Method for surgical management of dacryocystitis in adults with implanting lachrymal surgical drain tube

FIELD: medicine.

SUBSTANCE: lower lachrymal point is expanded. A probe is projected along a lower lachrymal duct all the way to the bone. A light guide is delivered through the expanded lower lachrymal duct all the way to the bone and fixed manually. A nasal cavity is visualised with an endoscope. Bone tissue of a lateral wall of the nasal cavity is burned through with endoscopically controlled laser light until the laser light appears in the nasal cavity. That implies using a diode laser at wave length 970 nm, emission power 6-7 Wt, in the continuous mode. An endoscopically controlled drain tube is inserted into the formed fistula through the nasal cavity by means of a plastic injector 10.01 mm long, 2 mm in diameter. The drain tube is 8.4 mm long. An external diameter of the cylindrical portion is 3 mm, whereas an internal diameter is 2 mm with the length of 6 mm. For the purpose of fixation in the lachrymal sac, an implanted end of the drain tube has deformable fletching elements 5 mm in diameter, 1 mm wide from each side, and 3.2-3.5 mm in flexion diameter. At the opposite side of the drain tube, there is a pad 5 mm in diameter fixed in the nasal cavity. Along the entire drain tube, there are grooves 0.25 mm wide, 8-8.1 mm long for additional outflow of the lachrymal fluid.

EFFECT: method enables preventing recurrent atresias of the formed fistulas between the lachrymal sac and nasal cavity by long-term postoperative drainage of the formed fistula.

2 ex

 

The invention relates to medicine, in particular to ophthalmology and otorhinolaryngology, and can be used in transcanalicular endoscopic laser dacryocystorhinostomy in patients with chronic, acute, or recurrent purulent dacryocystitis.

Dacryocystitis in adults continues to be one of the urgent problems of modern medicine, often causing long-term disability and disability of the population, are 2-73,5% of the whole number of ophthalmological diseases. Existing treatments are not always possible to avoid recurrence of the disease, manifested in the form of scarring, Sardinia nasolacrimal fistula in the postoperative period.

The known method of treatment of dacryocystitis (classic external dacryocystorhinostomy) in which external access quickly formed a fistula between the lacrimal SAC and the nasal cavity. An incision of the skin and soft tissue up to 3 cm, which start at 2-3 mm above the internal ligaments of the eyelids and lead downwards, slightly rounding ninepenny edge. Overlap the retractors. Soft tissue stupidly stratified to visualize the internal ligaments of the eyelids. The periosteum is cut and useprivate outwards by 0.5-1 cm medial to the internal ligaments. With the help of a chisel and hammer formed bone �CCW value(1,5-2)×(1,2-1,5) see Within the bore longitudinally cut the inner wall of the lacrimal SAC and the nasal mucosa. The flaps of the wall of the SAC and nasal mucosa are sutured with catgut, forming the front and rear lips formed stoma. Skin and soft tissue sutured in layers [Chirkunov B. F. Diseases of the lacrimal organs, Samara, 2001, p. 219-220].

Among the disadvantages of this method it is possible to note the high trauma, longer duration of surgery, presence of skin scar, frequent complications (including fusion formed stoma).

The known method of treatment of dacryocystitis endonasal approach (internal dacryocystorhinostomy). In the nose, ahead of the middle shell, produce the cutting out and removal of the flap of mucous by the projection of the lacrimal fossa. Anteriorly from the resulting defect is formed U-shaped flap of nasal mucosa. A chisel or boron form the bone window. An incision of lacrimal SAC and remove its inner wall. U-shaped flap is returned into place. Operation complete front nose tamponade [Chirkunov B. F. Diseases of the lacrimal organs, Samara, 2001, p. 272].

The use of this method may be limited by physiological or pathological narrowness of the nasal passage, as well as the presence of pathology in the proximal parts of the lacrimal drainage system. It should be noted that when the endonasal approach deletelines�ü transactions may increase due to intraoperative bleeding.

