The way percutaneous puncture of cholecystostomy and device for its implementation

 

(57) Abstract:

Usage: in medicine, for drainage of the gallbladder under ultrasound scanning, including decompression of the gallbladder in acute cholecystitis. The way percutaneous puncture of cholecystostomy includes percutaneous puncture of the gall bladder under control of the ultrasonic scan. First, in the plane of the ultrasound scan to produce a puncture of the gall bladder with a thin needle through the channel which remove the contents, produce diagnostic manipulations and injected into the cavity of the gall bladder medicinal or antiseptic, obtulerunt channel needle mandrel, and then parallel to the thin needle in the plane of the ultrasound scan, perform the puncture and drainage of the gallbladder, and then extracted from the last thin needle. Device for cholecystostomy contains a bracket with a leader to conduct punchthrough element, such as a needle or trocar. The bracket consists of a bracket to the primary transducer of the ultrasonic scanning and fork set can be rotated in the scanning plane and connected to the bracket using a hinge with picmenu and angular rotation of the installed sleeve, in which in the plane of the ultrasound scan performed at least two parallel one to the other guide hole punctidae elements. The plug is provided with tabs longitudinal and angular position of the sleeve. 2 S. p. f-crystals, 2 Il.

The invention relates to the field of medicine and is intended for percutaneous drainage of the gallbladder under the control of ultrasound scanning during decompression of the gallbladder in acute cholecystitis.

Known method of micropaleontology, including puncture of the gall bladder with a thin needle, conduction through the channel past the metal of the conductor and, with the help of straddling, installation of flexible drainage tube [1]

The disadvantages of this method of micropaleontology are technological complexity and duration of the operation, as well as the increased likelihood of septic complications and the occurrence of bleeding, which caused numerous manipulations and additional impacts on injured biopsy of the tissue such elements as metal angiographic guidewire length 70-120 cm and straddling various diameters, designed for dilations and expansion of the lumen of InEU puncture (2), which is a bracket that includes the leader of the puncture needles in the form of conductor guides a linear movement with transportation and angle-finders is considered, as well as clips of their mutual arrangement and placement of the bracket on the whole body of the patient in surgery.

A disadvantage of the known device is that it cannot be used to cholecystostomy in which it is necessary to provide the possibility of a secondary puncture of the gallbladder in the plane of the primary puncture.

The technical result of the invention is to improve the reliability and efficiency of cholecystostomy.

In Fig. 1 shows a device for cholecystostomy; Fig. 2-section a-a in Fig. 1.

The device (Fig. 1, 2) contains a bracket for attaching a primary transducer 1 of the apparatus ultrasonic scanning, the bracket consists of a bracket 2 mounting to the primary transducer 1 and the plug 3 mounted to rotate and connected to the bracket 2 by means of the axial hinge 4 latch 5 angular position of the fork 3 relative to the bracket 2. In the slots 6 of the plug 3 with the possibility of longitudinal displacement and angular rotation otnositel who's to each other guide holes 11, 12 under a thin needle and trocar, which should be located in the plane of the scan. The plug 3 is provided with a longitudinal tabs 13 and 14 and angular position of the sleeve 10. The axle 8 is made together with the sleeve 10 by means of a cylindrical guide finger 15 mounted for movement in the bore 16 of the sleeve 10.

The way the needle cholecystokin as follows.

Primary Converter 1 is set to the scanning plane passed simultaneously through the liver parenchyma and the maximum longitudinal lumen of the gallbladder. The plug 2 by rotating around the axis 4, is placed on the skin punktirnym tissues and is clamped by a clamp 5 angle to the bracket 2. Point to puncture choose on the projection of the longitudinal axis of maximum lumen of the gallbladder, some distance from the edge of the liver in the direction of the parenchyma 2-3 For more information, see the sleeve 10 is moved in the slots 6 of the plug 2 and turn on the axes 8 and 9. After determining the point of puncture longitudinal position of the sleeve 10 is fixed with the clamp 13, and the angle to the axis 7 of the transducer 1 with the clamp 14. According to the guiding hole 11 of the sleeve 10 under the control of ultrasound scanning to produce a puncture of the gall PR measure the pressure in the cavity of the gall bladder, introducing the latest medicinal or antiseptic solutions, which leads to a readjustment of the cavity of the gall bladder and reduce infection rates. Enter the maximum number of medicinal or antiseptic solutions in the cavity of the gall bladder and obturateur channel thin needle with mandrin, which prevents the leakage of fluids from the cavity of the gall bladder. Introduction the maximum number of solutions leads to an increase in the cavity of the gall bladder and reduce the thickness of the gallbladder wall due to stretching, which improves the visualization of the gallbladder and facilitates vypolnyaemogo drainage. Puncture of the gallbladder fine needle allows you to choose the optimal trajectory promotion, and when necessary, even to repeated manipulation. Then, without removing a thin needle, parallel to it, in the plane of the ultrasound transducer 1 are puncture of the gall bladder, for example, a trocar, which is the guiding hole 12 of the sleeve 10 is injected into the cavity of the gall bladder. Through the sleeve of the trocar into the cavity of the gall bladder enter the drainage in the form of an elastic tube, which is fixed in the plane using special hooks. Then remove the trocar sleeve and drew the second tube. Similarly perform operations to drain when the puncture is made by a special catheter with a metal stiletto inside.

