MD621Z - Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis - Google Patents
Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis Download PDFInfo
- Publication number
- MD621Z MD621Z MDS20120157A MDS20120157A MD621Z MD 621 Z MD621 Z MD 621Z MD S20120157 A MDS20120157 A MD S20120157A MD S20120157 A MDS20120157 A MD S20120157A MD 621 Z MD621 Z MD 621Z
- Authority
- MD
- Moldova
- Prior art keywords
- patients
- cholecystectomy
- infiltrated
- aprotinin
- laparoscopic cholecystectomy
- Prior art date
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- 238000002192 cholecystectomy Methods 0.000 title claims abstract description 14
- 238000000034 method Methods 0.000 title claims abstract description 10
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 9
- 108010039627 Aprotinin Proteins 0.000 claims abstract description 8
- VEXZGXHMUGYJMC-UHFFFAOYSA-M Chloride anion Chemical compound [Cl-] VEXZGXHMUGYJMC-UHFFFAOYSA-M 0.000 claims abstract description 8
- 108090000190 Thrombin Proteins 0.000 claims abstract description 8
- 229960004405 aprotinin Drugs 0.000 claims abstract description 8
- 210000000232 gallbladder Anatomy 0.000 claims abstract description 8
- ZPNFWUPYTFPOJU-LPYSRVMUSA-N iniprol Chemical compound C([C@H]1C(=O)NCC(=O)NCC(=O)N[C@H]2CSSC[C@H]3C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@H](C(N[C@H](C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](CC=4C=CC(O)=CC=4)C(=O)N[C@@H](CC=4C=CC=CC=4)C(=O)N[C@@H](CC=4C=CC(O)=CC=4)C(=O)N[C@@H](CC(N)=O)C(=O)N[C@@H](C)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C)C(=O)NCC(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CSSC[C@H](NC(=O)[C@H](CC(O)=O)NC(=O)[C@H](CCC(O)=O)NC(=O)[C@H](C)NC(=O)[C@H](CO)NC(=O)[C@H](CCCCN)NC(=O)[C@H](CC=4C=CC=CC=4)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CCCNC(N)=N)NC(=O)[C@H](CCCCN)NC(=O)[C@H](C)NC(=O)[C@H](CCCNC(N)=N)NC2=O)C(=O)N[C@@H](CCSC)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@@H](CSSC[C@H](NC(=O)[C@H](CC=2C=CC=CC=2)NC(=O)[C@H](CC(O)=O)NC(=O)[C@H]2N(CCC2)C(=O)[C@@H](N)CCCNC(N)=N)C(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCC(O)=O)C(=O)N2[C@@H](CCC2)C(=O)N2[C@@H](CCC2)C(=O)N[C@@H](CC=2C=CC(O)=CC=2)C(=O)N[C@@H]([C@@H](C)O)C(=O)NCC(=O)N2[C@@H](CCC2)C(=O)N3)C(=O)NCC(=O)NCC(=O)N[C@@H](C)C(O)=O)C(=O)N[C@@H](CCC(N)=O)C(=O)N[C@H](C(=O)N[C@@H](CC=2C=CC=CC=2)C(=O)N[C@H](C(=O)N1)C(C)C)[C@@H](C)O)[C@@H](C)CC)=O)[C@@H](C)CC)C1=CC=C(O)C=C1 ZPNFWUPYTFPOJU-LPYSRVMUSA-N 0.000 claims abstract description 8
- 239000000203 mixture Substances 0.000 claims abstract description 8
- 229960004072 thrombin Drugs 0.000 claims abstract description 8
- 210000001367 artery Anatomy 0.000 claims abstract description 5
- QTCANKDTWWSCMR-UHFFFAOYSA-N costic aldehyde Natural products C1CCC(=C)C2CC(C(=C)C=O)CCC21C QTCANKDTWWSCMR-UHFFFAOYSA-N 0.000 claims abstract description 5
- ISTFUJWTQAMRGA-UHFFFAOYSA-N iso-beta-costal Natural products C1C(C(=C)C=O)CCC2(C)CCCC(C)=C21 ISTFUJWTQAMRGA-UHFFFAOYSA-N 0.000 claims abstract description 5
- 230000003287 optical effect Effects 0.000 claims abstract description 5
- 206010052428 Wound Diseases 0.000 claims abstract description 4
- 208000027418 Wounds and injury Diseases 0.000 claims abstract description 4
- 230000002439 hemostatic effect Effects 0.000 claims abstract description 4
- 210000001096 cystic duct Anatomy 0.000 claims description 4
