RU2668790C2 - Method of collection of biopsy material of a colon wall for microbiological research from patients with ulcerative colitis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely, surgery and can be used to collect biopsy material of the colon wall for microbiological examination in patients with ulcerative colitis. Biopsy is performed not from the superficial layers of the mucosa, but from ulcerative and erosive defects, which are previously released from the fibrin film by scraping fibrinous overlays and detritus with open jaws of biopsy forceps. In the case where erosive and ulcerative defects are not detected, biopsy forceps take a mucosal site, which is sent for histological examination. Then, also biopsy forceps take the target material from the site of the previously taken biopsy.EFFECT: method allows to obtain exact quantitative and qualitative indices of microflora from the biopsy material of the mucous membrane of the colon, to reduce the effect on the result of microbiological examination of the transit intestinal microflora, which does not participate in the pathological process due to taking a biopsy from ulcerous and erosive defects, and in their absence from the place of the previously taken biopsy.1 cl

Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to surgery, and can be used to collect biopsy material of the colon wall to assess microbiological parameters in patients with ulcerative colitis.

State of the art

Known methods of collecting material from the mucous membranes of the gastrointestinal tract for microbiological examination by direct biopsy of the mucous membrane or ulcer, by aspiration of the material after washing [Ed. Prof. S.A. Blashentseva. - M .: GEOTAR - Media, 2009. - 520 s: ill. - (Library of a specialist doctor). ISBN 978-5-9704-1036-3].

A known method of collecting material for microbiological research, carried out using a sigmoidoscope, recommended mainly for determining the presence of Entamoeba histolytica and Micobacterium spp., As well as for Cl. difficile and S. aureus. The method includes the following steps: sigmoidoscopy is performed using a flexible or rigid sigmoidoscopy; receive biopsy material of any visible lesion [Colonoscopy: illustrated guide / ed. Douglas G. Adler; lane with English I.S. Kozlova; under. ed. V.V. Veselova. - M .: GEOTAR - Media, 2016 .-- 224 p. ISBN 978-1-61711-614-8]; additionally aspirate the fluid from the inflamed intestine using a pipette inserted through a sigmoidoscope; transfer samples to sterile disposable containers with a screw cap or other containers with a ground stopper; if the biopsy sample is very small, add a small amount of sterile non-bacteriostatic physiological (official) solution to the container into which it was transferred to prevent it from drying out; deliver the material to the laboratory [MU 4.2.2039-05 Guidelines Technique for collecting and transporting biomaterials to microbiological laboratories]. This method is adopted as a prototype.

The disadvantage of this method is the claimed restriction in relation to microorganisms, which are mainly evaluated when it is used. Given the possible participation in the pathological process on the mucous membrane of the colon in patients with ulcerative colitis of another microflora, in particular enterobacteria, it is difficult to differentiate the microflora and microflora directly involved in the pathological process during microbiological examination. Also, when using this method, fibrin and other deposits are not removed from the ulcer surface, the microflora of which can significantly affect the result of the study.

A known method of collecting material for microbiological research, which consists in the following. Wash off the mucosal lesions by injecting 25-30 ml of sterile non-bacteriostatic isotonic saline through the biopsy channel into the lesion; a sample is collected by aspirating the liquid through an endoscope into a sterile container that is connected to a suction probe; with a clearly contoured ulcerative lesion, samples are collected from the base of the gastric mucosa surrounding the ulcer and each of the four quadrants of the edges of the ulcer; when the material is delivered to the laboratory, if it is necessary to obtain data on the quantitative composition of the microorganisms released, indicate the volume of liquid used to obtain the aspirate [MU 4.2.2039-05 Methodical Instructions Technique for collecting and transporting biomaterials to microbiological laboratories].

The disadvantage of this method is the use as a method of cleaning the mucous membrane and ulcer defects of physiological saline, which may not be effective enough to remove fibrin fragments and other pathological elements from the surface of the ulcer defect, the microflora of which may be saprophytic and not participate in the pathological process. Also known is a method of collecting material for microbiological examination from a remote macrodrug (colon mucosa) after surgery. The disadvantage of this method is the fact that the material is taken from the "non-viable" wall of the intestine, where the attached surrounding microflora may be present, and the results obtained will not be able to provide significant assistance to the patient undergoing the study.

Disclosure of invention

The aim of the invention is to obtain accurate quantitative and qualitative indicators of microflora from biopsy material of the mucous membrane of the colon, reducing the effect on the result of microbiological studies of transit intestinal microflora, which is not involved in the pathological process.

This is achieved by the fact that, in contrast to the known methods of collecting material for microbiological examination, the biopsy was taken not from the surface layers of the mucous membrane, but from ulcerative and erosive defects that were previously freed from the fibrin film by scraping the fibrinous deposits and detritus with the opened branches of the biopsy forceps. In the case when erosive and ulcerative defects were not detected, the biopsy was performed as follows: with the help of biopsy forceps, a section of the mucous membrane was taken, which was sent for histological examination, then, with the help of biopsy forceps, a targeted sampling of material from the place of the previously taken biopsy was carried out.

The implementation of the invention

The essence of the proposed method is as follows: a biopsy is taken not from the surface layers of the mucous membrane, but from ulcerative and erosive defects that are previously freed from the fibrin film by scraping the fibrinous deposits and detritus with the opened branches of the biopsy forceps. In the case when erosive and ulcerative defects are not detected, biopsy forceps are used to take a section of the mucous membrane, which is sent for histological examination, then, using biopsy forceps, a targeted sampling of material from the site of a previously taken biopsy is also performed.

The invented method allows to obtain accurate quantitative and qualitative indicators of microflora from biopsy material of the mucous membrane of the colon, reducing the effect on the result of microbiological studies of transit intestinal microflora, which makes it possible to conduct a series of studies. This may allow appropriate antibiotic therapy in patients with ulcerative colitis to achieve remission of the disease and reduce the number of postoperative complications in this category of patients. There are no possible restrictions on the use of this method.

Claims (1)

A method of collecting biopsy material of the colon wall for microbiological examination in patients with ulcerative colitis, characterized in that the biopsy is taken not from the surface layers of the mucous membrane, but from ulcerative and erosive defects that are previously freed from the fibrin film by scraping the fibrinous deposits and detritus with the opened jaws of biopsy forceps or, when erosive and ulcerative defects are not detected, biopsy forceps are used to sample the area of the mucosa that sent etsya for histological examination, biopsy forceps is then also carried out of the impact fence material space previously taken biopsy.