MD398Z - Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis - Google Patents
Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis Download PDFInfo
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- MD398Z MD398Z MDS20100202A MDS20100202A MD398Z MD 398 Z MD398 Z MD 398Z MD S20100202 A MDS20100202 A MD S20100202A MD S20100202 A MDS20100202 A MD S20100202A MD 398 Z MD398 Z MD 398Z
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- Moldova
- Prior art keywords
- patients
- lymphocirculation
- peritoneal
- resorption
- processes
- Prior art date
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- 238000000034 method Methods 0.000 title claims abstract description 16
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 6
- 230000008569 process Effects 0.000 title claims abstract description 6
- 230000004936 stimulating effect Effects 0.000 title claims 2
- 230000007420 reactivation Effects 0.000 title abstract description 3
- 208000031513 cyst Diseases 0.000 claims abstract description 11
- 230000001926 lymphatic effect Effects 0.000 claims abstract description 10
- 206010011732 Cyst Diseases 0.000 claims abstract description 5
- 108010023197 Streptokinase Proteins 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
- 238000009434 installation Methods 0.000 claims abstract description 5
- 229960005202 streptokinase Drugs 0.000 claims abstract description 5
- 239000000243 solution Substances 0.000 claims description 5
- 239000012530 fluid Substances 0.000 claims description 4
- 239000000819 hypertonic solution Substances 0.000 claims description 4
- 229940021223 hypertonic solution Drugs 0.000 claims description 4
- 239000003814 drug Substances 0.000 abstract description 2
- 210000000115 thoracic cavity Anatomy 0.000 abstract description 2
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 abstract 1
- 239000007788 liquid Substances 0.000 abstract 1
- 210000002751 lymph Anatomy 0.000 abstract 1
- 239000011780 sodium chloride Substances 0.000 abstract 1
- 206010003445 Ascites Diseases 0.000 description 18
- 206010034674 peritonitis Diseases 0.000 description 9
- 238000002604 ultrasonography Methods 0.000 description 4
- 239000003242 anti bacterial agent Substances 0.000 description 3
- 229940088710 antibiotic agent Drugs 0.000 description 3
- 210000003567 ascitic fluid Anatomy 0.000 description 3
- 208000011580 syndromic disease Diseases 0.000 description 3
- 230000006872 improvement Effects 0.000 description 2
- 210000004185 liver Anatomy 0.000 description 2
- 230000001629 suppression Effects 0.000 description 2
- 208000004998 Abdominal Pain Diseases 0.000 description 1
- 206010037660 Pyrexia Diseases 0.000 description 1
- 208000001647 Renal Insufficiency Diseases 0.000 description 1
- 210000000683 abdominal cavity Anatomy 0.000 description 1
- 238000010521 absorption reaction Methods 0.000 description 1
- 206010003549 asthenia Diseases 0.000 description 1
- 230000003115 biocidal effect Effects 0.000 description 1
- 230000006837 decompression Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 230000010339 dilation Effects 0.000 description 1
- 239000002934 diuretic Substances 0.000 description 1
- 229940030606 diuretics Drugs 0.000 description 1
- 230000003483 hypokinetic effect Effects 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 230000001788 irregular Effects 0.000 description 1
- 201000006370 kidney failure Diseases 0.000 description 1
- 238000002350 laparotomy Methods 0.000 description 1
- 230000003908 liver function Effects 0.000 description 1
- 208000007232 portal hypertension Diseases 0.000 description 1
- 210000003240 portal vein Anatomy 0.000 description 1
- 238000002310 reflectometry Methods 0.000 description 1
- 230000008439 repair process Effects 0.000 description 1
- 239000013049 sediment Substances 0.000 description 1
- 210000000955 splenic vein Anatomy 0.000 description 1
- 230000000638 stimulation Effects 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 230000000472 traumatic effect Effects 0.000 description 1
Landscapes
- 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 poate fi folosită pentru stimularea resorbţiei proceselor peritoneale prin reactivarea limfocirculaţiei la bolnavii cu ciroză hepatică. The invention relates to medicine, especially to hepatology, and can be used to stimulate the resorption of peritoneal processes by reactivating lymphocirculation in patients with liver cirrhosis.
