RU2767889C1 - Method for surgical management of epithelial coccygeal passage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to colorectal surgery, and can be used for treating epithelial coccygeal passage. Method involves laser ablation of the cavity and fistulous passages, under local anesthesia, after excising the primary fistulous opening. Button-like probe is used to inspect a fistulous passage with a counteropening in an upper point of the fistula. Folkman's spoon is used to process and remove the contents of the fistulous passage with granulations. Cavity is washed with a solution of aqueous chlorhexidine; under ultrasound control of tumescent anesthesia, a sleeve is created, which reduces the cavity of the fistulous passage. Cavity of the fistulous passage is coagulated with a laser in a continuous mode of wave length 1,470 nm, power 9 W, at rate of 1 mm/s.

EFFECT: method provides improved results and reduced length of treatment, prevented recurrences of the disease and postoperative complications, as well as improved cosmetic results due to tumescent anesthesia and laser coagulation of the fistulous passage cavity.

1 cl, 1 ex

Description

The invention relates to medicine, namely to colorectal surgery, and can be used for the treatment of epithelial coccygeal passage.

Epithelial coccygeal passage is a congenital disease caused by a defect in the development of the caudal end of the embryo, in which a passage expelled by the epithelium remains under the skin. This anomaly is quite common. The adult population, children and adolescents in more than 5% of cases suffer from the presence of an epithelial coccygeal passage and its complications (Dultsev Yu.V., Rivkin VL Epithelial coccygeal passage. - M., 1998). The frequency of epithelial coccygeal passage is 7.1 per 1000 population. Among the diseases of the rectum, this disease is 14-20% (Vrublevsky V.A., Militarev Yu.M. Problems of proctology. - M., 1983, Issue 4 C. 6-9).

Conservative methods of treatment do not provide a lasting cure, since they do not eliminate the causes of the disease and the conditions for its development. Such methods include the use of sclerosing agents, treatment with a solution of silver nitrate or hydrochloric acid (Berger H. US Navy med. Bull - 1945, Korb J. Milit. Surg.-1951.-Vol.108. - P. 29-34, Burns F. Arch. Surg. - 1946, - Vol. 52. - P. 33-41).

The main and effective method of treatment is surgical, which consists in excision of the epithelial coccygeal passage, which is divided into: deaf suturing with various types of sutures, the use of skin plastics. Partial suturing of the wound (Nalivkin A.I., Ektov V.N., Khryachkov A.A. et al. Surgery 1983), suturing the edges of the wound to its bottom in various modifications (Dultsev Yu.V., Rivkin V.L. Epithelial coccygeal passage. - M., 1988.), open wound management (Allabergenov A., Koplatadze A.M., Nazemets V.M., Martynenko A.P., Problems of proctology - M., 1980. Issue 1. - pp. 55-58). A method for radical surgical treatment of the epithelial-coccygeal tract, which consists in excising the epithelial-coccygeal tract without suturing the wound with its further open management (Dultsev Yu.V., Rivkin V.L. Epithelial pilonidal tract. - M .: Medicine, 1988, S. 92-94 Lavreshin P.M., Nikulin D.Yu., Korablina S.S. Diagnosis and treatment of the epithelial coccygeal passage. Medical Bulletin of the North Caucasus, No. 4, 2011, p. 100).

The above methods have their positive and negative results. For example, with a purulent complication or bleeding, they resort to opening the wound in order to revise and sanitize it. As a result, the healing process takes longer and often ends with the formation of rough scars and frequent relapses up to 14.7-20.4% (lesalnieks I., Fiirst A., Rentsch M. Rezidivrisiko nach primarem medianem Wundverschluss bei Patienten mit Pilonidalsinus Chirurg. - 2003. - Bd. 74. - S. 461-468, Morozov Yu.I., etc. All-Union conference on proctology, theses).

