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4MEDICAL SCIENCES
INCREASING THE EFFICIENCY OF TREATMENT IN PATIENTS WITH CHRONIC DACRYOCYSTITIS IN THE POSTOPERATIVE PERIOD
Khushvakova N.
MD Professor Head of the Department of Otorhinolaryngology No. 1
Samarkand State Medical University Samarkand, Uzbekistan Nurmuhamedov F.
Assistant of the Department of Otorhinolaryngology No. 1 Samarkand State Medical University Samarkand, Uzbekistan Burkhanov U.
Assistant of the Department of Otorhinolaryngology No. 1 Samarkand State Medical University Samarkand, Uzbekistan DOI: 10.5281/zenodo.7234426
Abstract
The evaluation of the effectiveness of treatment in the postoperative period in 50 patients with chronic dacryocystitis was determined as the goal of our study. All processes in the wound occur due to the activation of complex enzyme-catalytic systems and the effective healing of the wound strictly depends on the prescribed differential treatment depending on the stage of the wound process. The process of wound healing in a short time is possible if the prescribed measures and prescribed drugs correspond to the physiological stages of the wound process. After endonasal endoscopic dacryocystorhinostomy, a gel-type anti-adhesin drug was injected into the lacrimal duct every 2 hours and the cytological composition of smears of the nasal mucosa was examined to evaluate the course of reparative processes in surgical wounds. The study showed that the effectiveness of postoperative treatment of patients with chronic dacryocystitis increased in the main group of patients using antiadhesin, which led to better healing of wounds and epithelization by the 7th day, whereas in the comparative group this process occurred only on the 14-17th day.
Keywords: chronic dacryocystitis, end of mucosal damage, endoscopic dacryocystostomy, antiadhesin.
Relevance. Regardless of the type of injury and the degree of tissue damage, each injury process takes place in three physiological stages at the cellular and tissue level, corresponding to morphological changes. At the time, N.I. Pirogov also distinguished 3 stages.
Today, M.I. The Kuzin approach is widely used. Thus, in the exudation stage, all physiological processes are now focused on isolating the damaged tissue, which is irreversible and serves as a potential source for the development of infection and intoxication. All processes in the wound at this stage occur due to the activation of complex enzymatic-catalytic systems (kallikrein-kinin, Hageman factor, fibrinogen, S-reactive protein, prostaglandins, biogenic amines, etc.). In the proliferation stage, collagen synthesis by cells and the formation of foci of cell division in the cleared areas - i.e. granulation tissue -are observed. Then the epithelialization stage or the final finishing process begins. The stages usually pass from one to the other in sequence, and it is not always possible to tell exactly at which stage the injury is currently occurring when the stages pass from one to the other. Even if sometimes one stage is going on in some areas of the injury, another stage can be observed in another area of it. When the periodicity is disrupted in the stages of injury, the formation of a rough scar, the development of endless wounds with constant granulation growth, which is often associated with the influence of exogenous causes.
Recently, a number of scientists have begun to pay more attention to a topical issue such as diagnosing narrowing and occlusion of the tear ducts, as well as studying their anatomy.
This suggests that changes in the tear sac relative to intranasal structures have created great opportunities for more adequate selection of the type of operation.
The rapid development of modern research methods based on the application of computer technology in this area has predetermined new qualities of diagnostics. Modern stage computed tomography (CT) of diagnosis is the most informative. Research methods that allow the assessment of the anatomical structure of the nasal cavity i.e. the nasal and nasal lateral cavities and their relationship to the lacrimal sac are more clearly demonstrated by CT.
Well-known advances in medical science and modern technology on this problem are already evolving in the form of dacryocystitis some methods of diagnosis, treatment and prevention of potassium pathology related to.
However, many of the treatments used were radical in nature, excluding physiological and organ preservation functions. But in modern endoscopic surgery it is necessary to follow the most important rules of functional and soft surgery. Thanks to the advances of modern rhinology with the introduction of endoscopic rhinosinus surgery for more than thirty years, rhinosinusologists are new to surgical
intervention. using high technology and functional approaches.
To one degree or another, all who suffer from chronic caloric dacryocystitis patients are usually suitable for rhinopathology. The direct correlation of lacrimation with changes in the nasal cavity is related to the anatomical and topographical features of the lacrimal and rhinological systems. Close anatomical proximity, fullness of the nasal mucosa and nasolacrimal duct identification, their transition from one to another, their blood and The pathological processes in the lymphatic circulation in the presence of a single dense venous plexus leading to the direct thief's spread from the nasal cavity to the tube ducts is coming.
In recent years, the development of dynamic minimally invasive microendoscopic surgical interventions in the treatment of patients with chronic dacryocystitis output and implementation were recorded. However, the development of an effective treatment diagnostic algorithm and perioperative patient data management remains open to improving the quality of their treatment.
The task of all diagnostic methods is to determine the presence of purulent discharge in patients with lacrimation and in a particular rhinopathology, as well as to determine the predicted zone of obstruction of the lacrimal drainage apparatus. A well-conducted diagnostic examination will help to determine the correct treatment tactics.
The use of soft functional rhinosinusology and endoscopic equipment, video equipment and monitors, originally provided by M. Messerklinger, has improved the quality of life of operated patients and reduced postoperative complications. Therefore, the novelty of modern surgical practice of su-runcal dacryocystitis with, it is necessary to develop similar surgical intervention methods that can combine the high efficiency of functional results with the maximum preservation of existing anatomical structures.
