MD1593Z - Method for improving liver microcirculation in decompensated and ascites-peritonitis complicated liver cirrhosis - Google Patents
Method for improving liver microcirculation in decompensated and ascites-peritonitis complicated liver cirrhosis Download PDFInfo
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- MD1593Z MD1593Z MDS20210058A MDS20210058A MD1593Z MD 1593 Z MD1593 Z MD 1593Z MD S20210058 A MDS20210058 A MD S20210058A MD S20210058 A MDS20210058 A MD S20210058A MD 1593 Z MD1593 Z MD 1593Z
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- 206010003445 Ascites Diseases 0.000 title claims abstract description 18
- 206010034674 peritonitis Diseases 0.000 title claims abstract description 15
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- 230000004089 microcirculation Effects 0.000 title claims abstract description 10
- 238000000034 method Methods 0.000 title claims description 17
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- 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 14
- 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 14
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- BWGVNKXGVNDBDI-UHFFFAOYSA-N Fibrin monomer Chemical compound CNC(=O)CNC(=O)CN BWGVNKXGVNDBDI-UHFFFAOYSA-N 0.000 claims abstract description 10
- 229950003499 fibrin Drugs 0.000 claims abstract description 10
- 210000000416 exudates and transudate Anatomy 0.000 claims abstract description 8
- 210000000056 organ Anatomy 0.000 claims abstract description 8
- 108010003272 Hyaluronate lyase Proteins 0.000 claims abstract description 7
- 102000001974 Hyaluronidases Human genes 0.000 claims abstract description 7
- 229960003405 ciprofloxacin Drugs 0.000 claims abstract description 7
- 238000002695 general anesthesia Methods 0.000 claims abstract description 7
- 229960002773 hyaluronidase Drugs 0.000 claims abstract description 7
- 238000002357 laparoscopic surgery Methods 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 6
- 229960004194 lidocaine Drugs 0.000 claims abstract description 6
- 210000001659 round ligament Anatomy 0.000 claims abstract description 6
- 230000002440 hepatic effect Effects 0.000 claims description 8
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- 230000003187 abdominal effect Effects 0.000 abstract description 4
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- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 abstract 3
- 239000011780 sodium chloride Substances 0.000 abstract 3
- 210000003567 ascitic fluid Anatomy 0.000 description 5
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- 230000006872 improvement Effects 0.000 description 4
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- 238000002360 preparation method Methods 0.000 description 3
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- 208000004998 Abdominal Pain Diseases 0.000 description 2
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- 238000009825 accumulation Methods 0.000 description 2
- 239000003242 anti bacterial agent Substances 0.000 description 2
- 229940088710 antibiotic agent Drugs 0.000 description 2
- 230000007882 cirrhosis Effects 0.000 description 2
- 238000004140 cleaning Methods 0.000 description 2
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- 210000003200 peritoneal cavity Anatomy 0.000 description 2
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- 102000009027 Albumins Human genes 0.000 description 1
- 108010088751 Albumins Proteins 0.000 description 1
- 206010010075 Coma hepatic Diseases 0.000 description 1
- 206010062070 Peritonitis bacterial Diseases 0.000 description 1
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- 230000000844 anti-bacterial effect Effects 0.000 description 1
- 230000001580 bacterial effect Effects 0.000 description 1
- 230000003115 biocidal effect Effects 0.000 description 1
- 229960000484 ceftazidime Drugs 0.000 description 1
- NMVPEQXCMGEDNH-TZVUEUGBSA-N ceftazidime pentahydrate Chemical compound O.O.O.O.O.S([C@@H]1[C@@H](C(N1C=1C([O-])=O)=O)NC(=O)\C(=N/OC(C)(C)C(O)=O)C=2N=C(N)SC=2)CC=1C[N+]1=CC=CC=C1 NMVPEQXCMGEDNH-TZVUEUGBSA-N 0.000 description 1
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- 238000007449 liver function test Methods 0.000 description 1
- 210000003622 mature neutrocyte Anatomy 0.000 description 1
- 229960000282 metronidazole Drugs 0.000 description 1
- VAOCPAMSLUNLGC-UHFFFAOYSA-N metronidazole Chemical compound CC1=NC=C([N+]([O-])=O)N1CCO VAOCPAMSLUNLGC-UHFFFAOYSA-N 0.000 description 1
- 210000003240 portal vein Anatomy 0.000 description 1
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- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
- Medicines Containing Material From Animals Or Micro-Organisms (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la hepatologie şi hepatochirurgie şi poate fi aplicată pentru ameliorarea microcirculaţiei hepatice în ciroza hepatică decompensată şi complicată cu ascit-peritonită. The invention relates to medicine, in particular to hepatology and hepatosurgery and can be applied to improve hepatic microcirculation in decompensated liver cirrhosis complicated with ascites-peritonitis.
