METHOD OF INTREOPERATIVE INTRACAVITARY HYPERTHERMIC CHEMOTHERAPY FOR HUMAN DISSEMINATED MALIGNANT PLEURAL GROWTH Russian patent published in 2009 - IPC A61B17/00 A61K31/282 A61K31/407 A61K31/513 A61P35/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology. General combined anaesthesia is followed with visual estimation of cancer process dissemination in organs, including with using of intraoperative ultrasonic diagnostics to localise secondary cancerous lesions. Primary cancerous lesion is extracted. The diagnosed and visible secondary cancerous lesions are extracted in any sequence. Extended limphodissection is followed by lavage with irrigating solutions within 15-20 minutes after all surgery stages. Irrigating solution is removed to install suction drains made of polymeric material, namely of silicone. Polyethylene film crucially incised in the middle is attached to wound edges with filling the operative tank with dialytic-based or Ringer-Locke solution containing ground and supplementary chemicals. Herewith perfusion solution contains Mitomycin C dosed 20 mg/m² of body area as a ground chemical, 5-Fluorouracil dosed 1 g/m² of body area as a supplementary chemical. Perfusion solution is introduced through the suction drains into upper operational cavity, and evacuated therefrom at temperature 42.5°C or higher through the suction drains installed in lower operational cavity. The temperature of perfusion chemical solution is controlled by thermal sensors mounted in said suction drains. Intraoperative intracavitary hyperthermal chemotherapy involves closed circulation of perfusion chemical solution within 60-120 minutes in operational cavity at rate 500-2000 ml/min combined with simultaneous mechanical agitation of the chemical solution. Intraoperative intracavitary hyperthermal chemotherapy is followed with complete closure of operational cavity and introduction of chemotherapeutical dialytic-based or Ringer-Locke solution containing 5-Fluorouracil dosed 1 g/m² of body area and exposed in operational cavity within 8-12 hours, in the postoperative period daily 1^st to 5^th days after operation through the suction drains. Then the suction drains are removed. Thus prior to the operation the patient is placed on a mattress warmed up to 37-39°C on a surgical table. After extended thoracotomy, secondary cancerous lesions are localised and sised on parietal and visceral pleura with using intraoperative ultrasonic diagnostics. Pneumonectomy is carried out, while diagnosed and visible secondary cancerous lesions sised 10 mm and more including once penetrated 5 mm and deeper into invaded tissues, are extracted in any sequence. Parietal pleural areas are removed by including subtotal or total pleurectomy with thoracic lavage with irrigating solutions thereafter removed from thoracic cavity wherein suction drains made of polymeric material are installed. Polyethylene film crucially incised in the middle is attached to the edges of formed thoracic reservoir. In hyperthermal chemotherapy preparation stage, the heating mattress is disabled, while in the beginning and during hyperthermal chemotherapy, occiput and great vessel neck area are artificially cooled. Also 5% glucose solution is used as perfusion solution for hyperthermal chemotherapy. Besides the ground chemical of perfusion solution is Oxaliplatine (Eloxatine) dosed 50-130 mg/m² of body surface area. The temperature of perfusion solution for hyperthermal chemotherapy is 43-48°C. It is introduced through the suction drains into upper thoracic cavity and evacuated through the suction drains installed in lower thoracic cavity. Intrapleural chemotherapy of the postoperative period involves introduction of chemotherapeutic solution of temperature 37-38°C through the left suction drains, combined with additional introduction of perfusion solution of 5% glucose.

EFFECT: more reliable prevention of intraoperational tumour cell penetration into vascular and lymphatic bed, prevention of malignant cell distribution and growth.

3 cl, 3 ex