MD1153Z - Method for laparoscopic marsupialization of hepatic posthydatid cavity - Google Patents
Method for laparoscopic marsupialization of hepatic posthydatid cavity Download PDFInfo
- Publication number
- MD1153Z MD1153Z MDS20160135A MDS20160135A MD1153Z MD 1153 Z MD1153 Z MD 1153Z MD S20160135 A MDS20160135 A MD S20160135A MD S20160135 A MDS20160135 A MD S20160135A MD 1153 Z MD1153 Z MD 1153Z
- Authority
- MD
- Moldova
- Prior art keywords
- cavity
- cyst
- hepatic
- posthydatid
- hydatid
- Prior art date
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- 238000000034 method Methods 0.000 title claims abstract description 13
- 230000002440 hepatic effect Effects 0.000 title claims abstract description 9
- 208000031513 cyst Diseases 0.000 claims abstract description 15
- 206010011732 Cyst Diseases 0.000 claims abstract description 14
- 208000004751 Hepatic Echinococcosis Diseases 0.000 claims abstract description 9
- 230000015572 biosynthetic process Effects 0.000 claims abstract description 7
- 239000002775 capsule Substances 0.000 claims abstract description 6
- 206010052428 Wound Diseases 0.000 claims abstract description 5
- 208000027418 Wounds and injury Diseases 0.000 claims abstract description 5
- 238000013459 approach Methods 0.000 claims abstract description 5
- 239000000645 desinfectant Substances 0.000 claims abstract description 5
- QTCANKDTWWSCMR-UHFFFAOYSA-N costic aldehyde Natural products C1CCC(=C)C2CC(C(=C)C=O)CCC21C QTCANKDTWWSCMR-UHFFFAOYSA-N 0.000 claims abstract description 4
- ISTFUJWTQAMRGA-UHFFFAOYSA-N iso-beta-costal Natural products C1C(C(=C)C=O)CCC2(C)CCCC(C)=C21 ISTFUJWTQAMRGA-UHFFFAOYSA-N 0.000 claims abstract description 4
- 230000003287 optical effect Effects 0.000 claims abstract description 4
- 230000002021 scolicidal effect Effects 0.000 claims abstract description 4
- 239000012530 fluid Substances 0.000 claims description 6
- 239000012528 membrane Substances 0.000 claims description 5
- 238000001356 surgical procedure Methods 0.000 abstract description 3
- 239000003814 drug Substances 0.000 abstract description 2
- 239000007788 liquid Substances 0.000 abstract 1
- 210000004185 liver Anatomy 0.000 description 5
- 210000004379 membrane Anatomy 0.000 description 5
- 208000009366 Echinococcosis Diseases 0.000 description 4
- 230000002980 postoperative effect Effects 0.000 description 4
- 206010014096 Echinococciasis Diseases 0.000 description 3
- 210000002747 omentum Anatomy 0.000 description 3
- 208000008599 Biliary fistula Diseases 0.000 description 2
- 210000000941 bile Anatomy 0.000 description 2
- 230000029142 excretion Effects 0.000 description 2
- 238000002695 general anesthesia Methods 0.000 description 2
- 238000002357 laparoscopic surgery Methods 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 230000008929 regeneration Effects 0.000 description 2
- 238000011069 regeneration method Methods 0.000 description 2
- 238000002604 ultrasonography Methods 0.000 description 2
- 230000002792 vascular Effects 0.000 description 2
- CPKVUHPKYQGHMW-UHFFFAOYSA-N 1-ethenylpyrrolidin-2-one;molecular iodine Chemical compound II.C=CN1CCCC1=O CPKVUHPKYQGHMW-UHFFFAOYSA-N 0.000 description 1
- 201000003808 Cystic echinococcosis Diseases 0.000 description 1
- 208000035965 Postoperative Complications Diseases 0.000 description 1
- 229940064804 betadine Drugs 0.000 description 1
- 210000000013 bile duct Anatomy 0.000 description 1
- 230000000740 bleeding effect Effects 0.000 description 1
- 230000000903 blocking effect Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 210000000569 greater omentum Anatomy 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 238000002955 isolation Methods 0.000 description 1
- 238000002350 laparotomy Methods 0.000 description 1
- 239000004576 sand Substances 0.000 description 1
- 210000001519 tissue Anatomy 0.000 description 1
Landscapes
- Materials For Medical Uses (AREA)
Abstract
Description
Invenţia se referă la medicină, şi anume la chirurgie, şi poate fi utilizată pentru marsupializarea cavităţii posthidatice printr-o metodă miniinvazivă după echinococectomie hepatică. The invention relates to medicine, namely to surgery, and can be used for marsupialization of the posthydatid cavity by a minimally invasive method after hepatic echinococcectomy.