Este cunoscută metoda de tratament al ascit-peritonitei în ciroza hepatică decompensată, şi totodată, cu scop de ameliorare a microcirculaţiei hepatice prin laparocenteză fracţionară dirijată cu efectuarea lavajului intraabdominal şi administrarea iniţială intraabdominală a antibioticelor de spectru larg, iar după obţinerea antibioticogramei cu efectuarea antibioticoterapiei ţintite [1]. Totodată, în cazul sindromului ascitic cirogen evoluează o suprimare a proceselor peritoneale resorbtive cu instalarea unei staze circulatorii, care menţine procesul inflamator peritoneal, ce provoacă în coninuare complicaţii potenţial letale, ca insuficienţa hepato-renală şi coma hepatică. The method of treating ascites-peritonitis in decompensated liver cirrhosis is known, and at the same time, with the aim of improving hepatic microcirculation by directed fractional laparocentesis with intra-abdominal lavage and initial intra-abdominal administration of broad-spectrum antibiotics, and after obtaining the antibiogram with targeted antibiotic therapy [1]. At the same time, in the case of surgical ascites syndrome, a suppression of peritoneal resorptive processes evolves with the installation of a circulatory stasis, which maintains the peritoneal inflammatory process, which in turn causes potentially lethal complications, such as hepatorenal insufficiency and hepatic coma.
Dezavantajul metodei constă în eficientă redusă în ce priveşte asanarea cavităţii peritoneale, deoarece accesul este redus, drenarea este insuficientă, totodată nu are loc o ameliorare satisfăcătoare a microcirculaţiei hepatice, nu are loc administrarea topică a preparatelor medicamentoase, iar administrarea intraabdominală sau sistemică nu este eficientă, deoarece în cazul ascit-peritonitei cirogene are loc o suprimare a proceselor peritoneale resorbtive. The disadvantage of the method is its low efficiency in terms of cleaning the peritoneal cavity, because access is limited, drainage is insufficient, and there is no satisfactory improvement in hepatic microcirculation, topical administration of medicinal preparations does not take place, and intra-abdominal or systemic administration is not effective, because in the case of surgical ascites-peritonitis, there is suppression of peritoneal resorptive processes.
Mai este cunoscută metoda de tratament al ascit-peritonitei în ciroza hepatică decompensată, şi totodată, cu scop de ameliorare a microcirculaţiei hepatice, care constă în aceea că se efectuează laparoscopia sub anestezie generală, se aspiră lent exudatul peritoneal, după care se efectuează inspecţia organelor abdominale cu înlăturarea aderenţelor fibrinice, se efectuează lavajul cu 1...2 L de soluţie fiziologică, ulterior se aspiră complet soluţia şi se introduce un amestec care conţine: hialuronidază 640...1080 UC dizolvată în 200...400 mL de soluţie fiziologică şi soluţie de ceftriaxonă 2...4 g, totodată, concomitent se administrează intravenos soluţie de ciprofloxacină 200 mg, de 2 ori pe zi şi soluţie de ceftriaxonă 2 g, de 2 ori pe zi, seria de tratament parenteral constituie 5...7 zile [2]. There is also a known method of treating ascites-peritonitis in decompensated liver cirrhosis, and at the same time, with the aim of improving hepatic microcirculation, which consists in performing laparoscopy under general anesthesia, slowly aspirating the peritoneal exudate, after which the abdominal organs are inspected with the removal of fibrin adhesions, lavage is performed with 1...2 L of physiological solution, then the solution is completely aspirated and a mixture containing: hyaluronidase 640...1080 UC dissolved in 200...400 mL of physiological solution and ceftriaxone solution 2...4 g is introduced, at the same time, ciprofloxacin solution 200 mg, 2 times a day and ceftriaxone solution 2 g, 2 times a day are administered intravenously, the parenteral treatment series is 5...7 days [2].
