Method of removing veins
The invention relates to medicine, surgery. The method involves piercing the skin, flashing insolvent perforating veins on the border of a modified and healthy veins. In the distal part of the expanded veins enter trumbower. After electrocautery veins her tied up and cross. Then through an incision in the skin over the veins in the subcutaneous tissue impose lebensretter. Remove the vein, the diameter of which more than 12-15 mm, by scraping the inner surface of the skin. First scrape off the main trunk, and then its tributaries. The method improves the cosmetic effect of treatment. 2 Il.
Diseases of the veins are widely distributed among the population, often causing disability and sometimes disability. According to H. Dodd, F. B. Cockett varicose veins (DFDS) of the lower extremities occurs in every fifth woman. In Russia varicose disease affects approximately half of the population, especially after 30 years of life. Modern medicine offers different treatment methods: from local conservative therapy before surgical intervention, which is necessary when medications, wearing elastic stockings, etc., are unable to help.
Modern social conditions and the desire of people m Onomichi, but no less effective treatment than traditional surgery. Surgeons develop new approaches in the treatment of varicose veins: the failure of many patients from the traditional surgical treatment has some dark sides, in favor of combination therapy in the clinic.
The basis of conservative therapy DFDS is the hardening of veins modified by injecting a special preparations. Phlebosclerosis combined with subcutaneous temporary or permanent flashing of Vienna with endoscopic overlay clips on insolvent perforating veins of the thigh and lower leg, and so on, the Main drawback of sclerosing therapy - low efficiency when the diameter of the vein more than 12-15 mm and degeneration of the walls of veins, which leads to the disappearance of the ability of the veins to spadats. Poor contact of sclerosant with the walls of the veins causes a slight inflammatory response of the endothelium, the lack of proliferative activity of connective tissue and, as a consequence, the rapid recurrence of the disease that frustrate all the efforts of the physician and diminishes in the eyes of the patient treatment goals. To increase the effect of sclerotherapy with a large diameter veins, apply various red coagulation - impact Yes vessel is carried out indirectly through the “black pad”, formed a loose blood clot over time dissolving, leading to recanalization of the vessel. A significant drawback is the high cost of the energy source is a laser. Used various ways electrocautery veins that efficiency is comparable with the laser. Even in case of complete coagulation in combination with the hardening and the full adhesion of the walls of the vein and subsequent obturation (until complete disappearance of the lumen), under the skin remain using dense large diameter fibers, practically does not disappear with time. Over time over them only reduced pigmentation of the skin, but never fully goes away.
There is a way to remove varicose veins Mueller (Vienna and surgery. 1999, M.: Medical edition servie, S. 6) through a separate puncture the skin. Vienna raise special hook, separated with a maximum length from the skin with a thin clip and remove small areas.
The method is good only for small diameter veins. Extensive degenerative modified Vienna unable to mobilize to a considerable extent, as they are intimately fused with the skin, and removes list, may result in the formation of unsightly scars.
For the same reason, are not satisfied and method “of twisting and pulling out sections of the veins isolated from subcutaneous tissue after skin puncture and placed on a clip or spooled on a special “file” (Y. C. Belov. Manual of vascular surgery. M: De Novo, 2000, S. 411).
Difficult to remove large veins and clip introduced into the subcutaneous tissue along the veins, by extrusion: the veins are broken into separate pieces that are attached to the skin and tissue, and not fully recovered (Y. C. Belov. Manual of vascular surgery. M: De Novo, 2000, S. 401-411).
The closest is “a Method of treatment of varicose veins of the lower extremities” (Patent RU 2170551, C1, 20.07.2001, IPC 7 AND 61 IN 17/00, 17/32, 18/04, TPMF No. 20, S. 216). The method includes the electrocoagulation insufficient communicative vein when injecting electrode to a depth of subcutaneous fat. Additionally spend electrocoagulation great saphenous vein of the thigh, as well as conduct nadfascikle destruction varicose nodes and commutative veins in the area of venous ulcers.
