MD115Y - Method for treating right recurrent pleurisies to patients with hepatic cirrhosis - Google Patents
Method for treating right recurrent pleurisies to patients with hepatic cirrhosis Download PDFInfo
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- MD115Y MD115Y MDS20090158A MDS20090158A MD115Y MD 115 Y MD115 Y MD 115Y MD S20090158 A MDS20090158 A MD S20090158A MD S20090158 A MDS20090158 A MD S20090158A MD 115 Y MD115 Y MD 115Y
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- lymphatic
- patients
- duct
- liver cirrhosis
- cervical
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- 238000000034 method Methods 0.000 title claims abstract description 12
- 208000008423 pleurisy Diseases 0.000 title claims abstract description 12
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 11
- 230000000306 recurrent effect Effects 0.000 title claims abstract description 7
- 230000001926 lymphatic effect Effects 0.000 claims abstract description 19
- 210000000115 thoracic cavity Anatomy 0.000 claims abstract description 6
- 206010011224 Cough Diseases 0.000 claims abstract description 4
- 230000006837 decompression Effects 0.000 claims abstract description 4
- 210000003195 fascia Anatomy 0.000 claims abstract description 4
- 210000004731 jugular vein Anatomy 0.000 claims abstract description 4
- 238000002690 local anesthesia Methods 0.000 claims abstract description 4
- 239000003814 drug Substances 0.000 abstract description 3
- 210000003281 pleural cavity Anatomy 0.000 description 10
- 210000004910 pleural fluid Anatomy 0.000 description 7
- 230000035508 accumulation Effects 0.000 description 4
- 238000009825 accumulation Methods 0.000 description 4
- 238000002360 preparation method Methods 0.000 description 4
- 102000009027 Albumins Human genes 0.000 description 3
- 108010088751 Albumins Proteins 0.000 description 3
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 3
- 208000035475 disorder Diseases 0.000 description 3
- 239000003792 electrolyte Substances 0.000 description 3
- 239000012530 fluid Substances 0.000 description 3
- 102000004169 proteins and genes Human genes 0.000 description 3
- 108090000623 proteins and genes Proteins 0.000 description 3
- 239000010836 blood and blood product Substances 0.000 description 2
- 229940125691 blood product Drugs 0.000 description 2
- 230000003247 decreasing effect Effects 0.000 description 2
- 239000002934 diuretic Substances 0.000 description 2
- 230000001882 diuretic effect Effects 0.000 description 2
- 230000002443 hepatoprotective effect Effects 0.000 description 2
- 208000015181 infectious disease Diseases 0.000 description 2
- 210000004185 liver Anatomy 0.000 description 2
- 238000011477 surgical intervention Methods 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 206010003445 Ascites Diseases 0.000 description 1
- 206010051093 Cardiopulmonary failure Diseases 0.000 description 1
- 208000034767 Hypoproteinaemia Diseases 0.000 description 1
- NNJVILVZKWQKPM-UHFFFAOYSA-N Lidocaine Chemical compound CCN(CC)CC(=O)NC1=C(C)C=CC=C1C NNJVILVZKWQKPM-UHFFFAOYSA-N 0.000 description 1
- 208000001647 Renal Insufficiency Diseases 0.000 description 1
- 238000010521 absorption reaction Methods 0.000 description 1
- 150000001413 amino acids Chemical class 0.000 description 1
- 229940124350 antibacterial drug Drugs 0.000 description 1
- 230000000721 bacterilogical effect Effects 0.000 description 1
- 230000003115 biocidal effect Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 230000008030 elimination Effects 0.000 description 1
- 238000003379 elimination reaction Methods 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 230000003601 intercostal effect Effects 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 201000006370 kidney failure Diseases 0.000 description 1
- 229960004194 lidocaine Drugs 0.000 description 1
- 230000003908 liver function Effects 0.000 description 1
- 210000002751 lymph Anatomy 0.000 description 1
- 230000003692 lymphatic flow Effects 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 230000035515 penetration Effects 0.000 description 1
- 230000000750 progressive effect Effects 0.000 description 1
- 230000000069 prophylactic effect Effects 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
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- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
Inventia se refera la medicina, in special la hepatologie si poate fi utilizata pentru tratamentul pleureziilor recidivante pe dreapta la pacientii cu ciroza hepatica. Metoda, conform inventiei, consta in aceea ca se administreaza tratamentul de baza al cirozei hepatice, iar suplimentar sub anestezie locala se efectueaza o incizie orizontala de 4…5 cm in regiunea supraclaviculara dreapta, se mobilizeaza vena jugulara interna si unghiul venos drept, se prepara ductul limfatic toracic drept pe tot segmentul cervical cu eliberarea din aderente si ńu excizia partiala a pachetului limfatic prescalenic pentru decompresia ductului, dupa care pacientul efectueaza cateva expiratii fortate si acte de tuse pentru restabilirea circulatiei limfatice, apoi se sutureaza prima fascie cervicala si pielea. The invention relates to medicine, especially to hepatology and can be used to treat right-sided recurrent pleurisy in patients with liver cirrhosis. The method, according to the invention, consists in administering the basic treatment of liver cirrhosis, and additionally under local anesthesia, a horizontal incision of 4 ... 5 cm is performed in the right supraclavicular region, the internal jugular vein is mobilized and the right venous angle is prepared. the right thoracic lymphatic duct throughout the cervical segment with release from adherence and partial excision of the prescalenic lymphatic package for the decompression of the duct, after which the patient performs several forced expirations and coughs for restoring the lymphatic circulation, then the first cervical fascia and suture are sutured.
