RU2624234C1 - Method for complications prevention in postoperative period during surgical treatment of nasal polyposis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: nasal cavity is cleaned and then washed with in octenisept solution diluted 1:5 with distilled water, followed by endaural electrophoresis with application of Fermenkol, after electrophoresis, reconstructed nasal cavity tamponade is performed using Fermenkol-gel impregnated turundas.

EFFECT: invention provides minimization of postoperative complications, namely, reduction of inflammation severity, reduction of adhesions, elimination of incomplete epithelialization of nasal mucosa, improvment of nasal functions.

4 cl, 3 ex

Description

The invention relates to medicine, namely to otorhinolaryngology.

Currently, chronic polypous rhinosinusitis occupies the largest share in the general structure of diseases of ENT organs and in the last decade there has been a tendency for this pathology to grow.

Chronic polypous rhinosinusitis significantly reduces the quality of life and patient capacity.

Reconstruction and therapeutic treatment of nasal polyposis is one of the most difficult problems in reconstructive surgery of the nose.

As a rule, by 14-23 days after surgery, the epithelization of the nasal mucosa should completely end, however, after nose reconstruction, complications such as: the occurrence of synechia of the nasal cavity, cicatricial processes in the nasal cavity, recurrence of polyps after 3-4 years, which are accompanied by difficulty in nasal breathing, nasal discharge, impaired sense of smell, headaches.

Particular attention is required when managing a patient in this postoperative period, since if the recovery process is delayed, this should be considered as a complication that occurs both in the early and in the long term.

Complications of a late period include the emergence of new polypous formations that adversely affect the functions of the nose.

These complications are caused by the peculiarities of the reparative process in patients, the peculiarities of the immunological and allergological status of the body, the state of soft tissues and circulatory disorders in the pathological area, genetically determined features such as the state of the fibroblastic sprout, activity of the adrenal glands, the level of concentration of their hormones in the blood, and much more.

There are various ways to treat these complications.

1. Introduction on turunda into the nasal passages of medicinal substances (MI Nikulin, VV Skorobogaty, 1993).

2. The introduction of medicinal gels to eliminate the phenomena that violate the outflow of secretions and hamper the natural aeration of the cavities.

3. (G.I. Markov, M.G. Markov, 1994).

3. Insufflation of fine powder into the nasal passages (V. T. Palchun, Diseases of the ear, throat, nose. - Moscow, "Medicine", 2000).

4. The use of "Plazon" in combination with ultrasonic irrigation with miramistin (V. M. Zaitsev 2004). A repeated nasal polypotomy is performed using a promising intranasal microendoscopic operation - FESH. During this operation, polyps are removed using a microdebrider under a microscope and an endoscope with the least possible trauma to surrounding tissues and organs.

However, these methods have the following disadvantages:

1. A burning sensation, pain and dryness of the nasal mucosa.

2. From the side of the central nervous system - rarely headaches.

3. On the part of the cardiovascular system - extremely rare arrhythmia and increased blood pressure.

4. Lack of effectiveness in the final elimination of the process.

The closest technical solution is a method of treating polypous rhinosinusitis with antibiotic therapy, anti-inflammatory therapy, intranasal proteolysis (Kim I.A., Treatment of polypous rhinosinusitis in the postoperative period, abstract of diss. ... MD, St. Petersburg, 2009).

However, this method does not take into account the peculiarities of physiological processes in the postoperative period and, in particular, is not aimed at restoring microcirculation of the mucous membrane of the nasal cavity, reducing edema and hyperemia of the mucous membrane, regenerating the epithelium of the mucous membrane of the nasal cavity, and the possibility of the presence of polypous tissue residues, which to relapse of the disease, the formation of scar tissue as a result of the operation.

In this regard, an important factor is the selection of such a form of drugs and such a method of its introduction into the nasal cavity, which would not depend on the intensity of the inflammatory process in the nasal structures and would provide a high concentration of enzymatic preparations in the focus of inflammation for a long time, without complicating the outflow of the discharge and aeration of the nasal cavity and enhancing the processes of epithelization, and would reduce the time of treatment.

The purpose of the invention is the prevention of complications arising after surgical treatment of nasal polyposis, namely: cicatricial stenosis of the nose, synechia, frequent recurrence of nasal polyps, rapid growth of granulations, incomplete epithelization of the nasal mucosa, which negatively affect important functions of the nose and contribute to the appearance of negative deviations in quality of life of the patient.

