Method for the treatment of toxic hepatitis and cirrhosis

 

The invention relates to medicine, in particular to surgery, and can be used for the treatment of toxic hepatitis and cirrhosis. Perform endoscopic kanalirovanie umbilical vein. Enter dispersed the Alloplant biomaterial 5,0 ml of 1 time per day. The rate of 3-5 injections. The method allows to stimulate the regeneration of hepatocytes. 1 table, 1 Il.

The invention relates to medicine, namely to surgery and gastroenterology, and can be used in the treatment of liver diseases.

The possibilities of surgical treatment of hepatitis and cirrhosis of the liver, in most cases, limited by the imposition portocaval anastomoses (Shalimov A. A. , Saenko C. F. Surgery of the digestive tract. Kiev: Health, 1987). Endosurgical methods of treatment of toxic hepatitis and cirrhosis are also in the formation of portocaval anastomoses, aminoheptanoic and operation type Kalb.

The prototype is a method for the prevention of postoperative complications after open cholecystectomy by perepechenny perfusion in the postoperative period (Ghanaians W. H. Optimization of diagnostics and surgical treatment combined Soboleva pancreatoduodenal zone and the round ligament of the liver interconnected, what is used in traditional surgery for the siege of the round ligament of the liver (paraumbilical blockade) in the complex conservative meropriyatiy.

The technical result - increasing the effectiveness of surgical treatment of toxic hepatitis and cirrhosis of the liver due to stimulation of regeneration of hepatocytes.

The method can be performed as one step in any laparoscopic surgery (e.g., cholecystectomy) or to run as an independent manipulation.

The method is as follows. After performing laparoscopic revision of the abdominal cavity spend laparoscopic cannuscio the round ligament of the liver, the catheter set closer to the goal and the liver under laparoscopic control, fixed on the skin. In the postoperative period through a catheter introduced in 5.0 ml of dispersed Alloplant biomaterial (TU 42-2-537-97 permitted for use by the Ministry of health (decree 901 from 22.07.87). In addition, introducing antispasmodic mixture: novocaine (a 0.5% 20,0) with a preliminary introduction of the solution lidz (5,0), heparin (2.5 thousand UNITS) and lidocaine (2,0). Introduction mixtures carried out every 8 hours for 2-3 days after surgery, depending on the severity paleopalynology" enter 1 time per day, this is achieved by creating a depot of the drug in the lymph collector typical for hepatic-pancreaticoduodenal area. In the course of treatment it is necessary to introduce 3-5 doses of the drug. The treatment is carried out on the background of traditional hepatotropic, desintoxication therapy and other Previous studies have shown the effectiveness of dispersed Alloplant biomaterial in the treatment of toxic hepatitis and liver cirrhosis (Muslimov S. A. Morphological aspects of regenerative surgery. Bashkortostan. - Ufa, 2000. - S. 165).

This method is used by us in 6 patients with toxic hepatitis and cirrhosis of the liver. Complications and side effects when using this method, we did not observe.

As you know, cytochemical study of cells provides an opportunity to evaluate not only the effectiveness of the treatment, but also to predict the course of disease. The study Entomologicheskoe activity of leukocytes in the dynamics allows to determine the severity of the pathological process in inflammatory and destructive processes in the hepatic parenchyma. Therefore, the study of the functional activity of leukocytes, providing a protective reaction of the organism has not only clinical diagnostic value.

Quantitative izmenenennoj (6 patients), in addition to traditional therapy was performed laparoscopic kanalirovanie the round ligament of the liver and the introduction of dispersed Alloplant biomaterial, and in the control (11 people) - which were treated according to traditional principles (hepatotropic drugs, desintoxication therapy, and so on ). The number of granules redox enzyme LDH of peripheral blood lymphocytes of patients with hepatitis and cirrhosis decreased significantly after the application of the developed method compared with the control group. At the same time, the peroxidase activity of polymorphonuclear leukocytes continues to rise and after surgery. The decrease in LDH activity in immune cells - lymphocytes indicates a gradual stabilization of their functional voltage, whereas the peroxidase activity of polymorphonuclear leukocytes is still high. Indicators of change in alkaline phosphatase activity of neutrophils is very revealing. As can be seen from the data obtained, within a week after surgery there is a significant reduction of this enzyme activity. On the contrary, in all investigated groups in the activity of acid phosphatase lymphocytes is determined by a significant increase in the p>

Thus, a significant change in the activity of key enzymes of peripheral blood leukocytes in patients with hepatitis and cirrhosis is the result of functional metabolic changes due to the considerable plasticity of the blood system. Increase Entomologicheskoe status of leukocytes, their energy balance, as well as reducing the activity of certain enzymes after surgery leads to increased production of high energy compounds that, in turn, increases the permeability of the membrane structures of blood cells, including lysosomes. The increase in the activity of some enzymes of leukocytes indicates a functional initiation of protective blood system, as a reflection of ongoing pathological processes in the body. Activation of intracellular enzyme system can be considered as manifestation of protective and compensatory functions of the body. However, in the postoperative period, blood counts and cytochemical data status leukocytes continue to be strained. Therefore, a significant increase in the activity of peroxidase and hydrolases, especially of acid phosphatase as a marker of lysosomes, testifies to the high functionality of the whole of Olesno 2672, he entered an emergency order 22.02.01, with complaints of weakness, abdominal pain, nausea, dryness, bitterness in the mouth, yellowing of the skin, discolored feces, dark urine. Was sick for about 7 days, when there were abdominal pain, jaundice.

Surveyed: b/x blood from 23.02.01 g: glucose - 3.1 mmol/l, protein - 65 g/l, total bilirubin - 115,3 Ámol/l, direct bilirubin - of 83.4 mmol/l, ACT - 180 ME, ALT - 165 ME, alkaline phosphatase - 2455 ME. Ultrasound of the liver increased echogenicity, increased vascular pattern, choledoch not expanded in the gall bladder concretions were found.

Receptorgamma patient with hepatitis - significant hemodynamic disturbances of blood flow in the liver is shown in the drawing.

A course of conservative infusion-inflammatory, detoxification therapy as preoperative preparation. 15.03.01, routinely operated under endotracheal anesthesia produced laparoscopy through subcritically access. Through umbilically access the entered clip, skeletron in the mass of the round ligament of the liver umbilical vein. Through an additional incision length 0.1 cm to 2 cm above the navel conducted bougie. Made Bagirova umbilical vein. Then made kanalirovanie umbilical vein by methods which escapisim control. The effectiveness of koulali round ligament checked procaine blockade ligament through the catheter.

Layered seams on the wound. Aseptic bandage. The duration of 15 minutes

In the postoperative period through the catheter produced by the introduction of 5.0 ml of dispersed Alloplant biomaterial. In addition, it was conducted introduction antispasmodic mixtures: novocaine (a 0.5% 20,0) with a preliminary introduction of the solution lidz (5,0). heparin (2.5 thousand UNITS) and lidocaine (2,0). A similar procedure was carried out every 8 hours for 2-3 days after surgery. This is achieved by creating a depot of dispersed Alloplant biomaterial in the lymph collector typical for hepatic-pancreaticoduodenal area.

The postoperative period is smooth, without features. Wound healing by primary intention, the sutures were removed on the 7th day. B/x blood test before discharge within normal limits. The patient was discharged on the 12th postoperative day in good condition.

Claims

Method for the treatment of toxic hepatitis and cirrhosis, including kanalirovanie umbilical vein and endolymphatic administration of drugs, characterized in that it further impose dispergirovannogo laparoscopically.

 

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