MD1154Z - Mini-invasive method of correction of central lymphocirculation in the treatment of cirrhotic ascites - Google Patents
Mini-invasive method of correction of central lymphocirculation in the treatment of cirrhotic ascites Download PDFInfo
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- MD1154Z MD1154Z MDS20160145A MDS20160145A MD1154Z MD 1154 Z MD1154 Z MD 1154Z MD S20160145 A MDS20160145 A MD S20160145A MD S20160145 A MDS20160145 A MD S20160145A MD 1154 Z MD1154 Z MD 1154Z
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- 206010003445 Ascites Diseases 0.000 title claims description 17
- 238000000034 method Methods 0.000 title claims description 11
- 238000012937 correction Methods 0.000 title description 3
- 230000001926 lymphatic effect Effects 0.000 claims abstract description 35
- 210000000115 thoracic cavity Anatomy 0.000 claims abstract description 12
- 210000004731 jugular vein Anatomy 0.000 claims abstract description 7
- NNJVILVZKWQKPM-UHFFFAOYSA-N Lidocaine Chemical compound CCN(CC)CC(=O)NC1=C(C)C=CC=C1C NNJVILVZKWQKPM-UHFFFAOYSA-N 0.000 claims abstract description 5
- 230000015572 biosynthetic process Effects 0.000 claims abstract description 5
- 229960004194 lidocaine Drugs 0.000 claims abstract description 5
- 210000001370 mediastinum Anatomy 0.000 claims abstract description 5
- 210000003195 fascia Anatomy 0.000 claims abstract description 4
- 230000001483 mobilizing effect Effects 0.000 claims description 7
- 230000032630 lymph circulation Effects 0.000 claims description 5
- 210000001165 lymph node Anatomy 0.000 claims description 2
- 208000019425 cirrhosis of liver Diseases 0.000 abstract description 9
- 208000011580 syndromic disease Diseases 0.000 abstract description 7
- 239000003814 drug Substances 0.000 abstract description 4
- 210000000609 ganglia Anatomy 0.000 abstract 1
- 230000004087 circulation Effects 0.000 description 9
- 230000003872 anastomosis Effects 0.000 description 5
- 230000006837 decompression Effects 0.000 description 4
- 208000007232 portal hypertension Diseases 0.000 description 4
- 239000002934 diuretic Substances 0.000 description 3
- 230000001882 diuretic effect Effects 0.000 description 3
- 206010059240 Lymphostasis Diseases 0.000 description 2
- 208000004880 Polyuria Diseases 0.000 description 2
- 229940079593 drug Drugs 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 230000002440 hepatic effect Effects 0.000 description 2
- 238000002690 local anesthesia Methods 0.000 description 2
- 210000002751 lymph Anatomy 0.000 description 2
- 210000003205 muscle Anatomy 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 230000007420 reactivation Effects 0.000 description 2
- 230000000241 respiratory effect Effects 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 210000002978 thoracic duct Anatomy 0.000 description 2
- 210000001519 tissue Anatomy 0.000 description 2
- 102000004506 Blood Proteins Human genes 0.000 description 1
- 108010017384 Blood Proteins Proteins 0.000 description 1
- 206010011224 Cough Diseases 0.000 description 1
- 206010019663 Hepatic failure Diseases 0.000 description 1
- 206010020772 Hypertension Diseases 0.000 description 1
- 206010020880 Hypertrophy Diseases 0.000 description 1
- 206010061218 Inflammation Diseases 0.000 description 1
- 208000036142 Viral infection Diseases 0.000 description 1
- 206010052428 Wound Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 239000002250 absorbent Substances 0.000 description 1
- 230000002745 absorbent Effects 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000000903 blocking effect Effects 0.000 description 1
- 230000037396 body weight Effects 0.000 description 1
- 210000003109 clavicle Anatomy 0.000 description 1
- 238000003759 clinical diagnosis Methods 0.000 description 1
- 230000001143 conditioned effect Effects 0.000 description 1
- 238000001804 debridement Methods 0.000 description 1
- 238000001784 detoxification Methods 0.000 description 1
- 238000011161 development Methods 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 208000035475 disorder Diseases 0.000 description 1
- 230000035619 diuresis Effects 0.000 description 1
- 229940030606 diuretics Drugs 0.000 description 1
- 238000001914 filtration Methods 0.000 description 1
- 229940083561 furosemide 40 mg Drugs 0.000 description 1
- 230000004054 inflammatory process Effects 0.000 description 1
- 238000001990 intravenous administration Methods 0.000 description 1
- 210000004185 liver Anatomy 0.000 description 1
- 208000007903 liver failure Diseases 0.000 description 1
