METHOD OF PHOTODYNAMIC THERAPY OF ACUTE STONE-FREE CHOLECYSTITIS IN ELDERLY AND SENILE PATIENTS WITH HIGH OPERATION AND ANAESTHESIOLOGY RISK

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to surgery. Gallbladder is punctured under the ultrasound control by the trocar. Inflammatory exudate and bile are removed. Surgical endoscope is inserted into the gallbladder, the gallbladder cavity and the cystic duct mouth are inspected. That is followed by high-power laser coagulation of the gallbladder duct mouth under visual control to shut off the gallbladder. That is followed by a photodynamic therapy (PDT) of the gallbladder, for which an elastic silicone balloon with an optical light guide with a cylindrical diffuser is inserted into the gallbladder cavity through the trocar. Balloon is filled with distilled water in amount of 50–80 ml under ultrasonic control so that the balloon receives the contours of the gallbladder, and the laser is exposed to the gallbladder mucosa. In a particular case, laser coagulation of the mouth of the cystic duct for the gallbladder disconnection is performed by means of a laser apparatus with wave length from 881 ± 0.3 nm to 1060 ± 0.3 nm after tissue infiltration of the cystic duct mouth area with 0.25 % novocaine or 0.9 % sodium chloride solution. In a particular case, laser coagulation of the mouth of the cystic duct is performed by contact with a laser light guide with diameter of 0.6–0.8 mm at radiation power at the end of the light guide of 8–10 W to form a uniform coagulation scull. In a particular case, 40–60 minutes before PDT, the patient is intravenously injected with a chlorine-based photosensitizer solution in amount of 0.8 mg/kg of body weight in 100 ml of 0.9 % sodium chloride. In a particular case, the illumination of the gallbladder mucosa is performed by irradiating a laser apparatus with wavelength of 635 ± 0.3 nm to 670 ± 0.3 nm with laser radiation power density on the surface of gallbladder mucosa 0.05–0.3 Wt/cm² and light energy dose of 80–100 J/cm². In a particular case, the manipulations are terminated by inserting 5 mm diameter drain tube into the gallbladder cavity to flush the residual cavity, and 3 days later, control cholecystoscopy is performed to control mucosal necrosis and the drain tube is replaced with a smaller tube. In a particular case, starting from 10 days from the beginning of treatment, every 5 days later, an ultrasonic examination of the gallbladder is performed to control the efficiency of obliteration of the cavity and the drain tube is replaced by a smaller one.;EFFECT: method enables radically eliminating an inflammatory process in the gallbladder by a one-step method in a sparing manner using the antibacterial photodynamic therapy method, thereby preventing generalization of the process, causing gallbladder wall necrosis within pathologically altered tissues with subsequent fast and complete obliteration and gallbladder cicatrisation, in addition, enables to expand the indications for the radical surgical intervention in the therapy of the patients with acute no-bone cholecystitis of the elderly and senile ages with a high surgical-anaesthesia risk, avoiding the possible complications observed in conventional methods of treatment, and considerably shortening the length of treating the patients.;7 cl, 1 ex