Method of sealing a puncture channel after diagnostic endoscopic biopsy of the liver in patients with hemophilia and

 

(57) Abstract:

The invention relates to medicine, in particular to Hematology, and can be used for sealing a puncture channel after diagnostic endoscopic biopsy of the liver in patients with hemophilia A. Prior to biopsy a patient is injected concentrate factor VIII clotting before reaching its activity level in the blood is not less than 50%. Puncture the liver channel fill a concentrate of factor VIII clotting activity 250-500 IU dissolved in 3-5 ml of a 5% solution of aminocaproic acid. In the postoperative period, the activity of factor VIII clotting of blood in the patient support of at least 50% within the first 3 days and not less than 10% within the next 7 days. The method allows for the rapid formation of a blood clot in the needle channel and prevent its lysis. This reduces the risk of bleeding from the puncture channel after manipulation.

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

Currently kachestvennoi biopsy of the liver, use plasma, fibrin (Falstrom J. K. et al. J. of vascular and interventional radiology (apr. 1999), vol. 10, N 4, pp. 457-462).

However, we have found domestic work related to liver biopsy in patients with hemophilia, there are only a few overseas studies devoted to this problem.

As a prototype, we used a method of sealing a puncture channel using fibrin as described in the article "Use of fibrin sealant to reduce bleeding after needle liver biopsy in an anticoagulated canine model: Work in progress" (Falstrom J. K. 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 sealing a puncture channel when liver biopsy is not pathogenetically substantiated. The amount of fibrin in the blood in this category of patients, usually within normal limits, sometimes raised.

According to the Kirov research Institute of Hematology and blood transfusion 78% of patients with hemophilia have had hepatitis B, 75% of hepatitis C and only 5% of patients do not have markers of hepatitis b and C. the Number of patients not infected with hepatitis b and C, with age dramatically reduced. So, if among children under 14 years do not have markers of hepatitis In about 46% among persons aged 15-34 years - 13%, in the senior who is Apatity, that is because the nature of the underlying disease (large amounts of input protein drugs, taxinomia when resorption shed abroad in the tissue of the blood). Verification of liver damage in these patients, and therefore holding pathogenetically and morphologically-based treatment is difficult due to the limited possibility of using invasive methods.

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

The technical result consists in providing quick clot formation within the needle channel of the liver and prevent lysis by suppressing local fibrinolysis.

To achieve a technical result, we propose the joint use of a concentrate factor VIII clotting and a 5% aqueous solution of aminocaproic acid.

We have not found work, in which was described the local concentration of factor VIII, as in most cases it is economically unreasonable.

In our proposed method, a concentrate of factor VIII clotting solutionsi effect.

Since the dimensions of needle channel are technically standard, us imperiously matched the original dose concentrate of factor VIII clotting and-aminocaproic acid for sealing a puncture channel.

Joint use of a concentrate of factor VIII and a 5% aqueous solution of aminocaproic acid allows you to simultaneously ensure the rapid formation of a blood clot in the needle channel and prevent lysis by suppressing local fibrinolysis.

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

The method is as follows. Before diagnostic needle biopsy of the liver to the patient intravenously injecting the concentrate of factor VIII is based achievements of its activity level in the blood is not less than 50%. The doctor is located to the right of the patient. Produce layered anesthesia 20 ml of 0.5% solution of novocaine in the top right point of Coolest introduce the trocar diameter 10 mm The trocar connecting the tube to overlay pneumoperitoneum in the abdominal cavity serves oxygen 4-6 l using insufflator. Through a trocar introduced optics and inspect the abdominal cavity by sector copy. Through the biopsy channel of the laparoscope was introduced puncture needle mounted on the cannula of the syringe. Choose a technically convenient for biopsy or visually affected segment of the liver. Make puncture with a syringe namasivaya the liver tissue. Pull the needle puncture. The contents of the puncture needle is sent for histological and cytological examination. Immediately before use, prepare a hemostatic sealing material: concentrate of factor VIII activity 250-500 IU and dissolved in 3-5 ml of a 5% solution of aminocaproic acid. Through the biopsy channel of the laparoscope was introduced metal tube with a diameter of 5 mm, needle hole fill hemostatic sealing material. Optics is extracted from the abdominal cavity. Through the trocar oxygen is evacuated from the abdominal cavity. Put the seam on the wound with a sterile dressing. In the postoperative period activity deficient proco-agulant support of at least 50% within the first three days and not IU the CLASS="ptx2">

Patient B. 24 years. The diagnosis of hemophilia And has 2 years of age. The activity of factor VIII 2% (norm 85-125%). Has markers for viral hepatitis b and C. the Last 3 years in a patient in the blood was periodically increased transaminases, bilirubin, has deteriorated over the underlying disease (more frequent spontaneous bleeding into joints and soft tissue). Verification of character and depth of liver damage non-invasive methods, it was not possible. Diagnostic laparoscopic needle biopsy of the liver. Before carrying out the manipulations introduced 1000 U activity of factor VIII concentrate, which allowed to increase the activity of scarce proco-agulant in the blood by up to 50%. Visually the liver is a common color, not increased. 4 segment produced by needle biopsy. From a place of vcol marked moderate bleeding. After introduction into the puncture channel 250 UNITS activity factor VIII is dissolved in 5 ml of 5% -aminocaproic acid, the bleeding stopped. In the postoperative period, the activity of factor VIII in the blood during the first 3 days was maintained at 50% in the subsequent 7 days at 10%. Postoperative complications associated with bleeding from puncture Cana is eskay biopsy of the liver in patients with hemophilia A, characterized in that prior to biopsy a patient is injected concentrate factor VIII clotting before reaching its activity level in the blood is not less than 50%, puncture channel after liver biopsy fill a concentrate of factor VIII clotting activity 250-500 IU dissolved in 3-5 ml of a 5% solution of aminocaproic acid, and in the postoperative period, the activity of factor VIII clotting of blood in the patient support of at least 50% within the first 3 days and not less than 10% within the next 7 days.

 

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