MD343Z - Method for prevention of secondary rectal varicose formation in patiens with splenomegaly in cirrhogenic portal hypertension - Google Patents
Method for prevention of secondary rectal varicose formation in patiens with splenomegaly in cirrhogenic portal hypertension Download PDFInfo
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- MD343Z MD343Z MDS20100206A MDS20100206A MD343Z MD 343 Z MD343 Z MD 343Z MD S20100206 A MDS20100206 A MD S20100206A MD S20100206 A MDS20100206 A MD S20100206A MD 343 Z MD343 Z MD 343Z
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- artery
- vein
- splenic
- rectal
- formation
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- 208000007232 portal hypertension Diseases 0.000 title claims abstract description 10
- 230000015572 biosynthetic process Effects 0.000 title claims abstract description 9
- 206010041660 Splenomegaly Diseases 0.000 title claims abstract description 6
- 238000000034 method Methods 0.000 title claims description 12
- 230000002265 prevention Effects 0.000 title abstract 2
- 210000001367 artery Anatomy 0.000 claims abstract description 13
- 210000003462 vein Anatomy 0.000 claims abstract description 10
- 210000002563 splenic artery Anatomy 0.000 claims abstract description 7
- 238000010911 splenectomy Methods 0.000 claims abstract description 6
- 230000023597 hemostasis Effects 0.000 claims abstract description 5
- 210000000955 splenic vein Anatomy 0.000 claims abstract description 5
- 230000002792 vascular Effects 0.000 claims abstract description 5
- 238000002350 laparotomy Methods 0.000 claims abstract description 4
- 210000000952 spleen Anatomy 0.000 claims abstract description 4
- 210000000683 abdominal cavity Anatomy 0.000 claims abstract description 3
- 230000003393 splenic effect Effects 0.000 claims abstract description 3
- 206010046996 Varicose vein Diseases 0.000 claims description 9
- 208000027185 varicose disease Diseases 0.000 claims description 9
- 238000011321 prophylaxis Methods 0.000 claims description 5
- 230000001483 mobilizing effect Effects 0.000 claims 1
- 208000019425 cirrhosis of liver Diseases 0.000 abstract description 6
- 238000001356 surgical procedure Methods 0.000 abstract description 4
- 239000003814 drug Substances 0.000 abstract description 2
- 230000007704 transition Effects 0.000 abstract 1
- 210000003041 ligament Anatomy 0.000 description 4
- 206010016654 Fibrosis Diseases 0.000 description 2
- 208000032843 Hemorrhage Diseases 0.000 description 2
- 206010038063 Rectal haemorrhage Diseases 0.000 description 2
- 230000000740 bleeding effect Effects 0.000 description 2
- 230000007882 cirrhosis Effects 0.000 description 2
- 210000000496 pancreas Anatomy 0.000 description 2
- 210000002784 stomach Anatomy 0.000 description 2
- 208000000624 Esophageal and Gastric Varices Diseases 0.000 description 1
- 208000030984 MIRAGE syndrome Diseases 0.000 description 1
- 206010030209 Oesophageal varices Diseases 0.000 description 1
- 208000003144 Subphrenic Abscess Diseases 0.000 description 1
- 206010056091 Varices oesophageal Diseases 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 210000003815 abdominal wall Anatomy 0.000 description 1
- 230000003872 anastomosis Effects 0.000 description 1
- 230000000747 cardiac effect Effects 0.000 description 1
- QTCANKDTWWSCMR-UHFFFAOYSA-N costic aldehyde Natural products C1CCC(=C)C2CC(C(=C)C=O)CCC21C QTCANKDTWWSCMR-UHFFFAOYSA-N 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 238000002224 dissection Methods 0.000 description 1
- 208000024170 esophageal varices Diseases 0.000 description 1
- 201000010120 esophageal varix Diseases 0.000 description 1
- 230000002496 gastric effect Effects 0.000 description 1
- 238000002695 general anesthesia Methods 0.000 description 1
- 238000002682 general surgery Methods 0.000 description 1
- 201000004108 hypersplenism Diseases 0.000 description 1
- ISTFUJWTQAMRGA-UHFFFAOYSA-N iso-beta-costal Natural products C1C(C(=C)C=O)CCC2(C)CCCC(C)=C21 ISTFUJWTQAMRGA-UHFFFAOYSA-N 0.000 description 1
- 238000002357 laparoscopic surgery Methods 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 238000012141 orotracheal intubation Methods 0.000 description 1
- 210000004197 pelvis Anatomy 0.000 description 1
- 210000004303 peritoneum Anatomy 0.000 description 1
- 230000002688 persistence Effects 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 238000004321 preservation Methods 0.000 description 1
- TVLSRXXIMLFWEO-UHFFFAOYSA-N prochloraz Chemical compound C1=CN=CN1C(=O)N(CCC)CCOC1=C(Cl)C=C(Cl)C=C1Cl TVLSRXXIMLFWEO-UHFFFAOYSA-N 0.000 description 1
- 208000012951 rectorrhagia Diseases 0.000 description 1
- 210000000664 rectum Anatomy 0.000 description 1
- 210000001599 sigmoid colon Anatomy 0.000 description 1
- 238000011282 treatment Methods 0.000 description 1
- 210000001364 upper extremity Anatomy 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 chirurgia complicaţiilor cirozei hepatice şi poate fi aplicată pentru profilaxia formării varicelor rectale secundare la bolnavii cu splenomegalie în hipertensiunea portală cirogenă. The invention relates to medicine, in particular to surgery of complications of liver cirrhosis and can be applied for the prophylaxis of secondary rectal variceal formation in patients with splenomegaly in cirrhosis-induced portal hypertension.
