SU1466717A1 - Method of treatment of peritoneal adhesions - Google Patents

Abstract

The invention relates to medicine, namely to the X-ray endoabdominal method of examination and treatment of patients. To reduce the number of complications, the patient is administered under the control of 3900-5500 cm of gas before the diaphragm moves no more than 10 mm. The patient is transferred to the position on the abdomen and the rhythmic pumping movements of his body are gradually made in both directions by at least 80-90 ° C. within 10-15 minutes It is then transferred to the position on the back and the artificial peritoneum is dismissed.

Description

one

The invention relates to medicine, namely to the X-ray endoabdominal method of examination and treatment of patients.

The purpose of the invention is to reduce complications.

The method is carried out as follows.

The patient takes 400-500 ml of a barium sulphate suspension or is injected through the rectum up to 1500 ml. After the contrast agent reaches the terminal ileal or sigmoid colon, the patient is subjected to a strained pneumoperitoneum in a supine position (after sedation with analgesic drugs). Gas is introduced into the abdominal cavity under a pressure of 700-800 mm of water. Art. within 15–20 min in an amount of from 3,000 to 5,500 cm. The introduction of gas is monitored during X-ray examination, both during radiography and during rheithographography. In this case, the main focus is on determining the mobility of the diaphragm. Introduction of gas to the abdominal

the cavity is stopped at the moment when the patient switches mainly to the rib type of respiration, and the respiratory movements of the diaphragm cease and do not exceed 10 mm in amplitude. After removing the puncture needle and placing the aseptic dressing, the patient is placed in a position on the abdomen and gradually begins to make rhythmic swinging movements of his body in both directions for at least 80-90 ° for 10-15 minutes. After completion of the procedure for stretching and breaking adhesions in the process of rhythmic rocking movements, the patient is placed in a position on his back and artificial peritoneum is opened. To this end, the puncture needle is reintroduced into the abdominal cavity, and after the needle is removed, the puncture site is lubricated with 3% iodine solution and covered with aseptic dressing.

Example 1. Patient K. has a clinical diagnosis of radiographic examination of the abdominal organs: adhesions 4ik

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on peritoneal disease. A study of the gastrointestinal tract. The patient received 400 ml of barium sulfate suspension; after 4 h, the contrasting mass at translucency reached the terminal section of the ileum, as well as the blind and ascending part of the large intestine. When X-ray, pain in the right iliac region and limited mobility of the ileocecal angle was noted. In position on the patient's back after lubricating the skin with 3% iodine solution, an abdominal puncture was performed along the white line of the abdomen 2 cm below the navel after local anesthesia (20 ml of 0.25% novocaine) and subcutaneous injection 1 ml of 2% solution of promedol. With help, and the Bobrov apparatus, 3000 cm of oxygen was introduced into the abdominal cavity. When 2600 cm of oxygen were introduced into the abdominal cavity, the patient felt difficulty in breathing, a feeling of distended abdomen and increased pain in the right iliac region. When radiography at this point, there was a sharp limitation of mobility around the diaphragm during deep inspiration and expiration in comparison with the initial data. 15 minutes after the start of the introduction of gas into the abdominal cavity, when the amount of oxygen reached 3000 cm, the patient noted a more significant difficulty in breathing. In the case of radiography and reference X-ray polygraphy, it was established that the respiratory mobility of the diaphragm is 5 mm. The introduction of gas was stopped, the pressure in the abdominal cavity was 800 mm of water. Art. The needle is removed, the puncture site is closed with an aseptic dressing. The patient was transferred to a position on the abdomen, noted a significant increase in pain in the right iliac region. Rhythmic swinging movements of the patient's body were initiated in both directions, the frequency of which gradually increased. The inclination of the body in each direction was 80-90 °. The duration of the procedure was 10 minutes. Upon completion of this treatment for adhesive disease, the patient noted a significant reduction in pain in the right iliac region. The patient is laid in position on the back. By repeated puncture of the abdominal cavity, the pneumoperitoneum was dissolved through the needle at the site of anesthesia, and an aseptic sticker was applied to the puncture site. Patient's state of health is satisfactory. When observed for 1 year, the pain syndrome of adhesive disease is not resumed.

Example 2. Patient R., with a diagnosis of adherent peritoneal disease. When the barium suspension of the digestive tract (250 ml) was contrasted, slowed passage of barium along the loops of the small intestine was noted.

Palpation noted tenderness in the epigastric region and a restriction

active and passive mobility of small intestine loops. After 24 h, the contrast suspension is located in the terminal part of the ileum, blind, dawn, transverse, descending, and sigmoid colon. Assigned additional 250 ml of barium suspension. After filling the jejunum, 1 ml of 2% p-ra promedol was subcutaneously injected. In the supine position, a tensioned pneumoperitoneum is applied.

Within 20 minutes, 5500 cm of oxygen was introduced into the abdominal cavity. The maximum pressure at the time of transition to the fin type of breathing was 700 mm of water. Art. X-ray polygraphically determined that the mobility of the diaphragm was 10 mm. The therapeutic procedure for stretching and breaking adhesions lasted 15 minutes. The rhythmic oscillations of the body from one side to the other were 80-90 °. The patient is under medical observation for 6 years. Sprasob treatment of adhesive disease with an interval of 7 months. held twice. In the past 4 years, the symptoms of adhesive disease have not resumed.

Example 3. Patient 3. A clinical and radiological examination, including a diagnostic pneumoperitoneum, revealed multiple adhesions in the cecum and ascending colon. Treatment of adhesive disease was carried out after medication and tight filling of the colon in the position on the right side. Using an enema, 1500 ml of barium suspension was injected. The strained pneumoperitoneum was carried out in the same way as in Example 1. 4200 cm of oxygen was injected into the blasting cavity under a pressure of 740 mm of water. Art. within 18 min It was found radiographically that the mobility of the diaphragm was 7 mm. After removing the puncture needle, an aseptic dressing is applied and the patient is placed in a position on the abdomen. Carried out the rhythmic movement of the body from side to side at an angle of 80-90 ° for 12 minutes. At the beginning of the treatment procedure, the patient noted an increase in pain in the right half of the abdomen, and after it ended, subjective relief came. Therapeutic pneumoperitoneum was dissolved as well as in other patients. In a radiological X-ray study, the disappearance of thin adhesions and stretching of thicker ones were recorded. It is monitored for 4 years. The state of health is satisfactory.

The proposed method was tested in 57 patients. In the treatment with the proposed method, no opening of the quarrel cavity is performed and thus excludes possible complications associated with laparotomy, laparoscopy. In addition, the proposed method can be applied in polyclinic conditions.

Thus, the proposed method significantly expands the treatment of peritoneal adhesive disease, while it is less traumatic, since it is not accompanied by opening of the abdominal cavity, so it is possible to carry out it directly in X-ray diagnostic rooms and in outpatient clinics.

Claims (1)

Invention Formula A method of treating peritoneal adhesive disease by stretching and breaking adhesions, characterized in that, in order to reduce of complications, 400-500 ml of barium suspension are injected into the gastrointestinal tract, after contrasting the terminal ileum or sigmoid colon, the gas is injected into the abdominal cavity under a pressure of 700-800 mm of water. Art. within 15-20 minutes in the amount of 3000-5500 cm, and the introduction of gas is controlled by X-ray printing and stops when the diaphragm moves no more than 10 mm, after which the patient is placed in a position on his stomach and rhythmic oscillatory movements are made in both directions for at least than 80-90 ° for 10-15 minutes.