RU2622744C1 - Method for combined treatment of chronic haemorrhoid - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes endovascular desarterization of internal hemorrhoids (IH EDSA). Before and after surgery, the patient takes Detralex according to the scheme: a week before IH EDSA - 1000 mg/day - 2 pills; after IH EDSA, for 7 days: Detralex - 2000 mg/day - 4 pills and Mucofalk - 1 sachet 2 times per day; further Detralex only, for 2 weeks - 1000 mg/day - 2 pills.

EFFECT: improved results internal hemorrhoids desarterization due to timely correction of the underlying pathogenesis of the disease and prevention of the main causes of its relapse.

1 tbl, 1 ex

Description

The invention relates to medicine, namely to general proctology, and can be used to treat chronic hemorrhoids.

Known drug treatment of acute and exacerbations of chronic hemorrhoids, aimed at eliminating certain symptoms of the disease. Therapy involves a comprehensive medical treatment. The basis of conservative therapy is the normalization of bowel function and bowel movements (plant fiber, heavy drinking, drugs to regulate stool). Against this background, derivatives of flavonoids (Detralex), local drugs (anti-inflammatory suppositories and ointments, painkillers, vasotropic drugs) are used [1, 5, 6].

The disadvantage of this treatment is its palliativeness. The effect is noted only during therapy itself and for a short period after it. From a socio-economic point of view, drug treatment leads to the loss of a large number of working days and excludes the possibility of persistent labor rehabilitation of patients.

Surgical treatment of hemorrhoids is known: Milligan-Morgan operation, which until recently was the main radical treatment of hemorrhoids in Russian clinics practically without taking into account the stage of the process [1-4].

However, with a sufficiently high radicalism, this treatment has a number of significant drawbacks. The duration of hospitalization is from 4 to 8 days, the period of disability is up to 21-28 days. Patients are exposed to pain and drugs, postoperative stress due to the presence of pain (in 100% of cases). In addition, with this treatment, the spectrum of early and late postoperative complications is most fully represented: bleeding due to slipping of the ligature of the vascular pedicle of the node is recorded in 1-2% of cases, purulent-inflammatory complications (suppuration of postoperative wounds, paraproctitis) in 2%, reflex urinary retention in 5-15%, cicatricial stenosis of the anal canal - in 1%, anal incontinence - in 2%. [8].

HAL-RAR (ligation of hemorrhoidal arteries - recto-anal repair) belongs to the modern treatment. Surgery is performed from transanal access and has the risks of developing traditional postoperative complications: bleeding, inflammation in the intervention area, reflex urinary retention, impaired anal sensitivity [3]. In this case, the problem of postoperative anal pain syndrome (ABS) and discomfort is not finally resolved.

Closest to the proposed is a method of endovascular treatment of chronic hemorrhoids [8].

Endovascular deserterization of internal hemorrhoidal nodes - (EDA VSU) includes intraarterial dearteriolization of internal hemorrhoidal nodes at the level of the main trunk of the superior rectal artery, while endovascular occlusion is carried out superselectively introducing non-lysing radiopaque contrast embryos into the mouth of the distal branches of the upper rectal arteries - non-ionic contrast agents (omnipack, ultravist).

Due to intravascular access to the distal branches of the superior rectal artery (according to Seldinger) and the absence of invasion in the localization site of the VSU, the intravascular access to the VSU completely excludes the likelihood of complications observed during transanal interventions. Although, like any other invasive method, it is not without risks of other complications, but already associated with the technology of endovascular intervention.

When carrying out endovascular desarterization of internal hemorrhoidal nodes, only one pathogenesis link is eliminated - arterial inflow to hemorrhoidal nodes, in turn, no effect is made on the venous outflow. As a result of this, a relapse of the disease is possible due to the resumption of blood circulation and impaired venous outflow. Also, patients suffering from chronic constipation are more prone to relapse. It follows from this that after the desarterization of the internal hemorrhoidal nodes, correction of venous hemodynamics and normalization of the colon function are necessary to prevent relapse of the disease and episodes of bleeding.

The objective of the proposed method is the maximum elimination of the risk of developing postoperative complications and relapses of the disease after EDHA of the Voronezh State University.

The task is achieved due to the fact that the patient before and after surgery takes Detralex drugs according to the scheme: a week before the EDZA VSU - 1000 mg / day - 2 tablets; after EDZA VSU for 7 days Detralex - 2000 mg / day - 4 tablets and Mukofalk 1 sachet 2 times a day; then 2 weeks only Detralex - 1000 mg / day - 2 tablets.

The method is as follows: patients before and after deserterization of the internal hemorrhoidal nodes take Detralex, this drug has venotonic and angioprotective properties, reduces venous congestion, reduces capillary permeability and increases their resistance. The results of clinical studies confirm the pharmacological activity of the drug in relation to venous hemodynamics. 1 tablet of Detralex contains 90% - 450 mg of the micronized flavonoid fraction and flavonoids in terms of hesperidin 10% - 50 mg.

Scheme of taking the drug Detralex:

1 week before the intervention - 1000 mg / day - 2 tablets; within 7 days after EDZA VSU - 2000 mg / day - 4 tablets; then 2 weeks - 1000 mg / day - 2 tablets.

Mukofalk is also prescribed to prevent chronic constipation in patients after EDA of the Voronezh State University (which is the main factor in the relapse of the disease), this drug retains fluid in the gastrointestinal tract due to hydrophilic fibers from the plantain seed coat, which helps soften the consistency of the stool.

The drug restores normal bowel function by regulating its activity and facilitating the passage of intestinal contents. Then, during the course of a life, a plant diet with the use of bran is prescribed.