Description
Invenţia se referă la medicină, în special la chirurgia toracică şi hepatologie şi poate fi utilizată pentru tratamentul pleureziilor recidivante pe dreapta la pacienţii cu ciroză hepatică. The invention relates to medicine, in particular to thoracic surgery and hepatology and can be used for the treatment of recurrent right-sided pleurisy in patients with liver cirrhosis.
Pentru pacienţii cu ciroză hepatică avansată este caracteristică apariţia unor pleurezii masive în cavitatea pleurală dreaptă cu o evoluţie progresivă şi acumularea unor cantităţi importante de lichid, care necesită puncţii pleurale frecvente cu evacuări repetate, acestea, la rândul lor, provoacă o acumulare mai rapidă cu o viteză de cca 1000…1200 ml/zi. Pentru a evita puncţiile repetate se instalează un dren în cavitatea pleurală pentru eliminarea permanentă a lichidului pleural, care provoacă pierderi masive de proteine şi dereglări hidro-electrolitice grave, pentru restituirea cărora sunt necesare transfuzii de preparate sangvine (plasmă, albumină etc.) şi preparate pentru restabilirea echilibrului electrolitic şi acido-bazic, care necesită cheltuieli suplimentare enorme. For patients with advanced liver cirrhosis, the appearance of massive pleurisy in the right pleural cavity with a progressive evolution and the accumulation of significant amounts of fluid is characteristic, which requires frequent pleural punctures with repeated evacuations, which, in turn, cause a faster accumulation at a rate of about 1000…1200 ml/day. To avoid repeated punctures, a drain is installed in the pleural cavity for the permanent elimination of pleural fluid, which causes massive protein losses and serious hydro-electrolyte disorders, for the restoration of which transfusions of blood products (plasma, albumin, etc.) and preparations for the restoration of electrolyte and acid-base balance are necessary, which require enormous additional expenses.
Este cunoscută metoda de tratament al pleureziilor recidivante pe dreapta la pacienţii cu ciroză hepatică, care include tratamentul de bază hepatoprotector, reologic, diuretic, iar în scopul înlăturării pleureziei pe dreapta se efectuează puncţia cavităţii pleurale drepte cu evacuarea lichidului pleural, după care în spaţiul intercostal V sau VI pe linia axilară medie se introduce un dren pentru evacuarea permanentă a lichidului pe un timp de 5…20 zile [1]. The method of treating recurrent right-sided pleurisy in patients with liver cirrhosis is known, which includes basic hepatoprotective, rheological, diuretic treatment, and in order to remove right-sided pleurisy, a puncture of the right pleural cavity is performed with the evacuation of pleural fluid, after which a drain is inserted into the V or VI intercostal space on the mid-axillary line for permanent evacuation of the fluid for a period of 5…20 days [1].
Dezavantajele metodei menţionate constau în aceea că drenul instalat în cavitatea pleurală serveşte drept o cale de pătrundere a infecţiei, ceea ce poate duce la apariţia complicaţiilor septice grave şi, respectiv, la mărirea termenului de spitalizare, totodată poate provoca pierderi masive de proteine şi dereglări hidro-electrolitice grave, pentru restituirea cărora sunt necesare transfuzii de preparate sangvine (plasmă, albumină etc.) şi preparate pentru restabilirea echilibrului electrolitic şi acido-bazic, care constituie cheltuieli suplimentare enorme. Totodată, complicaţiile caracteristice metodei de drenare a cavităţii pleurale provoacă agravarea stării pacienţilor cu decompensarea funcţiei hepatice, ceea ce duce la apariţia insuficienţei hepato-renale cu decesul pacientului. The disadvantages of the mentioned method are that the drain installed in the pleural cavity serves as a path for infection to enter, which can lead to the occurrence of serious septic complications and, respectively, to an increase in the length of hospitalization, and can also cause massive protein losses and serious hydro-electrolytic disorders, for the restoration of which transfusions of blood products (plasma, albumin, etc.) and preparations for restoring electrolyte and acid-base balance are necessary, which constitute enormous additional expenses. At the same time, the complications characteristic of the method of drainage of the pleural cavity cause a worsening of the condition of patients with decompensation of liver function, which leads to the occurrence of hepato-renal insufficiency with the death of the patient.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode, care înlătură dezavantajele menţionate, evită pierderile enorme proteice şi hidro-electrolitice, astfel micşorând considerabil necesitatea utilizării preparatelor medicamentoase costisitoare. The problem solved by the invention consists in developing a method that eliminates the aforementioned disadvantages, avoids enormous protein and hydro-electrolytic losses, thus considerably reducing the need to use expensive medicinal preparations.
