Needle for endoscopic puncture of intraoperative cholecystocholangiography

 

The invention relates to medicine, in particular to the treatment and intraoperative diagnosis of diseases of the hepatobiliary zone. Needle for endoscopic puncture of intraoperative cholecystocholangiography with sharpened proximal to the sick, end, consists of basic, intermediate, and working the metal tubes. Tubes are interconnected and axially mounted one within the other. Proximally, towards the patient end of the working tube is curved in a plane which is at an angle of 90° to the plane perpendicular to the maximum elliptical cross-section sharpened proximal in relation to the patient end of the working tube. In place of the bend has a restrictive emphasis. The diameter of a stop or less corresponds to the diameter of the inner section of the trocar and is made to pass through this section. Distal to the sick, the end made for dressing it with a silicone tube and provided with ribs in the form of circular rings. The opposite end of the silicone tube adapted to the cannula disposable syringe. Intermediate and working tubes are interconnected and made in the form of a set of interchangeable parts with different diameter of the working tube, to the d cut in the main pipe of the internal thread and the external thread of the intermediate tube. Restrictive emphasis is made in the form of a cone. The cone facing the top side of the intermediate tube. In the endoscopic puncture intraoperative cholecystocholangiography is held with varying degrees of inflammation of the wall of the neck of the gall bladder, reduced trauma and increases the quality of the images. 1 Il.

The invention relates to medicine, in particular to the treatment and intraoperative diagnosis of diseases of the hepatobiliary zone.

Closest to the claimed solution of the analogue selected as a prototype, is the needle for endoscopic puncture of intraoperative cholecystocholangiography (EPIC), intended for contrast studies of the biliary ductal system in the presence of obstacles to the flow of bile [1].

The needle is made in the form of rigidly interconnected basic, intermediate, and working the metal of the tubes, the latter of which has a sharpened end and curved in a plane running at an angle of 90° to the plane perpendicular to the maximum elliptical cross-section sharpened proximal in relation to the patient end of the working pipe is gnome the end of the needle ends in the form of a silicone tip to absorb shocks, with an inner diameter adapted to the cannula disposable syringe for injection.

The peculiarity of its use is that it is introduced into the abdominal cavity through the trocar 5 mm, and then puncture the neck of the gallbladder and into the ductal system injects contrast, after which x-rays are produced.

The main disadvantages of this needle that proximal, to the sick, the working end has a constant diameter, which is not always convenient when working on the neck of the gallbladder with elements of inflammation. The degree of inflammation, as a rule, has a different degree of severity, which determines the thickness and density of the wall. When more dense and thick the wall of the gallbladder, you must have a larger diameter of the working end of the needle. In addition, the bending of the working end of the needle includes a stop in the form of a restrictive ring, which allows you to control the depth of introduction of the latter into the fabric. But when you remove the needle from the abdominal cavity, the emphasis of this construction when the articulation sometimes rests on the edge of the trocar when removing the needle from its lumen, which leads to the impossibility of removal of the needle until the separation of its working parts. In addition, with the introduction of Comte, by the end of the main needle tube and a silicone tip, increasing the pressure in the lumen of the needle causes the leakage of contrast agent on the skin, i.e., there is no possibility of precise control of the amount of the introduced contrast agent. Sometimes when more intensive intravenous contrast is the breakdown of the silicone tip. In addition, after a contrast medium is reflected in the quality of the images.

The invention solves the problem of holding EPIC with varying degrees of inflammation of the wall of the gallbladder infundibulum, reduce morbidity and improve the quality of the images.

The problem is solved due to the fact that the needle for EPIC the sharpened proximal, to the sick, end, consisting of interconnected basic, intermediate, and working the metal tube that is axially installed one in another, and proximal relative to a patient, the end of the working tube made curved in a plane running at an angle of 90° to the plane perpendicular to the maximum elliptical cross-section sharpened proximal in relation to the patient, the end of the working tube of the needle, at the place of bending installed restrictive it through this section, made as follows:

- basic and intermediate needle tube are connected using pre-cut in the main pipe of the internal thread and the intermediate tube outer thread;

- working tube rigidly connected with the intermediate and may be of different diameter, but not exceeding the diameter of the intermediate tube, and the kit may include a few interchangeable parts with different diameters of the working tube;

- restrictive emphasis is made in the form of a cone, the apex facing the intermediate tube;

- distal, with respect to the patient, the end of the main needle tube for dressing it with a silicone tube, the opposite end of which is adapted to the cannula disposable syringe, caused at least three ribs in the form of circular rings.

Comparative analysis with known inventions and technical solutions shows that the claimed needle collapsible for EPIC differs in that, first, the main and intermediate needle tube are interconnected through a cut in the main pipe of the internal thread and the intermediate tube outer thread; secondly, the working tube with a diameter not exceeding the diameter of the intermediate tube, geschoren in the direction of the intermediate tube; fourthly, distal, with respect to the patient end of the needle caused ribs in the form of circular rings for dressing it with a silicone tube, the opposite end of which is adapted to the cannula disposable syringe.

Thus, the claimed technical solution meets the criterion of “novelty”.

The analysis of the known technical solutions allows to make a conclusion about the absence of these signs, similar to the distinctive features in the claimed device intraoperative diagnosis and entitles you to admit the solution meets the criterion of “inventive step” in accordance with the following conditions.

