Method for arrest of hemorrhage from duodenal ulcer penetrating into head of pancreas. RU patent 2510245.
 Automatically adjusted brace system with mems pump / 2506060Group of inventions refers to medicine. A medical limiting system comprises: an implanted limiting device which is adjustable and used to generate a limitation in the patient; an implanted microelectromechanical pump coupled to the limiting device and enabling the fluid flow. The system has a capability either with no energy, or with energy drop below a pre-set limit value to return into the condition wherein the limitation is at least one of the free or open condition. What is disclosed is the implanted medical device using the implanted microelectromechanical pump. |
 Device for removal of double-rod fixer from bone / 2489104Invention relates to traumatology and orthopedics. Device for removal of double-rod fixer from bone includes handle with hook on end. In handle made is through longitudinal canal for rod of holder, and in upper part of handle - wider canal with internal thread, in which between head of holder and bottom of canal placed are spring, head of holder and bolt rod. Working end of holder is placed at distance from internal surface of hook, exceeding width of fixer. Distance between upper concave surface of hook and lower transverse surface of handle is not less than double width of fixer, with working ends of holder and hook being made with slants, whose planes are parallel and face each other. |
 Method of surgical treatment of post operational tourniquet paresis of upper extremities / 2489103Invention relates to medicine, namely - to traumatology, orthopedics, surgery. Method includes carrying out perivasal sympathectomy after revision of main artery and vein accompanying it. Sympathectomy is carried out above tourniquet compression with application of microsurgical equipment. Adventitious membrane of vessels is circularly excised along 5-6 cm. Further treatment is realised in conservative way. |
 Method of creating "dry field" in application of anastomosis on coronary artery while carrying out aortocoronary bypass surgery on working heart / 2480163Invention relates to medicine, namely to cardiovascular surgery. Standard access to heart is performed. One padding is put on each of two prepared threads. First "П"-shaped suture is made under coronary artery in 3 mm from distal and proximal edges of planned cut. After that, second "П"-shaped suture is applied symmetrically from the opposite side of coronary artery, after application of suture puncture of padding with opposite thread is performed. After that, application of tourniquets from polypropylene tubes on distal and proximal from coronary artery cut threads of "П"-shaped sutures is carried out. Then, cut of coronary artery and tightening of tourniquets are performed. |
| Method for correction of ischemic disorders caused by reperfusion liver injury / 2479872 Correction of ischemic disorders caused by reperfusion liver injury in experiment in white Wistar male rats involves modelling an ischemic and reperfusion liver injury. 30 Minutes before, L-norvalin arginase blocker 10 mg/kg is introduced intraperitoneally, and distant ischemic pre-conditioning is conducted. Then, another dose of L-norvalin arginase blocker is introduced immediately after liver ischemia. |
 Method of temporary rib fixation in programmed rethoracotomy and device for implementing it / 2474389Group of inventions refers to medicine, namely thoracic surgery, and aims at surgical management of diffuse purulent mediastinitis. The used device consists of two locked braces. Each of the braces is made of titanium alloy; it has a blunt and rounded lateral end and a medial end whereon a flange for lock fixation is presented in the form of an oval ring. The method consists in the fact that when closing a wound, the braces are brought behind the adjoining ribs alternatively, positioned in inversed manner, clinched and locked. After final suturing, the braces are removed, and the wound is closed in layers. |
 Occluder and method for making thereof / 2465846Invention relates to medical equipment. An occluder comprises an element woven of thin wires and filaments which is mould and thermally treated to be properly shaped. The occluder has a proximal retaining area and a distal retaining area. Wire or filament ends fit together in the distal retaining area. A cylindrical bridge is placed between the proximal and distal retaining areas. For making the occluder which if opened is maximally placed on the bridge from the proximal side of the bridge defect, the proximal retaining area of the woven element of the presented device has a completely closed proximal wall which is placed to form a continuous surface on the proximal end of the occluder, thereby forming the proximal end of said occluder. The bridge defect is closed by the minimal number of portions of the occluder. |
