RU2627350C1 - Method of treatment of epithelial pilonidal sinus at the stage of abscedation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: after excision of the epithelial pilonidal sinus with the abscess shells, the wound bottom is treated for 5 minutes with a gas stream containing the nitrogen monoxide of the Plazon apparatus in the NO-therapy regime. After suturing and vacuum drainage of the wound along the Redon, deviating from the left and right edges of the ends of the postoperative wound, is administered subcutaneously in a solution of 32 units of lidase. 10 minutes after the administration of lidase, retreating to 1 cm from the place of its introduction, injected subcutaneously in a solution of 50 mcg of immunophane. The administration of lidase and immunofan is repeated after 48 hours in combination with the treatment of the postoperative wound for 5 minutes with nitrogen monoxide in the NO-therapy regimen.

EFFECT: method allows to improve the results of treatment of patients with epithelial coccygeal circulation at the stage of abscess formation, due to the combined and complex effect on the wound and its area.

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Description

The invention relates to medicine, namely to purulent surgery, coloproctology and can be used for surgical treatment of patients with epithelial coccygeal passage at the stage of abscess formation.

In medicine, in patients with epithelial coccygeal passage at the stage of abscess formation, the radical method of treatment is surgical intervention (Fedorov V.D., Vorobiev G.I., Rivkin V.L. Clinical surgical coloproctology. M .: Medicine, 1994. - P. 401-408; Alesperov E.E., Koptaladze AM, Protsenko V.M. Tactics and methods of surgical treatment of acute suppuration of the epithelial coccygeal passage // Actual problems of Coloproctology: Mat. All-Russian Conf. (Irkutsk, September, 1999) / TSMU. - Irkutsk, 1999. - S. 81-82; An V.K., Rivkin V.L. Emergency proctology // M .: Medi Ina, 2003. - S. 51-56; VL Bogdanov, Justification of the tactics of surgical treatment of suppurative epithelial coccygeal passage at the stage of abscess formation // Abstract of Candidate of Medical Sciences ... Rostov-on-Don, 2011. - 20 p. ; Zhdanov A.I., Korotkikh N.N., Brezhnev S.G. To the method of surgical treatment of epithelial coccygeal passage // Almanac of the A.V. Vishnevsky Institute of Surgery, 2015, No. 2. - P. 485).

The tactics of surgical treatment of epithelial coccygeal passage at the stage of abscess formation is carried out in two directions: one-stage and two-stage surgical interventions. One-stage operations include opening an abscess, excising the epithelial coccygeal passage with subsequent open wound management or suturing the wound tightly using flow drainage (Doditsa A.N., Remizov S.V. Surgical treatment of patients with epithelial coccygeal abscess // Problems of Coloproctology: Sat scientific science / SSC. - Moscow, 2006. - Issue 19. - P. 100-103; Lavreshin P.M., Muraviev A.V., Gobedzhishvili V.K. Optimization of treatment methods for epithelial coccygeal passage // Problems of Coloproctology: Collection of scientific papers / SSC.- Moscow, 2 000. - issue 17. - S. 126-131; Oncel M., Kurt N., Kement M. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial // Coloproctol., 2002; 6; 3: p. 165-169; Tritapepe R., Padova CD Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing // Am. J. Surg., 2002; 183; 2: p. 209 -211).

However, the size of the purulent cavity does not always allow an initial radical operation. Therefore, most surgeons resort to a two-stage method of treatment, with various therapeutic and tactical approaches.

A known method of delayed radical surgical treatment. First, a puncture is performed, pus is evacuated, a purulent cavity is filled with one or another antiseptic. After 3-6 days, a radical operation is performed (Alekperov E.E. Delayed radical operations in acute suppuration of the epithelial coccygeal passage: abstract of dissertation ... Candidate of Medical Sciences - M., 2002. - 21 p.). During the operations of opening the purulent cavity and radical excision of the epithelial coccygeal passage, the wound walls are treated with ultrasound (Sharipova M.A. Combined use of low-frequency ultrasound and perftoran in the treatment of purulent diseases of the perineum and coccyx // Actual problems of coloproctology: collection of scientific articles / SSCC. - Moscow, 2002. - Issue 18, - P. 51-53) or a laser (Matsyak Yu.A. Application of helium-neon laser irradiation in the complex treatment of postoperative wounds of the anorectal region: abstract of dissertation of Candidate of Medical Sciences . ... - Lviv , 1989. - P. 20; Krochek I.V., Sergienko S.V., Popov V.P. A method for treating epithelial coccygeal passage using a fiber optic laser // Almanac of the A.V. Vishnevsky Institute of Surgery, 2015, No. 2. P. 25-26; Galashtayan K.M., Cherkasov M.F., Startsev D.M., Cherkasov D.M. Comprehensive treatment of epithelial coccygeal passage using vacuum therapy // Almanac of the Institute of Surgery named after A. V. Vishnevsky, 2015, T. 2.P. 1078-1079).