Needle for EPIC designed so that the primary and intermediate needle tube are interconnected through a cut in the main pipe of the internal thread and the intermediate tube outer thread. This solution allows after treatment of the neck of the gallbladder and determine wall thickness and density of the latter to find the necessary replacement needle part, depending on the tube diameter of the working part of the needle, or to change the intermediate tube together with working, leaving the core in the process of intervention, replacement parts and inflammation of the walls of the neck of the gallbladder.

Restrictive emphasis is made in the form of a cone, the apex facing the intermediate tube. This solution allows for deviation from the Central axis of the working part of the needle that often happens during the execution of EPIC, freely remove it from the abdominal cavity, as at the moment of extraction of the needle from the lumen of the trocar emphasis glides wall of the cone along the edge of the trocar tube in which it is located.

At the distal, towards the patient end of the needle caused ribs in the form of circular rings, which enables to improve the seal when putting it with a silicone tube, the opposite end of which is adapted to the cannula disposable syringe. As a result, when the pressure inside the lumen of the needle contrast agent is not squeezed between the metal part of the needle and a silicone tube, and not tear the silicone tubing in the event of a sharp increase of the intraluminal pressure of the contrast medium. I.e., the contrast agent does not get to the skin of the patient, which improves image quality and diagnostic accuracy.

The drawing shows a General view of the proposed needle for API.

Needle for EPIC contains the main tube 1 coated on the inner diameter of the thread 2 and naicam the diameter of the needle tube must be of different diameters, but not more than the diameter of the intermediate tube of the needle, and on the opposite side of the working end of the intermediate tube of the tube is coated with a male thread 5. On the bend of the working needle tube has a restrictive emphasis 6, made in the form of a cone, the apex facing the intermediate tube 3. At the distal, with respect to the patient, the end of the base tube 1 caused at least three ribs 7, made in the form of circular rings.

Working with this device is as follows. After treatment of the neck of the gallbladder and determine wall thickness and density of the latter pick up the necessary replacement needle part, depending on the tube diameter of the working part of the needle. For example, the kit includes interchangeable parts with the diameter of the tube of 0.5, 0.75 and 1 mm Install the necessary replacement part in the main pipe needle, fix it and work as a standard needle. If necessary, change the working part of the needle for one reason or another, produce it, removing the needle from the abdominal cavity. Execution stops in the form of a cone, facing the top side of the intermediate portion of the needle enables the smooth extraction of the needle, even when the axial rotation of the working part because the water is a few seconds and the needle can be used again.

Execution distal, with respect to the patient, the end of the main tube with ribs in the form of circular rings prevents the expiration of contrast between the silicon tip and the main tube.

Thus, the use of the needle for API allows you to:

- to replace a working part of the needle both before and during surgical intervention, depending on the clinical need and the technical demands of this activity;

- to make selection of the diameter of the needle during surgical intervention depending on the severity of inflammation of the wall of the gallbladder infundibulum;

- remove the needle from the lumen of the trocar, due to the original design of the thrust ring, regardless of the axial displacement of the working part of the needle;

to obtain high - quality images due to the introduction of contrast medium into the ductal system of the extrahepatic bile ducts without danger to the expiration of contrast between the silicon tip and the basic metal tube of the needle.

The needle used in the clinic when performing video-assisted laparascopic cholecystectomy three times. Used this needle at different degrees of severity of inflammation with the Anna design retaining ring, occurred without any problems. The expiration of the contrast agent is not observed in any of the cases that had a positive impact on the quality of x-ray images.

Sources of information

1. Patent No. 2195180, And 61 In 10/00, 17/34, 2002

2. Endoscopic abdominal surgery. / A. C. Balalykin, O. E. Lutsevich, C. P. Sazhin, A. C. Anofriev, A. C. Fedorov // M: IMA-press, 1996. - 152 C.

3. Brown M. P. fundamentals of technology surgical operations./ Kharkov, RA and LLC “Knowledge”, 1998. - 480 S.

4. Voronin, C. M., Smirnov, A. A., Semkin Y. B. Use needle for endoscopic puncture of intraoperative cholecystocholangiography with video-assisted laparascopic cholecystectomy./ Bulletin of PFUR, series “Medicine”, № 2. - 2001. - S. 94-97.

Claims

Needle for endoscopic puncture of intraoperative cholecystocholangiography with sharpened proximal to the sick, end, consisting of interconnected basic, intermediate, and working the metal tube that is axially installed one in another, and proximal relative to a patient, the end of the working tube made curved in a plane running at an angle of 90° to the plane passing perpendicularity, at the place of bending has a restrictive emphasis with a diameter corresponding to, or lower than, the diameter of the inner section of the trocar and is made to pass through this section, characterized in that its distal in relation to the patient, the end made for dressing it with a silicone tube and provided with ribs in the form of circular rings, and the opposite end of the silicone tube adapted to the cannula disposable syringe, while the intermediate and working tubes are connected, and is made in the form of a set of interchangeable parts with different diameter of the working tube, which is not larger than the diameter of the intermediate tube, basic and intermediate tube are connected using pre-cut in the main pipe of the internal thread and the external thread of the intermediate tube, and a restrictive emphasis is made in the form of a cone, facing the top side of the intermediate tube.



 

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FIELD: medicine, clinical toxicology.

SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.

EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

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