A method for the treatment of initial stages of varicose disease of lower extremities
(57) Abstract:The invention relates to medicine, namely to vascular surgery, and can be used for the treatment of varicose disease of the lower extremities. Cross and tie a large subcutaneous vein in the initial section. Antegrade catheter into a vein to stilnovo valve. The position of the catheter in Vienna under ultrasound control duplex angiocardiogram. Produce manual compression of the abdomen. Simultaneously with manual compression of the abdomen is filled vein phlebosclerosis solution. The method allows to reduce the invasiveness of surgery and the number of intraoperative complications. The invention relates to medicine, namely to vascular surgery.The known method of intraoperative catheter stem sclerotherapy (Saveliev B. C., D. Konstantinov, Bogachev C. Y., Ignatenko, C. M. a Modern view of the sclerotherapy of varicose veins of the lower extremities. Thoracic and cardiovascular surgery. 1992, 7-8, 4-8), which is resection of pre-estuarial Department of a large or small saphenous vein with a mandatory audit of the sapheno-femoral anastomosis and legirovaniem all tributaries of Magistralnaya introduces a flexible catheter with perforations at one end, which is held to the level of the medial malleolus. Here also is cut, highlighted and Perevoznaya the initial division main saphenous vein. The catheter simultaneously with reverse traction it is injected sclerosing solution.The method has several disadvantages. First, the ligation of the great saphenous vein at the mouth must be accompanied by the allocation of the anterior wall of the femoral vein in this Department and the intersection and ligation of all the numerous mouth of tributaries. When performing these manipulations, there is always a real threat of damage or crossing the femoral vein with the development of massive bleeding. Secondly, the ligation of the great saphenous vein at the mouth must be performed under endotracheal or intravenous anesthesia, which increases the duration of interference for 25 - 30 minutes, third, wellhead resection of the great saphenous vein requires a skin incision in the groin area, which reduces the cosmetic result of the intervention, especially since the bulk of the patients are women of young age.The objective of the invention is to reduce the trauma reducing the risk intraoper the/P> In the proposed method under local anesthesia is allocated and intersects the initial division of the great saphenous vein at the medial ankle. Then its proximal end is inserted a flexible catheter with perforations on the end. The catheter is held in Vienna in an antegrade direction to the mouth. Concurrent with the catheter is made of ultrasonic duplex scanning of the area sapheno-femoral anastomosis. After a clear visualization on the screen of the device pre-estuarial Department of the great saphenous vein with Vienna catheter, the latter is set immediately under ostalnym valve. Then the assistant performs manual compression of the abdomen of the patient in order to increase the pressure in the deep veins of the limbs and to prevent possible contact with them sclerotiorum solution, and the operator removes the catheter, at the same time imposing on him phlebosclerosis. As far as the retrieval catheter from the vein of its lumen is compressed gauze rolls, with full compression of the veins is controlled by ultrasonic duplex scanning. The wound is then sutured, the limb bandaged elastic bandage. The patient begins to walk immediately after surgery. Elastic bandaging of the limb must preseparation complications and trauma intervention for the expense of surgical procedures in the area of the sapheno-femoral anastomosis. The operation time is compared with the known method is reduced to 3 to 4 times. Disabled patients recovered after 2 to 3 days. In the proposed method takes only one small (1 cm) incision, which allows to achieve high cosmetic result.A specific example of the way:
Patient A. , aged 22. When viewed diagnosed with varicose veins of the right lower extremity at the stage of subcompensation.When pre-operative duplex ultrasound scanning revealed the failure of the valves of the trunk of the great saphenous vein. During the physical examination revealed varicose tributaries of the great saphenous vein at lower leg.Final diagnosis: Varicose veins of right lower extremity at the stage of subcompensation, failure of the valves of the great saphenous vein. The patient underwent an operation - stem catheter sclerotherapy under ultrasound control. The sequence of operations was as follows: under local anaesthesia, incision 1 cm from the medial malleolus selected initial division of the great saphenous vein, the vein is crossed, the distal end tied, the proximal end is inserted catheter. Under ultrasound contravene with simultaneous filling her phlebosclerosis solution. Along the great saphenous vein imposed gauze swabs produced ultrasonic testing of the adequacy of compression. Tight elastic bandaging.The duration of 15 minutes. Immediately after elastic bandaging the patient independently went through 6 hours and was discharged for outpatient follow-up care. To work began on day 2. When the control ultrasonic studies on 3, 7 and 11 days showed complete obliteration of the trunk of the great saphenous vein. After 2 weeks made puncture sclerotherapy of varicose tributaries of the great saphenous vein. For dynamic monitoring of physical complaints and beauty of character is not present.During the application of the proposed method treated 38 patients with varicose disease, which is 45% of the total number of patients with this pathology is operated for a given period. The remaining 55% of the proposed method of treatment has not been demonstrated due to the presence of decompensated stage due to late referral. With increasing medical activity of the population the number of patients to be treated this way, may be increased to 90%. A method for the treatment of initial stages of varicose illness the catheter with perforations on the end phlebosclerosis solution characterized in that the intersection and the ligation of the great saphenous vein perform in her home Department, antegrade catheter to stilnovo valve and fill the veins phlebosclerosis solution with simultaneous manual compression of the abdomen, the position of the catheter in Vienna are controlled by ultrasonic duplex angiotenzinovye.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex
SUBSTANCE: inventions can be used as emergency aid at tableted medicine poisoning. For this purpose patient is placed on left side with elevated pelvis. Under ultrasonic control pyloric stomach is inserted with elastic probe of length 1000 mm with two oval apertures by rounded end with wall-region irrigational channel projecting in proximal part as additional tube and having indirect jet by working end. Then hyperosmotic hyperaerated liquid heated to 42-45°C is supplied to stomach through irrigational channel and indirect jet under excess air pressure to 0.2 atm. Liquid flow direction is controlled directing it to solid substances in stomach, moving and destroying them for removal. If it is impossible to remove all solid substances outside, under ultrasonic control slider placed on probe tip is used to take each solid substance one by one, destroy it to lavage stomach until each solid subject is removed outside.
EFFECT: inventions enable to increase efficiency of stomach lavage due to precisely directed liquid introduction so that to provide intensive destruction of solid substances in stomach for their fast removal.
2 cl, 1 ex, 1 dwg