- 231100000835 liver failure Toxicity 0.000 description 1
- 230000003692 lymphatic flow Effects 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 229940021182 non-steroidal anti-inflammatory drug Drugs 0.000 description 1
- 206010033675 panniculitis Diseases 0.000 description 1
- 230000001936 parietal effect Effects 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
- 238000004062 sedimentation Methods 0.000 description 1
- LXMSZDCAJNLERA-ZHYRCANASA-N spironolactone Chemical compound C([C@@H]1[C@]2(C)CC[C@@H]3[C@@]4(C)CCC(=O)C=C4C[C@H]([C@@H]13)SC(=O)C)C[C@@]21CCC(=O)O1 LXMSZDCAJNLERA-ZHYRCANASA-N 0.000 description 1
- 229960002256 spironolactone Drugs 0.000 description 1
- 238000010911 splenectomy Methods 0.000 description 1
- 210000004003 subcutaneous fat Anatomy 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
- 230000009385 viral infection Effects 0.000 description 1
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- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la hepatologia chirurgicală, şi poate fi aplicată în corecţia limfocirculaţiei centrale în tratamentul sindromului ascitic la pacienţii cu ciroză hepatică decompensată. The invention relates to medicine, in particular to surgical hepatology, and can be applied in the correction of central lymphocirculation in the treatment of ascites syndrome in patients with decompensated liver cirrhosis.
Este cunoscut faptul că principala cauză a evoluţiei ascitei la bolnavii cu ciroză hepatică este hiperlimfogeneza hepatică, ca urmare a hipertensiunii portale şi blocajul circulaţiei limfatice centrale aferente prin ductul toracic limfatic (DTL). În urma măririi presiunii intraductale are loc transsudarea transparietală a limfei, sedimentarea proteinelor plasmatice în ţesuturile cervicale moi adiacente cu inflamare productivă, formarea bridelor şi hipertrofia pachetului limfatic prescalenic, care deformează şi comprimă DTL, blocând limfocirculaţia centrală. Insuficienţa aparatului valvular al DTL, care apare, agravează blocajul circulaţiei limfatice centrale, ceea ce duce la progresarea ascitei cu evoluţia ei în stadiul refractar, când administrarea preparatelor diuretice devine neeficientă. It is known that the main cause of the development of ascites in patients with liver cirrhosis is hepatic hyperlymphogenesis, as a result of portal hypertension and the blockage of the afferent central lymphatic circulation through the thoracic lymphatic duct (TLD). As a result of the increase in intraductal pressure, transparietal transudation of lymph occurs, the sedimentation of plasma proteins in the adjacent soft cervical tissues with productive inflammation, the formation of clamps and hypertrophy of the prescalene lymphatic bundle, which deforms and compresses the TLD, blocking the central lymph circulation. The insufficiency of the valvular apparatus of the TLD, which occurs, aggravates the blockage of the central lymphatic circulation, which leads to the progression of ascites with its evolution into the refractory stage, when the administration of diuretic drugs becomes ineffective.
Este cunoscută metoda de decompresie a ductului toracic limfatic, ce include efectuarea operaţiei de drenaj exterior al DTL, care se aplică pentru corecţia chirurgicală a sindromului ascitic în ciroza hepatică, fiind considerată ca metodă extracorporală de dezintoxicare în ciroza hepatică cu complicaţii de insuficienţă hepatică. Intervenţia constă în introducerea în lumenul ductului a unui cateter de drenaj prin incizia peretelui vasului şi aplicarea suturii parietale de fixare. În acest caz se mobilizează doar un sector limitat al porţiunii cervicale a DTL suficient pentru aplicarea drenajului. Limfa evacuată se supune filtrării cu ajutorul absorbanţilor (limfosorbţie) şi reinfuziei ei intravenoase [1]. The method of decompression of the thoracic lymphatic duct is known, which includes performing the external drainage of the DTL operation, which is applied for the surgical correction of ascites syndrome in liver cirrhosis, being considered as an extracorporeal method of detoxification in liver cirrhosis with complications of liver failure. The intervention consists of introducing a drainage catheter into the lumen of the duct through an incision in the vessel wall and applying a parietal suture for fixation. In this case, only a limited sector of the cervical portion of the DTL sufficient for the application of drainage is mobilized. The evacuated lymph is subjected to filtration with the help of absorbents (lymphosorption) and its intravenous reinfusion [1].
