MD881Z - Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background - Google Patents
Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background Download PDFInfo
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- MD881Z MD881Z MDS20140075A MDS20140075A MD881Z MD 881 Z MD881 Z MD 881Z MD S20140075 A MDS20140075 A MD S20140075A MD S20140075 A MDS20140075 A MD S20140075A MD 881 Z MD881 Z MD 881Z
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- Moldova
- Prior art keywords
- tumor
- subhepatic
- tissue
- bipolar
- electrode
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Links
- 238000000034 method Methods 0.000 title claims abstract description 15
- 238000011282 treatment Methods 0.000 title claims abstract description 8
- 201000007270 liver cancer Diseases 0.000 title claims abstract description 6
- 208000014018 liver neoplasm Diseases 0.000 title claims abstract description 6
- 206010016654 Fibrosis Diseases 0.000 title claims abstract description 5
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 5
- 230000001394 metastastic effect Effects 0.000 title claims abstract description 5
- 206010061289 metastatic neoplasm Diseases 0.000 title claims abstract description 5
- 230000007882 cirrhosis Effects 0.000 title claims abstract description 4
- 210000004185 liver Anatomy 0.000 title abstract description 7
- 206010073069 Hepatic cancer Diseases 0.000 title abstract 2
- 206010028980 Neoplasm Diseases 0.000 claims abstract description 26
- 102000035195 Peptidases Human genes 0.000 claims abstract description 5
- 108091005804 Peptidases Proteins 0.000 claims abstract description 5
- 210000000683 abdominal cavity Anatomy 0.000 claims abstract description 5
- 239000003242 anti bacterial agent Substances 0.000 claims abstract description 5
- 229940088710 antibiotic agent Drugs 0.000 claims abstract description 5
- 238000001574 biopsy Methods 0.000 claims abstract description 5
- 239000000203 mixture Substances 0.000 claims abstract description 5
- 229940024999 proteolytic enzymes for treatment of wounds and ulcers Drugs 0.000 claims abstract description 5
- 210000003567 ascitic fluid Anatomy 0.000 claims abstract description 4
- 230000006378 damage Effects 0.000 claims description 8
- 210000005228 liver tissue Anatomy 0.000 claims description 8
- 210000001519 tissue Anatomy 0.000 claims description 5
- 230000000541 pulsatile effect Effects 0.000 claims description 3
- 206010019695 Hepatic neoplasm Diseases 0.000 claims 1
- 230000002440 hepatic effect Effects 0.000 abstract description 3
- 239000003814 drug Substances 0.000 abstract description 2
- 238000005070 sampling Methods 0.000 abstract 1
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 4
- 239000011780 sodium chloride Substances 0.000 description 4
- 210000004872 soft tissue Anatomy 0.000 description 4
- 210000003815 abdominal wall Anatomy 0.000 description 3
- 230000009471 action Effects 0.000 description 3
- 206010003445 Ascites Diseases 0.000 description 2
- 206010061249 Intra-abdominal haemorrhage Diseases 0.000 description 2
- 229960004755 ceftriaxone Drugs 0.000 description 2
- 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 description 2
- 238000002695 general anesthesia Methods 0.000 description 2
- 230000002008 hemorrhagic effect Effects 0.000 description 2
- 230000006872 improvement Effects 0.000 description 2
- 108010065073 lidase Proteins 0.000 description 2
- 230000008569 process Effects 0.000 description 2
- 108090000623 proteins and genes Proteins 0.000 description 2
- 102000004169 proteins and genes Human genes 0.000 description 2
- 102000009027 Albumins Human genes 0.000 description 1
- 108010088751 Albumins Proteins 0.000 description 1
- 102000004142 Trypsin Human genes 0.000 description 1
- 108090000631 Trypsin Proteins 0.000 description 1
- 239000008186 active pharmaceutical agent Substances 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
- 230000002349 favourable effect Effects 0.000 description 1
- 230000004761 fibrosis Effects 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 230000023597 hemostasis Effects 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 238000011321 prophylaxis Methods 0.000 description 1
- 239000000523 sample Substances 0.000 description 1
- 230000004083 survival effect Effects 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- 239000012588 trypsin Substances 0.000 description 1
Landscapes
- Investigating Or Analysing Biological Materials (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la hepatologie şi oncologie, şi poate fi utilizată pentru tratamentul miniinvaziv al cancerului hepatic metastatic pe fundal de ciroză. The invention relates to medicine, in particular to hepatology and oncology, and can be used for the minimally invasive treatment of metastatic liver cancer on the background of cirrhosis.
