RU2138203C1 - Surgical method for treating the cases of hepatic cirrhosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves placing oval porous titanium nickelide plates over diaphragmal liver surface in chessboard order 1.0-2.0 cm far one from another. The plates dimensions are in the range of 1.0 to 5 cm, each plate being 1.0-1.5 mm thick. Two parietal flaps are cut out from peritoneum. The flaps are sutured to the inferior surface of the liver. EFFECT: enhanced effectiveness of treatment; accelerated vascularized adhesion of the liver and diaphragm.

Description

 The invention relates to medicine, specifically to surgery, and relates to methods for the surgical treatment of cirrhosis.

Known methods for the surgical treatment of cirrhosis of the liver, which consists in reducing the pressure in the portal vein system by:
imposition of portocaval vascular anastomoses,
the formation of organ portocaval anastomoses [omentopexy, splenopexy, extraperitonization of the liver and np.] [Yu.M. Dederer, N.P. Krylova / Atlas of operations on the liver. - M., 1975].

The main disadvantages of traditional methods are:
the technical complexity, duration and morbidity of vascular porto-caval anastomoses, the high incidence of postoperative encephalopathy,
low efficiency of organoanastomoses due to the slow formation of weakly vascularized adhesions.

 The closest in technical essence to the proposed method is a method of surgical treatment of cirrhosis of the liver, which consists in the right hypochondrium, cutting two parietal flaps of the peritoneum: one from the diaphragm to the ventral and lateral attachment of the muscle to the ribs, midway reaching the crescent ligament, the other from the posterior sheet of the peritoneum , bringing them to the lower surface of the liver and hemming it with individual catgut sutures [I. Fagarasanu et al. / Surgery of the liver and intrahepatic biliary tract, 1976]. The main disadvantages of the method are that the fusion between the liver and the diaphragm are formed slowly and are weakly vascularized.

 The aim of the invention is to increase the effectiveness of surgical treatment of cirrhosis due to the rapid formation of richly vascularized adhesions between the liver and diaphragm, decompression of the portal system, regression of edematous ascites syndrome and improved blood circulation in the liver.

 The goal is achieved by making the right hypochondrium, cutting out two parietal flaps of the peritoneum: one from the diaphragm to the ventral and lateral attachment of muscles to the ribs, mid-reaching the crescent ligament, the other from the back sheet of the peritoneum, under the reflection line of the liver, reaching the upper duodenal angle impose in a checkerboard pattern on the diaphragmatic surface of the liver at a distance of 1.0 - 2.0 cm from one another oval-shaped plates of porous titanium nickelide (NiTi), impregnated with antibiotics, diameter 1.0 - 5.0 cm, 1.0 - 1.5 mm thick, after which both parietal flaps of the peritoneum are brought to the lower surface of the liver and hemmed with separate catgug sutures.

 New in the proposed method is that on the diaphragmatic surface of the liver, plates of porous NiTi impregnated with antibiotics are applied, oval in shape, diameter 1.0 - 5.0 cm, thickness 1.0 - 1.5 mm, staggered at a distance of 1.0 - 2.0 cm from one another.

 The proposed method meets the criterion of "novelty", since this set of distinctive features is unknown from the prior art. The invention meets the criterion of "inventive step", as it does not follow explicitly for a person skilled in the art. Porous NiTi plates act as matrices for tissue growing from the cirrhotic liver, and the rate of germination of the plates differs from the rate of formation of adhesions between directly sutured organs, and tissue growing from the cirrhotic liver has high vascularization and a rich lymphatic network. The method is industrially applicable, as it can be used in clinical medicine.

 The method is as follows: the patient is made the right hypochondrium, the parietal flap of the peritoneum is cut from the diaphragm above the right lobe of the liver, the liver is tilted down, opening the caudal surface of the dome of the diaphragm up to the coronary ligament of the liver, the parietal peritoneum is cut, the serous leaf is removed from the diaphragm to ventral and lateral attachment of muscles to the ribs, midway reaching the crescent ligament. Then the parietal flap of the peritoneum is cut out from the posterior zone of the peritoneum: the liver is folded back, the serous leaf is cut and the peritoneum is peeled to the upper duodenal angle. On the diaphragmatic surface of the liver, plates of porous NiTi are impregnated with antibiotic, 1.0 - 5.0 cm in diameter, 1.0 - 1.5 mm thick, oval, staggered, at a distance of 1.0 - 2.0 cm from one another, after which both parietal peritoneal flaps are brought to the lower surface of the liver and hemmed with separate catgut sutures, sutured the wound.

 Example. Patient B., 48 years old, medical history 478/175, was in the hospital 02/21/95 - 04/28/95.

 Diagnosis: micronodular cirrhosis, varicose veins of the esophagus, bleeding from the veins of the esophagus.

 Operation: 04/11/95 - laparotomy by the right hypochondrium. The liver is reduced, small-nodular. Two parietal flaps of the peritoneum were cut: one from the diaphragm to the ventral and lateral attachment of muscles to the ribs, midway reaching the crescent ligament, the other from the posterior sheet of the peritoneum, under the reflection line of the liver, reaching the upper duodenal angle. On the diaphragmatic surface of the liver at a distance of 1.0-2.0 cm from one another, oval-shaped plates 1.0 mm thick of porous titanium nickelide in an amount of 7 pieces are imposed in a checkerboard pattern (3 - 1.0 cm in diameter, 2 - 3 cm in diameter, 2 - 5 cm in diameter) pre-soaked in antibiotic. Both parietal flaps of the peritoneum are brought to the lower surface of the liver and hemmed with catgut sutures.

 The postoperative period was uneventful, the patient was discharged on day 16.

 Repeated hospitalization for follow-up after 6 months. The patient's condition is satisfactory, does not show active complaints, there was no recurrence of bleeding.

 Justification of the regime.

 1. The plates are made of porous titanium nickelide as a biologically inert material that is easily grown by tissues.

 2. The oval shape of the plates ensures their non-injuries.

 3. The plates are saturated with antibiotics to prevent purulent complications.

 4. The sizes of the plates from 1.0 to 5.0 cm are selected taking into account the consistency and curvature of the diaphragm and the diaphragmatic surface of the liver and provide a snug fit of the plates to the surface of the fixed organs.

 5. The thickness of the plates (1.0 - 1.5mm) is associated with the superelasticity effect, according to which NiTi products are able to restore their original shape after deformation due to external influences.

 6. The application of plates in a checkerboard pattern provides the maximum contact area and eliminates the mutual overlapping of plates during respiratory excursions.

 The positive effect is the rapid formation of richly vascularized adhesions between the liver and diaphragm, the creation of favorable conditions for the collateral outflow of blood from the liver to the superior vena cava system, the decrease in the degree of portal hypertension, the decrease in the degree of porto-lymphatic hypertension and the creation of favorable conditions for regression of ascites.

Claims (1)

 A method of surgical treatment of cirrhosis of the liver, including laparotomy by the right hypochondrium, cutting two parietal flaps of the peritoneum and suturing them to the lower surface of the liver, characterized in that the diaphragmatic surface of the liver is staggered at a distance of 1.0-2.0 cm from another oval-shaped plate of porous titanium nickelide impregnated with an antibiotic of a size of 1.0-5.0 cm and a thickness of 1.0-1.5 mm each.