 Hemostatic catheter and method of its application / 2463007Group of inventions relates to medicine, namely to otorhinolaryngology, and can be used in case of necessity to stop nose bleeding, mainly in patients with impairment of consciousness in extreme conditions. For this purpose hemostatic catheter is introduced into one or both nasal passages. Catheter consists of case with two balloons, one of which is fastened in back part of device and is provided with canal, inside which placed is plastic rod, made for modeling case in accordance with anatomy of nasal cavity, and valve for its inflation on anterior end of device. Second - anterior balloon, surrounds device case and is movable along it and has canal for air supply via valve. One catheter is introduced into each nasal passage with further filling of back and anterior balloons with air in volume 10-12 ml and 5-7 ml, respectively. |
 Guide device for transosseal suture / 2458642Invention relates to medicine, namely to operative traumatology and orthopedics. Guide device for transosseal suture consists of Kirchner wire with 1.1 mm diameter. One end of wire along 15-20 mm is flattened to 0,8 mm and figuredly curved with formation of unclosed loop of triangular shape, the other end of wire being curved at right angle to device longitudinal axis with formation of perpendicular handle in form of elongated closed 30-50 mm long loop. |
 Remote monitoring and regulation of device limiting food intake / 2456918Group of inventions relates to medical equipment and medicine, namely to systems for remote monitoring and regulation of device of limiting hole, implanted into patient, and methods for transmission of data between said device and unit located at a distance. System of bidirectional connection for application with the device of limitation of hole, implanted into patient, includes implanted into patient device for hydraulic and/or device for mechanic regulation of device of hole limitation and measuring device for measurement of parameter in device of hole limitation. Device for hydraulic regulation is made in form of injection port or bidirectional infuser. Measuring device is placed in implanted injection port, or bidirectional infuser and/or device for mechanic regulation. System also includes means of connection for transmission of measured parameter data from measuring device to local unit, located outside patient; and main unit, located at a distance from patient. Main unit includes means of user's interface for estimation of measured parameter data. Means of user's interface additionally include means for introduction of command of regulation of device for hole limitation. Between local and main units there is a canal of communication for transmission of data between units, transmitted data include measured parameter data. Group of inventions includes system for remote monitoring and regulation of device for limitation of hole, implanted into patient, in which measured parameter is presented by pressure of flowing medium in device for hole limitation. Method of data transmission between device for hole limitation and main unit, located at a distance from patient lies in measurement of flowing medium pressure in device of hole limitation by measuring means. After that, results are read in device of hole limitation and transmitted to main unit, estimated in main unit to determine dimensions of stoma, formed by device of hole limitation. |
 Instrument for tightening ligature knots / 2245111Device has elongated body having operation end engageable with ligature loop, lateral slit for ligature to exit and movable rod, mounted in the device body, having operation end for holding the ligature. The elongated body has special purpose design to match endosurgical port or trocar lumen. The rod is spring-loaded and has nonworking end projecting from the device body as handle. The rod operation end is hook arranged in front of the lateral slit for ligature to exit and making displacement at a distance minimum equal to distance from operation body end to end face of slit for ligature to exit, oriented towards the handle. |
| Method for treating the cases of lung carcinoma / 2245112 Method involves applying surgical intervention and antitumor therapy. After having removed a part or the whole lung, mediastinum is opened by cutting out horseshoe-shaped or rectangular flap of mediastinal pleura and carrying out lymphodissection. Then, hemostatic sponge is placed in mediastinum. The sponge is impregnated with antitumor chemotherapeutical preparations in intraoperative mode. Pleura is sutured above the sponge. Another hemostatic sponge impregnated with cytostatic preparations in intraoperative mode is attached to visceral pleura of interlobular sulcus. |
