. Injections are carried out in areas of a healthy gastric mucosa, which has a pink color, submucosal, visible peristaltic waves. The selected points are pretreated through a teflon catheter with 70% ethanol. As an injection drug, the Alloplant combined biomaterial is used, consisting of a stimulator of regeneration of connective tissues, a phagocytosis stimulator and a stimulator of regeneration of nerve structures. This combined biomaterial is known in the treatment of cardiospasm (RF patent No. 2325919, IPC A61K 35/12, A61P 1/06, publ. 06/10/2008).

For injection, a mixture of three components is diluted in a 2% lidocaine solution in the ratio: 10-15 g of biomaterial per 30 ml of solution. Treatment is carried out with courses in the amount of 8-12 with a break between them of 1-2 weeks.

Clinical examples

Patient N., 44 years old, with a clinic of decompensated pyloroduodenal stenosis. The duration of the disease is 7 years, was repeatedly treated with conservative methods almost annually up to 2 times inpatiently. Anamnestically, according to discharge epicrisis, a progression of the course of the disease is noted.

According to the proposed method, 8 courses of endoscopic injections were carried out at 10 points of a healthy mucosa, previously treated through a teflon catheter with 70% ethyl alcohol. Injections were carried out along the perimeter of the stomach at a distance of 1.5-2.5 cm from the scarred tissue of the duodenal bulb and the pyloric canal of the stomach with Alloplant biomaterial combined to obtain a stable clinical effect. As a result of treatment, the permeability of liquid and solid foods increased, and the diet was significantly expanded. The patient recovered in weight for 2 months by 6 kg, returned to his previous job.

Patient Z., 47 years old, with a clinic of decompensated pyloroduodenal stenosis. The duration of the disease is 7 years, asthenization, severe weight loss, only liquid food is observed. The treatment was carried out according to the proposed method by chipping with Alloplant combined biomaterial. It took 12 courses of endoscopic injections over 3 months to obtain a satisfactory clinical result. The patient gained 5 kg in weight.

Subsequently, all patients are registered with the annual courses of antiulcer sanatorium treatment.

Thus, the proposed invention improves the efficiency of non-surgical treatment of decompensated pyloroduodenal stenosis with the achievement of persistent clinical remission of the course of peptic ulcer.

Claims (1)

A method for the treatment of decompensated pyloroduodenal stenosis in case of duodenal ulcer by endoscopic injection of the drug into the gastric mucosa at a distance of 1.5-2.5 cm from the scarred tissue of the duodenal bulb and the pyloric stomach along the perimeter of the stomach, in which as a drug the agents use the Alloplant combined biomaterial, consisting of a stimulator of regeneration of connective tissues 35-45 wt.%, a phagocytosis stimulator 35-45 wt.% and sti 10-30 wt.% regenerator of nerve structures, and injections are carried out in 8-12 courses with a break between them of 1-2 weeks for 4-12 injections per course.