A method of treatment of metastases in the liver

 

The invention relates to medicine and can be used for the treatment of liver metastases. Under ultrasound guidance using a bipolar electrode applied to the site of lesion, conduct electrochemical lysis (ECL) metastasis DC current strength not less than 80 mA and a duration of at least 30 minutes, visualize echopositive education and the session goes cease when echopositive formation of rounded in the area of metastasis with its full coverage and capture 5-10 mm normal liver parenchyma. Treatment is considered effective when a stable size echopositive education after the ECL within 24 hours. The method allows to increase the effectiveness of the treatment of metastases in the liver. 2 Il.

The invention relates to medicine and can be used in surgery, Oncology.

A known method for minimally invasive treatment of liver metastases by electrochemical lysis (ECL). The essence of this method lies in the fact that the generator of direct current between two electrodes (anode and cathode) leads to the destruction (lysis) of tissues and liver metastasis with education in the area of the cathode, alkali and hydrogen, and in the area of the anode of hydrochloric acid and oxygen. Session licencing needle injected electrode, then the needle is removed. The ECL is carried out with a current of 50 mA and a duration of 30 minutes, after which the treatment area excised and subjected to microscopic examination. During the ECL is 2-stage destruction of the tumor: both due to the direct action of a constant electric current, and due to the toxic effects of alkali and acid formed during operation of the electrodes (token A. N. et al./ The scientific. conference “Current issues of diagnosis and surgical treatment of metastatic liver cancer”, M. 2001, 165-167 C.; Wemyss - Holden, S. A. et al., Clin. Sci. 2000; 98; R. 561-567; Robertson. G. S. M. et al., Br.J. Surg., 1998; 85; P. 1212-1216).

The disadvantage of the proposed method is that when conducting the ECL metastases in the liver in humans control is a visual inspection of the surface zone of the liver, while the deeper layers of metastasis are evaluated only after the tumor removal surgery. I.e., non-invasive monitoring in the form of ULTRASONIC tomography for the nature of the treatment of the ECL and its results no. All this leads to a lack of clear treatment and evaluation criteria necrosis of metastasis of a non-invasive manner in the conduct of ECL in humans.

The method of treatment of metastases in the liver by the ECL is that of ECL metastasis carry out the assessment necrosis of metastasis is the appearance echopositive education around the electrode, preserving stable dimensions not less than 24 hours.

The mode of operation of a bipolar electrode with a current strength of not less than 80 mA and exposure time of at least 30 minutes grounded experimental research works on the liver of rabbits.

Appearance echopositive zone in the projection electrode and metastasis during the ECL caused by the appearance of gas bubbles containing products lysis. During the ECL echopositive education is found in 2 types: rounded or stellate forms. Rounded shape appears during treatment and reaches its maximum size by the end of the session of the ECL. It remains unchanged for 24-30 hours, then gradually fades to 5-8 days. “Star” shape, also reaches its maximum by the end of the session, however, rapidly decreases in size (up to 50% of baseline) in 6-12 hours. This is because echopositive “spikes” of this education are tubular structures of the liver (bile ducts, portal and hepatic segmental and vnutritrekovye veins and arteries), which is filled with gas bubbles from the ECL. They quickly washed away by bile or blood, which leads to their rapid disappearance, and not a total necrosis of the surrounding tissues. Rounded ehoose, also indicate incomplete tissue necrosis. Thus, the total necrosis occurs only when echopositive the formation of a rounded shape having a constant stable size of a duration not less than 24 hours, because that is where there is a dense fabric of metastasis and liver, imperiously products electrolysis, gas bubbles and destroyed tissues from the direct effects of electric current. Exposure time is not less than 24 hours these aggressive from the point of view of impact on the whole of metastatic cells products provides reliable tissue necrosis, coincide with the boundaries echopositive education on the screen ULTRASONIC device that arise during the session of the ECL and preserving stable dimensions within 24 hours.

