The method of combined treatment of cancer of the pelvic organs

 

(57) Abstract:

The invention relates to medicine, Oncology, can be used in the treatment of pelvic tumors. Perform the access. Eliminate the cause operational interference. Spend the lad. Install the drain tube for the evacuation of lymph and wound discharge. Sources of radiation radiation is placed in the lumen of the tubing of the drainage system. In women with cancer of the cervix and body of uterus install drains from the 4th lumbar vertebra to the entrance of the vagina. Men with cancer of prostate, rectum, ovary drains installed in the iliac regions. Tube drains connect to the storage of radioactive sources. Irradiation sources move from radioactive storage in the lumen of the tubing of the drainage system. The method allows to increase the effectiveness of radiation exposure in the area of metastasis. 4 Il.

The present invention relates to medicine, namely to Oncology, primarily to cancer, require extended operations with removal of regional lymph collector and combined (surgery and radiation) treatments. Basically combined the key, for men with prostate cancer and testicular.

Characterized by high potency to lymphogenous metastasis, the above localization of the cancer process, even in the initial stages of tumor development (stage I) requires not only extended operations (removal of regional lymph nodes and imposedon), and radiation methods of influence in the postoperative period on the regional metastasis sites. The combination of different methods of influence on the tumor and regional metastasis sites increases the effectiveness of treatment and significantly improves long-term results of treating, preventing the recurrence of the cancer process.

The most frequent area regional metastasis in cancer of the cervix and uterine body are lymph nodes located along the iliac vessels. Their x-ray projection is from the middle of the womb to the 4th lumbar vertebra. The location of metastatic tumors in the wall of the pelvis, where vessels and major nerve plexus during their involvement in the neoplastic process, often makes it impossible to carry out radical surgery removal of metastatic tumor. In ecstasy of intracavitary and remote methods of treatment. Use only the remote radiation therapy may not be efficient due to the impossibility of deciding on large doses of radiation in an area of lymphogenous metastasis without damage to the surrounding tissue and skin, through which the rays pass. The use of intracavitary irradiation is possible only with the use of vaginal colostate (irradiation through the vagina, that may not generate a high dose of radiation to the pelvic wall and to irradiate up to level 4 of the lumbar vertebrae.

In the application of conventional irradiation techniques, as a rule, unable to bring the dose to the pelvic wall more than 5600 rad (Clifford R. Wheeless, Jr., M. D. 1999). This dose radiation exposure may not lead to the destruction of tumor tissue. The question of closing higher doses of radiation exposure in the area of metastasis without radiation destruction of others, not cancerous adjacent tissues. It should be noted that for each type of tumor has its own distinctive area most likely metastatic lesions. For vulvar cancer such area is the inguinal-femoral and iliac lymph collector for cervical cancer this area iliac lymph nodes. The zone size calibrating changes in metastatic tumor cells with minimal effect on surrounding healthy tissue.

The most appropriate method for this purpose is the method attendinging summarize the sources of low activity directly to the zone of probable metastasis and location of metastatic tumor.

In the present method attendinging irradiation of the pelvic wall after removal of the pelvic organs through punctures in the iliac regions with special grooves, made from materials exposed in the tissue of the hydrolysis and do not require removal. This method is described in the book "Atlas of pelvic surgery", Clifford R. Wheeless, Jr., M. D., 1999 edition, page 392-393. Apalategui conductors are installed in the slots and attached to the computerized storage of radioactive elements. When nominating radioactive sources in the area of radiation is radiation exposure directly on the specified area. The surrounding tissue is separated from sources of radioactivity greater omentum, which reduces radiation exposure to the bowel and the bladder wall. There is a method allows to achieve significant radiation exposure in the area of regional lymph metastasis. Despite the many positive aspects of the known method is not devoid of the scarlet pelvic radiation exposure is possible not earlier than 8-10 days if the condition is not complicated postoperative period. Given the large surgical volume of surgical intervention, to hope for uncomplicated postoperative period is not necessary. Installation with fixation to the wall of the pelvis of the special support device for avtalegiro very difficult and traumatic event, given the rich venous network, located at the wall of the pelvis. The slightest injury of the vascular wall will cause more substantial bleeding, and when varicose veins of the pelvis will make installing and fixing the supporting device is generally impossible. Long location-aware devices and avtalegiro directly in the field of blood vessels can cause decubitus ulcer vascular wall with subsequent bleeding. The presence of a foreign object in the retroperitoneal space will inevitably cause inflammatory changes in the surrounding tissue and will complicate the postoperative period. The absence of drainage system during the removal of iliac lymph nodes will cause the accumulation of lymph and the formation of lymphoid cysts that will lead to the impossibility of radiation treatment and will cause the need for measures aimed at the elimination or reduction of simpatiche infection retroperitoneal space and will make it impossible to undergo radiation treatment. Department of pelvic partially resected gland from avtalegiro will take time and will delay and without having a long and very complicated operation. The seal cannot serve as a reliable protection against intracavitary irradiation is not cancer of the internal organs.