When entering a trocar or stylet into the cavity of the gall bladder fine needle plays the role of the sender, and also captures the surrounding tissue, which simplifies the technique and increases the safety of operation. Punkte gall bladder by trocar or style, having a relatively large diameter, in the proposed method, percutaneous puncture of cholecystostomy in relation to the expiry of the contents of the gall bladder is not as dangerous as the contents of the cavity of the gall bladder in this case is a solution of a medicinal or antiseptic means. Reduces the likelihood of damage to the opposite wall of the gallbladder with a puncture and eases herself puncture, as the gallbladder wall, and thinning of the walls are located at a considerable distance from each other due to the filling of the gallbladder antiseptic or medicinal solutions. After removal of the stylet trocar or stylet catheter is removed and a thin needle. Through the sleeve of the trocar into the cavity of the gall bladder catheter with hooks. After drainage due to the impact forces is etera the gallbladder wall and reduces the likelihood of leakage of the contents of the gall bladder. Due to the fact that the gall bladder is drained elastic tube of relatively large diameter and the pressure in it is minimal, under the forces of elasticity of tissues is a reliable, without complications, the closure of small puncture channel of a thin needle.

The distance between the guide holes 11 and 12 are selected for each patient depending on the condition of the tissue, the size and thickness of the gallbladder wall. The sleeve 10 (Fig. 2) has two pairs of parallel guide holes 11, 12, allowing the combination of four different values of the distance, the best of which is selected depending on individual patient data.

Device for percutaneous puncture of cholecystostomy allows the puncture from different angles and at different distances from the axis 7 of the Converter 1.

This way percutaneous puncture of cholecystostomy and device for its implementation improves the reliability and efficiency of the operation.

1 1. The way percutaneous puncture of cholecystostomy, including percutaneous puncture of the gall bladder under control of the ultrasonic scanning, the reorganization of the gallbladder, install it Dreux is antisepticise solution block the lumen of the small needle with mandrin, additionally the dotted line in the gall bladder in parallel overlapped with the needle and place it in the cavity of the bladder drainage.2 2. Device for percutaneous puncture of cholecystostomy containing the bracket with a leader under pontiroli element, linear guides and hinges angular movements, as well as clips of their mutual arrangement, characterized in that the bracket consists of a bracket to the primary transducer of the ultrasonic scanning and plugs installed with possibility of rotation and connected to the bracket using a hinge with lock the angular position of the plug relative to the bracket, and in the slots of the fork with the possibility of longitudinal displacement and angular rotation of the installed sleeve, which is made of at least two, parallel to each other, the guide hole punctidae elements, moreover, the plug is provided with tabs longitudinal and angular position of the sleeve.

 

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FIELD: medical engineering.

SUBSTANCE: device has casing with lumen, cannula and sharp tip. It is connected to Waldmann unit for measuring current and filling sterile solution. The casing has a lateral opening soldered acute end and mandrin having through canal. The mandrin has cannula and is set in the lumen to enable the lateral opening to be fully overlapped.

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SUBSTANCE: device has hollow casing having two parts of equal lengths. The first part diameter is twice as large as the second one. The first casing part has ring-shaped handles located at the place it makes junction to the second casing part. Two through guiding holes are made along the first casing part. The holes face each other from opposite sides of the first casing part. The holes plane is set in perpendicular to the plane in which the ring-shaped handles are arranged. Working end of the second casing part has conic shape. Piston is introduced into the casing, the piston length being equal to the second casing part length. A through canal is available in the piston through which a tube passes that has puncture needle inside it. Tube diameter is less than that of the second casing part. Tube length is greater than the casing length. Needle length is greater than the tube length. Filling substance is available in the space between the second casing part wall and tube wall.

EFFECT: improved device structure.

11 dwg

FIELD: medical engineering.

SUBSTANCE: device has flexible chamber having working canal oriented along longitudinal axis. It has presser end parts connected to each other with neck member having small external cross-size and means for making connection to overpressure source. The working canal has walls forming lumen or walls engageable to each other for closing the lumen. The presser end parts are designed as autonomous reservoirs having equal or unequal external cross-sizes. Means for making connection to overpressure source has separate canal attached to each reservoir. Lesser presser end part cross-size or minimum cross-size of equal presser end parts exceeds the external neck cross size not less than by 1/4 of its size.

EFFECT: reliable and suitable device.

2 cl, 3 dwg

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