 Instrument for making operation on thyroid gland / 2245113Device has two branches with rack and pinion and lips. The lips are curved in a plane and have longitudinal cuts on the ends. Ligature placed in grooves on branch edges is introduced into the cuts. The ligature is introduced into the cuts to enable one to catch tissue under the instrument when being applied. Ligature ends are arranged in a way allowing their release from the grooves for being tightened. |
 Method for treating massive diffuse intracavitary hemorrhages / 2246272Method involves applying tampon having injector drains between its layers near bleeding focus and napkin possessing enhanced absorbing properties. The tampon is surrounded with biologically inactive polyethylene envelope. |
 Hemostatic duodenal probe / 2252041Device has 150 cm long rubber double-lumen tube, hemostatic balloon placed 3.0-3.5 cm from the beginning of the rubber tube, holes in anterior and posterior portion of the hemostatic balloon and metal olive placed at the probe end. Marks are available on the probe at 45, 70 and 80 cm from its beginning. |
| Method for videothoracoscopic extravasal occlusion of opened arterial duct / 2254075 One should introduce three trocars into patient's thorax, perform videoendosurgical isolation of anterior, superior and inferior ductal walls followed by squeezing the duct with clips. After isolating anterior, superior and inferior ductal walls one should measure external diameter of its narrowest part and match a clip in accordance with the ratio of clips' sizes to external diameter of a vessel. At this ratio, external diameter of the vessel of 3.0 mm corresponds to clips of 5.0 mm and 6.0 mm in closed state, in case of external diameter of vessels being 3.5 mm, 4.0 mm and 5.0 mm one should match clips of 8.7 mm and 9.0 mm length, and at vessels' diameter being 5.5 mm and 6.0 mm it is necessary to take clips of 12.0 mm length. To perform clipping one should substitute instrumental trocar for that for clip-applicator in the desired point. As a result, it is possible to decrease traumaticity of operative interference, decrease cases of intraoperational hemorrhages and lesion of recurring-laryngeal nerve, save residual circulation or renew it along opened arterial duct. |
 Method for superior lobectomy at locally metastasing pulmonary cancer / 2255666One should ligate patient's superior pulmonary vein, suture superior lobar bronchus, mobilize left pulmonary artery near pericardium and inferior lobar artery in interlobar fissure, perform patient's total heparinization, temporarily clip the mobilized section, dissect that of left pulmonary artery and remove it together with the superior lobe. Integrity of left pulmonary should be restored with a coniform prosthesis and "end-to-end" anastomosis. Then clips should be removed to restore circulation. The method enables to save patient's inferior pulmonary lobe. |
 Method for superior lobectomy from the left at pulmonary tumors / 2255667One should ligate superior pulmonary vein, suture superior lobar bronchus, mobilize and temporarily clip left-hand pulmonary artery near pericardium and the section of inferior lobar artery in interlobar fissure and remove together with mobilized superior pulmonary lobe. Integrity should be restored with a fragment cut out of pericardium in the form of a truncated pyramid, its length being equal to that of resected arterial part, its bottom being equal to the length of circumference of resected arterial part, the top is equal to circumference length of resected arterial part. This fragment should be rolled up into conical tube, its free sides should be sutured with atraumatic suture. One should anastomose the conical transplant with resected parts by "end-to-end" technique. The method enables to keep inferior lobe of left-hand lung. |
 Method for preventing hemorrhage at lobectomy / 2255668One should ligate segmental arterial trunks, carry out patient's heparinization, tighten pulmonary vein beforehand, temporarily clip left pulmonary artery near pericardium and inferior lobar artery. Moreover, one should ligate proximal departments of segmental arterial trunks only coming towards the superior lobe. The method enables to completely stop arterial circulation. |
 Method for left-side superior lobectomy in case of pulmonary tumors / 2255669One should tighten superior pulmonary vein, suture super lobar bronchus, isolate left pulmonary artery near pericardium and artery of inferior lobe. After preliminary total heparinization one should clip the vessels isolated. Superior pulmonary lobe should be removed with the tumor and part of left pulmonary artery not far from clipping line. Then one should resect the part of the great subcutaneous vein, anastomose a venous transplant with remained part of left pulmonary artery and that of inferior lobe by "end-to-end" technique. Clips should be removed to restore circulation. The method enables to save inferior lobe of patient's left lung. |
FIELD: medicine.
