Probe for carrying out ultrasonic duodenum examination

FIELD: medical engineering.

SUBSTANCE: device has tube and metal ball. The ball is connected to the tube by means of thread. The ball is 1.5 cm far from the tube. The tube is manufactured from polyvinyl chloride. Its wall is 1 mm thick and 1500-1600 mm long. Two marks are available on the probe one showing distance to antral stomach section and distance to greater duodenal papilla.

EFFECT: accelerated examination method; controlled probe working end.

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The invention relates to medicine, namely to diagnosis of diseases. Crucial to the successful implementation of endovideoscopic transduodenal interventions in the conduct of diagnostic and treatment program for patients with diseases typical for hepatic-pancreaticoduodenal area (GPDS) has the correct pathogenetic and tactical approach to the determination of the indications for whatever transpapillary and respectully interventions performed under endovideoscopic control. The success of transduodenal manipulation under endovideoscopic control largely depends on the anatomic-physiological condition of the duodenum (duodenal) at the time of the diagnostic or therapeutic procedures. This comprehensive revision of the duodenum, its buds, walls, mucous membrane, the definition of safety research, opportunities to conduct transduodenal interventions is important. It also determines the amount of preparatory and preventive measures. This approach to conducting transduodenal research significantly relieves the percentage of failed attempts and complications.

Analogues. To determine the anatomical and functional status of the duodenum proposed numerous methods, based on different from the local physical, technical mechanical phenomena. (Authors: S. Mikhailov, 1972, A.I. Kovalev with co., 2000, Semenko Z.A., Grigorieva GA UZ-research method in the diagnosis of diseases of the stomach and duodenum, 1985, Sov. Medicine, No. 3, s-102.)

From the point of view of determining the feasibility transduodenal diagnostic interventions in the biliary pathology uses the following methods:

- registration methods, intracolonic pressure (manometrically, radio)

methods study peristalsis (electroputere)

- methods of studying the evacuation function (rentgenologicheski, ultrasonic)

- fibrobronchoscopy

- the study of tone in the bowel wall.

Criticism analogues. Most often for examination of the duodenum are used:

a) rentgenologicheski research method.

b) fibrobronchoscopy

C) an ultrasonic method

A) x-Ray examination of the duodenum has a long history, often used in clinical practice to identify various pathological conditions of the duodenum. However, this technique does not allow to clearly identify: the state of the walls of the duodenum, the thickness of the wall of the duodenum, the location of the duodenum relative to art is, the lower cavity of the vein, superior mesenteric artery, pancreas, gall bladder. In addition, the radiological examination is the radial load.

B) Fibrobronchoscopy is a widely used method, highly informative for detecting diseases of the mucosa of the duodenum and peterboro papilla. But this method, moderately invasive, does not allow to judge about the shape, the location, the outer loop of the duodenum, the thickness and structure of walls, the location of the duodenum relative to nearby organs and blood vessels.

B) In recent years, ultrasound is widely used to determine the anatomical and functional status of not only solid, but hollow bodies. The method is based on the filling of the stomach fluid with subsequent visualization of the duodenum as the evacuation of stomach contents into the duodenum.

The disadvantages of this method is incomplete filling of the duodenum, which does not allow to judge about the structure of the wall, increases the research time.

The prototype. As a prototype we have taken the way Mitkova CENTURIES (a Practical guide to ULTRASOUND diagnostics, edited by ITU - 2003) According to this method, ultrasound examination of the duodenum should be carried out the ü on an empty stomach, after 8-10 hours after a meal. The first stage ULTRASONIC research is the study of the duodenum on an empty stomach. Then the subject should drink 500 ml of liquid at a temperature of 25-35°C. Next, the patient is required to lie down for a few minutes on the right side, after which the study continues with the position of the patient stayed on the right side (preferably to explore bulbs and downward Department) or lying on the back or vertical position of the subject.