The present invention is to eliminate the disadvantages of the known method and the reduction of possible complications, increasing efficiency of radiation therapy in an area of probable metastasis or metastatic tumors.

In accordance with the task by the applicant created a method of combined treatment of pelvic organs. It includes the implementation of the operational access into the abdominal cavity, the surgical removal of about surgical intervention, access to the retroperitoneal space, revision zone regional lymphogenous metastasis, holding iliac lymphadenectomy (removal of lymph nodes and vessels iliac region). In the presence of unresectable metastatic tumors produce marking rentgencontrastnami markers. Next, install a drainage system for the evacuation of lymph, which is the delivery system of radioactive elements, the status is simpaticheskogo collector. Drainage system (a system for conveying radioactive elements) is displayed through the lumen of the vagina in a situation where the reason for the surgery was cancer of the neck or body poppies. In a situation where a hysterectomy was not performed and there is no possibility to withdraw the drainage system of tubes through the vagina, removal of pipes of the drainage system directly through punctures in the iliac regions. Drainage tubes are retroperitoneal and appear on the skin iliac regions. This method of removing the drainage system is possible in men with prostate cancer and testicular. The drainage system that is derived through the vagina or through a separate incision in the iliac regions, connected to a vacuum system for creating evacuation lymph and wound discharge. In uncomplicated postoperative period of 8-9 days, and if complicated after fixing the cause of the complications, using a system of tubes arranged along the remote lymphatic vessels, hollow lumen tube is the summing up of radioactive sources for radiation exposure in the area of regional metastasis or metastatic unresectable tumor, whic is offered the appropriate device for its implementation consisting of a system of drainage pipes with small holes on the end. In the lumen of the drainage tube on 8-9 day of the postoperative period is entered attending consisting of radioactive sources. One side of the tube is covered with a material which prevents the passage of the rays, to protect healthy not cancerous organs and directional radiation exposure. Attending due to the application of substances that prevent the passage of the rays, is radiopaque and well contrastives on radiographs, it is possible to accurately calculate the dose of radiation exposure in the area likely lymphogenous metastasis or metastatic tumor.

The device depicted in the accompanying Fig.4, where 1 is the drainage holes in the distal part, 2 - apologing with linear sources of radioactive radiation, covered on one side with a material that prevents the passage of the rays and which is the protective shield, 3 - scheme of distribution of radiant energy by atoladinha.

The device in the form of a flexible tubular catheter with drainage holes in the distal, into the lumen of the tubular catheter, affording containing sources of radiation, one of the parties to attala the s beam radiation and protection of healthy, not cancer of the internal organs (see Fig. 4., POS. 3). For uniform distribution of radiant energy in the pelvis, we offer a way intracavitary irradiation and device for its implementation, consisting of a tube with many small holes at the distal part of the system of pipes installed during operation (see Fig. 1), during inspection region of the retroperitoneal space and the detection of metastatic tumor in the inability of the removal of the tube down to tumor tissue and fixed so that they are evenly surrounded metastatic tumor, in the absence of visible metastatic changes, after conducting iliac lymphadenectomy tube is placed along the lymphatic collector and is fixed to the formations of the pelvic thin kemptville seams.

Projection area regional limpiando metastasis on radiographs in cancer of the cervix and uterine body is from the middle of the pubic bone to 4th lumbar vertebra. Throughout this length is placed and fixed Tenaga tube in the first 8-9 days of the postoperative period, functioning as a drain for wound and lymph. Before the beginning of exposure need printerov pelvis and spine, that allows, in accordance with their location accurately calculate the dose of radiation exposure, and turning a protective shield to reduce the dose of radiation effects on bowel and bladder (Fig. 2).

In accordance with the invention, the method is as follows. At the first stage, surgical intervention to remove a tumour organ regional lymph system, it is most often extended hysterectomy method Wertheim Nicholas, this operation is performed when cervical cancer, uterine body and sarcoma of the uterus. One of the stages of this operation is the revision of the retroperitoneal space and the removal of lymph collector consisting of iliac lymph nodes. After conducting lymphadenectomy (removal of lymph nodes) or the attempted removal of the metastatic tumor, if it is inoperable metastatic tumor, metastatic tumor is marked with radiopaque markers for precise definition of its boundaries and calculate the dose of radiation therapy in the postoperative period. It is fixed tube operating in the first 8-9 days as drainage, maguirei lymph and wound, and with 8-9 days as the course iliac lymphatic vessels, the other end of the excreted into the lumen of the vagina and are ejected, and the tubes are fixed in the course of their situation seams.

Cancer of the vulva, in the case where the uterus is not removed, or men of the drainage system is displayed through a separate puncture on the Ilium (Fig. 3), such activities are conducted in male patients with cancer of the rectum, testis, prostate, etc.