Este cunoscută metoda de lichidare a cavităţii posthidatice hepatice cu plastia canalelor biliare, care constă în laparotomia subcostală dreaptă, mobilizarea chistului hidatic hepatic cu deschiderea şi evacuarea conţinutului (lichid hidatic, nisip hidatic, membrană germinativă). Apoi se tratează cavitatea fibroasă restantă cu soluţie de iodanat. Totodată se examinează cavitatea fibroasă pentru a depista canalele biliare ce comunică cu cavitatea. Se croieşte un lambou pe picioruş vascular din omentul mare, care este utilizat pentru tamponarea cavităţii cu scopul stopării biliragiei. Laparorafie [1]. The method of liquidation of the hepatic posthydatid cavity with biliary duct plasty is known, which consists of right subcostal laparotomy, mobilization of the hepatic hydatid cyst with opening and evacuation of the contents (hydatid fluid, hydatid sand, germinal membrane). Then the remaining fibrous cavity is treated with iodanate solution. At the same time, the fibrous cavity is examined to detect the bile ducts communicating with the cavity. A flap is cut on the vascular pedicle from the greater omentum, which is used to tamponade the cavity in order to stop biliary bleeding. Laparoscopic surgery [1].
Dezavantajul metodei constă în aceea că deseori dimensiunile picioruşului omentului sunt reduse şi nu poate fi fixat în cavitatea reziduală posthidatică, totodată în cavităţile restante de dimensiuni mari este necesară o porţiune mai voluminoasă de oment pentru a umple cavitatea posthidatică hepatică. Deci asemenea metodă este utilă numai pentru chisturile hidatice mici, cu un diametru de cel mult 5...7 cm. De asemenea lambourile vasculare din oment nu pot fi utilizate în cazul localizării chisturilor în segmentele posterioare ale ficatului, fiind posibilă detaşarea lamboului de la cavitatea restantă şi provocarea complicaţiilor postoperatorii, iar perioada de spitalizare este de 10...14 zile. The disadvantage of the method is that often the size of the omentum leg is small and it cannot be fixed in the residual posthydatid cavity, at the same time in large residual cavities a larger portion of omentum is needed to fill the hepatic posthydatid cavity. Therefore, such a method is useful only for small hydatid cysts, with a diameter of no more than 5...7 cm. Also, vascular flaps from the omentum cannot be used in case of cysts located in the posterior segments of the liver, as it is possible for the flap to detach from the residual cavity and cause postoperative complications, and the hospitalization period is 10...14 days.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode miniinvazive eficiente de înlăturare a cavităţii restante posthidatice hepatice şi totodată de blocare a fistulelor biliare de calibru mic prin utilizarea ţesuturilor locale de membrană fibroasă, excluzând necesitatea preparării şi utilizării altor ţesuturi. The problem solved by the invention consists in developing an effective mini-invasive method for removing the remaining post-hydatid hepatic cavity and at the same time blocking small-caliber biliary fistulas by using local fibrous membrane tissues, excluding the need to prepare and use other tissues.
