RU2568889C1 - Method of treating pylorospasm following pylorus-preserving pancreatoduodenectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: Levomecol ointment 40 g with diluted 0.5% Novocaine 20 ml and 0.1% atropine 0.1 ml is administered into a stomach through a probe once a day at regular intervals during at least two days.

EFFECT: method enables increasing the clinical effectiveness.

1 ex

Description

The invention relates to medicine, namely to methods for treating pylorospasm after pyloric preservation of pancreatoduodenal resection, which in 30-75% of cases accompany the course of the early postoperative period.

A known method of treating pylorospasm after pyloric preservation of pancreatoduodenal resection (Alikhanov RB Pancreatoduodenal resection with preservation of the pylorus. Indications, features of the technique and immediate results. - Diss. ... Ph.D. medical sciences. - Moscow. - 2003. - 124 p .; Kubyshkin V.A., Vishnevsky V.A. Pancreatic cancer.M: Publishing House "Medpraktika - M. - 2003. - 386 pp.), Which consists in the complex parenteral administration of antispasmodics, gastroduodenokinetics, antisecretory drugs and the correction of water-electrolyte disorders.

The disadvantage of this method is its lack of effectiveness, since parenteral administration of antispasmodics, gastroduodenokinetics, antisecretory drugs and the correction of water-electrolyte disorders excludes the local effect that is so important in this pathology.

The present invention solves the problem of developing a new method of treating pylorospasm after pyloric preservation of pancreatoduodenal resection in patients with cancer of the head of the pancreas and Vater papilla. The technical result obtained in this case consists in increasing the effectiveness of the treatment of pylorospasm after pyloric preservation of pancreatoduodenal resection. The multicomponent solution used contains Levomekol ointment - 40 g (polyethylene glycol - 40 g, levomethicin - 0.75 g, methyluracil - 4.0 g), novocaine 0.5% - 20 ml and atropine 0.1% - 1, 0 ml Polyethylene glycol is the basis of Levomekol ointment, its molecules are water-soluble polymers of ethylene oxide with two terminal hydroxyl groups. Polyethylene glycol molecules do not lead to a change in the structure of the molecules (as a chemical concept) of drugs included in this multicomponent solution and, due to their high hydrophilicity, significantly increase their solubility, bioavailability and enhance their effect. The ability to high yield of drugs dissolved in polyethylene glycol, in our case novocaine and atropine, and its wide hydrodynamic radius allows them to quickly and deeply penetrate into the intercellular spaces of the wall of the duodenum and stomach without damaging biological membranes and eliminate pylorospasm. Polyethylene glycol does not lead to an increase in side effects associated with the complex use of drugs included in this multicomponent solution. Atropine due to blockade of m-cholinergic receptors in smooth muscles relieves spasm from the pyloric department. Novocaine due to local anesthetic action enhances the effect of atropine. The proposed method of treatment is safe to use, does not require additional equipment, devices and complex manipulations to eliminate this type of complication in patients after pyloric preserving pancreatoduodenal resection, is simple and accessible for use by a surgeon and / or resuscitator of any skill. The proposed method has proven to be highly efficient, cheap and easy to perform.

The specified technical result is achieved by the fact that in the method of treating pylorospasm after pyloric preservation of pancreatoduodenal resection consisting in parenteral administration of antispasmodics, gastroduodenokinetics, antisecretory drugs and correction of water-electrolyte disorders, an additional 40 g of Levomekol ointment with 20 ml of Neuvomeol ointment are dissolved into the stomach with the solution ml - 0.5% novocaine solution and 1.0 ml - 0.1% atropine solution, once a day with an equal time interval between the introduction of at least two days.

A method of treating pylorospasm after pyloropancreatic pancreatoduodenal resection is as follows.

If the patient exhibits clinical and radiological signs of pylorospasm against the background of standard postoperative therapy, the patient is given a comprehensive treatment consisting of parenteral administration of antispasmodics, gastroduodenokinetics, antisecretory drugs and correction of water-electrolyte disorders, and 40 g of Levomekol ointment are additionally introduced into the stomach through the probe "And dissolved in it 20 ml - 0.5% solution of novocaine and 1.0 ml - 0.1% solution of atropine, once a day with an equal time interval between the introduction of at least two days.

In 14 patients after pyloric preserving pancreatoduodenal resection with pronounced clinical and radiological signs of pylorospasm, a multicomponent solution was introduced into the stomach by the probe according to our method. In all cases, after 4-36 hours, pylorospasm was stopped.

1. Clinical example: on 03/03/12, patient S., 64 years old, in a surgical unit at the surgical department No. 12 in the surgical department for the treatment of pancreatic head cancer T ₃ N _o M _o , a pylor-preserving pancreatoduodenal resection was performed. The early postoperative period was complicated by pylorospasm leading to gastrostasis. After eating, the patient had a feeling of fullness of the stomach, followed by nausea and vomiting. On contrast radiography, a delay in contrast in the stomach was observed for more than 48 hours. Within 5 days after the operation, the patient was given parenteral administration of antispasmodics, gastroduodenokinetics, antisecretory drugs and correction of water-electrolyte disorders, however, it was not possible to stop the phenomena of pylorospasm. Given the ineffectiveness of the therapy, the patient was injected with a probe into the stomach with 40 g of Levomekol ointment and 20 ml of 0.5% novocaine solution and 1.0 ml of 0.1% atropine dissolved in it. 4 hours after the introduction of the multicomponent solution into the stomach, the patient noted the disappearance of a feeling of fullness of the stomach, appetite appeared, the patient independently removed the probe and took food in a volume of 500 ml. The patient did not notice any negative effects of eating. In the future, clinical symptoms of pylorospasm did not appear; there was no delay in the evacuation of contrast from the stomach and stump of the duodenum on contrast radiography.

To restore the passage of food from the stomach and stump of the duodenum to the patient, a single injection of a multicomponent solution by the proposed method was sufficient. The patient in satisfactory condition on the 14th day of hospital stay was discharged under the supervision of an oncologist.

Claims (1)

A method of treating pylorospasm after pyloric preservation of pancreatoduodenal resection, which consists in parenteral administration of antispasmodics, gastroduodenokinetics, antisecretory drugs and correction of water-electrolyte disorders, characterized in that 40 g of Levomekol ointment and 20 ml of dissolved in it are additionally introduced into the stomach, 5% novocaine solution and 1.0 ml - 0.1% atropine solution, once a day with an equal time interval between the introduction of at least two days.