When electrocautery is sticking to the walls of the veins, but they remain under the skin and form a contour dense triplemania methods of operation, achieving complete removal of the veins loose type when the combination therapy DFDS when the diameter of varicose veins more than 12 mm when expressed degenerative changes, as well as improving the cosmetic effect of the treatment.
The task is achieved by a method of vein removal involves piercing the skin, the electrocoagulation veins. First stitch insolvent perforating vein on the border of a modified and healthy veins. In the distal part of the expanded veins enter trumbower. After electrocautery vein tied up and cross. Then through an incision in the skin over the veins in the subcutaneous tissue impose lebensretter made of plate, in the middle part having a corrugation, from which both parties depart tapering neck with shovels of varying width, curved with a curvature in opposite directions from the longitudinal axis of the plate and bent back. The edge of the spade has a cutting edge at the working end. Remove the vein with a diameter of more than 12-15 mm, by scraping the inner surface of the skin, first scrape off the main trunk, and then its tributaries.
The proposed solution has novelty, as:
First stitch insolvent perforating veins on the verge of the population of Vienna bandage and cross,
Then through an incision in the skin over the veins in the subcutaneous tissue impose lebensretter.
- Lebensretter consists of a plate, in the middle part of the corrugation. From the plot with ribs on both sides depart tapering neck with shovels various widths. Spatula is curved with a curvature in opposite directions from the longitudinal axis of the plate, recurved. Spatula have a cutting edge at the working end.
- Veins with a diameter of more than 12-15 mm removed by means of scraping.
Scraping is carried out with the inner surface of the skin. The method is as follows. Want to delete parts of varicose veins are marked on the skin with a solution of potassium permanganate or brilliant green. Stitch the veins on the border of a modified and healthy veins. In one or two points from which you can reach all the deleted Vienna, a special tool do the punctures of the skin with a length of 4-5 mm and injected at the beginning of electrocoagulator and the changed portion of the vein diameter up to 12 mm process technology electrocautery, i.e. enter trumbower and spend electrocoagulation. Bandage changed the vein of the boundary in place, the change of the diameter of the vein and cross it. In the subcutaneous tissue in the immediate vicinity of Vienna pairs is but-and-forth movements, focusing on labeling, Vienna oskablivajutsja with the inner surface of the skin, separated from the subcutaneous tissue and squeeze the received substrate to the outside through skin punctures. Moreover, first scrape the primary trunk, and then its tributaries. By scraping to remove veins with a diameter of more than 12-15 mm
The invention is illustrated in the drawing, where Fig.1 shows a General view of phlebectasia.
In Fig.2 presents a photograph of the instrument.
Lebensretter presents plate 1 from medical steel, in the middle part has a corrugated extension for easy retention and manipulation in the subcutaneous tissue. The ends of plates arranged in the form of spade 2, 3 width 5, and 9 mm, respectively (for possible use in punctures in the skin of different length depending on the diameter of veins removed) and curved in opposite directions from the longitudinal axis of the plate. The curved spatula with rounded, recurved, the edge of the spade has a cutting edge at the working end.
Between spade 2, 3 and plate 1 instrument in the middle part there are 4 cervical length of 7-8 cm, which taper from the side of the plate with ribs to the spade that during the extraction, the veins do not extend the length of the puncture of the skin due to its stretch and do not apply on the 43 years has addressed to the surgeon with complaints about the presence of varicose veins in the right leg. Moderate expansion of the subcutaneous veins of the said 14 years ago after pregnancy and childbirth. The degree of expansion in the last 10 years have not changed, and the woman for medical help is not sought. 4 last year has been quite involved in shaping and, despite the wearing of elastic stockings, the length of the dilated vein and the intensity of the expansion began to worsen. During the inspection and examination of women using ultrasound and x-ray methods was diagnosed with DFDS right tibia and femur II-III degree in the basin of the great saphenous vein, the main type of varicose veins, the failure of perforating veins in the middle third of the thigh.
