SU1683753A1 - Method for therapy of cholelithiasis - Google Patents

Abstract

This invention relates to medicine, in particular to gastroenterology and surgery. The goal is to increase the lytic effect. To do this, examine the crystal structures of the patient's bile during polarization microscopy, and further introduce those cholelithic drugs that cause the dissolution of the crystals in their 1: 1 volume ratio. The method improves the efficiency of dissolution of gallstones in patients who do not show abdominal surgery and removal of stones surgically.

Description

This invention relates to medicine, in particular to gastroenterology and surgery.

The purpose of the invention is to increase the lytic effect in patients who do not show the removal of calculi by surgery.

The method is carried out as follows.

Prior to the introduction of solvents into the biliary tract, their direct effect on the crystal structures of the bile of the patient, obtained by duodenal sounding, puncture or drainage of the biliary tract, is studied using the method of polarization microscopy. Bile samples of 5 ml immediately after preparation are centrifuged for 10 minutes at a speed of 3000 rpm. After that, two drops of sediment are placed between the slide and cover glasses and viewed on an optical microscope in polarized light under low magnification. The study was carried out at room temperature immediately after preparation. The presence of solid crystalline structures is recorded in the field. Solid crystals of cholesterol monohydrate, which are a sign of cholesterol impurity in the composition of the stone, have the appearance of quadrangular stepped structures. Microspherolites, indicative of calcium carbonate impurities, are visualized as oval-shaped structures with concentric circles or zones of luminescence diverging from the periphery to the center. Calcium bilirubinate structures, indicating pigment impurities, are seen as lumps or granules of irregular shape, and also amorphous masses with low optical density.

Then tests are carried out with the available drugs. A physiological solution of sodium chloride is used for control. A drop of bile sediment is mixed with a glass rod with a drop of solvent and the reaction is observed for 30 minutes, in the polarized light of a microscope. Depending on the effect of which solvents, when observing for a given period of time, is the most effective.

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the combination of these crystals is selected according to the speed and completeness of the lysis of the crystals. The treatment is carried out by the introduction of selected solvents into the biliary tract. The introduction of solvents is carried out sequentially in fractional or constant droplet method in a 1: 1 ratio. Fractional administration is used to dissolve gallbladder stones. The single dose for fractional administration is determined by the capacity of the gallbladder, the intervals between injections vary from 4 to 12 hours. Permanent drip is used for residual choledocholithiasis. The daily dose of solvents is 100-150 ml. Monitoring the effectiveness of treatment is carried out every 5-7 days using x-ray television and ultrasound.

Example 1. Patient K., 70 years old, was admitted to the hospital with a diagnosis of acute obstructive calculous cholester-pancreatitis. Due to the ineffectiveness of conservative treatment and the high risk of abdominal intervention, laparoscopic cholecystostomy has been performed. Decompression drainage and gallbladder sanation were performed. Acute inflammatory events in the biliary tract were stopped after 10 days. In samples of bile obtained from the gallbladder, cholesterol monohydrate crystals and microspherolites were revealed, indicating a cholesterol-lime composition of stones. The effect of four solvents (neparin, sodium citrate, No. 2-EDTA, monooctanoin) on bile crystal structures was studied. It was found that monooctanoin has the highest efficiency with respect to cholesterol crystals, and sodium citrate with respect to microspherolites. Heparin and Naa EDTA had no effect on the crystals. The introduction of selected solvents in the gallbladder e ratio of 1: 1. A single dose ranged from 20 to 40 ml. The intervals of administration were 8 hours. During the control examination, after 12 days, a reduction in the size of stones to 2-4 mm in diameter was revealed. After 21 days, complete dissolution of the stones was achieved.

Example 2. Ill., 72 years old, was admitted to the hospital with a diagnosis of acute calculous cholecystitis. The therapy was not effective, laparoscopic cholecystostomy was performed. In the study of bile, obtained by puncture of the gallbladder, cholesterol monohydrate crystals and microspherulitis were revealed. It was found that the greatest efficiency to cholesterol crystals

monoctanoin possesses, and microspherolites possesses L-EDTA. Conducted fractional introduction of these solvents in 20 ml three times a day in a 1: 1 ratio. With

examination after 10 days the size of stones decreased twice. Complete dissolution was obtained after 20 days.

Example 3. Patient K., 41 years old, was admitted to the hospital with a diagnosis of acute

calculous cholecystitis. Produced cholecystectomy with drainage of the stump of the cystic duct. In the postoperative period, a single calculus was found during X-ray examination.

choledoch. In samples of bile obtained from drainage, crystals of cholesterol monohydrate are revealed. When studying the effect of various solvents, monooctanoin was the most effective. The solvent was introduced by a constant drop method of 100 ml per day.

During follow-up examination after 7 days, the size of the stone decreased to 0.5 by 0.4 cm. After 14 days, the complete dissolution of the calculus was achieved.

The proposed method for the treatment of gallstone disease was used in 10 patients with multiple gallbladder stones and bile ducts. In all cases, complete dissolution of the stones was achieved.

In order to determine the individual character of therapy with litholytic, a study

stones, as before, and a study of the crystal structures of the bile of the patient, obtained by duodenal intubation, puncture or drainage of the biliary tract, which increases the efficiency

dissolving gallstones in patients who do not show abdominal surgery.

Individual selection of drugs can be carried out not only in patients with residual choledocholithiasis, but in all

patients with gallstone disease.

The possibility of studying the litholytic effect on crystals of various preparations promotes an increase in the efficacy in the dissolution of biliary stones.

Claims (1)

Invention Formula A method for the treatment of cholelithiasis, including the introduction of cholelithic drugs into the biliary tract, characterized in that, in order to increase the lytic effect in patients who do not show surgical removal of stones, the effect of preparations on crystalline preparations; preparations that exert the bile structures of the patient during conduction are applied, in a volume correlation microscopy, followed by 1: 1.