The closest analogue of the invention is a method of treatment of dacryocystitis using the solid-state laser Nd YAG, which has two variants of application. In the first exercise the expansion of the lacrimal punctum, the passage of the probe through the lower lacrimal canaliculus until it stops in the bone, conduction through the advanced lower lacrimal canaliculus of the fiber laser to lock into the bone, the visualization of the nasal cavity by the endoscope, control of location of the optical fiber produced by diaphanoscopy raying through the bone. Burning bone of the lateral wall of the nasal cavity is performed using laser radiation with the formation of a fistula between the lacrimal SAC and the nasal cavity to visualize the fiber in your course. In this case the lateral wall of the nasal cavity burn Nd YAG solid-state laser with a wavelength of 1.44 μm, with a pulse energy 300-440 MJ, a pulse frequency of 10-20 Hz, pulse width of 50 to 150 microseconds. The exposure time of the bone is 0.4-4 min fistula Formed inkubiruut through the lower lacrimal point with the conclusion in the nasal cavity drainage of silicone in the form of a hollow tube. In the second rendering of the nasal cavity by the endoscope and the burning of the bone tissue of the lateral wall of the nasal cavity by laser radiation. While summing up the fiber of the optical fiber produced from the nasal cavity. Burning bone lateral� wall of the nasal cavity is carried out contact 3 mm anterior to the middle turbinate in the projection of the lacrimal fossa Nd YAG solid-state laser with a wavelength of 1.44 μm with pulse energy 300-350 MJ, the pulse frequency of 10-12 Hz, pulse width of 50 to 150 microseconds. The effects on bone of 0.4-1 min Then produce sharp by passing through the lower lacrimal canaliculus until the probe into the fistula formed. This is followed by intubation of the fistula formed through the lower lacrimal point with the conclusion in the nasal cavity drainage of silicone in the form of a hollow tube [patent RU 2254843, 2005].

Despite the efficiency of this method it should be noted that intubation fistula formed using a silicone drainage through the lower lacrimal point with his conclusion in the nasal cavity partially occlusive duct lower lacrimal canaliculus, which further requires the removal of silicone drainage. This can lead to scarring and subsequent heals wounds formed fistula in the postoperative period, thereby causing the risk of recurrent dacryocystitis.

The technical problem solved by the invention is the achievement of patency of the lacrimal drainage system when dacryocystitis diode laser radiation and prosthetics formed fistula (dicristina) using drainage for lacrimile surgery "DCRYSTAL", which prevents fusion, while maintaining the normal flow of tears through the lacrimal drainage.

The technical result of the invention is reduced�e duration and traumatic way prevention of recurrence of Sardinia formed fistula between the lacrimal SAC and the nasal cavity in the postoperative period due to the long-term or permanent drainage in the postoperative period formed fistula between the lacrimal SAC and the nasal cavity.

The proposed method of treatment of dacryocystitis is as follows. Carry out the expansion of the lacrimal punctum, the extended lower the lacrimal canaliculus hold the optical fiber diode laser until it stops in the bone of the manual and fix it. Visualize the nasal cavity by the endoscope with the optical tip 0 degree. Burn laser under endoscopic control bone tissue of the lateral wall of the nasal cavity before the advent of the fiber laser in the nasal cavity. The radiation parameters of the diode laser was wavelength of 970 nm, the radiation power of 6-7 watts, continuous operation. Formed dacryocystorhinostomy washed with 3% solution of collargol. In a fistula formed through the nasal cavity under endoscopic control using plastic injector length of 10-12 cm, with curved at a 45 degree tip length 10,01 mm, diameter 2 mm, enter the hollow silicone drainage for lacrimile surgery "DCRYSTAL" with a total length of 8.4 mm, having a cylindrical portion with an outer diameter of 3 mm, an inner diameter of 2 mm, lengths�th 6 mm. For fixation in the cavity of the lacrimal SAC implantable end of the drain is provided with deformable elements of the type "fletching arrows with a diameter of 5 mm, a width of 1 mm on each side, diameter at bending a 3.2-3.5 mm at the opposite end of drainage made Playground with a diameter of 5 mm for fixing in the nasal cavity and the drainage is placed in the grooves of a width of 0.25 mm, a length of 8-8,1 mm for an additional outflow of tear fluid.

