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Articole originale Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341] Aceste rezultate s-ar putea îmbunătăţi prin administrarea concomitentă de terapii sistemice cu Irinotecan şi/sau utilizare de terapii ţintite ca inhibitori de EGFR sau de angiogeneză. Profilul toxicităţii observat este superpozabil pe cel al altor studii, sugerând buna toleranţă a perfuziei hepatice arteriale. Durerea abdominală post-procedurală a fost observată la cca 50% din pacienţi, dar a necesitat tratament cu opiacee doar la 6% din ei. Se confirmă lipsa toxicităţii biliare, chiar pentru administrare concomitentă de Dexametazonă, deci HAI devine o metodă tot mai sigură de terapie [11]. CONCLUZII Administrarea chimioterapiei prin perfuzie arterială hepatică este eficientă şi bine tolerată pentru metastazele hepatice nerezecabile ale cancerelor colo-rectale. Procedura de implantare a cateterului pe cale femurală este fezabilă şi face administrarea puţin invazivă pentru tratamentele paliative şi chiar neoadjuvante. BIBLIOGRAFIE 1. Boige V, Malka D, Elias D, Castaing M, De Baere T, Goere D, Dromain C, Pocard M, Ducreux M. Hepatic arterial infusion of oxaliplatin and intravenous LV5 fluorouracil2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann of Surg Oncology. 2008; 15(1): 219-226. 2. Breedis C, Young C. The blood supply of neoplasm in the liver. Am J Pathol 1954; 30: 969-974. 3. Chen GHG, Gross JF. Intra-arterial infusion of anticancer drugs: theoretic aspectsof drug delivery and review of respponses. Cancer Treat Rep 1980; 63: 31-40. 4. Meta-Analysis group in Cancer Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst 1996; 88: 252-258. 5. WHO Handbook for reporting results of cancer treatment. World Health Organisation, Geneva, Switzerland, 1979. 6. White RR, Jarnagin WR. The role of aggressive regional therapy for colorectal liver metastases. Cancer Invest. 2007; 25(6): 458-463. 7. Rougier P, Laplanche A, Huguier M, Hay JM, Ollivier JM, Escat J, Salmon J, Julien J, Gallot D. Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. Journal of Clinical Oncology. 1992; 10: 1112-1118. 8. Kemeny N, Gonen M, Sullivan D et al. Phase I study of hepatic arterial infusion of floxuridine and dexamethasone with systemic irinotecan for unresectable hepatic metastases from colorectal cancer. J Clin Oncol 2001; 19: 2687-2695 9. Kemeny NE, Niedywiecki D,. Hollis DR, Leny HJ, Warren RS, Naughton MJ, Weeks JC, Sigurdson ER, Herndon JE 2 nd , Zhang C, Mayer RJ. Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomised trial of efficacy, quality of life, and molecular markers. J Clin Oncol. 2006; 24(9): 1395-1403. 10. Kemeny N, Jarnagin W, Paty P et al. Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol 2005; 23: 4888-4896. 11. Ilina Diana, Mintioan Corina, Cărăbineanu A, Miclăuş Codruţa, Ilina R, Nicola T. Chimioterapia intaraarterială intrahepatică pentru metastaze hepatice ale cancerului colorectal J Chir. 2008; 4(2): 90-93. 379
Articole originale Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341] MANAGEMENTUL HERNIEI OMBILICALE ÎN CIROZA HEPATICĂ Gabriela Balan 1,2 , Anca Trifan 3 , Camelia Cojocariu 3 , D. Botezatu 2 1. Doctorand Universitatea de Medicină şi Farmacie „Gr. T. Popa” Iaşi 2. Clinica de Gastroenterologie, Spitalul Județean de Urgență „Sf. Ap. Andrei” Galați 3. Centrul de Gastroenterologie și Hepatologie Iași MANAGEMENT OF UMBILICAL HERNIA IN LIVER CIRRHOSIS – PROSPECTIVE STUDY (ABSTRACT): Umbilical hernia is a common finding in cirrhotic patients with ascites. Optimal management in patients with umbilical hernias and liver cirrhosis with ascites is still undefined. Aim: to evaluate the management of umbilical hernia in patients with liver cirrhosis and ascites and to determine the optimal management in these cases. Methods: In the period between 1 st January 2007-31 st December 2007, 31 patients with umbilical hernia combined with liver cirrhosis and ascites were admitted in our clinic. Because of high operative risks, 8 patients underwent elective hernia repair and 23 were managed initially conservatively. Results: The mean age of the group was 58,03±10,39 years and hernia occurred more frequently in men 17 of 31 cases (54,84%). The main indication for elective herniorrhaphy was incarceration in 6 cases (75%). Successful rate of the elective surgery was 62,5%, with 2 cases (25%) of wound-related complications and one case (12,5%) of hernia recurrence during follow up period. Complications occurred in 13 of 23 patients managed initially conservatively and 8 required emergent herniorrhaphy. In this group two patients (8,69%) died from complications of the umbilical hernia and 2 cases developed recurrent hernia, which were managed conservatory because of refractory ascites. Morbidity rate in emergent surgery was higher than in elective surgery group. Conclusions: Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis. The control of ascites is critical to a successful outcome. KEY WORDS: LIVER CIRRHOSIS; ASCITES; UMBILICAL HERNIA. Corespondenţă: Dr. Gabriela Bălan, doctorand Universitatea de Medicină şi Farmacie „Gr. T. Popa” Iaşi, Clinica de Gastroenterologie, Spitalul Județean de Urgență „Sf. Ap. Andrei” Galați, Str. Brăilei nr. 177, 800578. Tel.: 0236 301111, 0236 301112. Fax : 0236 461000, e-mail: gabrielamedicine@yahoo.com * . INTRODUCERE Herniile peretelui abdominal sunt frecvent întâlnite la bolnavii cu ciroză hepatică (CH) complicată cu ascită, hernia ombilicală apărând în peste 20% din cazuri [1]. Factorii care contribuie la formarea herniei ombilicale la acești pacienți sunt: creșterea presiunii intra-abdominale prin formarea ascitei, slăbirea fasciei și a musculaturii peretelui abdominal, consecință a statusului nutrițional precar și repermeabilizarea venei ombilicale cu lărgirea defectului preexistent al fasciei supraombilicale datorită hipertensiunii portale [2,3]. Herniile pot atinge dimensiuni impresionante prin mărirea defectului aponevrotic şi a sacului herniar la bolnavii cirotici, în special la cei cu ascită sub tensiune [4]. Distensia rapidă a ţesuturilor provoacă leziuni ischemice, ruptura învelișurilor herniare, scurgerea lichidului de ascită, hipotensiune şi dezvoltarea peritonitei bacteriene secundare. * received date: 18.05.2011 accepted date: 24.07.2011 380
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