Este cunoscută metoda de profilaxie a formării varicelor esofago-gastrice secundare la bolnavii cu splenomegalie în hipertensiunea portală cirogenă, care constă în deconectarea azigo-portală produsă prin mobilizarea, ligaturarea şi secţionarea arterei şi venei gastrice sinistra la nivelul curburii mici a stomacului, şi anume în regiunea cardiacă [1]. There is a known method of prophylaxis of secondary esophageal-gastric variceal formation in patients with splenomegaly in surgical portal hypertension, which consists of azygo-portal disconnection produced by mobilization, ligation and sectioning of the left gastric artery and vein at the level of the lesser curvature of the stomach, namely in the cardiac region [1].
Dezavantajul metodei constă în persistenţa riscului de formare a varicelor rectale secundare şi a unei eventuale rectoragii din cauza că se păstrează anastomozele porto-cavale la nivelul rectului, care la pacientul cirotic poartă un caracter vicios. The disadvantage of the method is the persistence of the risk of secondary rectal varices and possible rectorrhagia due to the preservation of the porto-caval anastomoses at the rectum, which in cirrhotic patients has a vicious character.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode eficiente de profilaxie a formării varicelor rectale secundare în hipertensiunea portală cirogenă, care înlătură dezavantajele menţionate, reduce numărul de recidive cu spitalizări repetate pentru stoparea hemoragiilor din varicele rectale. The problem solved by the invention consists in developing an effective method for the prophylaxis of the formation of secondary rectal varices in surgical portal hypertension, which eliminates the aforementioned disadvantages, reduces the number of relapses with repeated hospitalizations to stop bleeding from rectal varices.
Esenţa metodei constă în aceea că se efectuează laparotomia cu mobilizarea pediculului vascular splenic, se ligaturează şi se excizează artera splenică, apoi vena splenică, se mobilizează splina şi se efectuează splenectomia. În regiunea joncţiunii rectosigmoidale se mobilizează pe o distanţă de 3 cm artera şi vena hemoroidală superioară, se ligaturează şi se excizează artera, apoi vena omonimă. Se efectuează hemostaza, se drenează cavitatea abdominală şi se suturează plaga pe straturi. The essence of the method is that a laparotomy is performed with mobilization of the splenic vascular pedicle, the splenic artery is ligated and excised, then the splenic vein, the spleen is mobilized and splenectomy is performed. In the region of the rectosigmoid junction, the superior hemorrhoidal artery and vein are mobilized over a distance of 3 cm, the artery is ligated and excised, then the vein of the same name. Hemostasis is performed, the abdominal cavity is drained and the wound is sutured in layers.
Rezultatul invenţiei este profilaxia eficientă a formării varicelor rectale secundare la pacienţii cu hipertensiune portală cirogenă cu evitarea necesităţii de spitalizări repetate cauzate de hemoragiile din varicele rectale. The result of the invention is the effective prophylaxis of the formation of secondary rectal varices in patients with surgical portal hypertension, avoiding the need for repeated hospitalizations caused by bleeding from rectal varices.
Avantajele metodei revendicate sunt: The advantages of the claimed method are:
- se efectuează în cadrul unui acces laparotomic al unei operaţii programate, - it is performed during a laparotomic access of a scheduled operation,
- tehnica efectuării este simplă şi inofensivă, - the technique is simple and harmless,
- se micşorează riscul de constituire a varicelor rectale secundare în hipertensiunea portală cirogenă, - the risk of secondary rectal varices in surgical portal hypertension is reduced,
- se micşorează riscul rectoragiei postoperatorii. - the risk of postoperative rectal bleeding is reduced.