The regimen of the drug Mukofalk in the postembolization period: 1 sachet 2 times a day for 1 week.

The treatment results of 65 patients with stages I-III of chronic hemorrhoids (CG) were analyzed. EHEA of VSU was performed in 35 - without using Detralex (study group 1 (IG 1), in 30 - using Detralex (IG 2). Clinical results were evaluated in comparison within 7 days after DZA, 1 month (early postoperative period) and 1 year (long term) in all patients. [7].

Based on the results of table. The 1 positive effect of Detralex administration on long-term treatment outcomes is obvious.

The proposed method allows you to:

- supplement the endovascular desarterization of the upper rectal artery with drug therapy in order to prevent recurrence of the disease;

- affect the venous hemodynamics of hemorrhoids in the pre- and postembolization period to prevent bleeding episodes;

- to normalize the evacuation function of the colon - to prevent chronic constipation as the main factor in the development and progression of the recurrence of hemorrhoidal disease through drug therapy and a plant diet.

Correction of the venous component of pathogenesis - the use of MFF (Detralex) can improve the course of the early postoperative period and long-term treatment results.

Example.

Patient T., 47 years old, was admitted to the coloproctology department of the Road Hospital of the Krasnoyarsk station with a diagnosis of chronic internal hemorrhoids of the II degree, complicated by recurrent bleeding. Suffers from hemorrhoids 7 years. Over the past year, notes a deterioration. After the act of defecation, a small amount of blood discharge is observed in drops. He considers chronic constipation up to 4 days the cause of the disease. However, after sigmoidoscopy (RRS), organic pathology of the colon was ruled out. Against the background of a course of conservative therapy, the bowel movement normalized, rectal bleeding continued. Upon admission, the patient's condition is satisfactory. Somatic status without features. On local examination: external hemorrhoidal nodes are not detected. In the anal canal, at 3.7 and 11 hours, internal hemorrhoidal nodes are determined, enlarged to 1.0 cm in diameter, painless, eroded, and bleeding contact. The patient is shown planned surgical treatment, in the particular case of EDZA VSU. Within 7 days before the intervention, the patient took the drug Detralex 1000 mg / day (2 tablets). The VSA EDZA procedure was performed without any special features: 12 metal coils with a diameter of 0.1-0.3 mm were superselectively inserted into the distal branches of the superior rectal artery (BPA). On the control x-ray, radiopaque emboli are determined in the area of the mouths of the distal branches of the BPA, the absence of contrast of the internal hemorrhoidal nodes. The patient was discharged on the 3rd day in a satisfactory condition. In the post-embolization period for 7 days, Detralex 2000 mg / day - 4 tablets, then 2 weeks - 1000 mg / day - 2 tablets. Mucofalk is also prescribed for 1 sachet 2 times a day for 1 week. At the follow-up examination after 1 month, the patient does not show complaints, there are no episodes of bleeding, the stool is daily against the background of taking Mukofalk and a vegetable diet. An endoscopic examination of the rectum: the mucous membrane is pale pink, there is no swelling, the vascular pattern is normal, sclerotic internal hemorrhoids up to 0.5 cm in size, the surface is not eroded, there is no contact bleeding. When monitoring a patient for 2 years after treatment, every 3 months there is a lack of complaints of bleeding, no constipation.

A method for the combined treatment of chronic hemorrhoids improves the results of the deserterization of internal hemorrhoidal nodes by timely correction of the main links of the pathogenesis of the disease. In addition, when using the proposed method, there is a significant increase in the quality of life of the operated patient.

Information sources

1. Grateful L.A. Clinical and pathogenetic substantiation of the choice of a method for the treatment of hemorrhoids // Abstract. Dis. ... doctor. honey. sciences. - M., 1999.

2. Kecherukov A.M., Chernov A.M., Tikhomirov A.S. 30 years of experience in the treatment of hemorrhoidal disease // Problems of Coloproctology. - Vol. 16. - M., 1998 .-- S. 56-59.

3. Rivkin V.L., Kapuller L.L. Hemorrhoids. - 2nd ed. - M.: Medicine, 1984. - 176 p.

4. Fedorov V.D., Vorobev G.I., Rivkin V.L. Clinical surgical coloproctology. A guide for doctors. - M .: SSC Coloproctology of the Ministry of Health of the Russian Federation, 1994. - 432 p.

5. Godeberge P., Kontou J.F. Atlas of Hemorrhoids // Les Laboratoires Servier. - 1998 .-- P. 48.

6. Longo A. Treatment of hemorrhoids by excision of the mucous membrane and prolapsed hemorrhoidal nodes using a circular suture apparatus: a new method // Materials of the VI World Congress of Endoscopic Surgery. - Rome, Italy, 1998 .-- S. 777-784.

7. 3akharchenko A.A., Galkin E.V., Vinnik Yu.S., Kuznetsov M.N., Polevets K.O. Desarterization of internal hemorrhoidal nodes in hemorrhoidal disease: the choice of method is for and against. Is a correction of the venous component of pathogenesis necessary? // Journal "Coloproctology" No. 3_ (53) _2015. 35-46.

8. RF patent No. 2268754, A61M 5/00, Bull. No.3, January 27, 2006

Claims (1)

A method for the combined treatment of chronic hemorrhoids, including endovascular desarterization of internal hemorrhoids - EDZA VSU, characterized in that the patient before and after surgery takes Detralex drugs according to the scheme: a week before EDZA VSU - 1000 mg / day - 2 tablets; after EDZA VSU for 7 days Detralex - 2000 mg / day - 4 tablets and Mukofalk 1 sachet 2 times a day; then 2 weeks only Detralex - 1000 mg / day - 2 tablets.