MD370Z - Method for treatment of varicose rectal hemorrhages in cirrhogenic portal hypertension - Google Patents
Method for treatment of varicose rectal hemorrhages in cirrhogenic portal hypertension Download PDFInfo
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- MD370Z MD370Z MDS20100204A MDS20100204A MD370Z MD 370 Z MD370 Z MD 370Z MD S20100204 A MDS20100204 A MD S20100204A MD S20100204 A MDS20100204 A MD S20100204A MD 370 Z MD370 Z MD 370Z
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- Moldova
- Prior art keywords
- rectal
- incisions
- treatment
- varicose
- portal hypertension
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- 208000007232 portal hypertension Diseases 0.000 title claims abstract description 6
- 238000011282 treatment Methods 0.000 title claims abstract description 6
- 238000000034 method Methods 0.000 title claims description 12
- 206010038063 Rectal haemorrhage Diseases 0.000 title abstract description 5
- 210000003462 vein Anatomy 0.000 claims abstract description 12
- 210000001367 artery Anatomy 0.000 claims abstract description 7
- 210000001599 sigmoid colon Anatomy 0.000 claims abstract description 5
- 210000001113 umbilicus Anatomy 0.000 claims abstract description 4
- 230000000740 bleeding effect Effects 0.000 claims description 7
- 208000002847 Surgical Wound Diseases 0.000 claims description 3
- 230000001483 mobilizing effect Effects 0.000 claims description 2
- 208000019425 cirrhosis of liver Diseases 0.000 abstract description 6
- 239000003814 drug Substances 0.000 abstract description 3
- 238000001356 surgical procedure Methods 0.000 abstract description 2
- 206010052428 Wound Diseases 0.000 abstract 1
- 208000027418 Wounds and injury Diseases 0.000 abstract 1
- 208000032843 Hemorrhage Diseases 0.000 description 8
- 206010046996 Varicose vein Diseases 0.000 description 4
- 230000023597 hemostasis Effects 0.000 description 4
- 230000002439 hemostatic effect Effects 0.000 description 4
- 208000027185 varicose disease Diseases 0.000 description 4
- 238000002347 injection Methods 0.000 description 3
- 239000007924 injection Substances 0.000 description 3
- 206010002091 Anaesthesia Diseases 0.000 description 2
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 description 2
- LFQSCWFLJHTTHZ-UHFFFAOYSA-N Ethanol Chemical compound CCO LFQSCWFLJHTTHZ-UHFFFAOYSA-N 0.000 description 2
- GQPLMRYTRLFLPF-UHFFFAOYSA-N Nitrous Oxide Chemical compound [O-][N+]#N GQPLMRYTRLFLPF-UHFFFAOYSA-N 0.000 description 2
- 230000037005 anaesthesia Effects 0.000 description 2
- 230000003628 erosive effect Effects 0.000 description 2
- 238000002357 laparoscopic surgery Methods 0.000 description 2
- 210000004877 mucosa Anatomy 0.000 description 2
- 239000000126 substance Substances 0.000 description 2
- 208000032544 Cicatrix Diseases 0.000 description 1
- 206010069729 Collateral circulation Diseases 0.000 description 1
- 206010016654 Fibrosis Diseases 0.000 description 1
- WQZGKKKJIJFFOK-GASJEMHNSA-N Glucose Natural products OC[C@H]1OC(O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-GASJEMHNSA-N 0.000 description 1
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 description 1
- 241000168263 Palpatores Species 0.000 description 1
- 208000025865 Ulcer Diseases 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 230000003187 abdominal effect Effects 0.000 description 1
- 210000003815 abdominal wall Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 229910002092 carbon dioxide Inorganic materials 0.000 description 1
- 239000001569 carbon dioxide Substances 0.000 description 1
- 239000002729 catgut Substances 0.000 description 1
- 230000007882 cirrhosis Effects 0.000 description 1
- 230000007423 decrease Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 210000002815 epigastric artery Anatomy 0.000 description 1
- 239000004744 fabric Substances 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 238000002695 general anesthesia Methods 0.000 description 1
- 239000008103 glucose Substances 0.000 description 1
- 230000002008 hemorrhagic effect Effects 0.000 description 1
- 210000003111 iliac vein Anatomy 0.000 description 1
- 230000004054 inflammatory process Effects 0.000 description 1
- 238000001802 infusion Methods 0.000 description 1
- 238000001990 intravenous administration Methods 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 238000002483 medication Methods 0.000 description 1
- 210000001758 mesenteric vein Anatomy 0.000 description 1
- 210000003205 muscle Anatomy 0.000 description 1
- 239000001272 nitrous oxide Substances 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 210000004197 pelvis Anatomy 0.000 description 1
- 210000004258 portal system Anatomy 0.000 description 1
- 208000012951 rectorrhagia Diseases 0.000 description 1
- 210000001139 rectus abdominis Anatomy 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 230000037387 scars Effects 0.000 description 1
- 238000004904 shortening Methods 0.000 description 1
- 238000002579 sigmoidoscopy Methods 0.000 description 1
- 229910052708 sodium Inorganic materials 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
- 238000002693 spinal anesthesia Methods 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 230000001839 systemic circulation Effects 0.000 description 1
- 230000036269 ulceration Effects 0.000 description 1
- 210000001835 viscera Anatomy 0.000 description 1
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- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la proctologie şi chirurgia complicaţiilor cirozei hepatice şi poate fi utilizată pentru tratamentul rectohemoragiilor variceale în hipertensiunea portală cirogenă. The invention relates to medicine, in particular to proctology and surgery of complications of liver cirrhosis and can be used for the treatment of variceal bleeding in cirrhosis-related portal hypertension.