Metoda se efectuează în modul următor. The method is performed in the following way.
În mod necondiţionat este folosită anestezia generală cu intubare oro-traheala. Pacientul este în decubit dorsal cu membrele superioare în abducţie la 90°. General anesthesia with oro-tracheal intubation is unconditionally used. The patient is in the supine position with the upper limbs in 90° abduction.
Tehnica operatorie: Calea de abord - laparotomia mediană supraombilicală. Surgical technique: Approach - supraumbilical median laparotomy.
Explorarea abdomenului se face în mod complet, ferindu-se de mirajul primei leziuni, se izolează peretele abdominal cu meşe şi se ridică rebordul costal stâng cu ajutorul unei valve, se pătrunde în loja retrogastrică pentru a pune în evidenţă artera splenică la nivelul marginii superioare a pancreasului sau în partea posterioară a părţii lui caudale prin secţionarea ligamentului gastrocolic. Se deplasează median stomacul, se pătrunde printr-o zonă avasculară în ligamentul gastrosplenic, unde vasele pot fi pensate. Se identifică artera splenică cu traiect sinuos. Se deschide cu grijă peritoneul deasupra arterei şi se aplică o pensă vasculară, se ligaturează dublu, ligaturile fiind plasate pe artera splenică mobilizată la o distanţă de 2 cm una faţă de alta. În acest spaţiu se secţionează artera. După ligaturarea şi secţionarea arterei splenice, se procedează similar cu vena splenică. Se rezecă ligamentul gastro-splenic pornind de la polul inferior spre cel superior. Se secţionează şi ligamentele spleno-renal şi spleno-colic, ceea ce permite mobilizarea completă a splinei. Se separă prin disecţie boanta de coada pancreasului, se clampează vena splenică şi se ligaturează. Se secţionează şi se ligaturează vasele restante. Se efectuează splenectomia cu controlul hemostazei. Se montează drenajul cavităţii cu tub scos prin contraincizie pentru evitarea formării abceselor subdiafragmale stângi. Se mobilizează şi se ridică colonul sigmoidian. Pe peretele mezocolic în regiunea joncţiunii rectosigmoidiene se identifică artera şi vena hemoroidală superioară. Vasele se mobilizează pe un traiect de 3 cm şi se aplică o pensă vasculară, se ligaturează dublu, ligaturile sunt plasate pe artera hemoroidală superioară la nivelul promontoriului la o distanţă de 2 cm una faţă de alta. În acest spaţiu se secţionează artera. Similar se procedează cu vena hemoroidală superioară. The abdomen is explored completely, avoiding the mirage of the first lesion, the abdominal wall is isolated with stitches and the left costal margin is raised with the help of a valve, the retrogastric lodge is entered to highlight the splenic artery at the level of the upper edge of the pancreas or in the posterior part of its caudal part by sectioning the gastrocolic ligament. The stomach is moved medially, an avascular area is entered into the gastrosplenic ligament, where the vessels can be clamped. The splenic artery with a sinuous course is identified. The peritoneum is carefully opened above the artery and a vascular clamp is applied, it is double ligated, the ligatures being placed on the mobilized splenic artery at a distance of 2 cm from each other. In this space, the artery is sectioned. After ligation and sectioning of the splenic artery, the procedure is similar to the splenic vein. The gastrosplenic ligament is resected starting from the lower pole to the upper one. The splenorenal and splenocolic ligaments are also divided, which allows complete mobilization of the spleen. The tail of the pancreas is separated by blunt dissection, the splenic vein is clamped and ligated. The remaining vessels are divided and ligated. Splenectomy is performed with hemostasis control. The cavity drainage is mounted with a tube removed through a counterincision to avoid the formation of left subdiaphragmatic abscesses. The sigmoid colon is mobilized and raised. On the mesocolic wall in the region of the rectosigmoid junction, the superior hemorrhoidal artery and vein are identified. The vessels are mobilized over a 3 cm path and a vascular clamp is applied, they are double ligated, the ligatures are placed on the superior hemorrhoidal artery at the level of the promontory at a distance of 2 cm from each other. In this space, the artery is divided. The superior hemorrhoidal vein is similarly treated.
Revizia hemostazei. Drenarea bazinului mic. Laparorafia. Revision of hemostasis. Drainage of the small pelvis. Laparoscopic surgery.
Metoda revendicată a fost aplicată la 3 pacienţi cu ciroză hepatică complicată cu hipertensiune portală. La examenul repetat nu s-a determinat formarea varicelor rectale secundare. The claimed method was applied to 3 patients with liver cirrhosis complicated by portal hypertension. On repeated examination, no secondary rectal variceal formation was determined.
