MD774Z - Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis - Google Patents
Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis Download PDFInfo
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- MD774Z MD774Z MDS20130154A MDS20130154A MD774Z MD 774 Z MD774 Z MD 774Z MD S20130154 A MDS20130154 A MD S20130154A MD S20130154 A MDS20130154 A MD S20130154A MD 774 Z MD774 Z MD 774Z
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- sol
- ascites
- peritonitis
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- 238000000034 method Methods 0.000 title claims abstract description 15
- 206010003445 Ascites Diseases 0.000 title claims abstract description 14
- 206010034674 peritonitis Diseases 0.000 title claims abstract description 12
- 230000002269 spontaneous effect Effects 0.000 title claims abstract description 7
- 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 8
- 102000009123 Fibrin Human genes 0.000 claims abstract description 7
- 108010073385 Fibrin Proteins 0.000 claims abstract description 7
- BWGVNKXGVNDBDI-UHFFFAOYSA-N Fibrin monomer Chemical compound CNC(=O)CNC(=O)CN BWGVNKXGVNDBDI-UHFFFAOYSA-N 0.000 claims abstract description 7
- 229950003499 fibrin Drugs 0.000 claims abstract description 7
- 238000011282 treatment Methods 0.000 claims abstract description 7
- 210000000416 exudates and transudate Anatomy 0.000 claims abstract description 5
- 210000000056 organ Anatomy 0.000 claims abstract description 5
- 108010003272 Hyaluronate lyase Proteins 0.000 claims abstract description 4
- 102000001974 Hyaluronidases Human genes 0.000 claims abstract description 4
- 230000003187 abdominal effect Effects 0.000 claims abstract description 4
- 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 4
- 238000002695 general anesthesia Methods 0.000 claims abstract description 4
- 229960002773 hyaluronidase Drugs 0.000 claims abstract description 4
- 238000002357 laparoscopic surgery Methods 0.000 claims abstract description 4
- 239000000203 mixture Substances 0.000 claims abstract description 4
- 229960004755 ceftriaxone Drugs 0.000 claims description 6
- 208000019425 cirrhosis of liver Diseases 0.000 abstract description 6
- 239000003814 drug Substances 0.000 abstract description 2
- 238000007689 inspection Methods 0.000 abstract description 2
- 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 4
- 230000003908 liver function Effects 0.000 description 4
- 238000002604 ultrasonography Methods 0.000 description 4
- 210000000683 abdominal cavity Anatomy 0.000 description 3
- 230000008569 process Effects 0.000 description 3
- 206010016654 Fibrosis Diseases 0.000 description 2
- 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
- 238000003745 diagnosis Methods 0.000 description 2
- 230000006872 improvement Effects 0.000 description 2
- 230000004054 inflammatory process Effects 0.000 description 2
- 210000004185 liver Anatomy 0.000 description 2
- 208000004998 Abdominal Pain Diseases 0.000 description 1
- 206010060921 Abdominal abscess Diseases 0.000 description 1
- 206010010075 Coma hepatic Diseases 0.000 description 1
- 206010030302 Oliguria Diseases 0.000 description 1
- 206010037660 Pyrexia Diseases 0.000 description 1
- 230000003115 biocidal effect Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 238000004140 cleaning Methods 0.000 description 1
- 230000009089 cytolysis Effects 0.000 description 1
- 230000006837 decompression Effects 0.000 description 1
- 239000002934 diuretic Substances 0.000 description 1
- 229940030606 diuretics Drugs 0.000 description 1
- 230000000004 hemodynamic effect Effects 0.000 description 1
- 201000001059 hepatic coma Diseases 0.000 description 1
- 208000007386 hepatic encephalopathy Diseases 0.000 description 1
- 230000013632 homeostatic process Effects 0.000 description 1
- 238000009434 installation Methods 0.000 description 1
- 230000035987 intoxication Effects 0.000 description 1
- 231100000566 intoxication Toxicity 0.000 description 1
- 238000007912 intraperitoneal administration Methods 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 230000001788 irregular Effects 0.000 description 1
- 238000002350 laparotomy Methods 0.000 description 1
- 231100000518 lethal Toxicity 0.000 description 1
- 230000001665 lethal effect Effects 0.000 description 1
- 238000012423 maintenance Methods 0.000 description 1
- 210000003200 peritoneal cavity Anatomy 0.000 description 1
- 208000007232 portal hypertension Diseases 0.000 description 1
- 238000011321 prophylaxis Methods 0.000 description 1
- 230000009467 reduction Effects 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
- 230000003393 splenic effect Effects 0.000 description 1
- 239000013589 supplement Substances 0.000 description 1
- 230000001629 suppression Effects 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 230000000472 traumatic effect Effects 0.000 description 1
- 238000012800 visualization Methods 0.000 description 1
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- Medicines Containing Material From Animals Or Micro-Organisms (AREA)
- External Artificial Organs (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la hepatologie şi hepatochirurgie şi poate fi utilizată pentru tratamentul ascit-peritonitei spontane la pacienţii cu ciroză hepatică decompensată. The invention relates to medicine, in particular to hepatology and hepatosurgery and can be used for the treatment of spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis.