Also known is a method for the treatment of epithelial-coccygeal tract proposed by Duxbury and colleagues (Duxbury MS, Finaly IG, Butcher M., Lambert AW Use of a vacuum assisted closure device in pilonidal disease J. Wound Care. 2003; 12(9): 355) , including excision of the epithelial-coccygeal passage. 48 hours after excision of the epithelial-coccygeal passage, a removable drainage bandage is applied and round-the-clock vacuum therapy is carried out in a constant mode of operation with a negative pressure of 125 mm Hg. Subsequently, the drainage dressing is changed every 3 days. The course of vacuum therapy is 6 weeks, and the period of complete wound healing is 8 weeks. A known method for the treatment of epithelial-coccygeal stroke using vacuum therapy, described (Benderwald FP and colleagues Farrell D., Murphy S. Negative Pressure Wound Therapy for Recurrent Pilonidal Disease. A Review of the Literature \\ Wound Ostomy Continence Nurs. 2011), involving excision of the epithelial-coccygeal passage, the imposition of a removable drainage bandage, round-the-clock vacuum therapy in a constant mode of operation with a negative pressure of 125 mm Hg. Change of drainage dressings is performed every 2 days. The course of vacuum therapy is from 4 to 9 weeks. Vacuum therapy is stopped after the wound is completely filled with granulations; while the period of complete wound healing is from 9 to 22 weeks.

The disadvantage of the above methods of treatment is the long period of wound healing, which ranges from 8 to 22 weeks, as well as the possibility of developing postoperative complications in the form of wound dehiscence and infection.

Recently, new technologies have been searched for and developed using various physical factors that affect inflammatory processes in the sacrococcygeal region. Particular attention has been paid in recent years to laser therapy (Kuzin V.V., Morozov Yu.I. et al. All-Union Conference on Proctology, 2nd: Abstracts, M., 1981, pp. 106-107; Yaremchuk A. I. et al. Vesti khirurgii, 1982, v. 122, No. 4, pp. 64-66).

Known methods of treating wounds after excision of the epithelial coccygeal passage using ultrasound, CO2 laser (Yaremchuk A.Ya. Efindiev A.I., etc. Radical treatment of suppurated epithelial cysts of the coccyx Research Institute of Laser Surgery of the Ministry of Health of the USSR, 1987, Nurlyev K.G., Babaev Kh.B., Tachmuradov B.N., Kakabaeva O.S. TSMU, Patent for Invention Method of surgical treatment of epithelial coccygeal ducts 1989, NV Ulyashev, AP Penkov Treatment of patients with epithelial coccygeal tracts with CO2 laser, Stavropol 1990).

The disadvantage of these methods is the preliminary opening of the inflammatory focus, which significantly prolongs the healing and recovery time and contributes to the formation of rough scars. The healing time of a wound defect can be up to several months (Bascom J. Pilonidal sinus: experience with the Karydakis flap. Br. J. Surg. - 1998. Vol. 85. - R 874-877. Berger A., Frileux P. Sinus pilonidal. Pilonidal sinus Ann Chir 1995 Vol 49 P 889-892

As a prototype we have taken a method of minimally invasive treatment of pilonidal cysts (Abushkin I.A., Krochek I.V., V.A. Privalov, RF Patent No. 2283632 C1. dated September 20, 2006). A method of surgical treatment of epithelial coccygeal tract, including laser treatment with purification of the tract and evaporation of altered tissues, pocket cavities and fistulous tracts, according to the invention, the treatment is performed by 2-3-fold interstitial laser thermotherapy with a diode laser in continuous mode with a wavelength of 970 nm, a power of 2 .5 W with the introduction of a monofilament laser fiber with a diameter of 0.4 mm without expanding the coccygeal passage through the primary holes or transcutaneously, and the treatment is carried out under ultrasound control for a duration of 30-180 s.