Este cunoscută metoda de tratament al ascitei rezistente sau a ascit-peritonitei prin laparocenteză fracţionară dirijată cu efectuarea lavajului intraabdominal şi administrarea iniţială intraabdominală a antibioticelor de spectru larg, apoi a antibioticelor conform antibioticogramei [1]. The method of treating resistant ascites or ascites-peritonitis is known through directed fractional laparocentesis with intra-abdominal lavage and initial intra-abdominal administration of broad-spectrum antibiotics, then antibiotics according to the antibiogram [1].
Dezavantajele acestei metode constau în aceea că sindromul ascitic cirogen evoluează cu o suprimare a proceselor peritoneale resorbtive, mai ales în cazul închistării lichidului ascitic, amplificându-se în aşa fel riscul de dezvoltare a ascit-peritonitei. În acelaşi timp, la asemenea pacienţi se remarcă suprimarea limfocirculaţiei centrale ce capătă un caracter hipodinamic şi hipocinetic, totodată metoda menţionată posedă o eficienţă redusă în ce priveşte corecţia sindromului ascitic cirogen, risc sporit de declanşare a ascit-peritonitei cu evoluţia ulterioară a insuficienţei hepato-renale şi rată înaltă de deces prin această complicaţie. The disadvantages of this method are that the surgical ascites syndrome evolves with a suppression of the resorptive peritoneal processes, especially in the case of ascitic fluid retention, thus increasing the risk of developing ascites-peritonitis. At the same time, in such patients, the suppression of the central lymphocirculation is noted, which acquires a hypodynamic and hypokinetic character, at the same time the mentioned method has a reduced efficiency in terms of correcting the surgical ascites syndrome, an increased risk of triggering ascites-peritonitis with the subsequent evolution of hepato-renal insufficiency and a high death rate from this complication.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode complexe ce ar cuprinde măsuri terapeutice miniinvazive ecoghidate de tratare a ascitei închistate asociate cu antibioticoterapie raţională şi stimularea fenomenelor de absorbţie peritoneală, cât şi reactivarea limfocirculaţiei centrale prin decompresia ductului toracic limfatic. The problem solved by the invention consists in developing a complex method that would include ultrasound-guided minimally invasive therapeutic measures for the treatment of closed ascites associated with rational antibiotic therapy and stimulation of peritoneal absorption phenomena, as well as the reactivation of central lymphocirculation by decompression of the thoracic lymphatic duct.
Esenţa invenţiei constă în aceea că se efectuează puncţia ecoghidată a chisturilor lichidiene cu instalarea unor drenuri, lavajul cavităţii chistului cu soluţie hipertonică, apoi prin drenurile instalate se administrează soluţii de Ceftriaxone 1,0 g şi Streptochinază 20000 UI de 2 ori pe zi, timp de 4…5 zile, după care se efectuează o incizie în regiunea supraclaviculară stângă cu mobilizarea unghiului venos, se mobilizează ramura principală a ductului limfatic la nivelul segmentului cervical, se excizează aderenţele şi se ligaturează ramurile limfatice aferente, după care plaga se suturează pe straturi. The essence of the invention consists in performing ultrasound-guided puncture of fluid cysts with the installation of drains, lavage of the cyst cavity with hypertonic solution, then through the installed drains, solutions of Ceftriaxone 1.0 g and Streptokinase 20,000 IU are administered 2 times a day, for 4...5 days, after which an incision is made in the left supraclavicular region with mobilization of the venous angle, the main branch of the lymphatic duct is mobilized at the level of the cervical segment, adhesions are excised and the afferent lymphatic branches are ligated, after which the wound is sutured in layers.
Rezultatul invenţiei constă în ameliorarea proceselor de resorbţie peritoneală, reducerea ratei de evoluţie a ascit-peritonitei la bolnavul cirotic, ce de regulă prezintă o complicaţie fatală, reactivarea limfocirculaţiei centrale prin corecţia chirurgicală a sindromului ascitic cirogen. The result of the invention consists in improving peritoneal resorption processes, reducing the rate of evolution of ascites-peritonitis in cirrhotic patients, which usually presents a fatal complication, reactivating central lymphocirculation through surgical correction of cirrhogenic ascites syndrome.