Este cunoscută metoda de tratament al ascit-peritonitei prin laparocenteză fracţionară dirijată cu efectuarea lavajului intraabdominal şi administrarea intraabdominală a antibioticelor spectru larg de acţiune, apoi după obţinerea antibioticogramei se efectuează antibioticoterapia ţintită [1]. Totodată, în cazul sindromului ascitic cirogen, ascit-peritonita evoluează cu o suprimare a proceselor peritoneale resorbtive cu instalarea unei staze circulatorii, care menţine procesul inflamator peritoneal, ce provoacă în continuare complicaţii potenţiale letale ca insuficienţa hepato-renală şi coma hepatică. The method of treating ascites-peritonitis by fractional laparocentesis directed with intra-abdominal lavage and intra-abdominal administration of broad-spectrum antibiotics is known, then after obtaining the antibiogram, targeted antibiotic therapy is performed [1]. At the same time, in the case of surgical ascites syndrome, ascites-peritonitis evolves with a suppression of peritoneal resorptive processes with the installation of a circulatory stasis, which maintains the peritoneal inflammatory process, which further causes potentially lethal complications such as hepatorenal insufficiency and hepatic coma.
Dezavantajul metodei constă în eficienţă redusă în ce priveşte sanarea cavităţii peritoneale, deoarece accesul este redus, drenarea este insuficientă din cauza menţinerii unor colecţii restante în regiunile inferioare şi interintestinale, ceea ce poate duce la formarea unor abscese intraabdominale. The disadvantage of the method is its low efficiency in terms of cleaning the peritoneal cavity, because access is limited, drainage is insufficient due to the maintenance of residual collections in the lower and interintestinal regions, which can lead to the formation of intra-abdominal abscesses.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode complexe miniinvazive laparoscopice cu decompresia, 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 insuficienţei hepato-renale. The problem solved by the invention consists in developing a complex minimally invasive laparoscopic 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 efficient sanitation of the abdominal cavity with prophylaxis of septic complications and hepatorenal insufficiency.
Conform invenţiei, metoda revendicată 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: Hyaluronidase 640…1080 UC dizolvată în 200…400 ml de soluţie fiziologică şi sol. Ceftriaxonum 2…4 g, totodată, concomitent se administrează intravenos sol. Ciprofloxacinum 200 mg, de 2 ori pe zi, şi sol. Ceftriaxonum 2 g, de 2 ori pe zi, seria de tratament parenteral constituie 5…7 zile. According to the invention, the claimed method 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, subsequently the solution is completely aspirated and a mixture containing: Hyaluronidase 640…1080 UC dissolved in 200…400 ml of physiological solution and sol. Ceftriaxone 2…4 g is introduced, at the same time, sol. Ciprofloxacinum 200 mg, 2 times a day, and sol. Ceftriaxone 2 g, 2 times a day, the parenteral treatment series is 5…7 days.
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 şi ameliorarea funcţiei hepatice. 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 and improving liver function.
