METHOD FOR SIMULTANEOUS ARTERIOVENOUS HYPERTHERMIC LIVER CHEMOPERFUSION Russian patent published in 2022 - IPC A61M60/36 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely oncology. Laparotomy, cholecystectomy, mobilization of the liver and the retrohepatic part of the inferior vena cava from the retroperitoneal space and diaphragm are performed. The anterior wall of the gastroduodenal artery is dissected, a 6Fr cannula is inserted into the arteriotomic opening with its fixation to the artery. On the retrohepatic part of the inferior vena cava, caudal to the hepatic veins by 2 cm, a pouch suture is applied with a 5-0 thread, in the center of the suture, a vein is cannulated in the direction of the blood flow with an 18Fr cannula. Then the cannulas in the gastroduodenal artery, portal and inferior vena cava are combined by highways into a closed perfusion circuit with blood intake from the retrohepatic department of the inferior vena cava through a cardiotome, an oxygenator and a heater, with the help of two roller or centrifuge pumps fed into the cannula of the gastroduodenal artery and portal vein. The perfusion circuit is started and a hemodynamic response is expected. Before adding the chemotherapy drug to the perfusate, vascular isolation of the liver is performed, for which vascular clamps are applied to the inferior vena cava subdiaphragmally above the hepatic veins and cranial to the renal veins, common hepatic artery, portal vein and caudal. Perfusion is performed at a volumetric rate of 1500 ml per minute along the formed perfusion circuit with a heated solution up to t 40°C: 300 ml of erythrocyte mass, 700 ml of sodium chloride saline solution and cytostatic, including melphalan, 1.5 mg per 1 kg of body weight. The arterial line pressure is maintained at 110-200 mm Hg, in the portal line 2-6 cmH₂O, while heparin with an AST level of 350-400 sec is used to support hypocoagulation, and the duration of isolated liver perfusion is 60 min. After that, the liver is washed from perfusate with an isotonic solution of 1500 ml crystalloids and 500 ml colloids for 5 minutes. The cannulas of the perfusion circuit are removed and the places of vascular cannulation are sutured, the insulating clamps are removed, the cannulas of the shunting circuit are removed and the places of vascular cannulation are sutured, heparin is neutralized. The laparotomic wound is sutured in layers.

EFFECT: method provides the treatment of unresectable metastatic foci, by creating a high concentration of the chemotherapy drug selectively in the tumor due to isolated hepatic chemoperfusion.

1 cl, 1 dwg, 1 ex