The disadvantages of analogues are:

- the first stage - preparation for a radical operation is long in time (from 3 to 5 days);

- with preoperative preparation, local and general symptoms of a purulent infection persist;

- the microbial flora quickly adapts and acquires resistance to antibacterial drugs;

- methods that improve the quality of surgical treatment (ultrasound, laser beams, etc.) are not used;

- the length of inpatient treatment is lengthened;

- the labor costs of medical personnel and the consumption of medicines are increasing.

There is a method in which the abscess is pre-punctured with a needle followed by aspiration of the contents, and the movement of a monofilament fiber of a diode laser operating in a continuous mode with a wavelength of 970 nm with a power of 2.5 W occurs along a circular or serpentine path with exposure at one point from 3 up to 30 seconds (Method for surgical treatment of epithelial coccygeal passage. Authors: Abushkin I.A., Privalov V.A., Lapa A.V., Krochek I.V., Khatuntsev I.G., Tkacheva A.N. invention No. 20005100352 dated 06/20/2006).

The disadvantages of this method are:

- interstitial laser thermotherapy requires manipulation under the control of ultrasound;

- evaporation of the changed tissues is carried out 2-3 times;

- if necessary, the procedure is repeated up to 3 times with an interval of 10 days;

- long term treatment;

- this method is technically laborious.

The present invention is aimed at improving the effectiveness of the quality of treatment of patients with epithelial coccygeal passage at the stage of abscess formation.

The specified technical result is achieved by the fact that after excision of the epithelial coccygeal passage with abscess sheaths, the bottom of the wound is treated for 5 minutes with a gas stream containing nitrogen monoxide flowing from the manipulator-stimulator-coagulator of the Plazon apparatus, in the NO-treatment mode, and after suturing and vacuum drainage of the wound according to Redon, on both sides of the postoperative wound, 1 cm from the left and right edges, 32 U of lidase diluted in physiological saline of sodium chloride are injected subcutaneously 10 minutes after administration of lidase in the same areas of the postoperative wound, departing 1 cm from the injection site of lidase, subcutaneously injected with 50 μg of immunofan diluted in physiological saline sodium chloride, while the administration of lidase and immunofan is repeated every 48 hours in combination with postoperative treatment wounds for 5 minutes with a gas stream containing nitrogen monoxide flowing out of the manipulator-stimulator-coagulator apparatus "Plason", in the mode of NO-therapy.

The discovery in the mid-80s of the fundamental fact of the production of endogenous nitric oxide in the body and its functions as a universal physiological regulator was the largest event in biology and medicine at the end of the 20th century, which was confirmed by the 1998 award of US scientists with the Nobel Prize. To date, it is known that in the human body N0 performs the most important biological functions that determine its regulatory role in the functional activity of effector and regulatory systems, including during wound healing. A significant role in wound pathology and chronic inflammation is played by endogenous N0 deficiency.

In accordance with the results of biomedical research at the Research Institute of EM MSTU. N.E. Bauman created a new universal air-plasma apparatus "PLAZON", which provides both modes of destruction, coagulation, sterilization, and NO-therapy (www.noxlab.ru). The temperature of the cooled NO-containing gas stream is brought to 18-20 ° C. The content of N0 molecules in the gas stream can be dosed from 0 to 2500 rpm by changing the gas flow rate in the stream and the distance from the outlet to the object.

The PLAZON device allows performing and combining the surgical effect of air-plasma flows on tissues with their coagulating, sterilizing and hemostatic effects, and NO-therapy, which is distinguished by the breadth and multifactorial nature of the regulatory and normalizing effect on pathological processes (Grachev S.V., Krotovsky GS, Rudenko TG et al. Development and implementation in medical practice of new medical technologies and technical means based on the use of air plasma and exagenic nitric oxide. Met. Recommendations. M., 2004. - 1 14 pp .; Khrupkin V.I., Zudilin A.V., Pisarenko L.V., Vagapov A.B., Nastich Yu.N. Low-energy plasma in the local treatment of purulent wounds of soft tissues // Military Medical Journal .-- 2002. - No. 2, t. 323. - pp. 91-92; Moskalenko V.I., Marakhonich L.A. Methods of microcirculation correction. NO-therapy // Microcirculation and methods of its correction. - M., 2003. - chap. 4 - p. 74-75).