Este cunoscută metoda de tratament al cancerului hepatic nerezectabil şi metastatic, care include aplicarea unimomentană a termodistrucţiei cu unde de frecvenţă ultraînaltă de 120 kHz cu intensitatea de 100 W şi puterea curentului 1 A prin intermediul unor sonde-electrozi. Timpul de acţiune fiind de 2…3 min [1]. The method of treatment of unresectable and metastatic liver cancer is known, which includes the simultaneous application of thermodestruction with ultrahigh frequency waves of 120 kHz with an intensity of 100 W and a current strength of 1 A by means of probe electrodes. The action time is 2…3 min [1].
Dezavantajele metodei menţionate constau în aceea că sondele-electrozi folosite traumează ţesuturile moi ale peretelui abdominal, ţesutul hepatic şi cel tumoral, ceea ce poate provoca hemoragii intraabdominale masive, care necesită hemostază chirurgicală în cadrul unor intervenţii urgente cu riscuri majore. The disadvantages of the mentioned method are that the probes-electrodes used traumatize the soft tissues of the abdominal wall, liver and tumor tissue, which can cause massive intra-abdominal hemorrhages, which require surgical hemostasis during urgent interventions with major risks.
Problema pe care o soluţionează invenţia constă în elaborarea unei metode de tratament miniinvaziv prin abordul laparoscopic cu scopul distrucţiei termice parţiale centrale a tumorii, fără lezarea ţesutului hepatic neafectat de procesul tumoral, care ar evita, de asemenea, complicaţiile hemoragice hepatice şi ale ţesuturilor moi ale peretelui abdominal. The problem solved by the invention consists in developing a minimally invasive treatment method through a laparoscopic approach with the aim of partial central thermal destruction of the tumor, without damaging the liver tissue unaffected by the tumor process, which would also avoid hemorrhagic complications of the liver and soft tissues of the abdominal wall.
Conform invenţiei, metoda revendicată constă în aceea că prin accesul laparoscopic în regiunea subombilicală sub controlul opticii-video se introduce un trocar suplimentar în regiunea subhepatică, se evacuează lichidul ascitic din cavitatea abdominală, se identifică focarul tumoral hepatic şi se prelevă biopsia din tumoare, apoi cu ajutorul unui electrod bipolar, care se introduce prin portul trocarului, se efectuează diatermocoagularea bipolară cu frecvenţa de 33 kHz şi intensitatea de 50 W a suprafeţei centrale a tumorii cu aprofundarea lentă a electrodului şi termodistrugerea continuă a ţesutului tumoral fără lezarea ţesutului hepatic adiacent, timp de 1…5 min în regim pulsativ, după care în spaţiul subhepatic se introduce un dren pentru control pe o perioadă de 2…5 zile şi se efectuează lavajul peritoneal cu un amestec ce conţine antibiotice cu un spectru larg de acţiune şi fermenţi proteolitici. According to the invention, the claimed method consists in that through laparoscopic access to the subumbilical region under the control of video optics, an additional trocar is inserted into the subhepatic region, the ascitic fluid is evacuated from the abdominal cavity, the hepatic tumor focus is identified and a biopsy is taken from the tumor, then with the help of a bipolar electrode, which is inserted through the trocar port, bipolar diathermocoagulation is performed with a frequency of 33 kHz and an intensity of 50 W of the central surface of the tumor with slow deepening of the electrode and continuous thermal destruction of the tumor tissue without damaging the adjacent liver tissue, for 1...5 min in a pulsatile mode, after which a drain is inserted into the subhepatic space for control over a period of 2...5 days and peritoneal lavage is performed with a mixture containing broad-spectrum antibiotics and proteolytic enzymes.
Rezultatul invenţiei constă în elaborarea unei metode de tratament miniinvaziv prin abordul laparoscopic cu scopul distrucţiei termice parţiale centrale a tumorii, fără lezarea ţesutului hepatic neafectat de procesul tumoral, care ar evita, de asemenea, complicaţiile hemoragice hepatice şi ale ţesuturilor moi ale peretelui abdominal. The result of the invention consists in developing a minimally invasive treatment method through a laparoscopic approach with the aim of partial central thermal destruction of the tumor, without damaging the liver tissue unaffected by the tumor process, which would also avoid hemorrhagic complications of the liver and soft tissues of the abdominal wall.