Dezavantajele metodei menţionate constau în eficienţă redusă în ce priveşte asanarea cavităţii peritoneale, deoarece accesul este redus, drenarea este insuficientă, totodată nu are loc o ameliorare satisfăcătoare a microcirculaţiei hepatice, deoarece nu are loc administrarea topică a preparatelor medicamentoase, iar administrarea intraabdominală sau sistemică nu este eficientă, deoarece în cazul ascit-peritonitei cirogene are loc o suprimare a proceselor peritoneale resorbtive şi a circulaţiei aferente a ficatului. The disadvantages of the mentioned method consist in reduced efficiency in terms of cleaning the peritoneal cavity, because access is reduced, drainage is insufficient, at the same time there is no satisfactory improvement of hepatic microcirculation, because topical administration of medicinal preparations does not take place, and intra-abdominal or systemic administration is not effective, because in the case of surgical ascites-peritonitis there is a suppression of peritoneal resorptive processes and the related circulation of the liver.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode complexe miniinvazive cu decompresie, evacuarea totală a exudatului peritoneal, vizualizarea şi inspecţia completă a organelor intraabdominale cu înlăturarea aderenţelor fibrinice şi liza fermentativă a lor, pentru o asanare eficientă a cavităţii abdominale cu profilaxia complicaţiilor septice şi administrarea topică a preparatelor medicamentoase cu profilaxia insuficienţei hepato-renale. The problem solved by the invention consists in developing a complex minimally invasive method with decompression, total evacuation of peritoneal exudate, complete visualization and inspection of intra-abdominal organs with removal of fibrin adhesions and their fermentative lysis, for effective sanitation of the abdominal cavity with prophylaxis of septic complications and topical administration of medicinal preparations with prophylaxis of hepato-renal insufficiency.
Esenţa invenţiei constă în aceea că se efectuează laparoscopia sub anestezie generală, se aspiră lent exudatul peritoneal, după care se efectuează inspecţia organelor cavităţii abdominale cu înlăturarea aderenţelor fibrinice, se efectuează lavajul cu 1...2 L de soluţie fiziologică, apoi soluţia se aspiră complet şi se introduce un amestec care conţine hialuronidază 640...1080 UC dizolvată în 200...400 mL de soluţie fiziologică şi soluţie de ceftriaxonă 2...4 g. Apoi sub controlul laparoscopului se introduce transcutan un cateter în ligamentul rotund al ficatului, care se fixează de piele, prin care se introduce un amestec ce conţine soluţie de lidocaină de 2%, 2 mL, soluţie de actovegin 200 mg/5 mL şi soluţie de ceftriaxonă 1 g, care se introduce zilnic, timp de 7 zile, iar concomitent se administrează intravenos soluţie de ciprofloxacină 200 mg, de 2 ori pe zi, timp de 5...7 zile, apoi cateterul se înlătură. The essence of the invention is that laparoscopy is performed under general anesthesia, the peritoneal exudate is slowly aspirated, after which the abdominal cavity organs are inspected with the removal of fibrin adhesions, lavage is performed with 1...2 L of physiological solution, then the solution is completely aspirated and a mixture containing hyaluronidase 640...1080 UC dissolved in 200...400 mL of physiological solution and ceftriaxone solution 2...4 g is introduced. Then, under the control of the laparoscope, a catheter is inserted transcutaneously into the round ligament of the liver, which is fixed to the skin, through which a mixture containing 2% lidocaine solution, 2 mL, actovegin solution 200 mg/5 mL and ceftriaxone solution 1 g is introduced, which is introduced daily, for 7 days, and simultaneously ciprofloxacin solution 200 mg is administered intravenously, 2 times a day, for 5...7 days, then the catheter is removed.
Rezultatul invenţiei constă în rezolvarea ascit-peritonitei, ameliorarea proceselor de resorbţie peritoneală cu reducerea ulterioară a acumulării lichidului ascitic, micşorarea riscului de recidivare a procesului septic intraabdominal, ameliorarea microcirculaţiei hepatice pentru menţinerea funcţiei hepatice şi profilaxia insuficienţei hepato-renale. The result of the invention consists in resolving ascites-peritonitis, improving peritoneal resorption processes with subsequent reduction of ascitic fluid accumulation, reducing the risk of recurrence of the intra-abdominal septic process, improving hepatic microcirculation to maintain hepatic function and preventing hepatorenal insufficiency.