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,
- 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. După internarea pacientului şi efectuarea investigaţiilor clinice şi paraclinice, şi anume a ultrasonografiei pentru confirmarea diagnosticului, corecţia homeostazei şi stabilizarea hemodinamică, se recurge la metoda revendicată. 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: Hyaluronidase 640…1080 UC dizolvată în 200…400 ml de soluţie fiziologică şi sol. Ceftriaxonum 2…4 g, totodată, concomitent se administrează intravenos sol. Ciprofloxacinum 200 mg, de 2 ori pe zi, şi sol. Ceftriaxonum 2 g, de 2 ori pe zi, seria de tratament parenteral constituie 5…7 zile. The method is performed as follows. 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 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 sol. Ceftriaxone 2…4 g is introduced, at the same time, sol. Ciprofloxacinum 200 mg, 2 times a day, and sol. Ceftriaxone 2 g, 2 times a day, the parenteral treatment series is 5…7 days.
Metoda revendicată a fost aplicată la 11 pacienţi cu ciroză hepatică decompensată complicată cu ascit-peritonită spontană, după care s-a determinat rezolvarea procesului inflamator septic intraperitoneal fară necesitatea efectuării unor intervenţii chirurgicale traumatice (laparotomie) de sanare a cavităţii abdominale. The claimed method was applied to 11 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.
Exemplu Example
Pacientul M., 61 ani, a fost internat în secţia chirurgie cu diagnosticul de ciroză hepatică decompensată complicată cu ascit-peritonită. Pe parcursul a 4 luni antecedent s-au efectuat laparocenteze de volum repetate la fiecare 2…3 săptămâni cu evacuarea în medie a 5…6 1 de lichid ascitic, iniţial transparent, apoi tulbure cu sediment şi fire de fibrinină. Starea generală s-a agravat acuzând 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.portae - 18 mm şi v.splenice - l0 mm). În cavitatea abdominală o cantitate considerabilă de lichid ascitic neomogen cu elemente flotante, incluziuni hiperecogene şi fibrină - semne ecografice caracteristice ascit-peritonitei spontane. Pe fondal de tratament conservativ cu hepatoprotectoare, diuretice, antibiotice etc. s-a obţinut ameliorarea statutului hepatic funcţional şi s-a recurs la metoda revendicată. Patient M., 61 years old, was admitted to the surgery department with the diagnosis of decompensated liver cirrhosis complicated by ascites-peritonitis. During the previous 4 months, repeated volume laparocentesis was performed every 2…3 weeks with the evacuation of an average of 5…6 l of ascitic fluid, initially transparent, then cloudy with sediment and fibrin threads. The general condition worsened, accusing 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 (dilatation of v.portae - 18 mm and v.splenic - l0 mm). In the abdominal cavity a considerable amount of inhomogeneous ascitic fluid with floating elements, hyperechoic inclusions and fibrin - ultrasound signs characteristic of spontaneous ascites-peritonitis. Against the background of conservative treatment with hepatoprotectors, diuretics, antibiotics, etc. improvement of the functional liver status was achieved and the claimed method was resorted to.
Controlul dinamic clinic, paraclinic şi ultrasonografic a relevat ameliorarea stării generale a pacientului cu îmbunătăţirea funcţiilor hepatice, micşorarea cumulării lichidului ascitic fară elemente flotante, transparent, ce a permis externarea lui la a 10-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 10th day of hospitalization in a relatively satisfactory condition with stabilized liver function.
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), pp. 1-12
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| Application Number | Priority Date | Filing Date | Title |
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| MDS20130154A MD774Z (en) | 2013-09-12 | 2013-09-12 | Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis |
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|---|---|---|---|
| MDS20130154A MD774Z (en) | 2013-09-12 | 2013-09-12 | Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis |
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| MD774Y MD774Y (en) | 2014-05-31 |
| MD774Z true MD774Z (en) | 2014-12-31 |
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Families Citing this family (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| 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 |
| 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 |
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- 2013-09-12 MD MDS20130154A patent/MD774Z/en not_active IP Right Cessation
Non-Patent Citations (1)
| Title |
|---|
| Moore K., Aithal G. Guidelines on the management of ascites in cirrhosis. Gut, 2006, vol. 55, (Suppliment 6), p. 1-12 * |
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| Publication number | Publication date |
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| MD774Y (en) | 2014-05-31 |
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