- 208000032843 Hemorrhage Diseases 0.000 abstract description 3
- 239000003814 drug Substances 0.000 abstract description 2
- 238000002674 endoscopic surgery Methods 0.000 abstract description 2
- 238000011321 prophylaxis Methods 0.000 abstract description 2
- 210000000941 bile Anatomy 0.000 abstract 1
- 210000000013 bile duct Anatomy 0.000 abstract 1
- 230000023597 hemostasis Effects 0.000 description 5
- 208000007232 portal hypertension Diseases 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- 208000035965 Postoperative Complications Diseases 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 238000011477 surgical intervention Methods 0.000 description 2
- 206010003445 Ascites Diseases 0.000 description 1
- 206010008614 Cholecystitis acute Diseases 0.000 description 1
- 108010054218 Factor VIII Proteins 0.000 description 1
- 102000001690 Factor VIII Human genes 0.000 description 1
- 108010049003 Fibrinogen Proteins 0.000 description 1
- 102000008946 Fibrinogen Human genes 0.000 description 1
- 241000521257 Hydrops Species 0.000 description 1
- 206010061249 Intra-abdominal haemorrhage Diseases 0.000 description 1
- 206010030113 Oedema Diseases 0.000 description 1
- 230000000740 bleeding effect Effects 0.000 description 1
- 229940105778 coagulation factor viii Drugs 0.000 description 1
- 150000001875 compounds Chemical class 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 229940012952 fibrinogen Drugs 0.000 description 1
- 201000004108 hypersplenism Diseases 0.000 description 1
- 238000002357 laparoscopic surgery Methods 0.000 description 1
- 210000003041 ligament Anatomy 0.000 description 1
- 230000001483 mobilizing effect Effects 0.000 description 1
- 230000004660 morphological change Effects 0.000 description 1
- 210000002747 omentum Anatomy 0.000 description 1
- 238000007468 re-laparotomy Methods 0.000 description 1
Landscapes
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la chirurgia endoscopică şi poate fi utilizată pentru profilaxia hemoragiilor din loja vezicii biliare în colecistectomia laparoscopică la pacienţii cu ciroză hepatică. The invention relates to medicine, in particular to endoscopic surgery and can be used for the prophylaxis of bleeding from the gallbladder during laparoscopic cholecystectomy in patients with liver cirrhosis.
Este cunoscută metoda de colecistectomie laparoscopică, care constă în efectuarea abordului prin 4 puncte, şi anume în regiunea infraombilicală, epigastrică, sub rebordul costal drept şi regiunea iliacă dreaptă. Apoi se introduc consecutiv dispozitivul optic şi trocarele de lucru pentru efectuarea manipulaţiilor. Se efectuează mobilizarea, clamparea şi secţionarea consecutivă a ductului cistic şi arterei cistice. Se efectuează colecistectomia de la col cu hemostaza definitivă a fosetei vezicii biliare prin electrocauterizare [1]. The laparoscopic cholecystectomy method is known, which consists of performing the approach through 4 points, namely in the infraumbilical region, epigastric, under the right costal margin and right iliac region. Then the optical device and working trocars are consecutively introduced for performing the manipulations. The cystic duct and cystic artery are mobilized, clamped and consecutively sectioned. The cholecystectomy is performed from the neck with definitive hemostasis of the gallbladder fossa by electrocautery [1].