The technical result of the invention is to ensure a high concentration of drugs in the focus of inflammation for a long time, in the possibility of creating an unhindered outflow of detachable contents of the nose and aeration of the nasal cavity. The application of the proposed method also leads to the cessation of the abundant growth of granulations, polyps and accelerates the process of epithelization of the mucous membrane of the nasal cavity.

We propose a method for the prevention of complications in the postoperative period during the surgical treatment of nasal polyposis, in which a toilet of the nasal cavity is produced in the late postoperative period, then the cavity is rinsed with an octenisept solution diluted with distilled water 1: 5, after which endoural electrophoresis is carried out using fermencol, after electrophoresis tamponade of the reconstructed nasal cavity is used with gauze swabs soaked in fermencol gel.

The method is carried out in the late postoperative period (approximately two to four weeks after the operation) as follows: first, the toilet of the nasal cavity is carried out, where the nasal cavity is drained, it is cleaned of mucopurulent discharge, then it is washed with the help of an attic cannula with a syringe with octenisept solution (diluted with distilled water 1: 5). This drug belongs to the class of surface-active substances, has a wide spectrum of antimicrobial activity, is effective against aerobic, anaerobic, gram-positive and gram-negative bacteria, chlamydia, mycoplasmas, fungi, as well as viruses, has a disinfectant effect, enhances local protective reactions, regenerative processes, does not cause allergies.

After this, endoural electrophoresis is carried out using the preparation of fermencol using the Potok-1 apparatus.

To prepare the enzyme solution, Solactin was used, which is included in the kit for enzymatic correction of the fermencol preparation. The concentration of the enzyme solution was 0.1-1.0 mg / ml. The drug was injected from the anode at a current strength of 0.05 to 0.15 mA / cm for 10-15 minutes. The treatment was carried out in cycles of 5-7 procedures in 1-2 days, the interval between courses was 10-14 days.

After electrophoresis, tamponade of the reconstructed nasal cavity is immediately made with gauze swabs soaked in fermencol gel 3 times a day for 60 minutes.

The introduction of the drug does not require sterilization conditions and does not cause pain.

Contraindications to the electrophoresis procedure were: purulent-inflammatory processes, cardiovascular diseases, not perception by the body of a medicinal substance or galvanic current.

After the use of fermencol, the deep tissue trophic disturbance in the area of interest in patients with chronic polypous rhinosinusitis changes for the better, namely, there is a decrease in adhesions and inflammatory processes, the growth of scar tissue with its excessive formation is suppressed, a significant part of the trigger factors for the occurrence of polyps disappears.

Thus, the method is based on the action of an enzymatic preparation such as Fermencol, which includes digestive enzymes from king crab hepatopancreas, which in their collagenolytic activity are significantly (3.9 to 7.6 times) higher than collagenases obtained from other sources, in addition, it dissolves other components of the extracellular matrix, and in these parameters also exceeds hyaluronidase, it also activates the function of macrophages and fibroblasts, stimulate tissue regeneration.

Example 1. Patient R., date of birth: 01/08/1951.

Diagnosis: Chronic polypous rhinosinusitis. Bronchial asthma, mixed form. Deformation of the nasal septum. Chronic hypertrophic rhinitis.

Complaints before surgery: difficulty in nasal breathing, nasal mucosa, headaches, general weakness, itching in the nose, sneezing, dry mouth, sweating, and insomnia.

Anamnesis: Sick for about 5 years. Within 1 year he was treated with naphthyzine without positive dynamics. Earlier surgical treatment was not carried out.

Allergic history: on aspirin, NSAIDs, aspirin triad. It is observed by an allergist. From bronchial asthma takes salbutamol, beclason.

It was operated in 2003 in the ENT department of the Yaroslavl region. clinical hospital.

Complaints after surgery: lack of smell, moderate headaches and weakness, sweating.

Dynamics: Nasal breathing recovered, nasal discharge ceased, headaches decreased, miracle in the nose, sneezing and dry mouth disappeared. Anterior rhinoscopy and endoscopic examination of the nasal cavity: the nasal mucosa is pink, moist, the nasal septum along the midline, HHP in volume decreased, and polyps are absent in the nasal cavity and nasal passages.

In the late postoperative period (two weeks after surgery) anti-relapse treatment is prescribed according to the claimed method. The need for basic therapy for bronchial asthma in the postoperative period did not change.