SUBSTANCE: invention refers to medicine, specifically to surgery. An endostatic detection of a bleeding penetrating duodenal ulcer is followed by a laparotomy. An ulcer hemostasis is provided by a ligation about an ulcer substratum of anterior and posterior vascular branches of superior and inferior pancreaticoduodenal arteries.
EFFECT: method enables simplifying the technique of surgical hemostasis in bleeding duodenal ulcers penetrating into the head of pancreas.
2 ex
The invention relates to medicine, to abdominal surgery, can be used to stop bleeding when penetrating into the head of the pancreas duodenal ulcer patients at increased risk of surgery in patients of elderly and senile age with severe concomitant diseases.
Surgical treatment of acute bleeding from penetrating into the head of the pancreas ulcers duodenal ulcer is an actual problem emergency surgery. In ulcer bleeding in elderly and senile age is the most justified the use of sparing of organ-retaining operations. The most common way to stop bleeding is carrying out of duodenotomy with flashing bleeding ulcers ligature and suturing the last (Saveliev B.C. Guidance on emergency surgery of the abdominal cavity. / Viktor Saveliev, M. Abakumov, L.P. Bakulev and other M: Medicine, 1986. - S-511). The method is low-impact and allows you to save the patient's life. However, the flashing of a bleeding vessel and suturing penetrating ulcers often compounded by the provincial tissue necrosis, ulcers in the postoperative period, followed by a relapse of peptic ulcer bleeding. A relapse of peptic ulcer bleeding is even more dangerous to the life of patients, particularly the elderly, since the mortality among them grows up to 30-40% (Onopriev V.I. Position surgeon in the treatment of complicated duodenal ulcers and new technologies. / VI Onopriev // Russian journal of gastroenterology, Hepatology and Coloproctology, 1998. - №6. - P.63-70; Bushkov P.N. Ulcerous gastroduodenal bleeding in the Far North. / PN. Bushkov et al. // Bulletin of surgery, 2002. - T, №4. - P.17-19).
There is a method of treatment of duodenal bleeding ulcers, including duodenotomy, hemostasis, vagotomy draining stomach surgery, in order to prevent recurrence of bleeding hemostasis carried out by filing a peptic ulcer of a free site seal, then gradually invalidinput above the seal edges duodenalnogo cut to full coverage of the bowel lumen, and as draining operations use gastrojejunostomy (SU # 1158171, publ. 30.05.1985 the year, the IPC 7 A61B 17/00, A61B 17/11). The disadvantage of this method is that when using strands of greater omentum on the leg perhaps the necrosis of the packing and insolvency seam lines that leads to recurrent bleeding and peritonitis.
Known method of treatment of bleeding gastroduodenal ulcers in which ensure reliable hemostasis and prevent recurrence of bleeding after performing gastroduodenoscopy stitch large vessels at the bottom of ulcer 8-shaped joints of the bottom of the ulcer dried, treated with 70%ethanol and fill with glue composition, which contains between 50 and 200 IU powder thrombin 1 ml adhesive CL-3 with the addition of the accelerator polymerization. The plague stitch, spending ligatures under her bottom, and tighten after starts foaming and curing of the adhesive. While tightening the seams is the implantation of an adhesive (SU # 1507349, publ. 15.09.1989,, IPC 7 A61B 17/00, A61B 17/12, A61L 24/04). The disadvantage of this method is time limited action of thrombin and the possibility of migration of adhesive compositions that leads to recurrent bleeding.
Known way to stop bleeding by newdecimal penetrating ulcers duodenal intestine, which is a complete intersection of the duodenum for the plague that tamponiruut the Alloplant, then sutured stump duodenum, that is, stomach resection by Bilrot 2. In this case there is the risk of insolvency of the stump of the duodenum and the resumption of bleeding in the discharge of Alloplant from the bottom of the ulcer (RU №2173100, publ. 10.09.2001 IPC 7 A61B 17/00, A61B 17/12).
