The method of drainage of the bile ducts and the extraction device strings of bile ducts

 

(57) Abstract:

The invention relates to medicine, namely to the drainage of intra - and extrahepatic bile ducts. The method includes cholangiography under radiological control, retrograde conduction of the string through the channel of the endoscope through the major duodenal nipple in the bile ducts for the area of stenosis in the proximal sections of extrahepatic bile ducts, installation of wire stent with subsequent removal of the string. The working end of the string percutaneous perhepatic pull out, pull the string over the two ends and only after that install wire stent. The device comprises a hollow needle, which is telescopically placed the piston, and on the one hand the ends of the needle and piston combined and performed with the bevel at the end of the needle is made with a cutout in the shape of a hook at a distance of 2-3 mm from the edge with one hand, and on the other hand is equipped with: butt needles - coupling with the label, coaxially to the neck, and the end face of the piston - flange mounted with the possibility of fixing on the clutch. The invention provides the possibility of mounting the stent when the inefficiency of other methods of decompression of the biliary tract, small invasiveness of the surgery, reducing the number of postoperative OS is, the sludge.

The invention relates to the field of medical equipment and can be used for drainage of intra - and extrahepatic bile ducts.

There is a method of percutaneous drainage of the proximal bile ducts, including puncture intrahepatic ducts, holding the strings for the area of stenosis, the installation of drainage area stenosis ducts with use of special devices containing metallic conductor and screwdriver-punch ("Annals of surgical Hepatology": Century, Ivshin. Percutaneous perhepatic deprotonirovaniem bile ducts: the results of applying the tools of his own design. 1999, T. 4, N 2, S. 42-48).

The disadvantage of this method is the complexity and invasiveness of dilations and drainage, reducing the precision installation of drainage in the distal extrahepatic bile ducts (VIP).

The closest is the method of drainage of the bile ducts ("Surgery" M. C. Khrustaleva. Endoscopic duodenobiliary drainage in the treatment of obstructive jaundice blastomycosis etiology", N 5, 1998, S. 85-87). When endoscopic drainage of intra - and extrahepatic bile ducts (stent placement) Oswestry channel of the endoscope through the major duodenal nipple in the bile ducts for the area of stenosis in the proximal departments VIP. Remove the strings is performed after stent placement traction at the free end, performed by the surgeon.

This method has the following disadvantages: the need to have broadband, the endoscope channel where you can spend the stent into the area of stenosis, large technical difficulties, and often the impossibility of a stent in the proximal departments VIP due to the lack of string tension when the string-Explorer stops fulfilling its role and is the deviation of drainage in any direction, technical difficulties with drainage in conditions of almost complete block VIP because endoscopically difficult to beirout region of stenosis.

The task is to resolve these drawbacks by reducing the morbidity of the operation, reducing the risk of complications, the ability to beirout and install a stent in any Department VIP, i.e. the extension of the method's functionality.

For this method of drainage of the bile ducts, including cholangiography and papillosphincterotomy under radiological control, retrograde conduction of the string through the channel of the endoscope through the major duodenal nipple in the bile ducts for the area CTE CLASS="ptx2">

Known pneumatic extractor to extract the intramedullary rod from the bone-marrow channel (RF patent N 2018267, IPC And 61 In 17/92, publ. 1994), comprising a housing with a working chamber, a rod with grip.

However, such constructive capture cannot be applied in parenchymatous organs.

In the article "Surgery" M. C. Khrustaleva "Endoscopic duodenobiliary drainage in the treatment of obstructive jaundice blastomycosis etiology" N 5, 1998, S. 85-87 - string is removed by traction at the free end. In the time of traction tension of the strings in the bile ducts occurs.

The result of applying the proposed design is the possibility of percutaneous extract work end of a string of VIP out. Removing the working end of the string on the surface of the skin can create the necessary tension of the strings and needed a "focus" to move the stent wire into the area of stenosis in any Department VIP.

The extraction device strings of bile duct contains a hollow needle, which is telescopically placed the piston, and their distal ends are combined and performed with the bevel, while the needle is made with a cutout in the shape of a hook at a distance of 2-3 mm of the end face of the piston has a flange set to lock on the clutch.

Removing the working end of the string to the outside allows you to create a tension that, in turn, gives the opportunity to beirout and drain any Department VGP, including both proximal and distal. Performing these manipulations was not conducted due to the lack of appropriate device.

In Fig.1 shows a General view of the device of Fig.2 - capture the strings offered by the device.