The effective healing of the injury will depend on the differential treatment prescribed depending on the stage of the injury process. Each stage of the injury will have its own characteristics and specific needs that are necessary for the smooth running of the injury process. The use of such a method of treatment allows the wound to heal quickly.
Each injury has a true reparative potential, which has long been studied by researchers and is based on physiological processes, manifested by a clear, staged mechanism of the healing process. That is, the wound heals in a short time only if the prescribed measures and prescribed drugs in the course of wound healing are consistent with the physiological stages of the wound process. Taking into account the physiology of the traumatic process is one of the most important conditions for effective treatment of trauma.
Thus, in the process of differentiated treatment of the injury, it is necessary to take into account that the injury may have several stages of healing at the same time, and at the same time not to slow down the process of progress.
The purpose of the study was to assess the effectiveness of treatment of patients with chronic dacryocystitis in the postoperative period.
Sources and methods of examination: In the department of our clinic, we examined 50 patients aged 18 to 50 years who complained of tears on our part.
In order to assess the progress of reparative processes in the surgical wound after endonasal endoscopic dacryocystorinostomy, the cytological composition of the smears prepared on the subject glass was examined using a cotton swab under the control of a 0 ° endoscope from the nasal mucosa in the operated area. The surface of the subject glass was wiped with 90 ° alcohol to degrease. The drugs were stained by the Romanovsky-Gimza method, and then the cell elements were counted in a 5-dimensional field of view. The results were calculated in percentages. The process of recording the results and taking microphotos was carried out using a Leica microscope (Austria) and a camera "Zenit-ET" with a special photo pole.
All patients underwent endonasal dacryocystorinostomy, and 10 patients underwent reexamination using a 0.7-0.8 cm diameter dacryorinostoma with silicone stent-drainage (consisting of an intubation tube).
Patients were divided into two groups. In the main group (25 patients) immediately after the installation of an additional hole and for 20 days after surgery through the tear ducts (along the stent-drainage) antiadgesin drug in the form of gel every 2 hours, in the second - in the comparison group (25 patients) no anti-scar drug was used in the postoperative period. We used an antiadgesin drug in gel form. The effectiveness of the antiadgesin drug is due to the formation of a temporary artificial barrier between the damaged tissues and its bacteriostatic effect, which ensures the separation of surfaces during repair.
The results of the inspection and their discussion. The dynamics of the wound process was analyzed on the basis of cytological examination of smears taken from the wound site in the area where endonasal endoscopic dacryocystorinostomy was performed. formed leukocytes. The presence of individual macrophages in the phagocytosis stage, a very small number of polyblasts, was noted.
By day 7, the neutrophil count in the wound fluid was reduced by 30% (P <0.05) and the first signs of degeneration began to appear. The amount of eosinophils increased up to 5-fold, which is due to the reaction of the underlying tissues to the antiadgesin drug. There is also a significant increase in the number of lymphocytes, fat cells, plasma cells and macrophages, which is associated with a good quality of the inflammatory-regenerative type of injury. Migrated epidermal cell fragments appear in a state of destruction. By day 7, the appearance of epithelial cells is characteristic, indicating active epithelialization. By 14 days, a further decrease in neutrophil counts was observed, in which cells with distinct degenerative-dystrophic features predominated: loss of gravity between nucleus segments, their deformation and resizing, loss of granulation, and the formation of numerous vacuoles. The presence of traumatic detritus
is observed only in the form of residual cell-shadows, the amount of macrophages in the state of complete phagocytosis is significantly increased. It should be noted that fibroblasts appeared and their number increased to 17% (p <0.05). Epithelial cells were found at all times, and their numbers peaked at 14 days. By day 21, epithelialization of the wound surface was noted across all areas of the wound surface.
The smears of the second group showed a very dusty picture of cell composition: on the 3rd day after surgery, the main part of the cell content was neutrophilic leukocytes with clear granules (44%) (p <0.05), elderly fibroblasts with elongated nucleus (21%). (p <0.05) and epithelial cells - formed a simple cubic amniotic epithelium. Individual macrophages with weak phagocytic activity appear, and their quantitative composition is minimal. Lymphoid array cells are also characterized by their individual composition. By 7 days, neutrophil counts decreased by 10% (P <0.05), and macrophage counts doubled in parallel. The quantitative composition of the lymphoid row cells remained almost unchanged, while the composition of fi-broblasts remained at the same level as before. By day 14, the neutrophil count had almost halved, and most of them were characterized by weak granulation. The number of plasma cells increased almost 2-fold, while the quantitative index of macrophages remained unchanged, but phagocytosis took on a complete character and was observed to be quantitatively consistent with the number of neutrophils. It should be noted that at all periods of follow-up, patients in the second group showed a significant decrease in cellular elements in the inflammatory exudate, minimal changes in the quantitative parameters of cellular elements, which corresponds to the view of wound healing.
Conclusion. Thus, an assessment of increased postoperative treatment efficacy in patients with chronic dacryocystitis showed that the use of anti-adgesin in the main group of patients resulted in better wound healing and epithelialization by 7 days, compared with only 21 days in the comparative group. The antiadgesinic property of the drug reduces the permeability of the wound parts to large molecules, protects tissues from toxins and prevents the entry of microbes (bacteria, simple animals and fungi), rapid cleansing of wounds from enzymatic catalysis products and strong epithelialization of collagen and rough scar development.
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