To carry out laser destruction, an infrared diode laser LS-0.97 - "IRE-Pole" with a wavelength of 970 nm in continuous mode was used. Treatment was performed under local anesthesia with visual and ultrasound guidance. Through the primary openings of the epithelial coccygeal passage or transcutaneously, puncture and evacuation of the contents from the cyst cavity were carried out. After that, a thin quartz light guide was inserted through the existing primary holes or from additional punctures, and laser treatment of the coccygeal passage, cavities, and pockets was performed in a sparing mode of laser thermotherapy. If necessary, the procedure is repeated up to three times with an interval of 10 days.

The disadvantage of this method is the repeated use of the laser, leading to repeated injury and infection of the wound and prolongation of the healing of the postoperative wound. This significantly lengthens the recovery time up to 30 days.

The aim of this study was the development and implementation of a new method of minimally invasive treatment of epithelial coccygeal tract using a laser with a wavelength of 1470 nm.

The objective of the invention is to develop a highly effective method for the treatment of epithelial coccygeal tract, reduce the duration of treatment, prevent recurrence of the disease and postoperative complications and improve cosmetic results.

The technical result of the surgical treatment of the epithelial coccygeal tract, including laser ablation of the cavity and fistulous tracts, is achieved by the fact that under local anesthesia, after excision of the primary fistulous opening, a bellied probe is used to revise the fistulous tract with the removal of counter-opening at the upper point of the fistula, Volkmann's spoon is processed and the contents are removed of the fistulous tract with granulations, the cavity is washed with a solution of aqueous chlorhexidine, under the control of ultrasound with tumescent (infiltration) anesthesia, a "clutch" is created that reduces the cavity of the fistulous tract, the cavity of the fistulous tract is coagulated with a laser in a continuous mode of a long wave of 1470 nm, a power of 9 W, at a speed of 1 mm /from.

For the treatment of epithelial coccygeal tract, a portable compact 1470 nm long-wave laser is used. Laser radiation of a long wave of 1470 nm, due to its physical properties, has a pronounced sanitizing and coagulating effect on the epithelial coccygeal passages. The use of a tumescent “coupling” significantly reduces the cavity of the fistulous tract, increasing the area of tissue contact with the working surface of the laser, which makes it possible to perform a one-time and radical procedure of laser ablation of the cavity without repeated interventions. With this method, a good cosmetic effect is achieved. The high efficiency of the proposed method for the treatment of epithelial-coccygeal tract by reducing the time of complete wound healing and eliminating the possibility of postoperative bleeding allows treatment on an outpatient basis.

The method proposed by us has been introduced into the work of the surgical department of the CHUZ CB "RZD-Medicine" in Astrakhan and was used in the examination of 16 patients. Below are the test results.

Patient V. - 28 years old. Hospitalized with a diagnosis of epithelial coccygeal passage. The patient complains of moderate pain in the coccyx, itching and periodic serous discharge from the primary openings. When viewed in the intergluteal fold, there are two fistulous openings up to 0.3 cm. He was ill for 6 months. The patient was operated on, ultrasonography of the coccygeal passage was performed, laser ablation of the epithelial coccygeal passage was performed under ultrasound control, with a diode laser in continuous mode according to the method described above. The postoperative period was pain-free. The patient was discharged from the department on the 2nd day in a satisfactory condition, with a good cosmetic effect. Further observation took place on an outpatient basis. The period of disability was 4 days. At the control examination after six months, there were no relapses.

Claims (1)

A method of surgical treatment of the epithelial coccygeal tract, including laser ablation of the cavity and fistulous tracts, characterized in that under local anesthesia, after excision of the primary fistulous opening, a bellied probe is used to revise the fistulous tract with the removal of counterperture at the upper point of the fistula, Volkmann's spoon is used to process and remove the contents of the fistulous passage with granulations, the cavity is washed with a solution of aqueous chlorhexidine, under ultrasound control of tumescent anesthesia, a sleeve is created that reduces the cavity of the fistulous passage, the cavity of the fistulous passage is coagulated with a laser in continuous mode with a long wave of 1470 nm, a power of 9 W, at a speed of 1 mm/s.