The device comprises a hollow needle 1, in which telescopically posted by the piston 2, the distal ends of the combined and performed with the bevel preferably 30o. The needle 1 is equipped with a shaped cut in the shape of a hook 3, located at a distance of 2-3 mm from the distal edge. This helps to ensure sufficient stiffness at the moment traction while ensuring minimal liver injury. The gripper hook is executed corresponding to the diameter of the strings 4. The proximal end of the needle is provided with a sleeve 5 with the slot 6, and the proximal end of the piston has a flange 7 with the stop 8. Coaxially figure cut on the sleeve 5 is made label 9.

The method of using the device is as follows.

the dick. Under radiological control channel of the endoscope through the major duodenal papilla, retrograde, string gradually moving in the proximal sections of the bile duct, locating his work late in the ducts of the liver.

String 4 endoscopically performed for the area of stenosis or structure and is located in hepaticopsida or equity duct of the liver. Under local anesthesia (novocaine of 0.25% to 20.0 ml) in the 8th intercostal space on the right anterior axillary line is percutaneous perhepatic puncture duct, in which is located the working end of the string 4. The needle 1 is connected to the string 4, the surgeon will determine the position of the hook 3 on the label 9. Through the flange of the piston 2 is partially removed, opening the lumen of the hook 3. The string is caught by the hook 8, focusing on the flange 7 is fixed in the hook of the piston 2 and is extracted to the outside. Two end of the string is stretched inside the bile ducts. After this wire under x-ray and endoscopic control pusher tube of the appropriate diameter of the stent is pushed into the area of stenosis. Then on the working end of the string 4 in percutaneous bile duct external drainage to prevent complications and subsequent contrini N 18693,1999 year).

Diagnosis: tumor hepaticoholedochus at the level of the middle third, mechanical jaundice. Concern expressed itchy skin, pale stools, dark urine, yellowness of the skin. Sick about 3 months, when there were these complaints. History of cholecystectomy (1985). When entering a state of moderate severity, expressed yellowness of the skin and mucous membranes, moderate phenomena encephalopathy, renal and hepatic insufficiency. In the tests: bilirubin-174/72 Ámol/l, creatinine-100 Ámol/l, ALT/AST-412/233, alkaline phosphatase-2055 u/l, GGT-1661 u/L. the Patient made an ERCP revealed the formation of hepaticoholedochus, aktfoto growing into the lumen of the duct, severe bile duct ectasia over the area of the block. The patient attempted percutaneous perhepatic install an external drainage. Attempt ineffective, unsuccessful. 24.11.99 on our proposed method performed endoscopic cholangiography, string held over the area of tumor stenosis produced percutaneous perhepatic capture and retrieval of the working end, strings, under x-ray and endoscopic control was stent placement in the scope of the extrahepatic bile ducts. Percutaneous installed drainage to prevent kroondal period marked devolution of negative symptoms: after 3 days decreased yellowness of the skin, improved overall health, bilirubin 42/21 Ámol/l, creatinine-87 Ámol/l, ALT/AST-96/58, alkaline phosphate - 1197 u/l, HTTP-667 u/l: 2 weeks - the patient's condition is satisfactory, no jaundice, phenomena liver failure cropped, bilirubin-14/15 Ámol/l, ALT/AST-86/58, alkaline phosphatase-418 u/l, GGT-230 u/l, written under the supervision of a physician clinics in the community.

Advantages of the proposed method are: high efficiency, the ability of the stent in any Department of the bile ducts, the installation of the stent when the inefficiency of other methods of decompression of the biliary tract, small invasiveness of the surgery, fewer postoperative complications, quick recovery of patients after surgery, shorter hospital stay.

1. The method of drainage of the bile ducts, including cholangiography under radiological control, retrograde conduction of the string through the channel of the endoscope through the major duodenal nipple in the bile ducts for the area of stenosis in the proximal sections of extrahepatic bile ducts, install wire stent, and then remove the string, wherein the working end of the string percutaneous-crisper CLASS="ptx2">

2. The extraction device strings of bile ducts, characterized in that it comprises a hollow needle, which is telescopically placed the piston, and on the one hand the ends of the needle and piston combined and performed with the bevel at the end of the needle is made with a cutout in the shape of a hook at a distance of 2-3 mm from the edge with one hand, and on the other hand is equipped with: butt needles - coupling with the label, coaxially to the neck, and the end face of the piston - flange mounted with the possibility of fixing on the clutch.

 

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