Since 8-9 days the patient perform radiography of the lower abdomen. While the x-ray shows the position of the radiopaque drainage tubes and in the presence of unremoved tumor shows the position of the markers that define the size and position of inoperable tumors. Engineers, physicists calculate radiation exposure and dose radiation exposure on areas of metastasis, and the presence of a tumor in the area of the tumor by the location of the protective screen from healthy organs being the protection of bowel and bladder from radiation exposure intracavitary irradiation. There is no need to protect the healthy bodies by separating them packing. After intracavitary irradiation tube is easily removed by simply pulling them Koeva Etc., 44 years.

The history N 2348

Enrolled in the gynecologic Oncology clinic with a diagnosis of C-r colli uteri T2N1M0

Processed according to the method of Wertheim Nicholas. During the operation revealed metastatic changes in the internal iliac lymph nodes. Produced bilateral lymphadenectomy. In the course of regional lymph collector 3 lumbar vertebra on both sides of the laid pipe drainage system for evacuation of lymph. In the early days the number of removed lymph and wound up to 600-500 ml, the number of detachable lymph decreased with each passing day and finally stopped for 8 days, 10 days, the patient started intracavitary irradiation sources of low activity, introduced into the lumen of the tubes under the control of the x-ray studies. Calculated dose radiation exposure. The dose to the area of metastasis amounted to 6500 rad.

Example 2

Patient Romanov, L. P., 49.

The history N 1175

Enrolled in the gynecologic Oncology clinic with a diagnosis of C-r colli uteri T3N2M0.

The patient in connection with the development of bleeding from tumors removed the prod is tenki pelvis. Technical difficulties, we managed to move away from the iliac vessels. Along the lymphatic collector installed drainage system.

Using a system of drains, sources of low activity on the 11th day started intracavitary radiation therapy, dosimetry carried out after the x-ray and distribution of isodose curves. The area undeleted tumor was able to bring to the 6600 happy.

Example 3

Sick of Mamiek C. H., 56 years old.

The history N 3079.

Enrolled in the gynecologic Oncology clinic with a diagnosis of C-r hemangioma, post operative treatment. MTS in the lymph nodes of the right iliac region.

Made right iliac lymphadenectomy. Along the lymphatic vessels drain pipe laid, derived through a separate puncture through the iliac region. Since 7 days, initiated intracavitary therapy by summing up the sources of low activity to the wall of the pelvis. Total from sachitano-radiation therapy to the area of metastasis patient received up to 6000 rad.

Literature

1. Bohman Ya Century Guide to gynecology. - M.: Medicine, 1989.

2. To the x diseases of the pelvic organs, including the implementation of the operational access, revision, surgical removal of about surgical intervention, identification of metastatic tumors in the area of regional lymphogenous metastasis, holding lymphadenectomy, installation of pipe drainage systems for evacuation and lymph wound, characterized in that the radiation sources radiation is placed in the lumen of the tubing of the drainage system installed along the remote lymph nodes and vessels, from 4 lumbar vertebra to the entrance of the vagina cancer of the cervix and uterine body or through a separate incision in the iliac regions during surgery in men cancer of the prostate, rectum, testis, tube drainage system connected to the storage of radioactive sources, radiation sources move from radioactive storage in the lumen of the tubing of the drainage system.

 

Same patents:

The invention relates to medicine, more specifically to radiology, and may find application in radiation therapy of cancer patients
The invention relates to medicine and can be used in the treatment of pituitary adenomas

The invention relates to medicine, namely to Oncology, and can be used in the combined treatment of locally advanced cancer of the maxillary sinus

The invention relates to oncourology and can be used for the treatment of patients with cancer of the bladder and kidneys with the different stages in the development of tumor T1-3NxOoprevention of recurrence and metastases
The invention relates to medicine, in particular to cancer, and can be used for radical treatment of patients with locally advanced cancers of the cervix TCNXMABOUT

The invention relates to the field of medical devices, namely, devices for rotating radiation therapy

The invention relates to Oncology

The invention relates to the field of medicine

The invention relates to medicine, operative gynecology, and can be used in the treatment of kraurosis and leukoplakia of the vulva

How colpopoiesis // 2157122
The invention relates to medicine, gynecology, may be used to form the vagina

The invention relates to medicine, Oncology, can be used in the surgical treatment of malignant tumors of the vulva in women

The invention relates to medicine, namely to clinical immunology, gynecology and for the treatment of yeast obesity resistant to standard therapy

The invention relates to medicine, Oncology, gynecology, and can be used in surgical treatment of malignant tumors of the vulva in women

The invention relates to medicine and can be used in the treatment of gynecological diseases, namely endocervicitis
The invention relates to medicine, in particular to obstetrics and gynecology

The invention relates to medicine, namely to surgical dentistry
Up!