RU2833825C1 - Method of treating acute paraproctitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to coloproctology. Intraoperative sigmoidoscopy is performed with inspection at depth of 25 cm. Anal canal is examined for fistulas. Suppurative focus is opened at 3 o'clock; the purulent contents are evacuated. Abscess cavity is washed with 3 % hydrogen peroxide and chlorhexidine. Dye – a mixture of fucarcinum solution and 3 % hydrogen peroxide in ratio of 1:1 – is introduced into the cavity treated with antiseptics, and the presence of dye leaks in the anal canal from the abscess cavity is determined. Performing laser decontamination, including treatment of walls of abscess cavity with laser radiation at wave length 1.56 mcm and power 10 W fan-shaped superficially with speed of light guide 1 mm/s. Haemostasis is performed, turunda with Levomekol ointment is introduced and an antiseptic dressing is applied.

EFFECT: method provides preserving the obturator function, reducing the number of recurrences of the disease, reducing the risk of recurrent planned surgery for rectal fistula, reduced length of stay in hospital, higher quality of life due to reduced postoperative pain syndrome, faster healing and rehabilitation.

3 cl, 1 ex

Description

Field of technology

The invention relates to medicine, namely to proctology.

State of the art

A method for treating acute paraproctitis is known, during which the wound is treated with low-frequency ultrasound through a napkin with ozonized saline solution. Dressings are made with ozonized olive oil - in the first phase of the wound process, olive oil with a peroxide number of 8-9% is used, and in the second phase - with a peroxide number of 4-5%. The method allows for pathogenetic action on the phase of the wound process, while the effect is carried out both in the inflammation phase for the purpose of decontamination and eradication of microflora in the wound, and in the reparation phase of the wound process for the purpose of stimulating angiogenesis (RU 2376046 C1 20.12.2009).

A method of treating acute paraproctitis is known, which includes opening and draining the abscess. An elastic latex strip is passed through the purulent tract. The ends of the strip are fixed to the skin with tension. The place of fixation of the strip is moved. In this case, its constant tension is ensured until the fibers of the anal sphincter are cut through together with the purulent tract (RU 2190972 C2 20.10.2002).

A method for treating acute paraproctitis using laser radiation is known from the prior art (Kotenko K.V., Kovalev S.A., Bedzhanyan A.L., Khitaryan A.G., Alibekov A.Z., Mikhailova A.A., Korchazhkina N.B. Modern surgical technologies in the treatment of patients with chronic paraproctitis. Surgery. Journal named after N.I. Pirogov. 2022; 4:80–85), this method was chosen as a prototype.

Disadvantages of previously known methods. For method RU 2376046 C1 20.12.2009, special equipment is used - an ozone therapy apparatus, the hospitalization period for patients after surgery is at least 7 days, it is necessary to carry out manipulation daily for 6-7 days, the use of ozone increases the risk of bleeding, the method has a risk of relapse of the disease and involves a repeat planned operation for fistula of the rectum. For method RU 2190972 C2 20.10.2002, according to numerous literary data, the phenomena of anal insufficiency reach 46% in the late postoperative period in varying degrees of severity, the method is accompanied by severe pain syndrome until the ligature falls out, requires hospitalization for periods of 5 to 15 days, has a risk of sphincter tissue necrosis.

The problem that this invention is aimed at solving is to preserve the locking function, reduce the number of relapses of the disease, reduce the risk of repeated planned surgery for a fistula of the rectum, reduce the duration of hospitalization, improve the quality of life of patients by reducing postoperative pain syndrome, and accelerate the healing and rehabilitation processes.

Disclosure of invention

The technical result consists in vaporization of the abscess walls by laser radiation, which allows for their antimicrobial sanitation, elimination of the inflammatory cellular lining of the abscess cavity, preservation of the subcellular protein structures of the wall to accelerate the healing process. According to studies, heating of the surrounding tissues does not exceed 40 degrees Celsius, which significantly reduces the postoperative pain syndrome and perifocal inflammatory reaction.

This technical result is achieved through the following techniques.