Dezavantajul metodei menţionate constă în aceea că la pacienţii cu ciroză hepatică şi hipertensiune portală, hemostaza efectuată nu este eficientă, ceea ce poate provoca hemoragii masive intraabdomenale în perioada intra- şi postoperatorie. The disadvantage of the mentioned method is that in patients with liver cirrhosis and portal hypertension, the hemostasis performed is not effective, which can cause massive intra-abdominal bleeding during the intra- and postoperative period.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de hemostază definitivă şi eficientă, având ca rezultat evitarea apariţiei complicaţiilor postoperatorii, excluderea necesităţii efectuării relaparatomiilor şi micşorarea duratei de spitalizare. The problem solved by the invention consists in developing a definitive and efficient hemostasis method, resulting in avoiding the occurrence of postoperative complications, eliminating the need for repeat surgeries and reducing the duration of hospitalization.
Conform invenţiei, metoda de colecistectomie laparoscopică la pacienţii cu ciroză hepatică constă în aceea că se efectuează abordul prin 4 puncte, şi anume în regiunile subombilicală, epigastrică, sub rebordul costal drept şi în regiunea iliacă dreaptă, se introduc consecutiv dispozitivul optic şi trocarele de lucru, apoi se mobilizează, se clampează şi se secţionează ductul cistic şi artera cistică, se infiltrează subseros peretele vezicii biliare cu un amestec hemostatic, care conţine crioprecipitat plasmatic, aprotinină, sol. trombină şi sol. clorură de Ca2+ în următorul raport al componentelor, pentru 1 ml: According to the invention, the laparoscopic cholecystectomy method in patients with liver cirrhosis consists in performing the approach through 4 points, namely in the subumbilical, epigastric regions, under the right costal margin and in the right iliac region, consecutively introducing the optical device and working trocars, then mobilizing, clamping and sectioning the cystic duct and cystic artery, subserosally infiltrating the gallbladder wall with a hemostatic mixture containing plasma cryoprecipitate, aprotinin, thrombin sol and Ca2+ chloride sol in the following ratio of components, per 1 ml:
crioprecipitat plasmatic (mg) 45…50 aprotinină (KIU) 15…20 sol. trombină (UA) 30…35 sol. clorură de Ca2+ (mmol) 1…2.plasma cryoprecipitate (mg) 45…50 aprotinin (KIU) 15…20 thrombin solution (UA) 30…35 Ca2+ chloride solution (mmol) 1…2.
Apoi se efectuează colecistectomia de la col prin stratul subseros infiltrat cu amestecul menţionat, după care plăgile se suturează. Then, cholecystectomy is performed from the neck through the subserous layer infiltrated with the aforementioned mixture, after which the wounds are sutured.
Rezultatul invenţiei constă în atingerea unui hemostaze definitive şi eficiente, ceea ce duce la evitarea apariţiei complicaţiilor postoperatorii, excluderea necesităţii efectuării relaparatomiilor şi micşorarea duratei de spitalizare. The result of the invention consists in achieving definitive and effective hemostasis, which leads to avoiding the occurrence of postoperative complications, excluding the need to perform relaparotomy and reducing the duration of hospitalization.
Metoda se efectuează în modul următor. The method is performed in the following way.
Pacientul este investigat clinic şi paraclinic în perioada preoperatorie. După stabilirea indicaţiilor pentru operaţie de colecistectomie celioscopică şi aprecierea riscului intervenţiei chirurgicale se pregătesc componentele necesare pentru compusul menţionat, şi anume în cantităţile următoare pentru 1 ml: The patient is clinically and paraclinically investigated in the preoperative period. After establishing the indications for laparoscopic cholecystectomy and assessing the risk of surgical intervention, the necessary components for the aforementioned compound are prepared, namely in the following quantities for 1 ml:
crioprecipitat plasmatic (mg) 45…50 aprotinină (KIU) 15…20 sol. trombină (UA) 30…35 sol. clorură de Ca2+ (mmol) 1…2.plasma cryoprecipitate (mg) 45…50 aprotinin (KIU) 15…20 thrombin solution (UA) 30…35 Ca2+ chloride solution (mmol) 1…2.