Subcutaneous administration of lidase expands the fenestra between the lymphocytes and facilitates the penetration of immunofan into the lymphatic channel, which allows regional lymphoimmunomodulation aimed at increasing local immunity in the tissues of the wound wall and paravular tissue.

The method was tested on 23 patients who were urgently admitted to the purulent surgery department of GBUZ AO No. 3 of Astrakhan. Age from 18 to 29 years; men - 21, women - 2, from the onset of the disease from 3 to 7 days - 9 people, from 1 to 2 weeks - 6, more than 2 weeks - 2 and 6 months after spontaneous opening with fistulas in the coccyx. One patient had previously had an autopsy performed in another hospital. 20 people were self-medicating: antibiotics were introduced, topical dressings with ichthyol ointment (6), half-alcohol compresses (7) were used.

When removing the stitches in one patient seroma was released. There was no discrepancy between the edges of the wound. All patients were discharged in satisfactory condition. 18 people were examined after 1 month, no complaints. Pain when changing the position of the body, physical activity is not experienced, disability restored.

Below are the results of testing.

Example

B. T., 18 years old. Received December 11, 2015, 4 days after the onset of the disease with a diagnosis of "Epithelial-coccygeal passage at the stage of abscess formation." 12.12.2015, under intravenous anesthesia, after excision of the epithelial coccygeal passage with abscess sheaths for 5 minutes, the walls and bottom of the wound are treated with a gas stream containing nitrogen monoxide created by the Plazon apparatus in the mode of functioning of NO-therapy (Fig. 1). Then, after suturing and vacuum drainage of the wound according to Redon, on both sides of the postoperative wound, departing 1 cm from its left and right edges, 32 U of lidase diluted in physiological solution of sodium chloride are injected subcutaneously, and 10 minutes after the administration of lidase into the same areas of the postoperative wound, departing 1 cm from the injection site of lidase, are injected subcutaneously with 50 μg of immunofan diluted in physiological saline sodium chloride (Fig. 2). In this case, the administration of lidase and immunofan is repeated for a week every 48 hours in combination with the treatment of the postoperative wound for 5 minutes with a gas stream containing nitrogen monoxide flowing out of the Plazon apparatus stimulator-coagulator manipulator in the NO-therapy mode. Sutures were removed on the 7th day after the operation. The wound healed by primary intention. The patient was examined 1 month after the operation: a postoperative scar was formed, up to 0.2 cm wide (Fig. 3). No complaints. The proposed method is achieved:

- improving the effectiveness of the quality of treatment of patients with epithelial coccygeal passage at the stage of abscess formation;

- improving the quality and minimizing the time of preoperative preparation of the purulent foci for its radical surgical treatment;

- a gas stream of exogenous nitrogen monoxide produced by the Plazon apparatus in the NO-therapy mode flowing out of a manipulator-stimulator-coagulator, improving the quality of surgical treatment of a purulent focus;

- stimulation of regenerative processes in the postoperative wound by treating it and adjacent tissues with exogenous nitrogen monoxide;

- regional subcutaneous administration of an immunomodulator, targeted delivery of drugs to tissues of a postoperative wound and relief of local manifestations of inflammation;

- treatment with a gas stream containing nitrogen monoxide promotes activation of macrophages in the wound, proliferation of fibroblasts and wound healing.

Claims (1)

A method of treating the epithelial coccygeal passage in the abscess formation, namely, after excising the epithelial coccygeal passage in the abscess sheaths, the bottom of the wound is treated for 5 minutes with a gas stream containing nitrogen monoxide flowing out of the Plazon apparatus stimulator-coagulator, in the regimen NO-therapy, and after suturing and vacuum drainage of the wound according to Redon, on both sides of the postoperative wound, departing 1 cm from its left and right edges, 32 units of lidase diluted in physiological in a solution of sodium chloride, 10 minutes after the administration of lidase in the same areas of the postoperative wound, departing 1 cm from the injection site of lidase, subcutaneously injected with 50 μg of immunofan diluted in physiological saline sodium chloride, while the administration of lidase and immunofan is repeated for a week later every 48 hours in combination with the treatment of a postoperative wound for 5 minutes with a gas stream containing nitrogen monoxide flowing out of the manipulator-stimulator-coagulator of the Plazon apparatus in the NO-therapy mode.

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