Dezavantajul metodei constă în efectul temporar asupra sindromului ascitic, deoarece procedura acţionează o perioadă limitată de timp. Mai mult decât atât, ca rezultat al deformării DTL, dereglările circulaţiei limfatice aferente se pot ulterior agrava şi după înlăturarea cateterului de drenaj ascita se acumulează repetat. The disadvantage of the method is the temporary effect on ascites syndrome, since the procedure acts for a limited period of time. Moreover, as a result of the deformation of the DTL, the associated lymphatic circulation disorders may subsequently worsen and after the removal of the drainage catheter, ascites accumulates repeatedly.
Este cunoscută, de asemenea, metoda de decompresie internă a ductului toracic limfatic prin efectuarea anastomozei limfo-venoase, ce constă în exteriorizarea şi mobilizarea venei jugulare interne, separarea ductului toracic limfatic în regiunea unghiului venos stâng, mobilizarea porţiunii cervicale a DTL suficientă pentru aplicarea anastomozei (în regiunea proximală sau distală a porţiunii cervicale a DTL) şi formarea unei anastomoze între porţiunea cervicală a DTL şi vena jugulară internă pentru micşorarea hipertensiunii limfatice centrale în duct şi ameliorarea circulaţiei limfatice aferente [2]. The method of internal decompression of the thoracic lymphatic duct by performing lympho-venous anastomosis is also known, which consists of externalizing and mobilizing the internal jugular vein, separating the thoracic lymphatic duct in the region of the left venous angle, mobilizing the cervical portion of the TLD sufficient for applying the anastomosis (in the proximal or distal region of the cervical portion of the TLD) and forming an anastomosis between the cervical portion of the TLD and the internal jugular vein to reduce central lymphatic hypertension in the duct and improve afferent lymphatic circulation [2].
Dezavantajul metodei constă în aceea că efectul de drenaj este limitat şi local, metoda fiind eficientă doar în cazurile blocajului segmentar al circulaţiei limfatice, pe când blocajul circulaţiei limfatice centrale are un caracter difuz, înglobând toată porţiunea cervicală a DTL. În plus, operaţia poate cauza o deformare şi mai mare a ductului toracic, iar ca rezultat al scăderii gradientului de presiune între DTL şi vena jugulară internă, anastomozele deseori se trombează, fapt ce explică nereuşitele frecvente. The disadvantage of the method is that the drainage effect is limited and local, the method being effective only in cases of segmental blockage of lymphatic circulation, while the blockage of central lymphatic circulation has a diffuse character, encompassing the entire cervical portion of the DTL. In addition, the operation can cause even greater deformation of the thoracic duct, and as a result of the decrease in the pressure gradient between the DTL and the internal jugular vein, the anastomoses often thrombosed, which explains the frequent failures.
Problema pe care o rezolvă invenţia constă în înlăturarea blocajului limfodinamic al circulaţiei limfatice centrale aferente pe tot traiectul segmentului cervical al ductului toracic limfatic, acesta constituind una din principale mecanisme evolutive ale sindromului ascitic în ciroza hepatică. The problem solved by the invention consists in removing the lymphodynamic blockage of the afferent central lymphatic circulation along the entire path of the cervical segment of the thoracic lymphatic duct, this constituting one of the main evolutionary mechanisms of ascites syndrome in liver cirrhosis.