The method is as follows. After informed consent of the patient for manipulation spend morphological verification of the identified lesions in the liver. On medical consultation to review all of the clinical and instrumental data selection circuit of the ECL. The procedure consists of 2 stages:

I stage. On the screen of the ULTRASONIC device (Fig.1) by means of the sensor 1 visualize the liver 2 and metastasis 3. In the center of metastasis percutaneous enter biopsy needle 4. Then to 0 and set the parameters: the current strength of not less than 80 mA and a duration of ECL 30-45 minutes Begin the session electrochemical lysis, on the screen of the ULTRASONIC instrument visualize echopositive education 6 (Fig.2). Its diameter is 7 becomes maximum at the end of the session ECL i.e., 30-45 minutes. The session is terminated when the zone of lysis exceeds the boundaries of metastasis 5-10 mm (with capture normal liver parenchyma with the goal of ablation manipulation to prevent the dissemination of tumor cells outside the zone of treatment is a standard requirement for treatment of tumors in Oncology). When the control ultrasound after 24 hours echopositive education should be the same size as the end of a session of the ECL. Otherwise, the treatment is repeated with the direction of the electrode to the area where there has been a decrease in the size echopositive education and is determined by undamaged tissue metastasis.

Example. Patient S., 54 years old, And a/B No. 1245.

In the fall of 2001 was prooperirovanna in the Oncology center regarding tumor of the sigmoid colon (left-sided hemicolectomy, stage of the tumor after surgery - pT3N0M0). In February 2002 revealed a single education up to 20 mm in diameter in segment VII of the liver. For the period from February to may, 2002, the center was increased to 25 mm in diameter. It was decided to hold sessions of the ECL, because from surgical treatment of the patient from the but. In the lungs vesicular breathing, wheezing no. Heart - without features. Abdomen rounded, palpation of soft, painful during p/o scar and the point of the gall bladder, intestinal stoma in the left iliac region without features. The liver is not enlarged in size (12-8-6 cm Karlovo), the edge is soft, without features.

Complete blood count: erythrocytes 3,11012/l; hemoglobin 109 g/l; CPU 0,85; leukocytes 6,4109/l; ESR 28 mm/h

Biochemical blood test: whole protein 72 g/l, bilirubin 20 µmol/l, ALT 94 U/l, ACT 61 U/l, alkaline phosphatase 65 IU/L.

Roentgenography of organs of gr. cells: without features.

Liver ultrasound: VII segment is determined ekopozytywny hearth up to 26 mm in diameter with indistinct contours, homogeneous structure.

Irigaray right fragments of the colon - relapse no.

CT of the abdomen: secondary solitary change in the liver, enlargement of lymph nodes are not detected.

Clinical diagnosis: Cancer of the sigmoid colon T3N0M+ (surgical treatment in 2001), the progress of the disease in the form of single metastases to the liver.

Under the ULTRASOUND performed biopsy of the metastasis. Cytological conclusion: metastasis of poorly differentiated adenocarcinoma.

Held h is in. At the end of the session echopositive education was 30 mm in diameter and completely covering the area of metastasis and 5 mm of the liver parenchyma around him. After a session after 24 hours, the zone of necrosis is presented in the form echopositive education, its size was stable and amounted to 30 mm. of ECL. Conducted 2 control puncture metastasis after 1 and 5 days after the session of the ECL. Fence fabric material was carried out under ULTRASOUND control of the 6 points of metastasis. Identified tissue debris, no atypical cells. Within 3 months was carried out by clinical and instrumental monitoring of the patient: the growth of the lesion was not identified, new metastatic foci is not marked.

The proposed method is applied in 14 patients with metastases from various primary tumors (7-colon, 3-stomach, 2-mammary gland, 2-melanoma). All patients were operated 1-5 years ago, was held chemotherapy within the last 6-9 months, had the progress of the disease in the form of single metastases to the liver. After informed consent patients they held: 1 session 5 patients, 2 session 4 and 3 session 5 patients. The number of sessions depended on the number and size of metastases. The criterion of effectiveness of the ECL was the emergence of echopositive education in the area met the s courses of ECL remained stable for 24 hours after treatment. All patients are under medical supervision, is UZ-monitoring liver, metastasis, regional lymph nodes. Progress of the disease within 5 months of follow-up there in 10 patients. 1 patient died of intoxication (melanoma), in 2 patients there is the progress of the disease (cancerosas peritoneum), but in the area of the ECL was no relapse.

Thus, the proposed method of ECL liver metastases has advantages among minimally invasive palliative treatment of this group of patients, because it is a relatively simple, low-impact, control and reproduce.

Claims

A method of treatment of metastases in the liver, including ultrasonic testing, characterized in that by using a bipolar electrode applied to the site of lesion, conduct electrochemical lysis (ECL) metastasis DC current strength not less than 80 mA and a duration of at least 30 minutes, visualize echopositive education and the session goes cease when echopositive formation of rounded in the area of metastasis with its full coverage and capture 5-10 mm normal liver parenchyma, and the treatment is considered effective when a stable size echopositive the

 

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