The way sclerotherapy cysts of the liver and kidneys

 

(57) Abstract:

The invention relates to medicine and can be used for sclerotherapy cysts of the liver and kidneys. Make puncture cystic cavity and aspiration under ultrasound control. In the cyst cavity is injected 96% ethanol. Within 6-12 months to determine the growth rate of the cystic cavity. By increasing its volume by 20% or more of the original size enter the alcohol in the amount of 80% from a remote content cysts. The exposure time of ethanol 20-30 minutes Volume remote alcohol - no more than 50% of the administered. The method prevents the recurrence of the cyst.

The invention relates to medicine and can be used in therapy and surgery, departments of radiology, where the introduced techniques of minimally invasive interventions under ULTRASOUND control.

The known method of sclerotherapy cysts of the liver and kidneys when used to puncture the cyst under ULTRASOUND control, full aspiration and the introduction of 96% ethanol in the amount of 50-100% from a remote content. Temporary exposure time is about 5-10 minutes, then the alcohol is completely evacuated (Lots A. N. Minimally invasive interventions under the ULTRASOUND in surgical diseases of organs hepatopancreatobiliary C is their diseases, Stavropol 1991 , 203 S.; Ignatin N. S., Demin A. I. "Ultrasonography and computed tomography in the diagnosis and treatment of urological diseases", Vidar, 1997, 260 S.).

The disadvantage of this method is that the criterion of the program sclerotherapy is the only remote volume liquid fraction from the cavity of the cyst. Not taken into account the peculiarities of the growth rate of this hearth. This leads to a high risk of recurrence of the cyst and, ultimately, to the absence of the effect of manipulation.

Differential selection mode sclerotherapy with alcohol liver cysts and kidney under ULTRASOUND control on the basis of growth in the available literature no.

The essence of the proposed method is that the patient within 6-12 months to determine the growth rate of the cystic cavity, and by increasing its volume by 20% or more of the original size under the ULTRASOUND carry out puncture cystic cavity and aspiration of its contents, then enter 96% ethanol in the amount of 80% from a remote content cysts and after 20-30 minutes, the ethanol is removed in the amount of not more than 50% of entered.

The growth rate of the cystic cavity depends on 2 major pathophysiological mechanisms of filling the cavity of the liquid fraction:

1) list);

2) the number and total volume of arterial, venous vessels in the parenchyma of the liver or kidneys around the cyst, the degree of blood pressure in these vessels, the speed of Na, K-pump, the cell membrane, the efficiency of osmotic mechanism transudation of plasma from the vessel into the cell cavity (acquired cysts).

Evaluation of high growth as 20% or more of the original volume during the observation period of 6-12 months is based on the basic principles of pathological physiology, where the trigger at the same time two mechanisms of filling of the cyst (see above).

Introduction 96% ethanol in the cavity of the cyst in the amount of 80% of the original based on the fact that this amount of alcohol is enough to unfolding of the folds of endothelial cysts and diakonale the inner surface of the cyst.

The increase in the conduction of alcohol more than 80% is impractical because of the danger signs of complications such as perforation cavity and pronounced toxicity and inflammation. Deposition of ethanol in the cavity in an amount of 50% of the injected under high growth rate of the cyst allows you to prolong the effects of 96% alcohol on endothelial cells of the cyst and causes coarser connective tissue scar in the area of the capsule of the cyst, which is obstructing the support 2-30 minutes due to the optimal duration of the impact of ethanol on tissue.

The method was carried out as follows.

Within 6-12 months to determine the growth rate of the cystic cavity according to the ultrasound. The growth rate share: slow (increase to 10.0% of the original), average (15.0%) and high (20.0% and more). The growth rate is determined in terms of 12 months in the form of a comparison of cystic cavity with an ultrasound every month. Then hold the puncture cystic cavity needles G 20-18 with complete aspiration of the cyst. Spend an urgent and routine cytological examination, evaluate bacterial flora. After receiving a negative response when urgent Cytology begin infusion of alcohol, based on the growth of cysts. At high growth rate through the puncture needle is injected ethanol in the amount of 80% from a remote content. After 20-30 minutes, remove the alcohol in an amount of not more than 50% of the input. Then remove the needle, place a sterile dressing, the patient is transported to the chamber. Oseltamivir is prescribed broad spectrum antibiotics for 10 days. At slow and moderate pace of growth of the cyst sclerotherapy performed by standard methods without Deposit ethanol.

Clinical example 1.

Patient K. 59 years. Naha 2 times a year. With ultrasound for 3 years was observed surface cyst of the right kidney, which tends to increase (increased by 30.0% over 8 months). The last 6 months, the patient complained of aching pain in the right half of the back, pain in the course of the right ureter was observed frequent painful urination, nocturia. Objective: with the methodical palpation of the abdominal cavity in the right upper quadrant even royalty enlarged painful kidney. Symptoms of peritoneal irritation are not identified. Symptom tapping on the back right is positive. General analysis of blood without pathology. Urinalysis: tank weight. 1018, protein 0.083 g/l, squamous epithelium, a unit in a/C, 5-10 leukocytes in p/C, oxalates, mucus, bacteria in small amounts. Biochemical blood test: no abnormalities. Urine analysis according to Nechyporenko normal. Urine analysis zimnitsky: DD - 800 ml, SD - 1200 ml, beats. weight 1013 to 1031. Conclusion: adaptation, concentration and filtration of the kidney is not changed.