Este cunoscută metoda de hemostază a varicelor rectale secundare în hipertensiunea portală cirogenă complicată cu hemoragie, care constă în aceea că transrectal se aplică suturi hemostatice la nivelul nodului erupt [1]. The method of hemostasis of secondary rectal varices in surgical portal hypertension complicated by hemorrhage is known, which consists in applying hemostatic sutures transrectally to the erupted node [1].
Dezavantajele metodei constau în eficienţa hemostatică redusă, deoarece vasul lezat suturat cu catgut pe măsura micşorării procesului inflamator prezintă risc de repermeabilizare prin detaşarea suturilor aplicate, precum şi instalarea unor hemoragii erozive din mucoasa rectală congestionată, determinată de presiunea venoasă excesivă. The disadvantages of the method consist in the reduced hemostatic efficiency, because the injured vessel sutured with catgut, as the inflammatory process decreases, presents a risk of repermeability through detachment of the applied sutures, as well as the occurrence of erosive hemorrhages from the congested rectal mucosa, determined by excessive venous pressure.
O altă metodă cunoscută de hemostază în rectoragiile cirogene constă în injectarea de substanţe sclerozante ca: moroat de sodiu 5%, glucoză hipertonă, polidecanol, alcool absolut. Injectarea se poate efectua direct (intravariceal), indirect (perivariceal) şi mixt [2]. Another known method of hemostasis in surgical rectorrhagia consists of the injection of sclerosing substances such as: 5% sodium moroate, hypertonic glucose, polidecanol, absolute alcohol. The injection can be performed directly (intravariceally), indirectly (perivariceally) and mixed [2].
Dezavantajul metodei constă în eficienţa hemostatică redusă, deoarece peste scurt timp după injectarea de substanţe sclerozante, la nivelul mucoasei rectului se produce ulceraţie postnecrotică, care poate antrena straturile mai profunde ale peretelui rectal cu recidiva rectoragiei, care în hipertensiunea portală poate fi profuză. The disadvantage of the method is the reduced hemostatic efficiency, because shortly after the injection of sclerosing substances, post-necrotic ulceration occurs in the rectal mucosa, which can involve the deeper layers of the rectal wall with the recurrence of rectal bleeding, which in portal hypertension can be profuse.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode eficiente de hemostază miniinvazivă, care înlătură dezavantajele, reduce numărul de recidive hemoragice, micşorând totodată perioada de tratament. The problem solved by the invention consists in developing an effective method of minimally invasive hemostasis, which eliminates the disadvantages, reduces the number of hemorrhagic relapses, while also shortening the treatment period.
Esenţa invenţiei constă în aceea că se efectuează trei incizii de 1,0…1,5 cm pentru instrumentele laparoscopice, şi anume o incizie cu 1 cm mai jos de ombilic, a doua şi a treia incizii cu 2 cm mai sus şi, respectiv, cu 2 cm medial de spina iliacă anterosuperioară, laparoscopic se ridică colonul sigmoidian, se mobilizează, se secţionează şi se ligaturează vena şi artera rectală superioară la nivelul joncţiunii recto-sigmoidiene, după care plăgile operatorii se suturează. The essence of the invention consists in making three incisions of 1.0…1.5 cm for laparoscopic instruments, namely an incision 1 cm below the umbilicus, the second and third incisions 2 cm above and, respectively, 2 cm medial to the anterosuperior iliac spine, laparoscopically lifting the sigmoid colon, mobilizing, sectioning and ligating the superior rectal vein and artery at the recto-sigmoid junction, after which the surgical wounds are sutured.