Metoda, conform invenţiei, constă în aceea că se administrează tratamentul de bază al cirozei hepatice, iar suplimentar sub anestezie locală se efectuează o incizie orizontală de 4…5 cm în regiunea supraclaviculară dreaptă, se mobilizează vena jugulară internă şi unghiul venos drept, se prepară ductul limfatic toracic drept pe tot segmentul cervical cu eliberarea din aderenţe şi cu excizia parţială a pachetului limfatic prescalenic pentru decompresia ductului, după care pacientul efectuează câteva expiraţii forţate şi acte de tuse pentru restabilirea circulaţiei limfatice, apoi se suturează prima fascie cervicală şi pielea. The method, according to the invention, consists in administering the basic treatment of liver cirrhosis, and additionally, under local anesthesia, a 4...5 cm horizontal incision is made in the right supraclavicular region, the internal jugular vein and the right venous angle are mobilized, the right thoracic lymphatic duct is prepared throughout the cervical segment with release from adhesions and partial excision of the prescalenic lymphatic bundle for decompression of the duct, after which the patient performs several forced exhalations and coughing acts to restore lymphatic circulation, then the first cervical fascia and the skin are sutured.
Rezultatul invenţiei constă în îmbunătăţirea rapidă a drenajului limfatic al cavităţii pleurale pe dreapta cu mărirea absorbţiei lichidului din ea şi micşorarea transudaţiei pleurale, ceea ce duce la micşorarea treptată a pleureziei cu evitarea efectuării drenării cavităţii pleurale cu complicaţiile caracteristice. The result of the invention consists in the rapid improvement of the lymphatic drainage of the pleural cavity on the right with increased absorption of fluid from it and decreased pleural transudation, which leads to the gradual decrease of pleurisy with the avoidance of performing drainage of the pleural cavity with the characteristic complications.
Avantajele invenţiei constau în aceea că se efectuează o intervenţie chirurgicală miniinvazivă, fără implicarea organelor cavităţii pleurale cu evitarea pericolului de pătrundere a infecţiei, evitarea complicaţiilor septice severe cu utilizarea preparatelor medicamentoase antibacteriene, restabilirea fluxului limfatic prin ductul limfatic drept cu îmbunătăţirea drenajului limfatic din aria pleuro-pulmonară dreaptă. Ca rezultat are loc micşorarea termenului de spitalizare şi a cheltuielilor pentru tratamentul pleureziei recidivante la pacienţii cu ciroză hepatică avansată. The advantages of the invention are that a minimally invasive surgical intervention is performed, without involving the organs of the pleural cavity, avoiding the danger of infection penetration, avoiding severe septic complications with the use of antibacterial drugs, restoring lymphatic flow through the right lymphatic duct with improving lymphatic drainage from the right pleuropulmonary area. As a result, the length of hospitalization and expenses for the treatment of recurrent pleurisy in patients with advanced liver cirrhosis are reduced.
Metoda se efectuează în modul următor. The method is performed in the following way.
Pacientul se internează pentru efectuarea investigaţiilor clinice şi paraclinice cu aprecierea rezervelor hepatice funcţionale. Până la intervenţie se indică tratamentul de bază hepatoprotector, reologic, diuretic şi se efectuează o puncţie pleurală de diagnostic cu examinarea clinică şi bacteriologică a lichidului pleural. Sub anestezie locală cu 40…60 ml de soluţie de lidocaină de 0,5…1% se efectuează o incizie orizontală de 4…5 cm în regiunea supraclaviculară dreaptă, se secţionează consecutiv fasciile cervicale I-IV, se mobilizează vena jugulară internă cu unghiul venos drept, se prepară ductul limfatic toracic drept pe tot segmentul cervical cu eliberarea din aderenţe şi excizia parţială a pachetului limfatic prescalenic pentru decompresia ductului. După care, pacientul efectuează câteva expiraţii forţate şi acte de tuse pentru propulsarea limfei prin ductul drept în unghiul venos drept şi restabilirea circulaţiei limfatice. În urma preparării ductului limfatic drept cu înlăturarea aderenţelor şi a pachetului limfatic prescalenic se formează o cavitate interfascială, în care segmentul cervical al ductului limfatic funcţionează liber asigurând o drenare limfatică adecvată. După aceasta se suturează doar fascia superficială cervicală şi pielea. The patient is admitted for clinical and paraclinical investigations with assessment of functional liver reserves. Until the intervention, basic hepatoprotective, rheological, diuretic treatment is indicated and a diagnostic pleural puncture is performed with clinical and bacteriological examination of the pleural fluid. Under local anesthesia with 40…60 ml of 0.5…1% lidocaine solution, a 4…5 cm horizontal incision is made in the right supraclavicular region, cervical fasciae I-IV are consecutively sectioned, the internal jugular vein with the right venous angle is mobilized, the right thoracic lymphatic duct is prepared throughout the cervical segment with release from adhesions and partial excision of the prescalene lymphatic bundle for decompression of the duct. After that, the patient performs several forced exhalations and coughing acts to propel the lymph through the right duct into the right venous angle and restore lymphatic circulation. Following preparation of the right lymphatic duct with removal of adhesions and the prescalene lymphatic bundle, an interfascial cavity is formed, in which the cervical segment of the lymphatic duct functions freely, ensuring adequate lymphatic drainage. After this, only the superficial cervical fascia and skin are sutured.
