MD1204Z - Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis - Google Patents

Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis Download PDF

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MD1204Z
MD1204Z MDS20170073A MDS20170073A MD1204Z MD 1204 Z MD1204 Z MD 1204Z MD S20170073 A MDS20170073 A MD S20170073A MD S20170073 A MDS20170073 A MD S20170073A MD 1204 Z MD1204 Z MD 1204Z
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Moldova
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mixture
hours
ascitic fluid
liver cirrhosis
evacuation
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MDS20170073A
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Romanian (ro)
Russian (ru)
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Георге АНГЕЛИЧ
Серджиу ПИСАРЕНКО
Олег КРУДУ
Георге ЛУПУ
Татьяна ЗУГРАВ
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Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова
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Priority to MDS20170073A priority Critical patent/MD1204Z/en
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Abstract

The invention relates to medicine, in particular to hepatology and can be used for treating refractory ascites in patients with decompensated liver cirrhosis.Summary of the method consists in that a decompressed dosed laparocentesis is performed with partial evacuation of the ascitic fluid and intraperitoneal injection of ceftriaxone 2…4 g and ciprofloxacin 200…400 mg, simultaneously is transfused the frozen plasma 400…600 ml and cryoprecipitate 80…120 ml, after 24…48 hours is performed the laparoscopic intervention under general anesthesia, with complete evacuation of the ascitic fluid, the peritoneal lavage is performed with a mixture of 2000…4000 ml of physiological saline with dexamethasone 16…24 mg, followed by multiple punctiform excisions of 0.3…0.8 cm of the parietal peritoneum in the region of the diaphragm and the right lateral abdominal wall followed by drainage of the abdominal cavity for 3…5 days with daily lavages in the postoperative period with this mixture with the addition of 10% solution of lidocaine 4…6 ml, after the introduction of the mixture the drains are closed for 24 hours, after which they are evacuated.

Description

Invenţia se referă la medicină, în special la hepatologie şi poate fi utilizată pentru tratamentul ascitei refractare la pacienţii cu ciroză hepatică decompensată. The invention relates to medicine, in particular to hepatology and can be used for the treatment of refractory ascites in patients with decompensated liver cirrhosis.

Este cunoscută metoda de tratament a ascitei refractare, care constă în efectuarea laparoscopiei diagnostice cu evacuarea totală a lichidului ascitic şi drenarea cavităţii abdominale, asociată cu transfuzii de albumină 10% şi plasmă proaspăt congelată în scopul corecţei pierderilor proteice combinate cu infuzii de preparate macromoleculare şi terapie concomitentă simptomatică [1]. The treatment method for refractory ascites is known, which consists of performing diagnostic laparoscopy with total evacuation of ascitic fluid and drainage of the abdominal cavity, associated with transfusions of 10% albumin and fresh frozen plasma to correct protein losses combined with infusions of macromolecular preparations and concomitant symptomatic therapy [1].

Dezavantajul metodei date constă în eficacitatea redusă şi procentul înalt de recidive ale ascitei refractare din cauza micşorării capacităţii de absorbţie peritoneală în rezultatul edemului peritoneului parietal pe fundal de stază circulatorie în bazinul portal. The disadvantage of this method is the low effectiveness and high percentage of relapses of refractory ascites due to the decrease in peritoneal absorption capacity as a result of edema of the parietal peritoneum on the background of circulatory stasis in the portal basin.

De asemenea este cunoscută metoda de tratament chirurgical al ascitei refractare în ciroza hepatică decompensată, conform Kaliba, care constă în efectuarea laparotomiei cu evacuarea lichidului ascitic şi efectuarea unor excizii sectoriale ale peritoneului parietal în regiunile postero-laterale şi lombare cu scopul stimulării absorbţiei lichidului ascitic prin intermediul ţesuturilor retroperitoneale [2]. The method of surgical treatment of refractory ascites in decompensated liver cirrhosis is also known, according to Kaliba, which consists of performing laparotomy with evacuation of ascitic fluid and performing sectoral excisions of the parietal peritoneum in the posterolateral and lumbar regions with the aim of stimulating the absorption of ascitic fluid through the retroperitoneal tissues [2].

Dezavantajul metodei date constă în traumatismul major al intervenţiei chirurgicale cu riscuri de insuficienţă hepatică şi contaminarea potenţială a cavităţii abdominale şi a ţesuturilor retroperitoneale, eficacitate redusă şi procentul înalt de recidive. The disadvantage of this method is the major trauma of the surgical intervention with risks of liver failure and potential contamination of the abdominal cavity and retroperitoneal tissues, reduced efficacy and high recurrence rate.