Known way to stop gastroduodenal ulcer bleeding through overlay clips using andclimate, which pre-define the type of the ulcer in Jonhson and 1 type ulcers clipping carried out on the vessels of medium caliber, extending from the front and back of the descending branches of the left gastric artery, 2 type ulcers clipping of conduct on vessels that feed back wall 12 duodenal ulcer - branch front and rear pancreatoduodenal artery, at 3 type ulcers clipping of conduct on the branches of the right gastroepiploic artery and branches of the upper and lower pancreatic arteries, thus clips impose on distance of 1,5-2,0 cm from bleeding vessel (RU patent application №2010128665, publ. 20.01.2012 the year, the IPC A61B 17/00). The method is implemented through conducting of fibrogastroduodenoscopy, that is, during the inspection of the inside of the stomach and duodenal ulcers with the help of special equipment - andclimate, and has a number of disadvantages.
There is a method of treatment of gastroduodenal hemorrhage from acute ulcers by ligation of the main arteries that feed the stomach and duodenum, depending on localization of sources of bleeding with flashing ulcers (Milonov O. Postoperative complications and dangers in abdominal surgery. / O. Milonov, CD Toskin, V.V. Zhebrovsky. M: Medicine, 1990. - S-235). The method allows to achieve reliable hemostasis in the plague. However, ligation of the main arteries that feed the stomach and duodenum, can lead to the development of extensive necrosis of the walls of these bodies and peritonitis.
Known way to stop the bleeding of the major blood vessels of the bottom of the stomach and/or duodenum, which perform duodenotomy, identify a bleeding blood vessel in the bottom of ulcer. For this ulcer crater released from the liquid blood and clots using an electric pump. With a clear visualization of a bleeding vessel is put on it coaxial small clip Kocher, then do the traction from the bottom of the ulcer intima of the vessel and its tie with ligature. Then you stop the bleeding of the major blood vessels of the bottom ulcers, since only one of them it is possible to pull the intima of the vessel and bind it up. The disadvantage is that, first, you must run duodenotomy - it could face bankruptcy imposed joints in the postoperative period, secondly, the method is applicable only to stop bleeding from large vessels and is not applicable to stop bleeding from vessels of small and medium calibre, thirdly, the impact of acid secretion of the stomach in the postoperative period on the bottom of the ulcer can lead to arrosee tied vessel and re bleeding (RU №2445024, publ. 20.03.2012, IPC A61B 17/12).
The objective of the invention is to simplify the technique of surgical hemostasis for bleeding penetrating into the head of the pancreas in duodenal ulcers, increased efficiency of treatment ulcer bleeding in patients at increased risk, reducing the risk of recurrence of bleeding, decreased postoperative mortality.
The technical result is to stop bleeding from vessels of any caliber in the bottom of penetrating ulcers without duodenotomy and flashing ulcers by bandaging vascular branches in the place of their departure from arteria pancreaticoduodenalis anterior superior, arteria pancreaticoduodenalis anterior inferior, arteria pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior.
This is achieved by way stop bleeding from duodenal ulcers, penetrating into the head of the pancreas, which after endoscopic detection of bleeding penetrating ulcers perform laparotomy and implement a dressing around ulcerative substrate vascular artery branches pancreaticoduodenalis anterior superior, arteria pancreaticoduodenalis anterior inferior, arteria pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior. Ha operation in the beginning is ligation of vascular artery branches pancreaticoduodenalis anterior superior artery pancreaticoduodenalis anterior inferior. For bandaging of vascular artery branches pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior mobilization of the duodenum by Kocher (Volenko V.N. Atlas operations on the abdominal wall and abdominal organs. / V.N. Volenko, A.I. Medelyan, V.M. Omelchenko. M: Medicine. 1965. - 400 C., RIS, RIS, RIS). Tubal vascular branches in the place of their departure from arteria pancreaticoduodenalis anterior superior, arteria pancreaticoduodenalis anterior inferior, arteria pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior leads to stop bleeding from vessels of any caliber in the bottom of penetrating ulcers. Hemostasis in the plague on the operation is controlled endoscopically. Dressing on the operation of vascular artery branches pancreaticoduodenalis anterior superior, arteria pancreaticoduodenalis inferior anterior, arteria pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior to poor circulation in the wall of the intestine does not: the back wall of the duodenum is missing, because it is the plague, and after ligation of arterial trunks near ulcers retained enough of vascular anastomoses to ensure wealthy circulation in the front wall of the duodenum.