Avantajele metodei revendicate sunt: The advantages of the claimed method are:
- posedă o eficacitate înaltă în rezolvarea ascit-peritonitei spontane, reduce rata recidivelor ascit-peritonitei la bolnavii cu ciroză decompensată; - has high efficacy in resolving spontaneous ascites-peritonitis, reduces the rate of ascites-peritonitis relapses in patients with decompensated cirrhosis;
- ameliorarea microcirculaţiei hepatice pentru menţinerea funcţiei hepatice şi profilaxia insuficienţei hepato-renale; - improving hepatic microcirculation to maintain liver function and prevent hepatorenal insufficiency;
- nu necesită aparataj costisitor; - does not require expensive equipment;
- micşorează perioada de spitalizare şi reabilitare a acestor pacienţi. - reduces the hospitalization and rehabilitation period of these patients.
Metoda se efectuează în modul următor. The method is performed in the following way.
După internarea pacientului şi efectuarea investigaţiilor clinice şi paraclinice, şi anume a ultrasonografiei pentru confirmarea diagnosticului, corecţia homeostazei şi stabilizarea hemodinamicii, se recurge la metoda revendicată. Se efectuează laparoscopia sub anestezie generală, se aspiră lent exudatul peritoneal, după care se efectuează inspecţia organelor cavităţii abdominale cu înlăturarea aderenţelor fibrinice, se efectuează lavajul cu 1...2 L de soluţie fiziologică, apoi soluţia se aspiră complet şi se introduce un amestec care conţine hialuronidază 640...1080 UC dizolvată în 200...400 mL de soluţie fiziologică şi soluţie de ceftriaxonă 2...4 g. Apoi sub controlul laparoscopului se introduce transcutan un cateter în ligamentul rotund al ficatului, care se fixează de piele, prin care se introduce un amestec ce conţine soluţie de lidocaină de 2%, 2 mL, soluţie de actovegin 200 mg/5 mL şi soluţie de ceftriaxonă 1 g, care se introduce zilnic, timp de 7 zile, iar concomitent se administrează intravenos soluţie de ciprofloxacină 200 mg, de 2 ori pe zi, timp de 5...7 zile, apoi cateterul se înlătură. After the patient is admitted and clinical and paraclinical investigations are performed, namely ultrasonography to confirm the diagnosis, correct homeostasis and stabilize hemodynamics, the claimed method is used. Laparoscopy is performed under general anesthesia, the peritoneal exudate is slowly aspirated, after which the abdominal cavity organs are inspected with the removal of fibrin adhesions, lavage is performed with 1...2 L of physiological solution, then the solution is completely aspirated and a mixture containing hyaluronidase 640...1080 UC dissolved in 200...400 mL of physiological solution and ceftriaxone solution 2...4 g is introduced. Then, under the control of the laparoscope, a catheter is inserted transcutaneously into the round ligament of the liver, which is fixed to the skin, through which a mixture containing 2% lidocaine solution, 2 mL, actovegin solution 200 mg/5 mL and ceftriaxone solution 1 g is introduced, which is introduced daily, for 7 days, and simultaneously ciprofloxacin solution 200 mg is administered intravenously, 2 times a day, for 5...7 days, then the catheter is removed.
Metoda revendicată a fost aplicată la 26 de pacienţi cu ciroză hepatică decompensată complicată cu ascit-peritonită spontană, după care s-a determinat rezolvarea procesului inflamator septic intraperitoneal fără necesitatea efectuării unor intervenţii chirurgicale traumatice (laparotomie) de sanare a cavităţii abdominale. The claimed method was applied to 26 patients with decompensated liver cirrhosis complicated by spontaneous ascites-peritonitis, after which the resolution of the intraperitoneal septic inflammatory process was determined without the need for traumatic surgical interventions (laparotomy) to repair the abdominal cavity.