Avantajele metodei constau în: The advantages of the method consist of:
- evitarea traumatismului ţesuturilor moi şi celui hepatic, - avoiding soft tissue and liver trauma,
- profilaxia hemoragiilor intraabdominale, - prophylaxis of intra-abdominal hemorrhages,
- metodă miniminvazivă pentru pacient, - minimally invasive method for the patient,
- metodă tehnic accesibilă, - technically accessible method,
- ameliorarea calităţii vieţii şi supravieţuire până la 2…3 ani. - improvement of quality of life and survival up to 2…3 years.
Metoda se efectuează în modul următor. The method is performed in the following way.
Sub anestezie generală cu suport volemic şi proteic adecvat, prin accesul laparoscopic infraombilical sub controlul opticii-video printr-un trocar de lucru suplimentar, introdus în regiunea subhepatică, se evacuează lichidul ascitic din cavitatea abdominală, se identifică focarul tumoral din ficatul cirotic şi se prelevă biopsia din tumoare. Apoi, cu ajutorul unui electrod bipolar, care se introduce prin portul trocarului, se efectuează diatermocoagularea bipolară cu frecvenţa de 33 kHz şi intensitatea de 50 W a suprafeţei centrale a tumorii cu aprofundarea lentă a electrodului în adâncul tumorii şi termodistrucţia continuă a ţesutului tumoral, fără lezarea ţesutului hepatic adiacent. Timpul de acţiune fiind de 1…5 min în regim pulsativ. După finisarea distrucţiei în spaţiul subhepatic se introduce un dren pentru control pe o perioadă de 2…5 zile cu efectuarea lavajului peritoneal cu un amestec de antibiotice de spectru larg (ceftriaxon 4 g sau ceftazidim 2 g la 500 ml ser fiziologic) şi fermenţi proteolitici (lidază 640 UN sau tripsin la 500 ml ser fiziologic) introdus în get cu expoziţie de 12…24 ore, după care se evacuează, se repetă lavajul de 2…5 ori. Metoda revendicată a fost utilizată pentru tratamentul a 12 pacienţi. Under general anesthesia with adequate volume and protein support, through infraumbilical laparoscopic access under video-optical control through an additional working trocar, introduced into the subhepatic region, the ascitic fluid is evacuated from the abdominal cavity, the tumor focus in the cirrhotic liver is identified and the tumor biopsy is taken. Then, with the help of a bipolar electrode, which is introduced through the trocar port, bipolar diathermocoagulation is performed with a frequency of 33 kHz and an intensity of 50 W of the central surface of the tumor with slow deepening of the electrode into the depth of the tumor and continuous thermal destruction of the tumor tissue, without damaging the adjacent liver tissue. The action time is 1…5 min in pulsatile mode. After the destruction is completed, a drain is inserted into the subhepatic space for control for a period of 2-5 days with peritoneal lavage with a mixture of broad-spectrum antibiotics (ceftriaxone 4 g or ceftazidime 2 g in 500 ml of saline) and proteolytic enzymes (lidase 640 UN or trypsin in 500 ml of saline) introduced into the gut with exposure for 12-24 hours, after which it is evacuated, the lavage is repeated 2-5 times. The claimed method was used for the treatment of 12 patients.