Example 1.
Patient M, 76 years old, was receiving treatment at the surgical Department of the Republican clinical hospital No.1 with a diagnosis of peptic duodenal ulcers complicated by hemorrhage. CHD. Angina FC III. COPD. Pulmonary heart disease 2 tbsp. Was in serious condition in the intensive care unit. Upon receipt of the executed emergency fibrogastroduodenoscopy, where discovered that the bulb duodenum deformed scars, while the rear of the medial wall has deep ulcer size of 0.8 and 0.6 cm, bottom is filled with red blood clot. Conclusion: Chronic penetrating duodenal ulcer complicated by bleeding. Unstable hemostasis. Cicatricial deformity of the duodenum. The patient was conducted hemostatic therapy, transfusion odnorodnoi erythrocyte mass and fresh frozen plasma. After 4 hours after diagnosis, the patient by nasogastric probe appeared detachable mixed with red blood, a condition worsened drastically. With a diagnosis of bleeding recurrence of duodenal ulcer patient urgently made laparotomy. The lumen of the small and large intestines filled with masses of black color modified blood. Given the severity of the condition, massive blood loss, the presence of severe comorbidity, decided to execute the patient bandaging vascular artery branches pancreaticoduodenalis anterior superior, arteria pancreaticoduodenalis anterior inferior, arteria pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior around penetrating in the pancreas head of duodenal ulcers. Hemostasis in the plague on the operation controlled endoscopically - the bottom of the ulcer yellowish tint with small blood clots at the bottom of the signs of continuing bleeding not. In the postoperative period patient was conducted hemostatic, antiulcer antisecretory, substitution therapy. When the control fibrogastroduodenoscopy: chronic ulcer of the duodenum no signs of bleeding. The bottom of the ulcer is covered with a grey tinge. Hemostasis sustainable. Discharged in satisfactory condition.
Example 2.
Patient M, 67 years old, was receiving treatment at the surgical Department of the Republican clinical hospital No.1 with a diagnosis of peptic duodenal ulcers complicated by hemorrhage. CHD. Angina FC III. Postinfarction cardiosclerosis. Hypertensive disease III stage, the degree AG 3, the Risk 4. Chronic obstructive bronchitis. Pulmonary-cardiac insufficiency of II-III century Upon receipt of the executed emergency fibrogastroduodenoscopy, where it was found that in duodenal bulb fresh bright red blood, and on the back-medial wall has deep ulcer 1,0 x 0.8 cm, bottom is filled with red clot, with the edges of the ulcer is leaking from the bright red blood. Conclusion: Chronic penetrating duodenal ulcer complicated by bleeding. Further bleeding. The patient urgently made laparotomy. The lumen of the small and large intestines filled with masses modified dark color of blood. Given the severity of the condition and the presence of heavy comorbidity, the impossibility to perform radical surgery resection of the stomach, decided to execute the patient bandaging vascular artery branches pancreaticoduodenalis anterior superior, arteria pancreaticoduodenalis anterior inferior, arteria pancreaticoduodenalis superior posterior, arteria pancreaticoduodenalis posterior inferior around penetrating in the pancreas head of duodenal ulcers. When intraoperative fibrogastroduodenoscopy ongoing bleeding is not revealed. In the postoperative period patient was conducted hemostatic, antiulcer antisecretory, substitution therapy. When the control fibrogastroduodenoscopy ulcer covered with a grayish tinge to the level of the mucous. Hemostasis sustainable. Discharged in satisfactory condition.
All such transactions are executed nine. All nine patients in the postoperative period recurrence of bleeding was observed.