Exemplul 1 Example 1
Pacientul A., 64 ani, a fost internat în secţia chirurgie cu diagnosticul de ciroză hepatică decompensată complicată cu ascit-peritonită. Pe parcursul a 7 luni antecedent s-au efectuat laparocenteze de volum repetate la fiecare 3...4 săptămâni cu evacuarea în medie a 7...10 L de lichid ascitic, iniţial transparent, apoi tulbure cu sediment şi fire de fibrină. Starea generală s-a agravat, cu acuze la dureri abdominale difuze, frisoane cu febră intermitentă, progresarea intoxicaţiei endogene, oligurie, decompensarea funcţiei hepatice. Examenul ultrasonografic la internare denotă ficat cu parenchim cu reflectivitate crescută, contur neregulat, macronodular şi semne ecografice de hipertensiune portală (dilatarea v. porte - 21 mm şi v. splenice - 11 mm). În cavitatea abdominală se determină o cantitate considerabilă de lichid ascitic neomogen cu elemente flotante, incluziuni hiperecogene şi fibrină - semne ecografice caracteristice de ascit-peritonită spontană. Pe fondal de tratament conservativ cu hepatoprotectoare, diuretice, antibiotice administrate sistemic nu s-a obţinut o ameliorare bună, după care s-a recurs la metoda revendicată. S-a efectuat laparoscopia sub anestezie generală, s-a aspirat lent exudatul peritoneal, după care s-a efectuat inspecţia organelor abdominale cu înlăturarea aderenţelor fibrinice, s-a efectuat lavajul cu 2 L de soluţie fiziologică, ulterior s-a aspirat complet soluţia şi s-a introdus amestecul care conţine: hialuronidază 1080 UC dizolvată în 400 mL de soluţie fiziologică şi soluţie de ceftriaxonă 2 g, apoi sub controlul laparoscopului s-a introdus transcutan un cateter în ligamentul rotund al ficatului, care s-a fixat de piele, prin care s-a introdus amestecul ce conţine soluţie de lidocaină de 2%, 2 mL, soluţie de actovegin 200 mg/5 mL şi soluţie de ceftriaxonă 1 g, care s-a introdus zilnic, timp de 7 zile, iar concomitent s-a administrat intravenos soluţie de ciprofloxacină 200 mg, de 2 ori pe zi, timp de 7 zile, apoi cateterul a fost înlăturat. Patient A., 64 years old, was admitted to the surgery department with the diagnosis of decompensated liver cirrhosis complicated by ascites-peritonitis. During the previous 7 months, repeated volume laparocentesis was performed every 3...4 weeks with the evacuation of an average of 7...10 L of ascitic fluid, initially transparent, then cloudy with sediment and fibrin threads. The general condition worsened, with complaints of diffuse abdominal pain, chills with intermittent fever, progression of endogenous intoxication, oliguria, decompensation of liver function. The ultrasound examination upon admission shows a liver with parenchyma with increased reflectivity, irregular, macronodular contour and ultrasound signs of portal hypertension (dilation of the portal vein - 21 mm and the splenic vein - 11 mm). In the abdominal cavity, a considerable amount of inhomogeneous ascitic fluid with floating elements, hyperechoic inclusions and fibrin is determined - characteristic ultrasound signs of spontaneous ascites-peritonitis. Against the background of conservative treatment with hepatoprotectors, diuretics, systemically administered antibiotics, no good improvement was achieved, after which the claimed method was resorted to. Laparoscopy was performed under general anesthesia, the peritoneal exudate was slowly aspirated, after which the abdominal organs were inspected with the removal of fibrin adhesions, lavage was performed with 2 L of physiological solution, subsequently the solution was completely aspirated and the mixture containing: hyaluronidase 1080 UC dissolved in 400 mL of physiological solution and ceftriaxone solution 2 g was introduced, then under the control of the laparoscope a catheter was inserted transcutaneously into the round ligament of the liver, which was fixed to the skin, through which the mixture containing 2% lidocaine solution, 2 mL, actovegin solution 200 mg/5 mL and ceftriaxone solution 1 g was introduced, which was introduced daily, for 7 days, and concurrently ciprofloxacin solution 200 mg was administered intravenously, 2 times a day, for 7 days, then the catheter was removed.
Controlul dinamic clinic, paraclinic şi ultrasonografic a relevat ameliorarea stării generale a pacientului cu îmbunătăţirea funcţiilor hepatice, micşorarea acumulării lichidului ascitic fără elemente flotante, transparent, ce a permis externarea lui la a 12-a zi de spitalizare în stare relativ satisfăcătoare cu funcţia hepatică stabilizată. Dynamic clinical, paraclinical and ultrasonographic control revealed an improvement in the patient's general condition with improved liver function, a decrease in the accumulation of ascitic fluid without floating elements, transparent, which allowed his discharge on the 12th day of hospitalization in a relatively satisfactory condition with stabilized liver function.