Esenţa invenţiei constă în efectuarea abordului prin 4 puncte, şi anume în regiunea subombilicală, epigastrică, sub rebordul costal drept şi regiunea iliacă dreaptă, se introduc consecutiv dispozitivul optic şi trocarele de lucru, apoi se izolează chistul hidatic hepatic, se evacuează lichidul hidatic prin puncţie, se introduce o soluţie scolicidă în interiorul chistului cu o expoziţie timp de 5...7 min, apoi se înlătură membrana proligeră a chistului şi se prelucrează suprafaţa cavităţii posthidatice cu soluţie dezinfectantă, după care se excizează capsula fibroasă liberă a chistului cu păstrarea unei porţiuni cu lungimea de 0,5 cm, care se suturează de fundul cavităţii cu formarea unui tunel prin care se introduce un tub pentru drenare, apoi se înlătură instrumentele de lucru şi se suturează plăgile, iar după 2...3 zile se înlătură tubul pentru drenare. The essence of the invention consists in performing the approach through 4 points, namely in the subumbilical, epigastric region, under the right costal margin and the right iliac region, the optical device and the working trocars are consecutively introduced, then the hepatic hydatid cyst is isolated, the hydatid fluid is evacuated by puncture, a scolicidal solution is introduced inside the cyst with an exposure for 5...7 min, then the proliger membrane of the cyst is removed and the surface of the posthydatid cavity is processed with a disinfectant solution, after which the free fibrous capsule of the cyst is excised, preserving a portion with a length of 0.5 cm, which is sutured to the bottom of the cavity with the formation of a tunnel through which a drainage tube is inserted, then the working instruments are removed and the wounds are sutured, and after 2...3 days the drainage tube is removed.
Rezultatul invenţiei constă în aceea că are loc micşorarea suprafeţei cavităţii restante posthidatice hepatice cu comprimarea fistulelor biliare de calibru mic care se deschid în această cavitate, cu prevenirea eliminărilor de bilă în perioada postoperatorie, reducerea riscului de apariţie a complicaţiilor septico-purulente postoperatorii, vindecarea rapidă cu regenerarea suprafeţei fibroase hepatice şi micşorarea timpului de spitalizare. Metoda propusă poate fi folosită în toate cazurile de intervenţie chirurgicală pe cale laparoscopică la ficat cu echinococoză. În perioada postoperatorie precoce are loc regenerarea rapidă a ficatului, fără eliminări de bilă şi asociere de infecţie, cu perioada postoperatorie scurtă (de 4-5 zile), reducând esenţial costul eficienţă per caz. The result of the invention is that the surface of the remaining posthydatid hepatic cavity is reduced by compressing the small-caliber biliary fistulas that open into this cavity, preventing bile excretion in the postoperative period, reducing the risk of postoperative septic-purulent complications, rapid healing with regeneration of the hepatic fibrous surface and reducing the length of hospitalization. The proposed method can be used in all cases of laparoscopic surgery of the liver with echinococcosis. In the early postoperative period, rapid liver regeneration occurs, without bile excretion and infection, with a short postoperative period (4-5 days), essentially reducing the cost-effectiveness per case.
Metoda revendicată se explică prin figurile 1-2, care reprezintă: The claimed method is explained by figures 1-2, which represent:
- fig. 1, pregătirea marginilor libere de capsulă fibroasă pentru plastia cavităţii restante; - Fig. 1, preparation of the free edges of the fibrous capsule for the plasty of the remaining cavity;
- fig. 2, suturarea marginilor de fundul cavităţii cu formarea tunelului şi drenarea lui. - Fig. 2, suturing the edges of the cavity bottom with the formation of the tunnel and its drainage.
Metoda se efectuează în modul următor. The method is performed in the following way.