This method allows you to achieve patency of the lacrimal drainage system through effective controlled burning bone tissue diode laser with the proposed characteristics. Unlike all existing methods, this technique allows you to use the approach via the lacrimal canaliculus and through the nasal cavity. Significantly reduced the duration and trauma intervention and, consequently, the probability of postoperative complications. The size of the fibers allows the radiation through a natural way. The absence or significant reduction of recurrence of the fistula heals wounds is achieved by the introduction of shaped silicone fistula drainage "DCRYSTAL" using the injector. Drainage is designed for long-term drainage decreaseby providing throughout the postoperative period slezootdelenia.

Proposed�according to the invention features provide long-term drainage of the formed decreaseby using the proposed drainage "DCRYSTAL", to prevent or significantly reduce the frequency of recurrence.

The invention is illustrated by the following clinical examples.

Example No. 1. Patient S., 63 years. The number of medical cards 60168. Appealed with complaints of constant tearing from both eyes for 2 years. From history we know that for the last 2 years twice operated on for chronic dacryocystitis, OD - transcanalicular endoscopic laser dacryocystorhinostomy in 2012;

OS - transcanalicular endoscopic laser dacryocystorhinostomy with temporary silicone intubation stent During the 2012 survey: lacrimal drainage on both sides are not passable. According to x-ray study of the lacrimal ducts at both sides of the detected mechanical obstruction at the level of the lacrimal SAC. The right lachrymal SAC the size of 10.0×3.0 mm, left - contrast in the lacrimal canaliculi, the darkening of the maxillary sinus.

Diagnosis: OU - Chronic recurrent dacryocystitis. Mild myopia.

Given the history and findings, the patient was recommended dacryocystorhinostomy with the formation of a fistula between the lacrimal SAC and the nasal stroke with the introduction of silicone drainage "DCRYSTAL" in his right eye.

The government is processing the surgical field with 70% ethyl sleep�that twice. Epibulbar Saipan solution Inakaya 0.4% of the produced block anesthesia the lacrimal SAC lidocaine 2% - 2,0, 10% spray lidocaine intranasally. During the operation, after the expansion of the lower lacrimal point and passing through the tube to the nasal cavity through the lower lacrimal canaliculus under manual (through the skin) and endoscopic (by the nose) control was introduced fiber light guide with a diameter of 0.6 mm to the bone. Laser radiation under the control of the endoscope from the nasal cavity formed an artificial fistula between the lacrimal SAC and the nasal cavity. The radiation parameters of the diode laser was wavelength of 970 nm, the radiation power of 6-7 watts, continuous operation. In a fistula formed through the nasal cavity under endoscopic control introduced silicone drainage "DCRYSTAL" with the injector. Held the lacrimal lavage solution Collegare 3%, the permeability through drainage "DCRYSTAL free. Installation into the conjunctival cavity of a solution of levomycetin 0.3% and in the nose a solution of 2% epinephrine. Duration of intervention 10-15 minutes.

Recommended following post-operative appointments: instilled into the right eye:

1) a solution of Levofloxacin 0.3 percent to 6 times a day 3-4 days, 4 times a day for 10 days;

2) a solution of Dexamethasone 0.4 per cent to 2 times a day - 1 week, 1 day -1 week;

3) Drops � nose: Polymyxin b+Neomycin+Dexamethasone 4 times a day - 2 weeks;

4) Irrigation of the lacrimal ducts within 5 days after the operation.

At discharge, 5 days after surgery to outpatient treatment lacrimal drainage right passable, on drainage outflow "DCRYSTAL" is carried out. At the control examination after 3 months right lacrimal drainage passable. Drainage "DCRYSTAL operates, its position unchanged.