Under intravenous anesthesia, after treating the surgical field, treat the surgical field, perform intraoperative retroromanoscopy with examination to a depth of 25 cm, examine the anal canal for fistulas. Then, sharply open the purulent focus at 3 o'clock on the conventional dial, evacuate the purulent contents. Wash the cavity with a 3% solution of hydrogen peroxide and chlorhexidine. Then, a dye is introduced into the cavity treated with antiseptics - a mixture of fucorcin solution and 3% hydrogen peroxide solution in a ratio of 1: 1. And determine the presence of dye leaks in the anal canal from the cavity. If no leaks are detected, laser decontamination is performed, including treatment of the cavity walls - with laser radiation with a wavelength of 1.56 μm and a power of 10 W fan-shaped superficially at a speed of advancement of the light guide of 1 mm per 1 second. The locations of the leaks are treated with a radial light guide with a wavelength of 1.56 μm and a power of 10 W with a speed of advancement of the light guide of 1-2 mm per second. Fistulas are detected in the anal canal, and if they are detected, the fistula tracts are treated submucosally with an end light guide with a wavelength of 1.56 μm and a power of 10 W. At the end of the operation, hemostasis is performed. A turunda with Levomekol ointment is inserted. An antiseptic bandage is applied.

Implementation of the invention

Under intravenous anesthesia, after treating the surgical field, treat the surgical field, perform intraoperative retroromanoscopy with examination to a depth of 25 cm, examine the anal canal for fistulas. Then, sharply open the purulent focus at 3 o'clock on the conventional dial, evacuate the purulent contents. Wash the cavity with a 3% solution of hydrogen peroxide and chlorhexidine. Then, a dye is introduced into the cavity treated with antiseptics - a mixture of fucorcin solution and 3% hydrogen peroxide solution in a ratio of 1: 1. And determine the presence of dye leaks in the anal canal from the cavity. If no leaks are detected, laser decontamination is performed, including treatment of the cavity walls - with laser radiation with a wavelength of 1.56 μm and a power of 10 W fan-shaped superficially at a speed of advancement of the light guide of 1 mm per 1 second. The leaks are treated with a radial light guide with a wavelength of 1.56 μm and a power of 10 W with a speed of advancement of the light guide of 1-2 mm per second. Fistulas are detected in the anal canal, and if an internal fistula tract is detected, it is submucosally treated with an end light guide with a wavelength of 1.56 μm and a power of 10 W. Hemostasis is performed. A turunda with Levomekol ointment is inserted. An antiseptic bandage is applied.

Examples of implementation

A 42-year-old patient sought help with a diagnosis of acute ischiorectal paraproctitis. Surgical treatment was performed - opening the abscess cavity, sanitizing the abscess cavity with a chlorhexidine solution and swabs moistened with a 3% hydrogen peroxide solution. A dye was introduced into the cavity (a mixture of fucorcin solution and 3% hydrogen peroxide), the presence or absence of dye entering the anal canal was determined. The walls of the cavity were treated with laser radiation with a wavelength of 1.56 μm 10 W end-face light guide in a fan-shaped superficial manner at a speed of advancement of the light guide of 1 mm per 1 second. Leaks were detected, the places of which were treated with a radial light guide with a wavelength of 1.56 μm and a power of 10 W at a speed of advancement of the light guide of 1 mm per second. An internal fistula opening was detected and it was treated submucosally with an end-face light guide at the same power. A tampon with Levomekol ointment was inserted into the cavity. The tampon was removed the next day. The patient was discharged on the 2nd day after the operation. During the follow-up examination after 3-4 days, the drainage incision was checked and the cavity was washed with chlorhexidine solution.

Claims (3)

1. A method for treating acute paraproctitis, characterized in that, under intravenous anesthesia, after treating the surgical field, an intraoperative rectoscopy is performed with an examination to a depth of 25 cm, the anal canal is examined for fistulas, then the purulent focus is opened sharply at 3 o'clock on a conventional clock face, and the purulent contents are evacuated; the abscess cavity is washed with a 3% solution of hydrogen peroxide and chlorhexidine, then a dye is introduced into the cavity treated with antiseptics - a mixture of a solution of fucorcin and a 3% solution of hydrogen peroxide in a ratio of 1:1 and the presence of dye leaks into the anal canal from the abscess cavity is determined, then laser decontamination is carried out, including the treatment of the walls of the abscess cavity with laser radiation with a wavelength of 1.56 μm and a power of 10 W in a fan-shaped superficial manner with a light guide advancement speed of 1 mm / s, hemostasis is carried out, a turunda with levomekol ointment is inserted and an antiseptic bandage is applied. 2. The method according to paragraph 1, characterized in that, if there are leaks, their locations are treated with a radial light guide with a wavelength of 1.56 µm and a power of 10 W at a light guide advancement speed of 1-2 mm/s. 3. The method according to paragraph 1, characterized in that when fistulas are detected in the anal canal, the fistula tract is treated with an end-on light guide with a wavelength of 1.56 µm and a power of 10 W.