RU2578853C1 - Method of treating acute anal fissure and persistent wounds of anal canal - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: in treating acute anal fissure is auto plasma bubbling with increased content of platelets by ozone-oxygen mixture. Transferred by heating it in gel form, is introduced under anal crack in amount of 2.5-3.0 ml.

EFFECT: method improves the anal fissure epithelization and postoperative rehabilitation due to prolonged therapeutic effect, minimum operation.

1 cl, 1 ex, 4 dwg

Description

The invention relates to medicine, in particular to a method for the treatment of acute anal fissure and long non-healing wounds of the anal canal.

A known method of treatment using autoplasma containing platelets in high concentration (over 1,000,000 units). The method has found wide application primarily:

- in dermatocosmetology, trichology (PP Akhmerov, R.F. Zarudy, OI Korotkova, A.A. Vorobyov - "The use of autoplasma containing platelets in dermatocosmetology and dentistry. Plasmolifting TM technology" - journal Plastic Surgery and Cosmetology, 2013 (1), 1-192, pp. 94-104, 2013; Vorotelyak EA - “Regenerative potential of the hair follicle: A review of scientific research” - Plastic surgery and cosmetology. - 2010. - No. 1. - P. 118 -123);

- in dermatology (Akhmerov PP, Zarudy R.F., Rychkova OI. “Plasmolifting - treatment of age-related atrophy of the skin with platelet-rich autoplasma” Aesthetic medicine. - 2011. - T.Kh. No.2. - P. 181 -187);

- in maxillofacial surgery and dentistry (Akhmerov PP et al. "Plasmolifting technology - an injection form of platelet autoplasma for the treatment of chronic periodontitis 1-2 severity", Periodontics. - 2013. - No. 1 (66). - 45- 47; Akhmerov PP, Zarudy R.F., Akhmerov F.R., Ovechkina M.V., Zelyaev M.M., Korotkova O.I., Vorobyov A.A. - “A new method of stimulating tissue regeneration using rich platelets of plasma. "VIII-th Uzbekistan International Conference" Dentistry "Uzbekistan, Tashkent. P. 95. April 24-27, 2012);

- in surgery, gynecology, traumatology and rehabilitation medicine, in the treatment of burn wounds and long-term non-healing wounds (Akhmerov PP et al. “Plasma lifting in the treatment of dermal burns.” - Materials of a scientific conference in honor of the anniversary of the N.V. Sklifosovsky Research Institute. - M., 2013; V. Obolensky et al. “Application of platelet-rich autoplasma in the treatment of patients with chronic wounds of various etiologies: Guidelines (No. 2). - M., 2013. - P. 16; V. Obolensky ., Ermolova DA "use of platelet growth factors and collagen bioprep treatment in patients with chronic ulcers of various etiologies "Surgery. - 2012. - No. 5 (42). - S. 42-47).

This method is based on the regenerative effect of platelet-rich plasma, which is injected into problem areas and activates the functioning of connective tissue cells. As a result, due to the body's own reserves, the biological mechanism of natural skin rejuvenation is launched without surgical intervention and other cardinal measures. This technique is approved and registered by the Ministry of Health of Russia, is actively used in leading cosmetology clinics not only in our country, but also abroad. Autoplasma with a high platelet content contains protein factors, growth factors that activate the regenerative process in ordinary trauma. The idea is a biochemical “imitation” of bruising and local trauma during the administration of autoplasma with platelets (P. Akhmerov, “Regenerative medicine based on autologous plasma.” M. 2014, S. - 14).

Plasmolifting gel (plasmogel, plasmogel) is a continuation of the Plasmolifting technology and is used mainly as a filler to correct volume changes in the face in dermatocosmetology. The technique is described in detail by Akhmerov P.P. in many publications, in more detail in Chapter 5, Plasmolifting-Gel technology (“Regenerative medicine based on autologous plasma” M. 2014, S. 67-73).

Widely known and there are many publications on the use of ozone in various fields of medicine, including surgery, gynecology, traumatology and rehabilitation medicine. The positive effect of ozone is associated with the elimination of pain and swelling, a significant reduction in the duration of epithelization (in particular, superficial burns), which is the subject of extensive domestic and foreign literature. In therapeutic concentrations, ozone has an immunomodulating, anti-inflammatory, bactericidal, fungicidal, analgesic effect. Ozone therapy in surgery is used in the treatment of general peritonitis, diffuse peritonitis, local peritonitis, purulent soft tissue wounds, trophic ulcers, pressure sores (A. Zasorin, “Experience of ozone therapy in the complex treatment of surgical soft tissue infection” Medical almanac, 2013, No. 3, С 106-107; Struchkov AA, Morozov IN "The use of ozone therapy in the treatment of pressure sores" in the same place. S. 122-123).

We did not find the use of Plasmolifting, Plasmolifting-Gel and ozone therapy as an isolated effect or in combination with each other for acute anal fissures and long-term non-healing wounds of the anal canal.

These above methods are taken as a prototype.

The objective of the proposed method is the epithelialization of the anal fissure and long non-healing wounds of the anal canal by bringing Plasmolifting-Gel to a problem place, which will allow to achieve a good long-term effect due to the minimum invasiveness of the intervention and the lack of time for postoperative rehabilitation of patients.

The goal in the proposed method is achieved by bubbling autoplasma with an ozone-oxygen mixture for 5 minutes and transferring it into a gel form in order to prolong the therapeutic effect, after which the plasmogel is injected under the crack in a volume of 2.5-3.0 ml.