Example No. 2. Patient X., 52 years old. Appealed with complaints of constant tearing from the left eye over a year. From history we know that over the past year, twice referred to the clinic by place of residence, where he was prescribed a course of conservative therapy, which did not lead to a positive result. On examination: left lacrimal drainage is not drivable. According to x-ray study of the lacrimal ducts on the left side revealed a mechanical obstruction at the level of the lacrimal SAC. From left lachrymal SAC dimensions 11×3 mm.

The diagnosis: OS - Chronic recurrent dacryocystitis. OD - Healthy.

Given the history and findings, the patient was recommended dacryocystorhinostomy with the formation of a fistula between the lacrimal SAC and the nasal stroke with the introduction of silicone drainage "DCRYSTAL" in his left eye.

Processing the surgical field with 70% ethanol twice. Epibulbar Saipan solution Inocian� 0,4%, produced block anesthesia the lacrimal SAC lidocaine 2% - 2,0, endonasal introduced a solution of lidocaine 2% was 2.0. During the operation, after the expansion of the lower lacrimal point and passing through the tube to the nasal cavity through the lower lacrimal canaliculus under manual (through the skin) and endoscopic (by the nose) control was introduced fiber light guide with a diameter of 0.6 mm to the bone. Laser radiation under the control of the endoscope from the nasal cavity formed an artificial fistula between the lacrimal SAC and the nasal cavity. The radiation parameters of the diode laser was wavelength of 970 nm, the radiation power of 6-7 watts, continuous operation. In a fistula formed through the nasal cavity under endoscopic control introduced silicone drainage "DCRYSTAL" with the injector. Held the lacrimal lavage with a solution of Collargol 3%, the permeability through drainage "DCRYSTAL free. Installation into the conjunctival cavity of a solution of chloramphenicol 0.3% and in the nose a solution of 2% epinephrine. Duration of intervention 10-15 minutes Recommended following post-operative appointments: instilled into the left eye:

1) a solution of Levofloxacin 0.3% 6 times a day 3-4 days, 4 times a day for 10 days;

2) a solution of Dexamethasone 0.4 per cent to 2 times a day - 1 week, 1 per day - 1 week).

3) nose Drops: Polymyxin b+Neomycin+Dexamethas�n 4 times a day for 2 weeks;

4) Irrigation of the lacrimal ducts within 5 days after the operation.

At discharge, 5 days after surgery to outpatient treatment lacrimal drainage passable left, outflow on the drainage "DCRYSTAL" is carried out. At the control examination after 3 month left lacrimal drainage passable. Drainage "DCRYSTAL operates, its position unchanged.

Method of surgical treatment of dacryocystitis, including the extension of the lower lacrimal point, the passage of the probe through the lower lacrimal canaliculus until it stops in the bone, conduction through the advanced lower lacrimal canaliculus of the fiber laser to lock into the bone, the visualization of the nasal cavity by the endoscope, burning laser under endoscopic control bone tissue of the lateral wall of the nasal cavity with the formation of a fistula between the lacrimal SAC and the nasal cavity before the advent of the fiber laser in the nasal cavity, the introduction of the formed fistula drainage of silicone in the form of a hollow tube, characterized in that the radiation used diode laser with a wavelength of 970 nm, radiation power 6-7 watts, continuous operation, and as the drainage through the nasal cavity using a plastic injector length of 10-12 cm, with curved at a 45 degree tip length 10,01 mm, diameter 2 mm, enter drainage total length of 8.4 mm, having a cylindrical part with naru�tion with a diameter of 3 mm, internal diameter 2 mm, length 6 mm, with fixation in the cavity of the lacrimal SAC implantable end of the drain is provided with deformable elements of the type "fletching arrows with a diameter of 5 mm, a width of 1 mm on each side, diameter at bending a 3.2-3.5 mm at the opposite end of drainage made Playground with a diameter of 5 mm for fixing in the nasal cavity and the drainage is placed in the grooves of a width of 0.25 mm, a length of 8-8,1 mm for additional of the lacrimal fluid outflow.