Conform metodei date au fost trataţi 5 pacienţi cu rezultate satisfăcătoare. According to this method, 5 patients were treated with satisfactory results.
Exemplu Example
Pacienta M., 47 ani, a fost internată în secţia chirurgie toracică cu diagnosticul de ciroză hepatică decompensată, ascită moderată, pleurezie masivă recidivantă pe dreapta. Antecedent pe parcursul a 2 luni au fost efectuate multiple puncţii pleurale cu evacuarea a câte 2…3 l de lichid pleural de 2 ori pe săptămână. Apoi s-a instalat un dren în cavitatea pleurală dreaptă, prin care pe parcursul a 2 săptămâni s-au eliminat peste 12 l de lichid pleural, provocând dereglări grave hidroelectrolitice şi hipoproteinemie pronunţată, care au necesitat transfuzii repetate de albumină, plasmă congelată, aminoacizi, antibioticoterapie profilactică etc. În rezultatul agravării stării funcţionale a ficatului şi a pierderilor menţionate s-a impus necesitatea de a înlătura drenul din cavitatea pleurală. Deşi tratamentul a fost efectuat acumulările de lichid pleural au progresat provocând insuficienţă cardio-pulmonară. S-a luat decizia de a aplica metoda revendicată. După efectuarea metodei date starea s-a ameliorat, acumulările de lichid pleural pe dreapta treptat s-au micşorat. După o lună de la intervenţia chirurgicală efectuată pleurezia s-a rezolvat. La examenele de control pe parcursul unui an postoperator recidive de pleurezie nu s-au constatat. Patient M., 47 years old, was admitted to the thoracic surgery department with a diagnosis of decompensated liver cirrhosis, moderate ascites, and recurrent massive pleurisy on the right. Previously, multiple pleural punctures were performed over a period of 2 months with the evacuation of 2…3 l of pleural fluid 2 times a week. Then, a drain was installed in the right pleural cavity, through which over 12 l of pleural fluid were eliminated over a period of 2 weeks, causing serious hydroelectrolytic disorders and pronounced hypoproteinemia, which required repeated transfusions of albumin, frozen plasma, amino acids, prophylactic antibiotic therapy, etc. As a result of the worsening of the functional state of the liver and the aforementioned losses, it was necessary to remove the drain from the pleural cavity. Although the treatment was performed, the accumulations of pleural fluid progressed, causing cardiopulmonary failure. The decision was made to apply the claimed method. After performing the given method, the condition improved, the accumulations of pleural fluid on the right gradually decreased. One month after the surgical intervention, the pleurisy resolved. During the control examinations during the year postoperatively, no recurrences of pleurisy were found.
1. Колесников И.С., Лыткин М.И. Хирургия легких и плевры. Ленинград, Медицина, 1988, 384 с. 1. Kolesnikov I.S., Lytkin M.I. Lung and pleural surgery. Leningrad, Medicine, 1988, 384 с.
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Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20090158A MD115Z (en) | 2009-09-03 | 2009-09-03 | Method for treating right recurrent pleurisies to patients with hepatic cirrhosis |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20090158A MD115Z (en) | 2009-09-03 | 2009-09-03 | Method for treating right recurrent pleurisies to patients with hepatic cirrhosis |
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| MD115Y true MD115Y (en) | 2009-12-31 |
| MD115Z MD115Z (en) | 2010-07-31 |
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| MDS20090158A MD115Z (en) | 2009-09-03 | 2009-09-03 | Method for treating right recurrent pleurisies to patients with hepatic cirrhosis |
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| MD398Z (en) * | 2010-11-30 | 2012-02-29 | Георге АНГЕЛИЧ | Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis |
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| 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 |
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