Avantajele metodei revendicate faţă de soluţia cea mai apropiată sunt: The advantages of the claimed method over the closest solution are:
- reducerea ratei de evoluţie a ascitei în ascit-peritonită la bolnavul cirotic decompensat, - reducing the rate of evolution of ascites into ascites-peritonitis in decompensated cirrhotic patients,
- eficacitate relativ înaltă în tratarea ascit-peritonitei închistate, - relatively high efficacy in treating ascites-obstructive peritonitis,
- nu necesită tratament costisitor din punct de vedere al dotării cu aparataj, - does not require expensive treatment in terms of equipment,
- micşorarea perioadei de spitalizare şi reabilitare a acestor pacienţi. - reducing the hospitalization and rehabilitation period of these patients.
Metoda se efectuează în modul următor. După internarea pacientului şi efectuarea investigaţiilor clinice şi paraclinice ( ultrasonografia), se apreciază localizarea lichidului ascitic închistat, apoi se efectuează puncţia ecoghidată a chisturilor lichidiene cu instalarea unor drenuri, lavajul cavităţii chistului cu soluţie hipertonică, apoi prin drenurile instalate se administrează soluţii de Ceftriaxone 1,0 g şi Streptochinază 20000 UI de 2 ori pe zi, timp de 4…5 zile, după care se efectuează o incizie în regiunea supraclaviculară stângă cu mobilizarea unghiului venos, se mobilizează ramura principală a ductului limfatic la nivelul segmentului cervical, se excizează aderenţele şi se ligaturează ramurile limfatice aferente, după care plaga se suturează pe straturi. The method is performed as follows. After the patient is admitted and clinical and paraclinical investigations (ultrasound) are performed, the location of the trapped ascitic fluid is assessed, then ultrasound-guided puncture of the fluid cysts is performed with the installation of drains, the cyst cavity is washed with hypertonic solution, then through the installed drains, solutions of Ceftriaxone 1.0 g and Streptokinase 20,000 IU are administered 2 times a day, for 4…5 days, after which an incision is made in the left supraclavicular region with mobilization of the venous angle, the main branch of the lymphatic duct is mobilized at the level of the cervical segment, adhesions are excised and the afferent lymphatic branches are ligated, after which the wound is sutured in layers.
Metoda revendicată a fost aplicată la 9 pacienţi cu ciroză hepatică complicată cu ascită rezistentă sau ascit-peritonită închistată, după care s-a determinat o micşorare a progresării şi o rată redusă de declanşare a ascit-peritonitei, fără necesitatea efectuării unor intervenţii chirugicale traumatice (laparotomie) de sanare a cavităţii abdominale. The claimed method was applied to 9 patients with liver cirrhosis complicated by resistant ascites or ascites-peritonitis, after which a decrease in progression and a reduced rate of ascites-peritonitis were determined, without the need for traumatic surgical interventions (laparotomy) to repair the abdominal cavity.
Exemplul 1 Example 1
Pacientul C., 64 ani, a fost internat în secţia chirurgie cu diagnosticul de ciroză hepatică decompensată complicată cu ascit-peritonită. În antecedente, pe parcursul a 5 luni i s-au efectuat laparocenteze fracţionare dirijate repetate cu evacuarea în medie a 5…6 l de lichid ascitic, iniţial transparent, apoi tulbure cu sediment şi plăci fibrinice, totodată starea generală a bolnavului se agrava prin dureri abdominale difuze, febră intermitentă, creştea astenia. Examenul ultrasonografic la internare a stabilit un ficat cu contur neregulat şi parenchim cu reflectivitate crescut difuză, micronodulară, indici ecografici ai hipertensiunii portale (dilatarea v.portae - 17 mm şi v.splenice - 10 mm). Totodată sunt diagnosticate câteva colecţii sub formă de chisturi delimitate şi localizate suprahepatic şi parasplenic, cu dimensiuni medii de 5x6 ; 9x12 şi 7x10 cm respectiv, ecografic constatându-se hipoecogenitatea lor cu prezenţa maselor flotante, ascită. Patient C., 64 years old, was admitted to the surgery department with the diagnosis of decompensated liver cirrhosis complicated by ascites-peritonitis. In the past, over the course of 5 months, repeated directed fractional laparocentesis was performed with the evacuation of an average of 5…6 l of ascitic fluid, initially transparent, then cloudy with sediment and fibrinous plaques, at the same time the patient's general condition worsened with diffuse abdominal pain, intermittent fever, and increasing asthenia. The ultrasound examination upon admission established a liver with irregular contour and parenchyma with diffuse, micronodular increased reflectivity, ultrasound indices of portal hypertension (dilation of the portal vein - 17 mm and the splenic vein - 10 mm). At the same time, several collections in the form of delimited and suprahepatic and parasplenic cysts were diagnosed, with average dimensions of 5x6; 9x12 and 7x10 cm respectively, ultrasound showing their hypoechogenicity with the presence of floating masses, ascites.
