RU2200028C2 - Method for filling puncture canal after performing diagnostic endoscopic hepatic puncture biopsy in patients suffering from hemophilia a - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves intravenously administering blood coagulation factor VIII concentrate to reach its activity level of at least 50% before taking biopsy samples. Hepatic puncture canal is filled with blood coagulation factor VIII concentrate of 250- 500 ED diluted with 3-5 ml of 5% ε-aminocaproic acid. Patient blood coagulation factor VIII activity is supported in postoperative period at the level of not less than 50% during the first three days and of not less than 10% during the next 7 days. EFFECT: enhanced effectiveness of treatment; accelerated thrombus formation in puncture canal.

Description

 The invention relates to medicine, in particular to hematology, and for sealing the puncture channel after diagnostic endoscopic puncture liver biopsy in patients with hemophilia A.

 Currently, plasma, fibrin (Falstrom J.K. et al. J. of vascular and interventional radiology (apr. 1999), vol. 10, is used as a filling material used to treat and prevent bleeding during diagnostic puncture biopsies of the liver). N 4, pp. 457-462).

 However, we did not find domestic works on liver biopsy in patients with hemophilia, there are only a few foreign studies devoted to this problem.

 As a prototype, we used the fibrin puncture canal filling method described in the article “Use of fibrin sealant to reduce bleeding after needle liver biopsy in an anticoagulated canine model: Work in progress” (Falstrom JK et al.) In J. of vascular and interventional radiology (apr. 1999), vol. 10, N 4, pp. 457-462. A significant disadvantage of the prototype is that the use of fibrin in patients with hemophilia for filling the puncture channel during liver biopsy is not pathogenetically substantiated. The amount of fibrin in the blood in this category of patients, usually within normal limits, is sometimes increased.

 According to the Kirov Research Institute of Hematology and Blood Transfusion, 78% of hemophilia patients suffered hepatitis B, 75% hepatitis C and only 5% of patients do not have hepatitis B and C. markers. The number of patients not infected with hepatitis B and C viruses decreases sharply with age. So, if among children under 14 years of age there are no hepatitis B markers about 46%, among people aged 15-34 years - 13%, in the older age group there are no such patients at all. In patients with hemophilia, chronic hepatitis forms more often than in the population, which is associated with the specifics of the underlying disease (large volumes of injected protein preparations, toxinemia during resorption of blood spilled into the tissue). Verification of liver damage in this category of patients, and, consequently, carrying out pathogenetically and morphologically substantiated therapy is difficult due to the limited possibility of using invasive research methods.

 We set the task - to ensure the prevention of acute and delayed bleeding from the puncture channel during diagnostic liver biopsy in patients with hemophilia A.

 The technical result is to ensure the rapid formation of a blood clot inside the puncture channel of the liver and prevent its lysis by suppressing local fibrinolysis.

 To achieve a technical result, we proposed the joint use of concentrate VIII coagulation factor and a 5% solution of ε-aminocaproic acid.

 We have not found works in which the local application of the concentrate of factor VIII was described, since in most cases this is economically unreasonable.

 In our proposed method, the VIII coagulation factor concentrate fills a closed cavity when, with minimal losses of the drug, the maximum local hemostatic effect is achieved.

 Since the size of the puncture canal is technically standard, we empirically selected the original dose of concentrate VIII of coagulation factor and ε-aminocaproic acid concentrate for filling the puncture canal.

 The combined use of a concentrate of factor VIII and a 5% solution of ε-aminocaproic acid can simultaneously ensure the rapid formation of a blood clot in the puncture channel and prevent its lysis by suppressing local fibrinolysis.

 The combined use of factor VIII concentrate with ε-aminocaproic acid was previously tested in 6 hemophilia patients at the center for the treatment of hemophilia patients at the Kirov Research Institute of Hematology and blood transfusion when filling the holes after tooth extraction, which allowed a 25% reduction in the number of expensive hemostatic drugs.

 The method is as follows. Before diagnostic puncture biopsy of the liver, the patient is injected intravenously with a factor VIII concentrate based on the achievement of a level of its activity in the blood of at least 50%. The doctor is located to the right of the patient. Produce layer-by-layer anesthesia with 20 ml of a 0.5% solution of novocaine in the upper right point of Kalka. An incision is made in the skin, subcutaneous tissue 1 cm in size, an aponeurosis is dissected. A trocar with a diameter of 10 mm is inserted through the incision into the abdominal cavity. A tube is connected to the trocar for the application of pneumoperitoneum, 4-6 liters of oxygen are supplied into the abdominal cavity using an insufflator. Optics are introduced through a trocar and an examination of the abdominal cavity is carried out on the Kalka sectors. Through the biopsy channel of the laparoscope, a puncture needle is inserted with a syringe put on the cannula. A technically convenient biopsy or visually affected liver segment is chosen. A puncture is performed and liver tissue is sucked in with a syringe. The puncture needle is removed. The contents of the puncture needle are sent for histological and cytological examination. Immediately before use, hemostatic filling material is prepared: a factor VIII concentrate with an activity of 250-500 IU and diluted in 3-5 ml of a 5% solution of ε-aminocaproic acid. A metal tube with a diameter of 5 mm is inserted through the biopsy channel of the laparoscope, the puncture hole is filled with hemostatic filling material. Optics are removed from the abdominal cavity. Through a trocar, oxygen is evacuated from the abdominal cavity. Suture on the wound, aseptic dressing. In the postoperative period, the activity of a deficient procoagulant is maintained at a level of not less than 50% during the first three days and not less than 10% during the next 7 days using a factor VIII concentrate.

 Clinical example.

 Patient B. 24 years. Hemophilia A was diagnosed at 2 years of age. The activity of factor VIII is 2% (normal 85-125%). It has markers for viral hepatitis B and C. The last 3 years the patient has a periodic increase in transaminases, bilirubin in the blood, the course of the underlying disease has worsened (more frequent spontaneous hemorrhages in the joints and soft tissues). Verification of the nature and depth of liver damage by non-invasive methods was not possible. A diagnostic laparoscopic puncture biopsy of the liver was performed. Before the manipulation, 1000 IU of the activity of the factor VIII concentrate concentrate was introduced, which made it possible to increase the activity of deficient procoagulant in the blood up to 50%. Visually, the liver is a normal color, not enlarged. A puncture biopsy was performed in segment 4. From the injection site, moderate bleeding was noted. After the introduction of 250 PIECES of activity of factor VIII into the puncture channel, diluted in 5 ml of 5% ε-aminocaproic acid, the bleeding stopped. In the postoperative period, the activity of factor VIII in the blood was maintained at 50% during the first 3 days, and at 10% in the next 7 days. In the postoperative period, complications associated with bleeding from the puncture channel of the liver were not noted.

Claims (1)

 A method of filling the puncture canal for diagnostic laparoscopic puncture liver biopsy in patients with hemophilia A, characterized in that prior to the biopsy, the patient is injected with the coagulation factor VIII concentrate VIII until the level of blood activity is at least 50%, the liver puncture canal is filled with concentrate VIII after the biopsy coagulation factor with an activity of 250-500 IU, diluted in 3-5 ml of a 5% solution of ε-aminocaproic acid, and in the postoperative period, the activity of coagulation factor VIII blood from the patient is maintained at not less than 50% during the first 3 days and at least 10% within the next 7 days.