Visualized extended saphenous vein from the middle third of the leg up to the middle third of the thigh. Vienna moderately convoluted, in/3 leg it runs several advanced tributaries, each no longer than 5-7 cm, diameter of from 10 to 12-15 mm Main extended barrel for a considerable length has a diameter of up to 10. When an elevated position of the limb and the forcible expulsion of the blood from a vein intensive massaging her move in the proximal direction emptying and spadine Vienna practically does not occur, it immediately fills with blood and becomes still, oconeechee and insists on conservative therapy.
The patient is taken in x-ray operating room. Completed marking all of varicose veins with a solution of potassium permanganate. Position her on her back after local anesthesia solution of novocaine performed crossectomy. Under the control of ultrasound on the thigh two subcutaneous removable stitched seams insolvent perforating vein and the boundary of a modified and healthy veins. In the distal part of the dilated vein injecting introduced 10 ml of a 1.5% solution of tamboura. In the area of the knee joint under local anesthesia with 3 ml of 1% solution of novocaine eye with a scalpel made a puncture of the skin and veins, which entered electrocoagulation tool and held at the hip to the point of flashing Vienna. Made electrocoagulation trunk dilated vein in the thigh, after which the main trunk of the vein in/3 legs tied up and crossed. Through the same skin puncture introduced a tool for phlebectasia connected to the main trunk, and then in turn to each dramatically enhanced inflow and spatula width of 9 mm, carrying out reciprocating motion, the tributaries of erased with the inner surface of the skin separated from the subcutaneous tissue and removed by squeezing through the wound. Expressed the accumulation of blood. Instruiston bandage on the plot, where were scraping fragments veins, pre-Packed roller gauze to prevent the formation of a hematoma. The patient is given oral anesthetic, and an hour after manipulation she went home. Checks women was carried out after 2, 5, 10, 30 days and 6 months. The nearest period after combination therapy was progressing satisfactorily expressed pain syndrome, edema of limbs, extensive subcutaneous hemorrhage was not. After 3 days, the patient started to work (the operator in the coal warehouse). 10 day was filmed skin suture and thread, blocking the blood flow through the modified main stem of the great saphenous vein. Varicose extended backbone Vienna throughout slept fully removed with curettage tributaries visually and by palpation is not defined. There is moderate hyperemia and edema of the skin, small bruises on the areas of interventions. 30 day patient stopped wearing elastic bandage. Viewed through half a year - no complaints, varicose veins are not contribute, a slight redness of the skin along the vein in the middle third of the thigh, where palpation Vienna detected in the form of a thin be the In the classroom is elastic stocking. Increased exercise a negative influence on the limb does not cause. When ultrasonic control study extended earlier saphenous vein, insolvent perforating is not rendered.
Method of scraping degenerative changed dramatically extended tributaries, poorly treatable by other methods, applied in 3 patients - 2 women and 1 men. The method allowed us to achieve the desired effect, long-term results assessed for 6-12 months, complications and recurrence of the disease is not checked.
Thus, a method of scraping fragments of veins is a minimally invasive, gentle way to remove raspadayuschejsya, degenerative modified veins loose type with a diameter of 12-15 mm or more, which is not available for other conservative or minimally invasive treatment of varicose veins.
Method of removing veins, including skin puncture, the electrocoagulation veins, characterized in that the first stitch insolvent perforating vein on the border of a modified and healthy veins in the distal portion of the dilated vein injected trumbower, after electrocoagulation vein bandage and cross, then through Petit having corrugation, from which both parties depart tapering neck with shovels of varying width, curved with a curvature in opposite directions from the longitudinal axis of the plate and bent back edge of the spade has a cutting edge at the working end, remove the vein with a diameter of more than 12-15 mm by scraping the inner surface of the skin, first scrape off the main trunk, and then its tributaries.
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