Pe fondul tratamentului conservativ cu hepatoprotectoare, diuretice, antibiotice etc. s-a obţinut o ameliorare a statutului hepatic funcţional şi s-a recurs la puncţia ecoghidată a chisturilor lichidiene cu instalarea unor drenuri, lavajul cavităţii chistului cu soluţie hipertonică, apoi prin drenurile instalate se administrează soluţii de Ceftriaxone 1,0 g şi Streptochinază 20000 UI de 2 ori pe zi, timp de 4…5 zile, după care se efectuează o incizie în regiunea supraclaviculară stângă cu mobilizarea unghiului venos, se mobilizează ramura principală a ductului limfatic la nivelul segmentului cervical, se excizează aderenţele şi se ligaturează ramurile limfatice aferente, după care plaga se suturează pe straturi. Against the background of conservative treatment with hepatoprotectors, diuretics, antibiotics, etc., an improvement in the functional liver status was achieved and ultrasound-guided puncture of the fluid cysts was resorted to with the installation of drains, lavage of the cyst cavity with hypertonic solution, then through the installed drains, solutions of Ceftriaxone 1.0 g and Streptokinase 20,000 IU are administered 2 times a day, for 4...5 days, after which an incision is made in the left supraclavicular region with mobilization of the venous angle, the main branch of the lymphatic duct is mobilized at the level of the cervical segment, adhesions are excised and the afferent lymphatic branches are ligated, after which the wound is sutured in layers.
Controlul dinamic clinic, paraclinic şi ultrasonografic a relevat ameliorarea stării generale a pacientului cu îmbunătăţirea funcţiilor hepatice, micşorarea ascitei, ce a permis externarea lui la a 15-a zi de spitalizare în stare relativ satisfăcătoare. Dynamic clinical, paraclinical and ultrasonographic control revealed an improvement in the patient's general condition with improved liver function and a decrease in ascites, which allowed his discharge on the 15th day of hospitalization in a relatively satisfactory condition.
Claims (1)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20100202A MD398Z (en) | 2010-11-30 | 2010-11-30 | Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20100202A MD398Z (en) | 2010-11-30 | 2010-11-30 | Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis |
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| Publication Number | Publication Date |
|---|---|
| MD398Y MD398Y (en) | 2011-07-31 |
| MD398Z true MD398Z (en) | 2012-02-29 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| MDS20100202A MD398Z (en) | 2010-11-30 | 2010-11-30 | Method for stimulating the resorption of peritoneal processes by reactivation of lymphocirculation in patients with hepatic cirrhosis |
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| MD (1) | MD398Z (en) |
Families Citing this family (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD1154Z (en) * | 2016-12-08 | 2018-01-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Mini-invasive method of correction of central lymphocirculation in the treatment of cirrhotic ascites |
| 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 |
| MD1204Z (en) * | 2017-06-08 | 2018-05-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| 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 |
| MD115Z (en) * | 2009-09-03 | 2010-07-31 | Георге АНГЕЛИЧ | Method for treating right recurrent pleurisies to patients with hepatic cirrhosis |
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- 2010-11-30 MD MDS20100202A patent/MD398Z/en not_active IP Right Cessation
Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| 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 |
| MD115Z (en) * | 2009-09-03 | 2010-07-31 | Георге АНГЕЛИЧ | Method for treating right recurrent pleurisies to patients with hepatic cirrhosis |
Non-Patent Citations (1)
| Title |
|---|
| Arroyo V.,Sort P., Gines P., et al. Treatment of ascites by paracentesis. In: Arroyo V., Gines P., Schrier RW, eds. Ascites and rental dysfunction in liver disease. Mebourne, Blackwell Science, 1999, p. 463-479 * |
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| Publication number | Publication date |
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| MD398Y (en) | 2011-07-31 |
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