Esenţa invenţiei constă în aceea că se exteriorizează şi se mobilizează vena jugulară internă, se separă ductul toracic limfatic în regiunea unghiului venos stâng, se mobilizează ductul pe întreaga porţiune cervicală cu secţionarea tuturor ramurilor limfatice aferente de la locul de ieşire din mediastinul posterior până la unghiul venos stâng, se înlătură ganglionii limfatici prescalenici cu formarea unei cavităţi intermusculare, în care se introduce soluţie de 5...10% de lidocaină, în cantitate de 10...15 ml, după 5...10 min se aspiră soluţia şi se introduce soluţie de poliglucină, în cantitate de 15...30 ml, apoi se suturează fascia cervicală superficială şi tegumentele. The essence of the invention consists in exteriorizing and mobilizing the internal jugular vein, separating the thoracic lymphatic duct in the region of the left venous angle, mobilizing the duct over the entire cervical portion with the sectioning of all afferent lymphatic branches from the exit site from the posterior mediastinum to the left venous angle, removing the prescalene lymph nodes with the formation of an intermuscular cavity, into which 5...10% lidocaine solution is introduced, in an amount of 10...15 ml, after 5...10 min the solution is aspirated and polyglucine solution is introduced, in an amount of 15...30 ml, then the superficial cervical fascia and the skin are sutured.
Rezultatul invenţiei constă în reactivarea limfocirculaţiei centrale şi restabilirea funcţiei de drenare limfatică a DTL prin mobilizarea şi debridarea largă a ductului toracic limfatic pe tot segmentul cervical, de la locul de ieşire din mediastinul posterior până la confluenţa cu unghiul venos stâng, apoi se înlătură pachetul limfatic prescalenic pentru crearea unei cavităţi intermusculare cu eliberarea colectorului principal al DTL. Deci, rezultatul tehnic al invenţiei constă în restabilirea optimală a lumenului segmentului cervical al ductului toracic limfatic şi a funcţiei de drenare limfatică centrală. The result of the invention consists in reactivating the central lymph circulation and restoring the lymphatic drainage function of the LDT by mobilizing and debriding the thoracic lymphatic duct throughout the cervical segment, from the place of exit from the posterior mediastinum to the confluence with the left venous angle, then removing the prescalene lymphatic bundle to create an intermuscular cavity with the release of the main collector of the LDT. Thus, the technical result of the invention consists in the optimal restoration of the lumen of the cervical segment of the thoracic lymphatic duct and the central lymphatic drainage function.
Metoda se realizează în modul următor. The method is carried out in the following way.
Sub anestezie locală, prin abord chirurgical de-a lungul claviculei stângi cu lungimea de 5...7 cm se incizează pielea, ţesutul adipos subcutanat, muşchiul plat, fasciile cervicale. Se exteriorizează vena jugulară internă, care se mobilizează extins de-a lungul a 5...7 cm până la confluenţa ei cu vena subclaviculară stângă. În regiunea unghiului venos stâng se separă ductul toracic limfatic, care se ia pe fire de tracţiune. Se efectuează o mobilizare extinsă a ductului pe toată porţiunea cervicală, de la ostiumul confluenţei lui cu unghiul venos stâng până la locul de ieşire a ductului din mediastinul posterior. Toate ramurile limfatice secundare aferente, inclusiv tr. jugularis, subclavius, mammaris sinistra se ligaturează şi se secţionează. Se înlătură toate deformaţiile, bridele şi ţesuturile adiacente din zona cervicală, inclusiv pachetul limfatic prescalenic, care compresează ductul. Pacientului i se propune să efectueze mişcări respiratorii forţate (tuse, inspire profunde cu expiraţii forţate), ceea ce conduce la reactivarea limfocirculaţiei şi restabilirea funcţiei de drenare. Apoi în cavitatea formată se introduce soluţie de lidocaină de 5...10%, în cantitate de 10...15 ml, după 5...10 min se aspiră soluţia introdusă, iar cavitatea menţionată se umple cu soluţie macromoleculară de poliglucină în cantitate de 15...30 ml. În spaţiul liber format ductul de sine stătător reia forma optimă pentru condiţiile de flux limfatic central şi drenare limfatică adecvată. Se efectuează hemo- şi limfostaza necesară. Se suturează numai straturile superioare ale plăgii postoperatorii, superficial de muşchiul sterno-cleido-mastoidian. Se aplică pansament aseptic. Under local anesthesia, through a surgical approach along the left clavicle with a length of 5...7 cm, the skin, subcutaneous adipose tissue, flat muscle, cervical fascia are incised. The internal jugular vein is externalized, which is mobilized extensively along 5...7 cm until its confluence with the left subclavicular vein. In the region of the left venous angle, the thoracic lymphatic duct is separated, which is taken on traction threads. An extensive mobilization of the duct is performed along the entire cervical portion, from the ostium of its confluence with the left venous angle to the place of exit of the duct from the posterior mediastinum. All afferent secondary lymphatic branches, including tr. jugularis, subclavius, mammaris sinistra are ligated and sectioned. All deformations, clamps and adjacent tissues in the cervical area are removed, including the prescalenic lymphatic bundle, which compresses the duct. The patient is asked to perform forced respiratory movements (coughing, deep inhalations with forced exhalations), which leads to the reactivation of lymph circulation and the restoration of the drainage function. Then, a 5...10% lidocaine solution is introduced into the formed cavity, in an amount of 10...15 ml, after 5...10 min the introduced solution is aspirated, and the mentioned cavity is filled with a macromolecular solution of polyglucine in an amount of 15...30 ml. In the free space formed, the independent duct resumes the optimal shape for the conditions of central lymphatic flow and adequate lymphatic drainage. The necessary hemo- and lymphostasis is performed. Only the upper layers of the postoperative wound are sutured, superficial to the sterno-cleido-mastoid muscle. An aseptic dressing is applied.
