MD1204Z - Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis - Google Patents
Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis Download PDFInfo
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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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- mixture
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- ascitic fluid
- liver cirrhosis
- evacuation
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- 238000000034 method Methods 0.000 title claims abstract description 15
- 206010003445 Ascites Diseases 0.000 title claims abstract description 10
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 6
- 210000003567 ascitic fluid Anatomy 0.000 claims abstract description 14
- 239000000203 mixture Substances 0.000 claims abstract description 11
- MYSWGUAQZAJSOK-UHFFFAOYSA-N ciprofloxacin Chemical compound C12=CC(N3CCNCC3)=C(F)C=C2C(=O)C(C(=O)O)=CN1C1CC1 MYSWGUAQZAJSOK-UHFFFAOYSA-N 0.000 claims abstract description 10
- 210000000683 abdominal cavity Anatomy 0.000 claims abstract description 9
- 210000000505 parietal peritoneum Anatomy 0.000 claims abstract description 7
- 210000003815 abdominal wall Anatomy 0.000 claims abstract description 6
- 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
- 229960004755 ceftriaxone Drugs 0.000 claims abstract description 5
- VAAUVRVFOQPIGI-SPQHTLEESA-N ceftriaxone Chemical compound S([C@@H]1[C@@H](C(N1C=1C(O)=O)=O)NC(=O)\C(=N/OC)C=2N=C(N)SC=2)CC=1CSC1=NC(=O)C(=O)NN1C VAAUVRVFOQPIGI-SPQHTLEESA-N 0.000 claims abstract description 5
- 229960003405 ciprofloxacin Drugs 0.000 claims abstract description 5
- UREBDLICKHMUKA-CXSFZGCWSA-N dexamethasone Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@@H](C)[C@@](C(=O)CO)(O)[C@@]1(C)C[C@@H]2O UREBDLICKHMUKA-CXSFZGCWSA-N 0.000 claims abstract description 5
- 229960003957 dexamethasone Drugs 0.000 claims abstract description 5
- 238000002695 general anesthesia Methods 0.000 claims abstract description 5
- 229960004194 lidocaine Drugs 0.000 claims abstract description 5
- 238000011282 treatment Methods 0.000 claims description 6
- 230000000991 decompressive effect Effects 0.000 claims description 4
- 238000007912 intraperitoneal administration Methods 0.000 claims description 4
- 210000002966 serum Anatomy 0.000 claims description 2
- 230000002980 postoperative effect Effects 0.000 abstract description 4
- 239000003814 drug Substances 0.000 abstract description 2
- 239000002504 physiological saline solution Substances 0.000 abstract description 2
- 239000000243 solution Substances 0.000 abstract description 2
- 239000007928 intraperitoneal injection Substances 0.000 abstract 1
- 238000010521 absorption reaction Methods 0.000 description 4
- 210000002381 plasma Anatomy 0.000 description 4
- 238000011321 prophylaxis Methods 0.000 description 4
- 238000002357 laparoscopic surgery Methods 0.000 description 3
- 102000004169 proteins and genes Human genes 0.000 description 3
- 108090000623 proteins and genes Proteins 0.000 description 3
- 208000034767 Hypoproteinaemia Diseases 0.000 description 2
- 206010030113 Oedema Diseases 0.000 description 2
- 208000009190 disseminated intravascular coagulation Diseases 0.000 description 2
- 239000012530 fluid Substances 0.000 description 2
- 208000015181 infectious disease Diseases 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 230000004936 stimulating effect Effects 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 208000011580 syndromic disease Diseases 0.000 description 2
- 210000001519 tissue Anatomy 0.000 description 2
- 230000008733 trauma Effects 0.000 description 2
- 208000004998 Abdominal Pain Diseases 0.000 description 1
- 102000009027 Albumins Human genes 0.000 description 1
- 108010088751 Albumins Proteins 0.000 description 1
- 206010019663 Hepatic failure Diseases 0.000 description 1
- 208000002720 Malnutrition Diseases 0.000 description 1
- 206010030124 Oedema peripheral Diseases 0.000 description 1
- 206010030302 Oliguria Diseases 0.000 description 1
- 208000004880 Polyuria Diseases 0.000 description 1
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 1
- 206010003549 asthenia Diseases 0.000 description 1
- 238000001574 biopsy Methods 0.000 description 1
- 238000011109 contamination Methods 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 230000035619 diuresis Effects 0.000 description 1
- 239000004023 fresh frozen plasma Substances 0.000 description 1
- 238000001802 infusion Methods 0.000 description 1
- 238000002350 laparotomy Methods 0.000 description 1
- 208000007903 liver failure Diseases 0.000 description 1
- 231100000835 liver failure Toxicity 0.000 description 1
- 238000007449 liver function test Methods 0.000 description 1
- 210000004705 lumbosacral region Anatomy 0.000 description 1
- 230000001071 malnutrition Effects 0.000 description 1
- 235000000824 malnutrition Nutrition 0.000 description 1
- 208000015380 nutritional deficiency disease Diseases 0.000 description 1
- 208000007232 portal hypertension Diseases 0.000 description 1
- 239000011780 sodium chloride Substances 0.000 description 1
- 239000002689 soil Substances 0.000 description 1
- 238000011477 surgical intervention Methods 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
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
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20170073A MD1204Z (en) | 2017-06-08 | 2017-06-08 | Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis |
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| MDS20170073A MD1204Z (en) | 2017-06-08 | 2017-06-08 | Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis |
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| MD1204Y MD1204Y (en) | 2017-10-31 |
| MD1204Z true MD1204Z (en) | 2018-05-31 |
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Family Cites Families (11)
| 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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