Problema pe care o rezolvă invenţia constă în elaborarea unei metode de tratament laparoscopic al ascitei refractare cu scopul micşorării traumatismului, micşorării riscurilor evoluţiei complicaţiilor septico-purulente şi ameliorarea proceselor de absorbţie peritoneală. The problem solved by the invention consists in developing a method for laparoscopic treatment of refractory ascites with the aim of reducing trauma, reducing the risks of developing septic-purulent complications and improving peritoneal absorption processes.

Esenţa metodei constă în aceea că se efectuează laparocenteza dozată decompresivă cu evacuarea parţială a lichidului ascitic şi introducerea intraperitoneală a ceftriaxonului 2...4 g şi a ciprofloxacinei 200...400 mg, concomitent se efectuează transfuzii de plasmă congelată 400...600 ml şi crioprecipitat 80...120 ml, peste 24...48 ore se efectuează intervenţia laparoscopică sub anestezie generală cu evacuarea completă a lichidului ascitic, se efectuează lavajul peritoneal cu un amestec de 2000...4000 ml de ser fiziologic cu dexametazonă 16...24 mg, după care se efectuează multiple excizii punctiforme de 0,3...0,8 cm ale peritoneului parietal din regiunile diafragmei şi peretelui abdominal lateral drept cu drenarea ulterioară a cavităţii abdominale timp de 3...5 zile cu efectuarea lavajelor zilnice în perioada postoperatorie cu amestecul menţionat cu adaos de sol. de 10% de lidocaină 4...6 ml, după introducerea amestecului drenurile se închid pe 24 ore, după care se evacuează. The essence of the method is that dosed decompressive laparocentesis is performed with partial evacuation of ascitic fluid and intraperitoneal introduction of ceftriaxone 2...4 g and ciprofloxacin 200...400 mg, simultaneously transfusions of frozen plasma 400...600 ml and cryoprecipitate 80...120 ml are performed, after 24...48 hours laparoscopic intervention is performed under general anesthesia with complete evacuation of ascitic fluid, peritoneal lavage is performed with a mixture of 2000...4000 ml of physiological serum with dexamethasone 16...24 mg, after which multiple punctate excisions of 0.3...0.8 cm of the parietal peritoneum are performed in the regions of the diaphragm and the right lateral abdominal wall with subsequent drainage of the abdominal cavity for 3...5 days with daily lavages in the postoperative period with the aforementioned mixture with the addition of soil. of 10% lidocaine 4...6 ml, after introducing the mixture the drains are closed for 24 hours, after which they are evacuated.

Rezultatul invenţiei constă în stimularea proceselor de absorbţie peritoneală a lichidului ascitic prin orificiile formate, micşorarea edemului peritoneului şi profilaxia complicaţiilor septico-purulente. The result of the invention consists in stimulating the processes of peritoneal absorption of ascitic fluid through the formed holes, reducing peritoneal edema and preventing septic-purulent complications.

Metoda se efectuează în modul următor. The method is performed in the following way.

După pregătirea necesară a pacientului, s-a efectuat laparocenteza dozată decompresivă cu evacuarea parţială a lichidului ascitic şi cu introducerea intraperitoneală a ceftriaxonului 2...4 g şi a ciprofloxacinei 200...400 mg cu scop de profilaxie a infectării cavităţii abdominale, iar concomitent s-au efectuat transfuzii de plasmă congelată 400...600 ml şi crioprecipitat 80...120 ml pentru corecţia pierderilor proteice şi a hipoproteinemiei şi profilaxia sindromului intraopeator de coagulare intravasculară diseminată (CID), apoi peste 24...48 ore s-a efectuat intervenţia chirurgicală laparoscopică sub anestezie generală, unde s-a efectuat evacuarea completă a lichidului ascitic, lavajul peritoneal cu ser fiziologic 2000...4000 ml şi dexametazonă 16...24 mg, după care s-au efectuat excizii punctiforme multiple de 0,3...0,8 cm pe peritoneul parietal din regiunile diafragmei şi peretelui abdominal lateral drept cu drenarea ulterioară a cavităţii abdominale pe o perioadă de 3...5 zile cu efectuarea lavajelor zilnice în perioada postoperatorie cu amestecul menţionat, suplinit cu sol. lidocaină 10% - 4...6 ml şi închiderea drenurilor pe o perioadă de 24 ore, după care lichidul de lavaj s-a evacuat total cu repetarea procedurii de lavaj. After the necessary preparation of the patient, dosed decompressive laparocentesis was performed with partial evacuation of ascitic fluid and intraperitoneal introduction of ceftriaxone 2...4 g and ciprofloxacin 200...400 mg with the aim of prophylaxis of abdominal cavity infection, and simultaneously, frozen plasma transfusions 400...600 ml and cryoprecipitate 80...120 ml were performed for the correction of protein losses and hypoproteinemia and prophylaxis of intraoperative disseminated intravascular coagulation (DIC) syndrome, then after 24...48 hours, laparoscopic surgery was performed under general anesthesia, where complete evacuation of ascitic fluid, peritoneal lavage with physiological saline 2000...4000 ml and dexamethasone 16...24 mg were performed, after which multiple punctate excisions of 0.3...0.8 cm per the parietal peritoneum in the regions of the diaphragm and the right lateral abdominal wall with subsequent drainage of the abdominal cavity for a period of 3...5 days with daily lavages in the postoperative period with the aforementioned mixture, supplemented with 10% lidocaine solution - 4...6 ml and closing the drains for a period of 24 hours, after which the lavage fluid was completely evacuated with the repetition of the lavage procedure.