Drenajul venos se realizează prin vene sateliţi şi omonime arterelor. Alt punct de plecare este plexul venos submucos (hemoroidal), sângele venos este colectat în cea mai mare parte de vena rectală superioară, care prin intermediul venei mezenterice inferioare, se revarsă în sistemul portal. Din partea inferioară a reţelei hemoroidale pornesc venele rectale medii, tributare venelor hipogastrice şi venele rectale inferioare, tributare venelor pudende interne, la rândul lor tributare venei iliace interne, deci circulaţiei sistemice. Venous drainage is achieved through satellite veins and arteries of the same name. Another starting point is the submucosal venous plexus (hemorrhoidal), venous blood is collected mostly by the superior rectal vein, which, through the inferior mesenteric vein, flows into the portal system. From the lower part of the hemorrhoidal network, the middle rectal veins, tributaries of the hypogastric veins and the inferior rectal veins, tributaries of the internal pudendal veins, in turn tributaries of the internal iliac vein, therefore to the systemic circulation, start.
Avantajele metodei revendicate: Advantages of the claimed method:
- posedă o eficacitate hemostatică înaltă; - possesses high hemostatic efficacy;
- nu necesită tratamente costisitoare; - does not require expensive treatments;
- permite revizia organelor interne la bolnavii cu ciroză hepatică; - allows revision of internal organs in patients with liver cirrhosis;
- se micşorează perioada de spitalizare şi reabilitare a acestor pacienţi. - the hospitalization and rehabilitation period of these patients is reduced.
Metoda se efectuează în modul următor. După internarea pacientului şi efectuarea investigaţiilor clinice şi paraclinice, şi anume a rectoromanoscopiei se determină localizarea nodului variceal hemoragic, care este tamponat preventiv. Apoi, după pregătirea preoperatorie a pacientului, se intervine chirurgical prin utilizarea setului pentru laparoscopie video-asistată. Laparoscopia este efectuată de către un chirurg. De regulă, se aplică anestezia generală, însă se pot aplica şi alte tipuri de anestezii (precum rahianestezia). Se montează perfuzia intravenoasă la nivelul braţului, prin care se administrează lichide şi medicamente. The method is performed as follows. After the patient is admitted and clinical and paraclinical investigations are carried out, namely the rectoromanoscopy, the location of the bleeding varicose node is determined, which is preemptively tamponed. Then, after the preoperative preparation of the patient, surgical intervention is performed using the video-assisted laparoscopy set. Laparoscopy is performed by a surgeon. As a rule, general anesthesia is applied, but other types of anesthesia can also be applied (such as spinal anesthesia). An intravenous infusion is installed in the arm, through which fluids and medications are administered.
Se efectuează trei incizii de 1,0…1,5 cm pentru instrumentele laparoscopice, şi anume o incizie cu 1 cm mai jos de ombilic, a doua şi a treia incizii cu 2 cm mai sus şi, respectiv, cu 2 cm medial de spina iliacă anterosuperioară. Se evită accesul prin cicatricele abdominale şi muşchii drepţi abdominali (arterele epigastrice au traiectul prezent la acest nivel). La locul de puncţie se individualizează eventualele traiecte de circulaţie colaterală, care de asemenea se evită. La nivelul inciziei se introduce un ac, prin care se injectează încet gaz (dioxid de carbon sau oxid de azot) în abdomen. Gazul creează un spaţiu de manevră prin ridicarea peretelui abdominal. Apoi, prin prima incizie se introduce laparoscopul şi se vizualizează organele. După amplasarea instrumentelor lucrătoare prin celelalte incizii, pacientul se poziţionează culcat pe spate cu bazinul ridicat în raport cu umerii şi capul (poziţia Trendelenburg). Cu ajutorul palpatorului se ridică sigma pentru a permite mobilizarea, pensarea (cliparea), secţionarea şi ligaturarea arterei şi venei rectale superioare. Laparoscopic se ridică colonul sigmoidian, se mobilizează, se secţionează şi se ligaturează vena şi artera rectală superioară la nivelul joncţiunii recto-sigmoidiene. Se efectuează revizia minuţioasă a hemostazei. După efectuarea intervenţiei, laparoscopul şi gazul sunt îndepărtate. Se suturează plăgile operatorii, se aplică pansament aseptic. Procedeul descris durează în medie 30...45 min. După terminarea intervenţiei pacientul este plasat în salon şi supravegheat până se trezeşte din anestezie. Three incisions of 1.0…1.5 cm are made for laparoscopic instruments, namely an incision 1 cm below the umbilicus, the second and third incisions 2 cm above and, respectively, 2 cm medial to the anterior superior iliac spine. Access through abdominal scars and the rectus abdominis muscles is avoided (the epigastric arteries have their course at this level). At the puncture site, any collateral circulation routes are identified, which are also avoided. A needle is inserted at the incision level, through which gas (carbon dioxide or nitrous oxide) is slowly injected into the abdomen. The gas creates a maneuvering space by raising the abdominal wall. Then, the laparoscope is inserted through the first incision and the organs are visualized. After placing the working instruments through the other incisions, the patient is positioned lying on his back with the pelvis raised in relation to the shoulders and head (Trendelenburg position). Using the palpator, the sigmoid colon is raised to allow mobilization, clamping (clipping), sectioning and ligation of the superior rectal artery and vein. Laparoscopically, the sigmoid colon is raised, the superior rectal vein and artery are mobilized, sectioned and ligated at the recto-sigmoid junction. A thorough revision of hemostasis is performed. After the intervention, the laparoscope and gas are removed. The surgical wounds are sutured, an aseptic dressing is applied. The described procedure takes an average of 30...45 min. After the intervention is completed, the patient is placed in the ward and monitored until he wakes up from anesthesia.