Exemplu Example
Pacientul V., 42 ani, a fost internat în Secţia Chirurgie Generală cu diagnosticul de ciroză hepatică subcompensată HBV, Child „B”, hipertensiune portală, splenomegalie, hipersplenism gr. 3, varice esofagiene gr. 2. S-a efectuat rectomanoscopia, unde nu s-au stabilit varice hemoroidale. În cadrul operaţiei programate de splenectomie cu deconectarea azigo-portală s-a efectuat simultan ligaturarea şi secţionarea arterei şi venei hemoroidale superioare prin metoda revendicată. Controlul efectuat peste 6 şi 12 luni atestă lipsa varicelor rectale. Patient V., 42 years old, was admitted to the General Surgery Department with the diagnosis of subcompensated liver cirrhosis HBV, Child "B", portal hypertension, splenomegaly, hypersplenism gr. 3, esophageal varices gr. 2. Rectomanoscopy was performed, where no hemorrhoidal varices were established. During the scheduled splenectomy operation with azygo-portal disconnection, the superior hemorrhoidal artery and vein were simultaneously ligation and sectioned using the claimed method. The control performed after 6 and 12 months attested to the absence of rectal varices.
1. Hassab M.A. Gastro-oesophageal decongestion and splenectomy in the treatment of oesophageal varices in bilharzial cirrhosis: further studies with a report on 355 operations. Surgery, V. 61, 1967, p. 169-176 1. Hassab M.A. Gastro-oesophageal decongestion and splenectomy in the treatment of oesophageal varices in bilharzial cirrhosis: further studies with a report on 355 operations. Surgery, V. 61, 1967, p. 169-176
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20100206A MD343Z (en) | 2010-11-30 | 2010-11-30 | Method for prevention of secondary rectal varicose formation in patiens with splenomegaly in cirrhogenic portal hypertension |
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| Application Number | Priority Date | Filing Date | Title |
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| MDS20100206A MD343Z (en) | 2010-11-30 | 2010-11-30 | Method for prevention of secondary rectal varicose formation in patiens with splenomegaly in cirrhogenic portal hypertension |
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| Publication Number | Publication Date |
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| MD343Y MD343Y (en) | 2011-03-31 |
| MD343Z true MD343Z (en) | 2011-11-30 |
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| MDS20100206A MD343Z (en) | 2010-11-30 | 2010-11-30 | Method for prevention of secondary rectal varicose formation in patiens with splenomegaly in cirrhogenic portal hypertension |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| MD539Z (en) * | 2012-01-26 | 2013-03-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method for prevention of neovascularization after crossectomy |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD2328G2 (en) * | 2003-07-14 | 2004-07-31 | Константин ЦЫБЫРНЭ | Fibrinous adhesive and use thereof for endoscopic hemostasis of variceal hemorrhages in hepatic cirrhosis |
| MD2665G2 (en) * | 2004-09-24 | 2005-09-30 | Михаил ЭРЛИХ | Method of hemorrhoid nodules removal |
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- 2010-11-30 MD MDS20100206A patent/MD343Z/en not_active IP Right Cessation
Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD2328G2 (en) * | 2003-07-14 | 2004-07-31 | Константин ЦЫБЫРНЭ | Fibrinous adhesive and use thereof for endoscopic hemostasis of variceal hemorrhages in hepatic cirrhosis |
| MD2665G2 (en) * | 2004-09-24 | 2005-09-30 | Михаил ЭРЛИХ | Method of hemorrhoid nodules removal |
Non-Patent Citations (7)
| Title |
|---|
| Hassab M.A. Gastro-oesophageal decongestion and splenectomy in the treatment of oesophageal varices in bilharzial cirrhosis: further studies with a * |
| Hassab M.A. Gastro-oesophageal decongestion and splenectomy in the treatment of oesophageal varices in bilharzial cirrhosis: further studies with a report on 355 operations. Surgery, V. 61, 1967, p. 169-176 * |
| Hosking S.W., Smart H.L., Jonson A.G., Triger D.R. Anorectal varices haemorrhoids and portal hypertension. Lancet., v. 1, № 8634, 1989, p. 349- * |
| Paquet K.J., Kuhn R. Prophylactic Endoscopic sclerotherapy in Patients with Liver Cirrhosis, Portal Hypertension and Esophageal Varices.- * |
| report on 355 operations. Surgery, V. 61, 1967, p. 169-176 * |
| Ривкин В.Л., Капуллер Л.Л. Геморрой. Медицина, Москва, 1984, с.110-127 * |
| Федоров В.Д., Дульцев Ю.В. Проктология. Москва, 1984, с. 45-58 * |
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| Publication number | Publication date |
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| MD343Y (en) | 2011-03-31 |
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