Metoda revendicată a fost utilizată pentru tratamentul a 47 pacienţi. The claimed method was used for the treatment of 47 patients.

Exemplu Example

Pacienta D., 53 ani, a fost internată în secţia chirurgie septică cu diagnosticul ciroză hepatică decompensată HCV, Child “C”(11), hipertensiune portală, ascită masivă refractară, dureri abdominale cauzate de extensia peretelui abdominal, astenie generală, denutriţie, edeme periferice, oligurie. Pacientei i s-a efectuat laparocenteza dozată decompresivă cu evacuarea parţială a lichidului ascitic în volum de 8 L şi cu introducerea intraperitoneală a ceftriaxonului 2 g şi a ciprofloxacinei 200 mg cu scop de profilaxie a infectării cavităţii abdominale, iar concomitent se efectuează transfuzii de plasmă congelată 600 ml şi crioprecipitat 80 ml pentru corecţia pierderilor proteice şi a hipoproteinemiei şi profilaxia sindromului intraopeator de coagulare intravasculară diseminată (CID), apoi peste 24 ore se efectuează intervenţia chirurgicală laparoscopică sub anestezie generală unde se efectuează evacuarea completă a lichidului ascitic, lavajul peritoneal cu ser fiziologic 2000 ml şi dexametazonă 16 mg, după care se efectuează excizii punctiforme multiple de 0,3...0,8 cm pe peritoneul parietal din regiunile diafragmei şi peretelui abdominal lateral drept în număr de 8 cu ajutorul forcepsului laparoscopic pentru biopsii şi cu drenarea ulterioară a cavităţii abdominale pe o perioadă de 3 zile şi efectuarea lavajelor zilnice în perioada postoperatorie cu amestecul menţionat, suplinit cu sol. lidocaină 10% - 4 ml şi închiderea drenurilor pe o perioadă de 24 ore, după care lichidul de lavaj este evacuat total, procedura de lavaj se repetă. La a 4-a zi s-a înlăturat drenul. Patient D., 53 years old, was admitted to the septic surgery department with the diagnosis of decompensated HCV liver cirrhosis, Child “C” (11), portal hypertension, refractory massive ascites, abdominal pain caused by abdominal wall extension, general asthenia, malnutrition, peripheral edema, oliguria. The patient underwent dosed decompressive laparocentesis with partial evacuation of ascitic fluid in a volume of 8 L and intraperitoneal introduction of ceftriaxone 2 g and ciprofloxacin 200 mg for the purpose of prophylaxis of abdominal cavity infection, and simultaneously, 600 ml of frozen plasma transfusions and 80 ml of cryoprecipitate were performed for the correction of protein losses and hypoproteinemia and prophylaxis of intraoperative disseminated intravascular coagulation (DIC) syndrome. Then, 24 hours later, laparoscopic surgery was performed under general anesthesia where complete evacuation of ascitic fluid was performed, peritoneal lavage with 2000 ml of saline and 16 mg of dexamethasone was performed, after which multiple punctate excisions of 0.3...0.8 cm were performed on the parietal peritoneum in the regions of the diaphragm and the right lateral abdominal wall in number of 8 using laparoscopic forceps for biopsies and with subsequent drainage of the abdominal cavity for a period of 3 days and daily lavages in the postoperative period with the aforementioned mixture, supplemented with sol. lidocaine 10% - 4 ml and closing the drains for a period of 24 hours, after which the lavage fluid is completely evacuated, the lavage procedure is repeated. On the 4th day the drain was removed.

După 7 zile starea generală s-a ameliorat, s-a restabilit diureza, ascita s-a micşorat şi s-a stabilizat la nivel minim, probele funcţionale hepatice s-au ameliorat. Pacientul a fost externat pentru tratament ambulator peste 9 zile. After 7 days, the general condition improved, diuresis was restored, ascites decreased and stabilized at a minimum level, liver function tests improved. The patient was discharged for outpatient treatment after 9 days.