Prin aceasta se creează condiţii pentru circulaţia limfatică eficientă prin DTL, respectiv pentru deblocajul circulaţiei limfatice centrale aferente. Astfel, prin decompresia DTL se înlătură limfostaza hepatică şi intraabdominală ca una din principalele cauze de formare a ascitei în ciroza hepatică, ceea ce duce la regresul treptat al sindromului ascitic. This creates conditions for efficient lymphatic circulation through the DTL, respectively for the unblocking of the afferent central lymphatic circulation. Thus, by decompression of the DTL, hepatic and intra-abdominal lymphostasis is removed as one of the main causes of ascites formation in liver cirrhosis, which leads to the gradual regression of the ascites syndrome.
Metoda a fost utilizată pentru tratamentul a 23 de pacienţi cu ciroză hepatică decompensată. The method was used for the treatment of 23 patients with decompensated liver cirrhosis.
Exemplu Example
Pacienta M., 51 ani, a fost internată cu diagnosticul clinic: ciroză hepatică decompensată. Hipertensiune portală. Ascită masivă refractară. Antecedent, şi anume cu 7 ani în urmă pacientei i s-a efectuat splenectomie cu deconectare azigo-portală. În ultimul an, după o infecţie virală suportată tratată cu preparate medicamentoase antiinflamatorii nesteroidiene, a apărut ascita, care nu s-a supus terapiei conservative cu preparate diuretice, cu progresarea ei în dinamică. În scopul corecţiei sindromului ascitic refractar s-a efectuat intervenţia revendicată sub anestezie locală pentru decompresia porţiunii cervicale a DTL. S-a stabilit intraoperatoriu îngustarea şi deformarea segmentului cervical al ductului toracic. După o mobilizare şi debridare extinsă pe tot parcursul porţiunii cervicale a DTL cu înlăturarea pachetului limfatic prescalenic s-a obţinut reactivarea limfocirculaţiei centrale şi restabilirea funcţiei de drenare limfatică. Diametrul ductului deformat şi compresat anterior s-a mărit de la 0,3 până la 0,9 mm, segmental cervical al DTL s-a reexpansionat. S-a introdus soluţie de lidocaină de 10%, în cantitate de 10 ml, după 10 min s-a aspirat soluţia introdusă, apoi cavitatea menţionată s-a umplut cu soluţie macromoleculară de poliglucină în cantitate de 20 ml. În cavitatea formată arcul cervical al ductului limfatic funcţionează normal în funcţie de actul respirator. Perioada postoperatorie a decurs fără complicaţii. Diureza liberă s-a mărit până la 1500 ml. Administrarea dozelor moderate de preparate diuretice (furosemid 40 mg+ spironolactonă 150 mg) a condiţionat un efect diuretic adecvat - până la 2500 ml. Masa corporală peste 14 zile după operaţie s-a redus cu 10 kg datorită diminuării considerabile a ascitei. S-a externat în stare satisfăcătoare. La examenul de control peste 3 luni după operaţie ascita s-a redus la nivel minimal, probele hepatice erau în limitele normei. Patient M., 51 years old, was hospitalized with the clinical diagnosis: decompensated liver cirrhosis. Portal hypertension. Massive refractory ascites. Previously, namely 7 years ago, the patient underwent splenectomy with azygo-portal disconnection. In the last year, after a viral infection treated with nonsteroidal anti-inflammatory drugs, ascites appeared, which did not respond to conservative therapy with diuretics, with its progression in dynamics. In order to correct the refractory ascites syndrome, the claimed intervention was performed under local anesthesia for decompression of the cervical portion of the DTL. Intraoperatively, narrowing and deformation of the cervical segment of the thoracic duct were established. After extensive mobilization and debridement throughout the cervical portion of the DTL with removal of the prescalene lymphatic bundle, the reactivation of central lymph circulation and restoration of lymphatic drainage function were achieved. The diameter of the previously deformed and compressed duct increased from 0.3 to 0.9 mm, the cervical segment of the DTL was re-expanded. 