Exemplul 2 Example 2
Pacientul D., 48 ani, a fost internată în secţia chirurgie septică cu diagnosticul: ciroză hepatică decompensată HBV+HDV, Child “C”(12), hipertensiune portală, ascit-peritonită spontană bacteriană tensionată, dureri abdominale, meteorism, febră, oligurie. S-a efectuat terapia infuzională detoxifiantă, reologică, hepatoprotectoare, transfuzii de plasmă, albumină, diureza forţată, terapia antibacteriană parenterală cu soluţie de ceftazidimă 1 g, de 2 ori zi şi soluţie de metronidazol 100 mg, de 2 ori pe zi, i/v, care nu a avut efect de ameliorare a stării pacientului. S-a efectuat puncţia cavităţii abdominale cu examinarea lichidului ascitic la prezenţa de neutrofile polimorfonucleare (NPN), care s-a stabilit la nivelul de 320 mm3, ce a confirmat diagnosticul de peritonită bacteriană spontană. Patient D., 48 years old, was admitted to the septic surgery department with the diagnosis: decompensated liver cirrhosis HBV+HDV, Child “C” (12), portal hypertension, tense spontaneous bacterial ascites-peritonitis, abdominal pain, flatulence, fever, oliguria. Detoxifying, rheological, hepatoprotective infusion therapy, plasma transfusions, albumin, forced diuresis, parenteral antibacterial therapy with ceftazidime solution 1 g, 2 times a day and metronidazole solution 100 mg, 2 times a day, i/v, was performed, which had no effect on improving the patient's condition. Abdominal cavity puncture was performed with examination of the ascitic fluid for the presence of polymorphonuclear neutrophils (PNF), which was established at the level of 320 mm3, which confirmed the diagnosis of spontaneous bacterial peritonitis.
S-a efectuat laparoscopia sub anestezie generală, s-a aspirat lent exudatul peritoneal, după care s-a efectuat inspecţia organelor abdominale cu înlăturarea aderenţelor fibrinice, s-a efectuat lavajul cu 2 L de soluţie fiziologică, ulterior s-a aspirat complet soluţia şi s-a introdus amestecul care conţine: hialuronidază 1080 UC dizolvată în 400 mL de soluţie fiziologică şi soluţie de ceftriaxonă 2 g, apoi sub controlul laparoscopului s-a introdus transcutan un cateter în ligamentul rotund al ficatului, care s-a fixat de piele, prin care s-a introdus amestecul ce conţine soluţie de lidocaină de 2%, 2 mL, soluţie de actovegin 200 mg/5 mL şi soluţie de ceftriaxonă 1 g, care s-a introdus zilnic, timp de 7 zile, iar concomitent s-a administrat intravenos soluţie de ciprofloxacină 200 mg, de 2 ori pe zi, timp de 7 zile, apoi cateterul a fost înlăturat. Laparoscopy was performed under general anesthesia, the peritoneal exudate was slowly aspirated, after which the abdominal organs were inspected with the removal of fibrin adhesions, lavage was performed with 2 L of physiological solution, subsequently the solution was completely aspirated and the mixture containing: hyaluronidase 1080 UC dissolved in 400 mL of physiological solution and ceftriaxone solution 2 g was introduced, then under the control of the laparoscope a catheter was inserted transcutaneously into the round ligament of the liver, which was fixed to the skin, through which the mixture containing 2% lidocaine solution, 2 mL, actovegin solution 200 mg/5 mL and ceftriaxone solution 1 g was introduced, which was introduced daily, for 7 days, and concurrently ciprofloxacin solution 200 mg was administered intravenously, 2 times a day, for 7 days, then the catheter was removed.
După 72 ore starea generală s-a ameliorat, a dispărut febra, s-a restabilit diureza, ascita s-a micşorat, probele funcţionale hepatice s-au ameliorat. Pacientul a fost externat pentru tratament ambulator peste 9 zile. After 72 hours, the general condition improved, the fever disappeared, diuresis was restored, ascites decreased, liver function tests improved. The patient was discharged for outpatient treatment after 9 days.
1. Moore K., Aithal G. Guidelines on the management of ascites in cirrhosis. Gut, 2006, vol. 55, (Suppliment 6), p. 1-12 1. Moore K., Aithal G. Guidelines on the management of ascites in cirrhosis. Gut, 2006, vol. 55, (Supplement 6), p. 1-12
2. MD 774 Y 2014.05.31 2. MD 774 Y 2014.05.31
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