Patent RU-2664631-C1 (RU)
Inventor: Majstrenko Nikolaj Anatolevich
IPC: A61K38/36
Filed: 2017-05-25
Granted: 2018-08-21
Abstract: FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to oncology, and can be used for surgical treatment of patients with inoperable liver metastases of colorectal cancer in progression after chemotherapeutic treatment. To do this, during the operation, the duodenum is mobilized and the transverse colon is removed, exposing the inferior vena cava from its subhepatic section to bifurcation. Then put Rummel tourniquet on the inferior vena cava in the subhepatic section above the right and the left renal veins 1 cm above the bifurcation of the inferior vena cava. After this, elements of the hepatic-duodenum ligament, a common hepatic artery, a gastroduodenal artery are mobilized, bandaged and cross the right gastric artery. Common hepatic artery and a portal vein are taken to the cords and Rummel tourniquet and perform a transverse diaphragmotomy, and in the space between the pericardial leaf and the diaphragm, the inferior vena cava is mobilized and taken to the Rummel tourniquet in the superhepatic section above the hepatic veins. Intravenously inject heparin at a rate of 100 U/kg. Dissect the front wall of the gastroduodenal artery, in the presence of retrograde blood flow, the distal end of the gastroduodenal artery is ligated, and a cannula is placed into the proximal end, which after carrying out preconditioning of the liver is conducted in proper hepatic artery, which in the absence of retrograde blood flow along the distal end of the gastroduodenal artery is dissected by 1/2 of its diameter. Cannula with a diameter of 1/4 or 3/16 inches is inserted into it and a seam is applied after the cannula is removed. Cannulate the inferior vena cava in its retro-hepatic segment with a cannula with a diameter of 3/8, with the end of the cannula being directed cranially and no higher than the tourniquet on the inferior vena cava in its superhepatic segment. Cannulate the portal vein with a cannula of 1/4 or 3/16 inches in diameter, and the cannula tip is directed in the caudal direction. Cannulate the portal vein with a cannula of 1/4 or 3/16 inch in diameter, the end of the cannula is directed cranially, puncture cannulate the inner jugular vein with a cannula of 1/4 or 3/16 inch in diameter parallel to the abdominal stage. Perform arteriography of the gastroduodenal artery and intravenous angiography of the portal vein to determine the source of circulation of metastases in the liver, and perform preconditioning of the liver. To do this, the portal vein and proper hepatic artery are clamped for 5 minutes with a subsequent resumption of blood flow for 5 minutes, this procedure is repeated 3 times. Close the perfusion contour for the return of venous blood from the kidneys, intestines and lower limbs: the blood from the portal vein and the subhepatic section of the inferior vena cava is fed into the reservoir and then into the upper jugular vein, and start the parallel circulation along this contour. Vascular isolation of the liver is performed by clamping the proper hepatic artery, the portal vein – above the cannula, the inferior vena cava – in the subhepatic section, the inferior vena cava – in the superhepatic section. Then, isolated liver perfusion is initiated by directing the contents of the reservoir into the oxygenator with a heat exchanger and then into a cannula mounted in the proper hepatic artery or the portal vein. Perfusion of the liver is carried out through the cannula installed in the retro-hepatic section of the inferior vena cava, and the reservoir. Perfusion is performed at a volumetric rate of 800 ml per minute on the formed time contour with solution consisting of 300 ml of erythrocyte mass, 700 ml of physiological solution of sodium chloride and cytostatic, including melphalan of 1.5 mg per 1 kg of body weight; TNF alpha of 1 mg per 1 kg of body weight under conditions of hyperoxia and hyperthermia at a temperature of 40 degrees Celsius. Duration of isolated liver perfusion is 60 minutes. Then, the liver is washed from the perfusate with 1,500 ml of isotonic solution of sodium chloride and 500 ml of gelofusin. Cannulas are removed and the sites of cannulation of vessels are sutured. Heparin is neutralized with a solution of protamine sulfate at a rate of 1.5 mg of protamine sulphate for every 100 IU of heparin. Perform cholecystectomy, suture laparotomic wound layer-by-layer.EFFECT: method provides an effective treatment of unresectable liver metastases in this category of patients.1 cl, 5 dwg