Exemplu Example
Pacientul D., 62 ani, internat în clinică cu DS: cancer hepatic primar pe fundal de ciroză hepatică HBV+HDV decompensată. H.T.P. Child "С" (11). Ascită refractară. Pacientul a fost pregătit pentru intervenţie timp de 4 zile. Sub anestezie generală cu suport volemic şi proteic adecvat (3 unităţi de plasmă PPC, sol. Albumini 10% - 200 ml, hepatoprotectoare, reologice), prin accesul laparoscopic infraombilical sub controlul opticii-video printr-un trocar de lucru suplimentar, introdus în regiunea subhepatică, s-au evacuat 8 litri de lichid ascetic din cavitatea abdominală, s-a identificat focarul tumoral din lobul drept al ficatului cirotic de dimensiunile 5x6 cm în S6, s-a prelevat biopsia din tumoare. Apoi, cu ajutorul unui electrod bipolar, introdus prin portul trocarului, s-a efectuat diatermocoagularea bipolară cu frecvenţa de 33 kHz, intensitatea de 50 W a suprafeţei centrale a tumorii cu aprofundarea lentă a electrodului în adâncul tumorii şi termodistrucţia continuă a ţesutului tumoral, fără lezarea ţesutului hepatic adiacent. Timpul de acţiune fiind de 2,5 min. După finalizarea distrucţiei, în spaţiul subhepatic s-a introdus un dren pentru control pe o perioadă de 5 zile cu efectuarea lavajului peritoneal cu un amestec de antibiotice de spectru larg (ceftriaxon 4 g la 500 ml ser fiziologic) şi fermenţi proteolitici (lidază 640 UN la 500 ml ser fiziologic) introdus în get cu expoziţie pe 24 ore, după care s-a evacuat, s-a repetat lavajul de 4 ori. S-a constatat o evoluţie clinică favorabilă cu rezolvarea ascitei şi ameliorarea rezervelor hepatice funcţionale. Externat în stare relativ satisfăcătoare la 12 zile după intervenţie. Examenul repetat peste 6 luni şi 1 an postoperator denotă prezenţa unui focar de fibroză 2x3 cm în zona intervenţiei. Patient D., 62 years old, admitted to the clinic with DS: primary liver cancer on the background of decompensated HBV+HDV liver cirrhosis. H.T.P. Child "С" (11). Refractory ascites. The patient was prepared for the intervention for 4 days. Under general anesthesia with adequate volume and protein support (3 units of PPC plasma, sol. Albumins 10% - 200 ml, hepatoprotectors, rheological), through infraumbilical laparoscopic access under video-optical control through an additional working trocar, introduced into the subhepatic region, 8 liters of ascetic fluid were evacuated from the abdominal cavity, the tumor focus in the right lobe of the cirrhotic liver measuring 5x6 cm in S6 was identified, a biopsy was taken from the tumor. Then, using a bipolar electrode, introduced through the trocar port, bipolar diathermocoagulation was performed with a frequency of 33 kHz, an intensity of 50 W of the central surface of the tumor with slow deepening of the electrode into the depth of the tumor and continuous thermal destruction of the tumor tissue, without damaging the adjacent liver tissue. The action time was 2.5 min. After the destruction was completed, a drain was inserted into the subhepatic space for control for a period of 5 days with peritoneal lavage with a mixture of broad-spectrum antibiotics (ceftriaxone 4 g per 500 ml of saline) and proteolytic enzymes (lidase 640 UN per 500 ml of saline) introduced into the tube with exposure for 24 hours, after which it was evacuated, the lavage was repeated 4 times. A favorable clinical evolution was noted with resolution of ascites and improvement of functional liver reserves. Discharged in relatively satisfactory condition 12 days after the intervention. Repeated examination after 6 months and 1 year postoperatively shows the presence of a 2x3 cm fibrosis focus in the intervention area.
1. RU 2231991 C2 2004.02.10 1. RU 2231991 C2 2004.02.10
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Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20140075A MD881Z (en) | 2014-05-21 | 2014-05-21 | Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20140075A MD881Z (en) | 2014-05-21 | 2014-05-21 | Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background |
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| Publication Number | Publication Date |
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| MD881Y MD881Y (en) | 2015-02-28 |
| MD881Z true MD881Z (en) | 2015-09-30 |
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| MDS20140075A MD881Z (en) | 2014-05-21 | 2014-05-21 | Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background |
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Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2231991C2 (en) * | 2002-07-30 | 2004-07-10 | Ростовский научно-исследовательский онкологический институт | Method for treating unresectable primary and metastatic hepatic tumors |
| 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 |
| MD621Z (en) * | 2012-11-08 | 2013-11-30 | Георге АНГЕЛИЧ | Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis |
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2014
- 2014-05-21 MD MDS20140075A patent/MD881Z/en not_active IP Right Cessation
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2231991C2 (en) * | 2002-07-30 | 2004-07-10 | Ростовский научно-исследовательский онкологический институт | Method for treating unresectable primary and metastatic hepatic tumors |
| 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 |
| MD621Z (en) * | 2012-11-08 | 2013-11-30 | Георге АНГЕЛИЧ | Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis |
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| Publication number | Publication date |
|---|---|
| MD881Y (en) | 2015-02-28 |
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