10% lidocaine solution was introduced, in an amount of 10 ml, after 10 min the introduced solution was aspirated, then the mentioned cavity was filled with macromolecular polyglucine solution in an amount of 20 ml. In the formed cavity the cervical arch of the lymphatic duct functions normally depending on the respiratory act. The postoperative period was without complications. Free diuresis increased to 1500 ml. Administration of moderate doses of diuretic preparations (furosemide 40 mg + spironolactone 150 mg) conditioned an adequate diuretic effect - up to 2500 ml. Body weight over 14 days after the operation was reduced by 10 kg due to a considerable decrease in ascites. He was discharged in satisfactory condition. At the follow-up examination 3 months after the operation, the ascites was reduced to a minimal level, and the liver tests were within normal limits.
1. Пациора М. Д. Хирургия портальной гипертензии. Медицина, Ташкент, 1984, p. 182-184 1. Paciora M. D. Surgery of portal hypertension. Medicine, Tashkent, 1984, p. 182-184
2. Пациора М. Д., Цацаниди К.Н., Лебезев В.М. Лимфовенозный анастомоз при асците у больных с портальной гипертензией. Хирургия, Москва, 1985, № 8, p. 80-83 2. Paciora M. D., Tsatsanidi K.N., Lebezev V.M. Lymphovenous anastomosis with ascites in patients with portal hypertension. Surgery, Moscow, 1985, № 8, p. 80-83
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Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD1093G2 (en) * | 1997-12-30 | 1999-05-31 | Gheorghe Anghelici | Method for thoracic lymphatic duct decompression |
| MD1091G2 (en) * | 1997-12-30 | 1999-05-31 | Gheorghe Anghelici | Method for determination of the lymphoduct state by means of the pectoral lymphatic duct at the biliary cirrhosis and ascites |
| MD116Y (en) * | 2009-10-07 | 2009-12-31 | Gheorghe Anghelici | Method for restoration of lymphocirculation through the thoracic duct in the hepatic cirrhosis with refractory ascites |
| MD398Y (en) * | 2010-11-30 | 2011-07-31 | Gheorghe Anghelici | Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis |
-
2016
- 2016-12-08 MD MDS20160145A patent/MD1154Z/en not_active IP Right Cessation
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD1093G2 (en) * | 1997-12-30 | 1999-05-31 | Gheorghe Anghelici | Method for thoracic lymphatic duct decompression |
| MD1091G2 (en) * | 1997-12-30 | 1999-05-31 | Gheorghe Anghelici | Method for determination of the lymphoduct state by means of the pectoral lymphatic duct at the biliary cirrhosis and ascites |
| MD116Y (en) * | 2009-10-07 | 2009-12-31 | Gheorghe Anghelici | Method for restoration of lymphocirculation through the thoracic duct in the hepatic cirrhosis with refractory ascites |
| MD398Y (en) * | 2010-11-30 | 2011-07-31 | Gheorghe Anghelici | Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis |
Non-Patent Citations (2)
| Title |
|---|
| Пациора М. Д. Хирургия портальной гипертензии. Медицина, Ташкент, 1984, p. 182-184 * |
| Пациора М. Д., Цацаниди К.Н., Лебезев В.М. Лимфовенозный анастомоз при асците у больных с портальной гипертензией. Хирургия, Москва, 1985, № 8, p. 80-83 * |
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| Publication number | Publication date |
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| MD1154Y (en) | 2017-06-30 |
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