După spitalizarea pacientului se efectuează examenele clinice şi paraclinice cu stabilirea localizării chistului hidatic hepatic. Se efectuează anestezie generală şi prelucrarea câmpului operator. Se efectuează abordul prin 4 puncte, şi anume în regiunea subombilicală, epigastrică, sub rebordul costal drept şi regiunea iliacă dreaptă, se introduc consecutiv dispozitivul optic şi trocarele de lucru, apoi se izolează chistul hidatic hepatic, se evacuează lichidul hidatic prin puncţie, se introduce o soluţie scolicidă în interiorul chistului cu o expoziţie timp de 5...7 min, apoi se înlătură membrana proligeră a chistului şi se prelucrează suprafaţa cavităţii posthidatice cu soluţie dezinfectantă, după care se excizează capsula fibroasă liberă a chistului cu păstrarea unei porţiuni cu lungimea de 0,5 cm, care se suturează de fundul cavităţii cu formarea unui tunel prin care se introduce un tub pentru drenare, apoi se înlătură instrumentele de lucru şi se suturează plăgile, iar după 2...3 zile se înlătură tubul pentru drenare. After the patient is hospitalized, clinical and laboratory examinations are performed to determine the location of the hepatic hydatid cyst. General anesthesia and preparation of the surgical field are performed. The approach is performed through 4 points, namely in the subumbilical, epigastric region, under the right costal margin and the right iliac region, the optical device and the working trocars are consecutively introduced, then the hepatic hydatid cyst is isolated, the hydatid fluid is evacuated by puncture, a scolicidal solution is introduced inside the cyst with an exposure for 5...7 min, then the proliger membrane of the cyst is removed and the surface of the posthydatid cavity is processed with a disinfectant solution, after which the free fibrous capsule of the cyst is excised, keeping a portion 0.5 cm long, which is sutured to the bottom of the cavity with the formation of a tunnel through which a drainage tube is inserted, then the working instruments are removed and the wounds are sutured, and after 2...3 days the drainage tube is removed.
Metoda a fost aplicată pentru 8 pacienţi. The method was applied to 8 patients.
Exemplu Example
Bolnavul K., 48 ani, internat în mod programat la SCM „Sfânta Treime”, secţia de chirurgie cu diagnosticul: boală hidatică, chist hidatic hepatic, lobul drept S7-8. La examenul ultrasonografic s-a determinat o formaţiune de volum lichidiană, localizată în lobul drept al ficatului S7-8 cu dimensiunile de 66x93 mm. Sub anestezie generală a fost aplicată metoda revendicată prin aborduri laparoscopice cu izolarea chistului hidatic hepatic, după care s-a evacuat lichidul hidatic prin puncţie, s-a introdus soluţie de betadină în interiorul chistului cu expoziţie pentru un timp de 7 min. Apoi s-a evacuat membrana proligeră a chistului cu prelucrarea suprafeţei cavităţii posthidatice cu soluţie dezinfectantă, după care s-a excizat capsula fibroasă liberă a chistului hidatic hepatic cu păstrarea unei porţiuni cu lungimea de 0,5 cm, care s-a suturat de fundul cavităţii cu formarea unui tunel prin care s-a introdus un tub pentru drenare, ulterior s-au înlăturat instrumentele de lucru şi s-au suturat plăgile, iar după 3 zile tubul pentru drenare a fost înlăturat. La examenul ultrasonografic de control după 3 săptămâni cavitatea restantă practic s-a redus. Patient K., 48 years old, was admitted to the SCM "Sfânta Treime", surgery department with the diagnosis: hydatid disease, hepatic hydatid cyst, right lobe S7-8. The ultrasound examination determined a fluid volume formation, located in the right lobe of the liver S7-8 with dimensions of 66x93 mm. Under general anesthesia, the claimed method was applied through laparoscopic approaches with isolation of the hepatic hydatid cyst, after which the hydatid fluid was evacuated by puncture, betadine solution was introduced inside the cyst with exposure for 7 min. Then the proligate membrane of the cyst was evacuated with the surface of the posthydatid cavity treated with a disinfectant solution, after which the free fibrous capsule of the hepatic hydatid cyst was excised, preserving a portion 0.5 cm long, which was sutured to the bottom of the cavity with the formation of a tunnel through which a drainage tube was inserted, subsequently the working instruments were removed and the wounds were sutured, and after 3 days the drainage tube was removed. At the control ultrasound examination after 3 weeks the remaining cavity had practically reduced.