 

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FIELD: medicine.

SUBSTANCE: percutaneous coronary intervention is performed and Zotarolimus-coated second-generation stents are implanted. They are implanted into the infarct-related coronary artery and into basilar epicardial arteries and their branches having stenosis ≥70%. Multivascular revascularisation is performed as either a single-stage operation for the purpose of a primary percutaneous coronary intervention procedure, or in two stages 4-12 days apart.

EFFECT: method enables improving the accessibility of myocardial revascularisation in the patients with a high risk of ST-segment elevation myocardial infarction with underlying multiple coronary bed lesion, improving the percutaneous coronary intervention outcome, reducing the risk of unfavourable immediate and remote cardiovascular events.

2 cl, 2 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to balloon catheters either with a corrugated stent or without it, the surface of which is coated with at least one antirestenosis therapeutic agent and at least one transport promoting molecular dispersing agent, as well as to a method for making these medical devices.

EFFECT: balloon catheter coating effectively reduces the premature release of the agents from the surface of the balloon catheters and provides the agent delivery from the balloon surface to a vascular wall in the highest effective form.

14 cl, 2 tbl, 25 ex

Falloprosthesis // 2543296

FIELD: medicine.

SUBSTANCE: falloprosthesis consists of proximal, intermediate, central and distal portions. The proximal and distal portions are made of soft silicone rubber. The central portion is integrated together with the intermediate portion in the form of a polyethylene rod. The proximal portion has a cylindrical socket 10mm deep. The proximal portion is presented in the form of a conical rod. The distal portion is presented in the form of a round shank with a rounded apex and has the cylindrical socket 10mm deep. The central portion has multiple holes along its full length, which enables eliminating a longitudinal displacement of the falloprosthesis when in use. Ends of the central portion are provided with cylindrical projections. The central portion comprises a dished intermediate portion, a section of which is less than the distal and proximal portions. After all the components are selected, they are connected together with a human body neutral glue.

EFFECT: higher manufacturability and reliability by eliminating a cross section area decrease in joints and avoiding injuries.

2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine. A catheter comprises a first tube, a second tube and a third tube. The catheter additionally comprises a handle enclosing a lengthwise slotted body and a first linearly movable actuating element integrated into the slot, and a closing device. The closing device comprising an expandable frame. The frame is formed by a number of wires extending from a proximal end to its distal end, and at least partially enclosed by a sealing element. The first linearly movable actuating element protracts or retracts the closing device, first tube or second tube independently. The handle additionally comprises a second actuating element releasing the closing device after the closing device unfolds.

EFFECT: closing device is applicable for healing cardiac or vascular defect or tissue opening, such as an open foramen oval or a cardiac or cardiovascular bypass, etc and particularly represents an occlusion device.

22 cl, 16 dwg

FIELD: medicinal equipment, in particular, expandable intravascular stents.

SUBSTANCE: stent has flexible tubular body with longitudinal axis. Tubular body wall is defined by interconnected closed carcass members equipped with at least two parts adjoining to each other around circumference. Carcass members have sides made from material comprising elongated threads, said material being capable of transmitting compression forces in axial direction of threads, said force being continuously transmitted from one carcass member directly into subsequent carcass member in longitudinal direction. Sides of part in individual carcass member include at least two elongated converging first sides of said member. Stent may be expanded from radially compressed state into state, wherein it has greater diameter. In expanded state of stent, two converging interconnected second sides of part opposite to two first sides of part have interconnection point oriented longitudinally with respect to interconnection point of two converging first sides of part. First angle α arranged between first sides of part and oriented into said part is ranging between 20° and 120°, and second angle β between second sides of part and oriented into said part is ranging between 210° and 320°. Stent body is manufactured from pipe or piece of plate equipped with openings.

EFFECT: increased efficiency, provision for radial compression and expansion of stent without substantially changing the length of body, high uniform flexibility and compression strength.

15 cl, 6 dwg

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