RU2266122C2 - Method for treating postnecrotic pancreatic cysts - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should introduce about 2-4 mg cyclophosphan diluted in 10-20 ml 0.9%-NaCl solution into cystic cavity at exposure of 15 min followed by aspiration. The innovation provides efficient and safe cystic obliteration due to cyclophosphan's capacity to decrease pancreatic tissue exudation and proliferation.

EFFECT: higher efficiency of therapy.

1 ex

Description

The invention relates to medicine and can be used in surgical practice.

To date, the problem of treatment of post-necrotic pancreatic cysts remains quite relevant. Attempts are being made to develop new minimally invasive methods of rehabilitation. In order to obliterate the cystic cavity after emptying, iodine solution and 96% ethanol to 1/3 of the initial volume of the cyst are used, which causes the development of aseptic inflammation with subsequent reduction of the cyst (S.E. Kozlov, V.Ya. Vasyutkov, A. E. Novoseltsev, GG Gviniashvili. Minimally invasive methods in the treatment of pancreatic cysts. // Annals of surgical hepatology. Materials of the Plenum of the Board of the Association of Surgeon-Hepatologists of Russia and the CIS. Perm 2001. C.116-117; MF Zarivchatsky , G.M. Bogatyreva, I.N. Mugatarov, A.V. Sandratskaya, A.A. Vladimir. Min. invasive techniques in the treatment of liquid formations of the liver and pancreas. Minimally invasive surgery in clinic and experiment. The materials of the Russian scientific-practical conference. Perm. 2003 s.52-53). However, the introduction of the used substances into the cystic cavity has a number of disadvantages:

- the likelihood of chemical damage to the flow system of the pancreas in the presence of its connection with the cavity of the cyst and, as a result, the progression of acute pancreatitis;

- the development of peritonitis with leakage of aggressive sclerosant in the free abdominal cavity;

- the absence of properties that affect the pathogenetic mechanisms of the development of acute pancreatitis, in particular the absence of a cytostatic effect.

The objective of the invention is to remedy the above disadvantages.

The problem is solved in that in the method of treatment of post-necrotic pancreatic cysts, including the introduction into the cyst cavity of a substance having an obliterating effect, 2-4 mg of cyclophosphamide diluted in 10-20 ml of a 0.9% NaCl solution with an exposure of 15 minutes and subsequent aspiration of the solution.

The drug is a cytostatic derivative of bis - (- chloroethyl) -amine and is widely used in oncology. Alkylating properties of the drug contribute to the reaction with nucleophilic centers of protein molecules, disrupting DNA synthesis (to a lesser extent RNA), as a result of which the vital activity of cells is disrupted and their mitotic division is blocked (MD Mashkovsky. Medicines. 1997, Volume 2. P.436 ) Allowed the introduction of the drug into the abdominal and pleural cavities (M.D. Mashkovsky. Medicines. 1997, Volume 2. S.439-440).

The only drawback of the drug is the immunosuppressive effect (M.D. Mashkovsky. Medicines. 1997, Volume 2. P.440). However, this action is offset by the fact that the drug is administered once, less often twice.

Example. Patient K., 38 years old, was admitted to the department with a clinic of acute pancreatitis. Intensive detoxification, anti-inflammatory therapy was carried out. On the 7th day, an inflammatory infiltrate of the upper floor of the abdominal cavity was formed. On the 22nd day, there was a significant decrease in the size of the infiltrate with the presence of liquid formation in the stuffing bag - 10 × 12 cm during ultrasound examination, there was a fever up to 38 ° C. A puncture of fluid formation was made, which was regarded as a forming post-necrotic pancreatic cyst. During puncture, 300 ml of serous-hemorrhagic exudate was evacuated and 2 mg of cyclophosphamide diluted in 10 ml of 0.9% NaCl solution was introduced with an exposure of 15 minutes and subsequent aspiration of the solution. After 7 days, an ultrasound scan revealed a liquid formation of 4x5 cm, which did not require repeated puncture and completely disappeared after a month.

This treatment method was used in a clinic in 10 people with post-necrotic cysts of varying degrees of maturity. Only three cases required repeated puncture.

The advantage of the proposed method compared to the analogue are:

- lack of local irritant effect (MD Mashkovsky. Medicines. Volume 2. S.439-440);

- low likelihood of complications when the drug leaks into the free abdominal cavity;

- cytostatic effect of the drug.

Claims (1)

A method of treating post-necrotic pancreatic cysts, comprising administering substances having an obliterating effect into the cyst cavity, characterized in that 2-4 mg of cyclophosphamide diluted in 10-20 ml of a 0.9% NaCl solution with an exposure of 15 minutes is injected into the cyst cavity and subsequent aspiration.