În crioprecipitatul uman preparat conform standardelor stabilite, şi anume în o doză de crioprecipitat de 20 ml se conţine factorul VIII de coagulare 100 UI şi 250 mg de fibrinogen. Human cryoprecipitate prepared according to established standards, namely a 20 ml dose of cryoprecipitate contains 100 IU coagulation factor VIII and 250 mg of fibrinogen.
Metoda se efectuează în modul următor: în timpul intervenţiei chirurgicale se efectuează abordul prin 4 puncte, şi anume în regiunile subombilicală, epigastrică, sub rebordul costal drept şi în regiunea iliacă dreaptă, se introduc consecutiv dispozitivul optic şi trocarele de lucru, apoi se mobilizează, se clampează şi se secţionează ductul cistic şi artera cistică, se infiltrează subseros peretele vezicii biliare cu un amestec hemostatic, care conţine crioprecipitat plasmatic, aprotinină, sol. trombină şi sol. clorură de Ca2+ în următorul raport al componentelor, pentru 1 ml: The method is performed as follows: during the surgical intervention, the approach is performed through 4 points, namely in the subumbilical, epigastric regions, under the right costal margin and in the right iliac region, the optical device and the working trocars are consecutively introduced, then the cystic duct and cystic artery are mobilized, clamped and sectioned, the gallbladder wall is infiltrated subserosally with a hemostatic mixture, which contains plasma cryoprecipitate, aprotinin, thrombin solution and Ca2+ chloride solution in the following ratio of components, for 1 ml:
crioprecipitat plasmatic (mg) 45…50 aprotinină (KIU) 15…20 sol. trombină (UA) 30…35 sol. clorură de Ca2+ (mmol) 1…2plasma cryoprecipitate (mg) 45…50 aprotinin (KIU) 15…20 thrombin solute (UA) 30…35 Ca2+ chloride solute (mmol) 1…2
Apoi se efectuează colecistectomia de la col prin stratul subseros infiltrat cu amestecul menţionat, după care plăgile se suturează. Then, cholecystectomy is performed from the neck through the subserous layer infiltrated with the aforementioned mixture, after which the wounds are sutured.
Exemplu Example
Bolnava R, 60 ani, a fost internată în secţia chirurgie a SCM „Sfânta Treime” cu diagnosticul: Colecistită acută calculoasă. Hidrops vezicular. Ciroză hepatică HBV decompensată. Hipertensiune portală. Ascită. Hipersplenism gr. II. În timpul intervenţiei chirurgicale de colecistectomie laparoscopică s-au constatat schimbări morfologice pronunţate macronodulare în ficat - ciroză cu semne de hipertensiune portală (vase dilatate ale omentului şi ligamentului hepato-duodenal). S-a apreciat pericolul major de hemoragie în timpul intervenţiei şi s-a utilizat metoda revendicată ce a permis o hemostază eficientă a fosetei vezicii biliare. În perioada postoperatorie nu au survenit complicaţii şi pacienta a fost externată în stare satisfăcătoare peste 7 zile după operaţie. Patient R, 60 years old, was admitted to the surgery department of the SCM "Sfânta Treime" with the diagnosis: Acute calculous cholecystitis. Vesicular hydrops. Decompensated HBV liver cirrhosis. Portal hypertension. Ascites. Hypersplenism gr. II. During the laparoscopic cholecystectomy surgery, pronounced macronodular morphological changes were found in the liver - cirrhosis with signs of portal hypertension (dilated vessels of the omentum and hepatoduodenal ligament). The major risk of hemorrhage during the intervention was assessed and the claimed method was used, which allowed for effective hemostasis of the gallbladder fossa. No complications occurred in the postoperative period and the patient was discharged in satisfactory condition 7 days after the operation.