1. Омиров Р.Ю., Кутлиев С.Р., Каххаров Б.И. Хирургическая тактика в лечении сочетанных форм эхинококкоза печени. Международный симпозиум, Хива, 1994 1. Омиров Р.Ю., Кутлиев С.Р., Каххаров Б.И. Surgical tactics in the treatment of combined forms of echinococcosis of the liver. International Symposium, Khiva, 1994
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20160135A MD1153Z (en) | 2016-11-23 | 2016-11-23 | Method for laparoscopic marsupialization of hepatic posthydatid cavity |
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|---|---|---|---|
| MDS20160135A MD1153Z (en) | 2016-11-23 | 2016-11-23 | Method for laparoscopic marsupialization of hepatic posthydatid cavity |
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| MD1153Y MD1153Y (en) | 2017-06-30 |
| MD1153Z true MD1153Z (en) | 2018-01-31 |
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Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU971285A1 (en) * | 1980-11-03 | 1982-11-07 | Таджикский Государственный Медицинский Институт Им.Абуали-Ибн-Сина | Method of treating echinococcus cysts of children |
| SU1421349A1 (en) * | 1986-05-16 | 1988-09-07 | Ташкентский государственный медицинский институт | Tip of device for removing the content of echinococcus cyst |
| SU1514378A1 (en) * | 1987-09-04 | 1989-10-15 | Nauchnyj Ts Khirurgii Amn Sssr | Arrangement for draining echinococcus cyst |
| SU1588394A1 (en) * | 1986-04-21 | 1990-08-30 | Ташкентский Филиал Всесоюзного Научного Центра Хирургии Амн Ссср | Method of treating echinococcus cysts of lung |
| MD2255G2 (en) * | 2003-01-17 | 2004-03-31 | Георге СТРЭЖЕСКУ | Method of autodermoplasty of the intrahepatic biliary ducts |
| MD710Y (en) * | 2013-06-17 | 2013-12-31 | Liviu Andon | Method for removing the residual cavity after pulmonary echinococcectomy |
-
2016
- 2016-11-23 MD MDS20160135A patent/MD1153Z/en not_active IP Right Cessation
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU971285A1 (en) * | 1980-11-03 | 1982-11-07 | Таджикский Государственный Медицинский Институт Им.Абуали-Ибн-Сина | Method of treating echinococcus cysts of children |
| SU1588394A1 (en) * | 1986-04-21 | 1990-08-30 | Ташкентский Филиал Всесоюзного Научного Центра Хирургии Амн Ссср | Method of treating echinococcus cysts of lung |
| SU1421349A1 (en) * | 1986-05-16 | 1988-09-07 | Ташкентский государственный медицинский институт | Tip of device for removing the content of echinococcus cyst |
| SU1514378A1 (en) * | 1987-09-04 | 1989-10-15 | Nauchnyj Ts Khirurgii Amn Sssr | Arrangement for draining echinococcus cyst |
| MD2255G2 (en) * | 2003-01-17 | 2004-03-31 | Георге СТРЭЖЕСКУ | Method of autodermoplasty of the intrahepatic biliary ducts |
| MD710Y (en) * | 2013-06-17 | 2013-12-31 | Liviu Andon | Method for removing the residual cavity after pulmonary echinococcectomy |
Non-Patent Citations (1)
| Title |
|---|
| Омиров Р.Ю., Кутлиев С.Р., Каххаров Б.И. Хирургическая тактика в лечении сочетанных форм эхинококкоза печени. Международный симпозиум, Хива, 1994 * |
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| Publication number | Publication date |
|---|---|
| MD1153Y (en) | 2017-06-30 |
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