The proposed method and features that distinguish it from those known in the medical and patent literature are not found, which allows us to conclude that its criterion of "novelty" is met.

The essence of the proposed method consists in the fact that autoplasma is bubbled with an ozone-oxygen mixture for 5 minutes and transferred to a gel form in order to prolong the therapeutic effect, after which the plasmogel is injected under the crack in a volume of 2.5-3.0 ml.

The method is illustrated by drawings:

In fig. 1 - centrifuge;

In fig. 2 - mono-council with Li-heparin and with a separation gel;

In fig. 3 - ozonizer;

In fig. 4 - thermostat.

The method is as follows:

1. Blood sampling from the patient's vein (8 ml) in a mono-council with Li-heparin and with a separation gel.

2. Centrifugation for 5 minutes at a speed of 1700 rpm (Fig. 1).

3. 2.5-3.0 ml of plasma enriched with platelets in a 20 gram syringe is taken from the mono-council (Fig. 2).

4. A plasma is bubbled in the syringe with an ozone-oxygen mixture with a concentration of 10,000 μg / l for 5 minutes (Fig. 3).

5. Next, the plasma enriched with platelets and sparged with ozone is taken into a 3-gram syringe (syringe with lock lock) and placed in the thermostat for 5 minutes at a temperature of 92 ° C, after which the plasma passes into a gel (viscous) form (Fig. four).

6. Under local or caudal anesthesia, a plasmogel in a volume of 2.5-3.0 ml is injected under a crack or a long non-healing wound of the anal canal. In the presence of spasm of the sphincter of the anus, sphincter (rectal speculum) divulsion is performed. The complex of subsequent treatment includes traditional methods of treatment: combating constipation, suppositories, thermal procedures, hygiene measures, and if indicated, nitroglycerin ointment. The frequency of the procedures is 1 time in 7-10 days.

The method of obtaining plasmogel described Akhmerov P.P. in Chapter 5, Autologous Plasma Regenerative Medicine. M. 2014, S. 67-73.

The proposed method is implemented in the presented clinical example.

Patient S., 45 years old, was admitted with complaints of pain and scarlet blood during defecation. It hurts for 2 weeks when, after a strong stool, the above complaints appeared. During an external examination in the anus at 12 hours when diluting the edges of the anus, there is a superficial mucosal defect of 0.7 cm in length with smooth edges and a soft bottom. With a manual examination - the sphincter tone is normal, at 12 hours - pain is noted. Diagnosed with acute anterior anal fissure.

Operation: Blood is taken from the patient's vein (8 ml) in a mono-cell with Li-heparin and with a separation gel. Then centrifugation for 5 minutes at a speed of 1700 rpm (Fig. 1). 3.0 ml of plasma are taken from the mono-council in a 20 gram syringe (Fig. 2). Plasma is bubbled in the syringe with an ozone-oxygen mixture with a concentration of 10,000 mg / l for 5 minutes (Fig. 3). After that, the plasma enriched with platelets and sparged with ozone is taken into a 3-gram syringe (syringe with lock lock) and placed in a thermostat for 5 minutes at a temperature of 92 ° С, after which the plasma passes into a gel (viscous) form (Fig. four). Under caudal anesthesia, a plasma gel in a volume of 3.0 ml is injected under the crack. After 20 minutes, the patient was released home. After 7 days, a similar intervention was performed according to the method described above. On the 13th day, the wound in the anal canal was epithelized.

Over the past 6 months (from September 2014 to February 2015), this technique was applied in 12 patients with acute anal fissure and in 31 patients with long-term non-healing anal canal wounds.

12 patients with acute anal fissure.

The duration of the disease is from 7 to 40 days. Number of procedures: 1 procedure - in 6 patients; 2 - in 4 patients; 4 - in 1 patient. Results: complete epithelization, absence of complaints - in 9 (75%) patients; partial with no complaints - in 2 (16.7%) and no effect - in 1 (8.3%) - directed to surgical treatment. Duration of treatment ranged from 6 to 33 days, an average of 13 days.

31 patients with long non-healing anal canal wounds.

Causes of development: condition after hemorrhoidectomy - 12 patients, excision of the anal fissure - 10, external hemorrhoidectomy (including with deserterization) - 5, excision of genital warts - 1, operations for rectal fistula - 1, removal of the hypertrophied anal papilla - 1 ECC excision - 1. Duration of the disease is from 14 to 240 days, on average - 49 days. All these patients underwent the necessary treatment and wound healing. Number of plasmogel procedures performed: 1 procedure in 14 patients; 2 - in 8 patients; 3 - in 7 patients; 4 - in 2 patients.

Results: complete epithelization, absence of complaints - in 22 (71%) patients in the period from 4 to 32 days (average 15 days); incomplete epithelization with no complaints - in 5 (16.1%) in terms from 14 to 60 days, an average of 31 days and no effect - in 4 (12.9%) patients, treatment periods ranged from 26 to 90 days , on average - 44 days. All four patients were referred to SSCC (in order to identify microbial contamination of problem areas). Thus, recovery from or improvement in patients with long-term non-healing anal canal wounds occurred in 27 of 31 patients (87%).

Claims (1)

A method of treating an acute anal fissure and long non-healing wounds of the anal canal, including the introduction of autoplasma enriched with platelets under the anal fissure, differs in that the autoplasma is bubbled with an ozone-oxygen mixture for 5 minutes and transferred to a gel form in order to prolong the therapeutic effect, after whereby the plasmogel is introduced under the crack in a volume of 2.5-3.0 ml.

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