1. Târgoveanu E. Elemente de chirurgie laparoscopică. Editura Dosoftei, Iaşi, 1996, v.II, cap. 12, p. 265-320 1. Târgoveanu E. Elements of laparoscopic surgery. Dosoftei Publishing House, Iaşi, 1996, v.II, chap. 12, p. 265-320
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Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20120157A MD621Z (en) | 2012-11-08 | 2012-11-08 | Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20120157A MD621Z (en) | 2012-11-08 | 2012-11-08 | Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis |
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| Publication Number | Publication Date |
|---|---|
| MD621Y MD621Y (en) | 2013-04-30 |
| MD621Z true MD621Z (en) | 2013-11-30 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| MDS20120157A MD621Z (en) | 2012-11-08 | 2012-11-08 | Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD881Z (en) * | 2014-05-21 | 2015-09-30 | Георге АНГЕЛИЧ | Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background |
Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1273075A1 (en) * | 1985-02-15 | 1986-11-30 | Волгоградский государственный медицинский институт | Method of treatment of acute cholecystitis |
| SU1507337A1 (en) * | 1986-10-29 | 1989-09-15 | Киевский Медицинский Институт Им.Акад.А.А.Богомольца | Method of laparoscopic cholecystectomy |
| SU1635967A1 (en) * | 1988-04-25 | 1991-03-23 | Днепропетровский медицинский институт | Method for cholecystectomy |
| MD2328G2 (en) * | 2003-07-14 | 2004-07-31 | Константин ЦЫБЫРНЭ | Fibrinous adhesive and use thereof for endoscopic hemostasis of variceal hemorrhages in hepatic cirrhosis |
| MD3093G2 (en) * | 2006-03-20 | 2007-02-28 | Георге АНГЕЛИЧ | Method of celioscopic cholecystectomy to patients with hepatic cirrhosis |
| MD124Z (en) * | 2009-04-08 | 2010-08-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of laparoscopic cholecystectomy |
-
2012
- 2012-11-08 MD MDS20120157A patent/MD621Z/en not_active IP Right Cessation
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1273075A1 (en) * | 1985-02-15 | 1986-11-30 | Волгоградский государственный медицинский институт | Method of treatment of acute cholecystitis |
| SU1507337A1 (en) * | 1986-10-29 | 1989-09-15 | Киевский Медицинский Институт Им.Акад.А.А.Богомольца | Method of laparoscopic cholecystectomy |
| SU1635967A1 (en) * | 1988-04-25 | 1991-03-23 | Днепропетровский медицинский институт | Method for cholecystectomy |
| MD2328G2 (en) * | 2003-07-14 | 2004-07-31 | Константин ЦЫБЫРНЭ | Fibrinous adhesive and use thereof for endoscopic hemostasis of variceal hemorrhages in hepatic cirrhosis |
| MD3093G2 (en) * | 2006-03-20 | 2007-02-28 | Георге АНГЕЛИЧ | Method of celioscopic cholecystectomy to patients with hepatic cirrhosis |
| MD124Z (en) * | 2009-04-08 | 2010-08-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of laparoscopic cholecystectomy |
Non-Patent Citations (2)
| Title |
|---|
| MD 3093 G2 2007.03.31 * |
| Târgoveanu E. Elemente de chirurgie laparoscopică. Editura Dosoftei, Iaşi, 1996, v.II, cap. 12, p. 265-320 * |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD881Z (en) * | 2014-05-21 | 2015-09-30 | Георге АНГЕЛИЧ | Method for mini-invasive treatment of metastatic liver hepatic cancer on cirrhosis background |
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| Publication number | Publication date |
|---|---|
| MD621Y (en) | 2013-04-30 |
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