RU2434591C1 - Method of treating cancer of rectum - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to oncology, and can be used for treatment of cancer of rectum. For this purpose during operation in presacral space till its complete filling-in introduced is medication - "hydrogel napkins with 5-fluoruracyl and sodium alginate "Coletex -5-ftur" with addition of 50 mg of carboplatin. Two drainages of different diameter are installed into presacral space. After that, peritonisation with uninterrupted suture is carried out tightly. On 5-6 day after operation hydrogel "Coletex-gel-DNA" is introduced through drainages into presacral space until it is completely filled.

EFFECT: method ensures reduction of frequency of local recurrences and metastases after cancer of rectum surgery due to efficient intraoperative local chemical therapy in combination with reparative therapy after operation.

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Description

The invention relates to medicine, namely to oncology, and can be used in the surgical treatment of colorectal cancer.

Colorectal cancer is a common disease and accounts for up to 8% of all human cancers. Worldwide, there is an increase in the incidence of colorectal cancer, the most intense in economically developed countries.

Severe symptoms appear after reaching a large (more than 2 cm) tumor size. As a rule, one of the first manifestations of the disease is the secretion of mucus and / or blood from the rectum.

The main treatment for colorectal cancer is surgical. Depending on the location of the tumor and its size, 4 basic operations are performed: intra-abdominal resection of the rectum, Hartmann's surgery, abdominal-anal resection of the rectum and extirpation of the rectum.

A known method of treating colorectal cancer (RF Patent 2367489, IPC A61N 5/10, publ. 2009), comprising administering a composite mixture containing sodium alginate, 2% solution of dimethyl sulfoxide and 5-fluorouracil before radiation therapy, and then the surgical interventions.

The disadvantage of this method is its complexity, the inability to use in urgent situations, the inability to properly staging the tumor process according to the results of histological examination of surgical material.

A known method of treating colorectal cancer (RF Patent 2336038, IPC AB 17/12, publ. 2008, prototype), including surgical treatment, placement in a presacral space of a drug containing 5-fluorouracil. The method consists in the fact that 200 ml of blood is taken from patients in the preoperative period, plasma is extracted from the blood by centrifugation, 40 ml of autoplasma and 500 mg of 5-fluorouracil are placed in the first bottle, and the remaining blood cells, plasma and 1000 mg are placed in the second bottle 5-fluorouracil; separate incubated vials for 40 minutes at 37 ° C. Then, rectal extirpation is performed; during the operation, incubated blood with a chemotherapy from the second bottle is injected dropwise; after removal of the rectum with the tumor in the tumor bed (on the sacrum), a hemostatic sponge soaked in incubated autoplasma with chemotherapy from the first vial is placed. After this, the perineal wound is plugged or sutured.

However, the use of autoplasma in combination with a hemostatic sponge as a carrier of 5-fluorouracil is not the optimal choice of the active substance delivery method, since it is almost impossible to achieve uniform distribution of the sponge along the wound walls and its fixation at the application sites. This leads to the impossibility of a uniform distribution of the chemotherapy along the surrounding tissues, and under certain conditions it can cause complications of a purulent-septic nature, in addition, in case of allergic reactions, it is impossible to quickly remove the carrier from the wound.

The objective of the proposed method is to eliminate these disadvantages, increasing the effectiveness of treatment by reducing the incidence of local relapses after surgical treatment of colorectal cancer.

To do this, during the operation, the drug “hydrogel wipes with 5-fluorouracil and Coletex-5-ftur sodium alginate” with the addition of 50 mg of carboplatin is placed in the presacral space, while the drug is introduced into the presacral space until it is completely filled, two drains are installed of different diameters into the sacral space, after which peritonization with a continuous suture is performed tightly, for 5-6 days after the operation, the Coletex-gel-DNA hydrogel is introduced through drains until the presa is completely filled stral space.

The method is as follows.

Under anesthesia, a lower middle laparotomy is performed. An audit of the abdominal organs is performed to clarify the location of the tumor and the prevalence of the process.

Two semilunar incisions open the pelvic peritoneum, and the rectum is mobilized in a blunt and sharp way.

A. mesenterica inferior bandages and intersects at the base. On direct clamps and staplers, the gut intersects. The rectum is removed en block with pararectal fiber. A colonic anastomosis is formed using a circular stapler or manually, in the case of obstructive resections of the rectum, the stump of the intestine is immersed with purse string sutures. Two plastic or rubber drains of various diameters are installed in the sacral space, mainly 0.5 and 1.0 cm. After this, the cavity of the sacral space is completely filled with hydrogel - hydrogel wipes with 5-fluorouracil and Coletex-5-ftur sodium alginate with the addition of carboplatin in an amount of 50 mg. Peritonization is performed with a hermetic continuous suture, which prevents the hydrogel from entering the abdominal cavity. Hemostasis is monitored. The median wound is sutured in layers.

On day 5-6, through the smaller diameter drainage, Coletex-gel-DNA is injected into the presacral space with a small amount of force once, until the hydrogel leaves the wide drainage. A small diameter drainage tube is removed immediately after the procedure, a large diameter drainage tube is removed approximately a day later.

The proposed method treated 26 patients, of whom 3 patients after 2 years of observation revealed distant metastases, the remaining 24 patients were observed for 2-5 years, no signs of recurrence or generalization of the process were found.

Example.

Patient D., 21 years old (and / on from 07/13/2007). He was admitted to the surgical department with a diagnosis of Cancer of the middle ampullar region of the rectum. Held bleeding.

The operation was performed: combined low anterior resection of the rectum with left-sided ovariectomy

By the proposed method described above, surgery has been performed. When revising distant metastases, ascites is not. The tumor is located at a height of 13 cm, all layers of the intestinal wall germinate, due to the tumor process, the sigmoid colon is invaginated into the rectal ampoule, the left ovary is soldered to the tumor, multiple dense lymph nodes are palpated along the a.mesenterica inferior. Formed a colonic colonic anastomosis end-to-side using a stapler. Two drains are installed in the sacral space.

70 ml of hydrogel “hydrogel wipes with 5-fluorouracil and Koleteks-5-ftur” sodium alginate with the addition of 50 mg of carboplatin were introduced into the sacral space.

Drainages of various sizes — 0.5 and 1.0 cm — were installed in the presacral space. Peritonization with a continuous suture. Layered suture of the wound. Iodine. Aseptic sticker. The stool was obtained 4 days after surgery.

On the 5th day, 20 ml of Coletex-gel-DNA hydrogel was introduced via a small diameter presacral drainage (until the gel was obtained through the second drainage), after which a 0.5 cm drainage tube was removed. On the 6th day, the remaining drainage was removed. No adverse effects were noted. During the observation, the patient's condition is satisfactory, there are no signs of progression.

Thus, intraoperative local chemotherapy of the bed of the removed tumor on the hydrogel material based on sodium alginate in combination with reparative therapy helps to prevent the occurrence of relapses and metastases in malignant tumors of the rectum.

Claims (1)

A method for the treatment of colorectal cancer, including surgical treatment, placement in a presacral space of a medicine containing 5-fluorouracil, characterized in that "hydrogel wipes with 5-fluorouracil and Coletex-5-ftur sodium," with the addition of 50 mg of carboplatin, while the drug is introduced into the presacral space until it is completely filled, two drainages of different diameters are installed in the presacral space, after which peritoneum is carried out tight seam with a continuous suture, on 5-6 days after the operation, the Coletex-gel-DNA hydrogel is introduced into the presacral space through drains until it is completely filled.