Metoda revendicată a fost aplicată la 3 pacienţi cu ciroză hepatică complicată cu hemoragie variceală rectală. Rectoragia la aceşti pacienţi nu s-a repetat. The claimed method was applied to 3 patients with liver cirrhosis complicated by rectal variceal bleeding. Rectal bleeding in these patients did not recur.
Exemplu Example
Pacientul N., în vârstă de 46 ani, a fost internat în secţia proctologie cu diagnosticul de hemoragie activă prin erodarea varicelui rectal secundar cirozei hepatice. S-a efectuat rectoromanoscopie cu stabilirea localizării varicelui hemoroidal, consemnându-se varice de gr. II plasate dispers cu hemoragie activă în pânză. După tamponarea temporară, peste 36 ore s-a efectuat pensarea, secţionarea şi ligaturarea arterei şi venei rectale superioare prin metoda descrisă. Controlul dinamic a relevat stoparea eficientă a hemoragiei. Pacientul a fost externat la a 12-a zi de la spitalizare în stare relativ satisfăcătoare. Patient N., aged 46, was admitted to the proctology department with the diagnosis of active bleeding due to erosion of rectal varices secondary to liver cirrhosis. Sigmoidoscopy was performed to establish the location of the hemorrhoidal varices, recording grade II varicose veins scattered throughout the fabric with active bleeding. After temporary tamponade, after 36 hours, clamping, sectioning and ligation of the superior rectal artery and vein were performed using the described method. Dynamic control revealed effective stopping of the bleeding. The patient was discharged on the 12th day of hospitalization in a relatively satisfactory condition.
1. Воробьев Г.И., Шелыгин Ю.А., Благодарный Л.А. Геморрой. Москва, 2002, с. 119-120 1. Vorobyev Г.И., Шелыгин Ю.А., Благодарный Л.А. Hemorrhoids. Moscow, 2002, p. 119-120
2. Воробьев Г.И., Шелыгин Ю.А., Благодарный Л.А. Геморрой. Москва, 2002, с. 104-108 2. Vorobyev Г.И., Шелыгин Ю.А., Благодарный Л.А. Hemorrhoids. Moscow, 2002, p. 104-108
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20100204A MD370Z (en) | 2010-11-30 | 2010-11-30 | Method for treatment of varicose rectal hemorrhages in cirrhogenic portal hypertension |
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|---|---|---|---|
| MDS20100204A MD370Z (en) | 2010-11-30 | 2010-11-30 | Method for treatment of varicose rectal hemorrhages in cirrhogenic portal hypertension |
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| MD370Y MD370Y (en) | 2011-05-31 |
| MD370Z true MD370Z (en) | 2011-12-31 |
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| MDS20100204A MD370Z (en) | 2010-11-30 | 2010-11-30 | Method for treatment of varicose rectal hemorrhages 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 MDS20100204A patent/MD370Z/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 (6)
| Title |
|---|
| 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.- * |
| Воробьев Г.И., Шелыгин Ю.А., Благодарный Л.А. Геморрой. Москва, 2002, с. 104-108 * |
| Воробьев Г.И., Шелыгин Ю.А., Благодарный Л.А. Геморрой. Москва, 2002, с. 119-120 * |
| 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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| MD370Y (en) | 2011-05-31 |
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