The condition of the mucosa after treatment: there is no swelling of the nasal mucosa and hypersecretion. The lumen of the nasal passages expanded. The mucous membrane of the nasal passages is pink, moist. Polyps are absent.

There is no need for reoperation.

Example 2. Patient A., date of birth: 07/04/1938.

Diagnosis: Chronic polypous rhinosinusitis. Deformation of the nasal septum. Chronic hypertrophic rhinitis.

Complaints before surgery: marked difficulty in nasal breathing, lack of smell, headaches, general weakness, dry mouth, and insomnia.

Anamnesis: Sick for about 10 years. For 10 years of the year it was treated with different vasoconstrictor drops without positive dynamics. 1 time polypotomy was performed, the dynamics is positive.

Allergic history: on suprastin. For 10 years, observed by an allergist. It was operated in 2003 in the ENT department of the Yaroslavl region. clinical hospital.

Complaints after surgery: lack of smell.

Dynamics: Nasal breathing recovered, headaches, general weakness, dry mouth, insomnia disappeared. Anosmia persists.

Anterior rhinoscopy and endoscopic examination of the nasal cavity: the nasal mucosa is pink, moist, the nasal septum along the midline, HHP in volume decreased, and polyps are absent in the nasal cavity and nasal passages.

In the late postoperative period (three weeks after surgery) anti-relapse treatment is prescribed according to the claimed method. The condition of the mucosa after treatment: swelling of the nasal mucosa is absent and hypersecretion is significantly reduced. The lumen of the nasal passages expanded. The mucous membrane of the nasal passages is completely epithelized, has a pink color, moist. Polyps in the nasal passages are not observed.

There is no need for reoperation.

Example 3. Patient C. Date of birth: 03/17/1957.

Diagnosis: Chronic polypous rhinosinusitis.

Complaints before surgery: severe nasal breathing, mucous discharge from the nose, headaches, general weakness, itchy nose, dry mouth, sweating, and insomnia.

Anamnesis: Sick for about 20 years. Earlier surgical treatment was not carried out.

Allergic history: no. Operated in 2002 in the ENT department of the Yaroslavl region. clinical hospital.

Complaints after surgery: nasal mucosa, minor headaches and sweating.

Dynamics: Nasal breathing recovered, headaches decreased significantly, general weakness, itching in the nose, dry mouth, insomnia disappeared.

Anterior rhinoscopy and endoscopic examination of the nasal cavity: the nasal mucosa is pale pink, moist, the nasal septum is curved, HHP are hypertrophied, and there are no polyps in the nasal cavity and nasal passages.

In the late postoperative period (four weeks after surgery) anti-relapse treatment is prescribed according to the claimed method.

The condition of the mucosa after treatment: significantly reduced swelling of the nasal mucosa and hypersecretion. The lumen of the nasal passages expanded. The mucous membrane of the nasal passages is pink in color, moist, completely epithelized. Polyps in the nasal passages are not noted.

There is no need for reoperation.

The claimed method was treated 16 patients with chronic polypous rhinosinusitis. A good therapeutic effect was obtained: a decrease in the severity of the inflammatory process, inhibition of the development of a progressive inflammatory process, a decrease in adhesions, normalization of immunological parameters, a sharp decrease in the recurrence of polyps was noted. These measures led to the elimination of inflammatory processes in the nasal cavity after surgery.

The proposed method allows to achieve complete epithelization, nasal mucosa, elimination of the polypous process.

A recovery of 98% was achieved. In all patients treated with the proposed method, relapse was not observed, and the period of remission lasts from 6 to 10 years or more.

Claims (4)

1. A method for the prevention of complications in the postoperative period in the surgical treatment of nasal polyposis, in which the toilet of the nasal cavity is produced in the late postoperative period, then the cavity is rinsed with an octenisept solution diluted with distilled water 1: 5, followed by endoural electrophoresis using fermencol, after electrophoresis Tamponade of the reconstructed nasal cavity is used with turundas soaked in fermencol gel. 2. The method according to p. 1, characterized in that the fermencol was injected from the anode at a current strength of 0.05 to 0.15 mA / cm ² for 10-15 minutes. 3. The method according to p. 2, characterized in that the electrophoresis treatment is carried out in cycles of 5-7 procedures in 1-2 days, the interval between courses is 10-14 days. 4. The method according to p. 1, characterized in that the tamponade of the reconstructed nasal cavity with turundas soaked in fermencol gel is carried out for 60 minutes.