Ultrasound of the kidneys: the left kidney him, Reno-cortical index 1:2, the thickness of the parenchyma of 16 mm, including HP is not extended. Right kidney: the contours of uneven sizes of buds increased (HH mm). In the middle segment of the kidney is defined unilocular cyst with a cups.

Given the clinic, these complaints and anamnesis diagnosed with congenital cyst of the right kidney with a high growth rate. Medical consultation is defined further treatment: MIM in the form of sclerotherapy 96% ethanol. At the first stage after the puncture is removed 170 mm light yellow liquid, transparent, odorless. Urgent Cytology cellular elements not found. In the second stage introduced 110 mm 96% ethanol. Exposure of alcohol was 20 minutes. The process of aspiration and infusion of alcohol was videoreviews. During the biopsy adverse prognostic ULTRASOUND criteria were not detected (presence of hypoechoic areas and static sections of the internal structure). Manipulation proceeded with minor pain, kupirovalsa yourself. The second ULTRASONIC period was uneventful.

After manipulation of the passed 9 years. Echostructure focus has not changed, its size is 15 mm in diameter. When carrying out control of dynamic scintigraphy function of the right kidney has improved.

The clinical course of pyelonephritis has changed, exacerbation observed once a year. They avoided medical treatment on an outpatient basis. Data from clinical example clearly shows the Oh W. 26 years. After a gunshot wound in the area of the right lumbar region was carried out surgical treatment perirenal hematoma. 2 months after operations began to complain of pain in the right lumbar region and in the course of the ureter, dysuric phenomena. When the control ULTRASOUND was determined cystic cavity to 35 mm in diameter in the lower pole of the right kidney. After a month, the size of the cyst was 58 mm in diameter (44% increase in volume from the original), it was decided to hold the cyst sclerotherapy 96% ethanol under ULTRASOUND control. At stage 1 during the puncture is removed 60 ml of liquid with a hemorrhagic component. In phase 2 introduced 50 ml of 96% ethanol (80% of the remote). Exposure time was 30 minutes for the formation of a pronounced inflammatory response of the capsule of the cyst. Then removed in 25 ml of ethanol (50% of the led). The residual cavity was 22 mm in diameter. The patient was under observation for 2 years. Signs of recurrence of the cyst no. The residual cavity when ULTRASOUND in size has not changed. Clinical manifestations from the kidneys no.

Clinical example 3.

Patient M. aged 47.

Five years was carried out dynamic monitoring of a single cyst in the right lobe of the liver to 40 mm within 6 months of the size of the cyst increased to 65 mm, appeared sporadic inclusion in the cavity. We decided to have a cyst sclerotherapy.

The laboratory investigations of changes in biochemical and General analyses have been identified. If scintigraphy is observed defect accumulation of the drug.

At stage 1 held puncture of cysts in the right lobe of the liver under ULTRASOUND control, removed 56 ml of clear liquid with a hemorrhagic component, cyst slept up to 29 mm in diameter. In phase 2 introduced 40 ml of 96% ethanol. After 30 minutes, aspirated 20 ml of ethyl alcohol.

The residual cavity was 25 ml, the Patient was under observation 1.5 years, signs of recurrence of the cyst no.

The proposed method was used in 76 patients (40 man - cysts kidney, 36 patients have cysts in the liver). Recurrence was observed in 3 patients with a high growth rate of the hearth. In all other cases, the manipulation was successful. Within 5-8 years of follow-up recurrence have been identified.

Thus, the proposed method sclerotherapy 96% ethanol uncomplicated cysts of the liver and kidney under ULTRASOUND control is a highly effective minimally invasive method of treatment of this pathology and can be used as alternatives to chirurgiche the second cavity, the aspiration of its contents under ULTRASOUND control and the introduction of 96% ethanol in the cavity of the cyst, followed by its removal, characterized in that within 6-12 months to determine the growth rate of the cystic cavity and by increasing its volume by 20% or more of the original size enter the alcohol in the amount of 80% from a remote content cysts, exposure to ethanol 20-30 min, the volume remote alcohol - no more than 50% of the administered.

 

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FIELD: medicine; pharmaceutical engineering.

SUBSTANCE: pharmaceutical composition COMPRISES 5-(2-pyrazinyl)-4-methyl-1,2-dithyol -3-thion (oltipraze) and dimethyl-4,4'-dimetoxi-5,6,5',6'-dimethylene-dioxybiphenyl-2,2' dicarboxilate (DDB) as the main components. Oltipraze: DDB proportion is preferentially equal to 50-1:1-50, the most preferential being 5:1.

EFFECT: enhanced effectiveness of treatment.

6 cl, 6 dwg, 9 tbl

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