1. Андреев Г.Н., Борисов А.В., Ибадильдин А.С.и др. Патогенез, диагностика и лечение циррозов печени, осложненных резистентным асцитом. Великий Новгород, 1999, p. 140-144 1. Andreev G.N., Borisov A.V., Ibadildin A.S. and others. Pathogenesis, diagnosis and treatment of liver cirrhosis complicated by resistant ascites. Veliky Novgorod, 1999, p. 140-144

2. Королев Б.А., Гагушин В.А. Хирургия циррозов печени. Москва, Медицина, 1973, рр. 78, 107 2. Korolev Б.А., Gagoushin В.А. Surgery of liver cirrhosis. Moscow, Medicine, 1973, рр. 78, 107

Claims (1)

Metodă de tratament laparoscopic al ascitei refractare în ciroza hepatică decompensată, care constă în aceea că se efectuează laparocenteza dozată decompresivă cu evacuarea parţială a lichidului ascitic şi introducerea intraperitoneală a ceftriaxon 2...4 g şi ciprofloxacină 200...400 mg, concomitent se efectuează transfuzii de plasmă congelată 400...600 ml şi crioprecipitat 80...120 ml, peste 24...48 ore se efectuează intervenţia laparoscopică sub anestezie generală cu evacuarea completă a lichidului ascitic, se efectuează lavajul peritoneal cu un amestec de 2000...4000 ml de ser fiziologic cu dexametazonă 16...24 mg, după care se efectuează multiple excizii punctiforme de 0,3...0,8 cm ale peritoneului parietal din regiunile diafragmei şi peretelui abdominal lateral drept cu drenarea ulterioară a cavităţii abdominale timp de 3...5 zile cu efectuarea lavajelor zilnice în perioada postoperatorie cu amestecul menţionat cu adaos de sol. de 10% de lidocaină 4...6 ml, după introducerea amestecului drenurile se închid pe 24 ore, după care se evacuează.Method of laparoscopic treatment of refractory ascites in decompensated liver cirrhosis, which consists in performing dosed decompressive laparocentesis with partial evacuation of ascitic fluid and intraperitoneal introduction of ceftriaxone 2...4 g and ciprofloxacin 200...400 mg, simultaneously performing transfusions of frozen plasma 400...600 ml and cryoprecipitate 80...120 ml, after 24...48 hours, laparoscopic intervention is performed under general anesthesia with complete evacuation of ascitic fluid, peritoneal lavage is performed with a mixture of 2000...4000 ml of physiological serum with dexamethasone 16...24 mg, after which multiple punctate excisions of 0.3...0.8 cm of the parietal peritoneum are performed in the regions of the diaphragm and the right lateral abdominal wall with subsequent drainage of the abdominal cavity for 3...5 days with daily lavages during the period postoperatively with the mentioned mixture with the addition of 10% lidocaine solution 4...6 ml, after introducing the mixture the drains are closed for 24 hours, after which they are evacuated.
MDS20170073A 2017-06-08 2017-06-08 Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis MD1204Z (en)

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Family Cites Families (11)

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Publication number Priority date Publication date Assignee Title
SU1079239A1 (en) * 1982-11-26 1984-03-15 Центральный научно-исследовательский рентгенорадиологический институт Method of treatment of cirrhosis of the liver
SU1421322A1 (en) * 1984-07-17 1988-09-07 Институт проблем криобиологии и криомедицины АН УССР Method of treatment of chronic hepatitis and cirrhosis of the liver
SU1253627A1 (en) * 1985-03-27 1986-08-30 1-Й Ленинградский Ордена Трудового Красного Знамени Медицинский Институт Им.Акад.И.П.Павлова Method of treatment of patients ill with cirrhosis of liver
SU1678335A1 (en) * 1989-12-26 1991-09-23 Центральный научно-исследовательский рентгенорадиологический институт Method for therapy of lymphostasis in cases of hepatic cirrohosis
SU1789230A1 (en) * 1990-09-04 1993-01-23 Kh Med Inst Method for treating cirrhosis hepatitis
MD3444G2 (en) * 2007-05-17 2008-07-31 Борис ПЫРГАРЬ Method of treating the spontaneous bacterial peritonitis in the decompensated hepatic cirrhosis with resistant ascitic syndrome
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
MD774Z (en) * 2013-09-12 2014-12-31 Георге АНГЕЛИЧ Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis
MD926Z (en) * 2014-09-11 2016-02-29 Георге АНГЕЛИЧ Method of laparoscopic treatment of spontaneous bacterial ascites-peritonitis in decompensated liver cirrhosis
MD927Z (en) * 2014-09-11 2016-02-29 Георге АНГЕЛИЧ Method for treatment of anaerobic spontaneous peritonitis in decompensated hepatocirrhosis with hepato-renal syndrome
MD1155Z (en) * 2016-12-08 2018-01-31 Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова Minimally invasive mathod for treating spontaneous ascites-peritonitis in decompensated liver cirrhosis

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