The disadvantages of the prototype. Ultrasound examination of the duodenum is still relatively rarely, because of technical difficulties during the examination. As a rule, in the gut registered a small amount of secret and gas, which makes it difficult for the visualization of the walls of the intestine and adjacent structures. This technique studies the duodenum provides for the preceding fluid intake. When the flow of fluid from the stomach to the duodenum insufficient expands as the liquid flows portions, sometimes with stops and pendulum-like movements. As a consequence difficult visualization of all departments of the duodenum, which is divided into 4 parts: the upper, downward, lower, horizontal and upward. The duodenum is not the part extends, they have no possibility to visualize the structure of the wall (serous, muscular, and mucous, membrane and submucosal basis). Passing a portion of liquid from falling into the duodenum from the stomach, is carried out in healthy subjects quickly, for 10-15 seconds, making it difficult to study.

The prototype. As a prototype to the object device taken the probe catalog"Chirurgie. Gastroenterologie. Drainagen. Krankenpflegeartikel.", Katalog III Ausgabe 3, Germany, 1977 (see p.20, RIS). The specified probe made of soft rubber, and as a conductor contains metal olive. The probe is made of radiopaque and graded.

The purpose of the invention; the aim of the invention is to increase the efficiency of determining the state of the duodenum at the time of execution transduodenal interventions and fewer complications. The proposed method contributes to the effective conduct a detailed audit of the duodenum, its forms, walls, mucous, forecasting the safety of surgical intervention, which determines the amount of preparatory and preventive measures.

The invention

In terms of method: ULTRASONIC study of the duodenum exercise on an empty stomach at different positions of the patient.

a) lying on the back,

b) lying on right side

C) standing in a bent p is the situation, then in terms of hydraulic dilation.

The elasticity and rigidity of the walls, the speed of evacuation of fluid from the lumen of the intestine was studied using the developed echo-controlled methods of examination of the duodenum.

The essence of the method consists in carrying out in the duodenum specially designed probe (drawing). Dynamics: the proposed probe is used to implement the method as follows:

The patient in the sitting position offered to swallow the probe of the proposed design. Upon reaching the probe antrum (to the level of 65 cm) patient offer to pass. The doctor periodically echotomography controls the location of the metal ball. When reaching the probe descending part of the duodenum it is administered distilled water in the amount of 400 to 500 ml with the purpose hydraulic stretching of the walls of the duodenum and improve conditions of ULTRASONIC research.

The ultrasonographic examination of the duodenum determine its location, shape, contours, the nature and quantity of content, thickness and structure of the walls, the condition of the pylorus, the presence or absence of peristalsis, the location of the distal duodenum relative to the aorta, inferior Vena cava, the upper brigadoi artery.

With allopregnane form duodenal ulcer, its motor activity, the degree of rigidity of the walls and thereby assess the potential for manipulation within the lumen of the intestine 97 patients with benign diseases of the biliary tract, which were identified in readings transduodenal interventions, we performed ultrasound of the duodenum. The elasticity and rigidity of the wall automattically distance, and the speed of evacuation of fluid from the lumen of the intestine was studied using the developed exocontralto methods of examination of the duodenum. Ultrasound examination of the duodenum drew attention to its location, shape, contours, the nature and quantity of content, thickness and structure of the walls, the condition of the pylorus, the presence or absence of peristalsis, the location of the distal duodenum relative to the aorta, inferior Vena cava, the upper brigadoi artery, and measured aortomesenteric distance and angle of divergence of the superior mesenteric artery from the aorta.

At the proposed probe is an elastic, vinyl chloride tube with an external diameter of 3 mm, a wall thickness of 1 mm and a length of 1500-1600 mm At the probe has 2 marks: 65 cm - distance from the antrum of the stomach., 85 cm distance to the major duodenal papilla. At the end of the ' silk thread attached to a stainless steel ball with a diameter of 4 mm The distance between the metal ball and the end of the tube is 1.5 cm, such design of the probe allows it into the duodenum accelerated way and to monitor whether its working end in the duodenum echotomography. For sonographic examination of the duodenum was used chotomska working in real time, and convex probe of 3.5 MHz (ALOKA-600)

A specific example. Driven observation. The patient, 85 years, and a/b No. 11/0392 entered the Republican gautengonline center with a diagnosis of PAS, choledocholithiasis, cholangitis, obstructive jaundice. Comorbidities: coronary heart disease, hypertension, varicose veins of the lower extremities.

Upon receipt of a complaint of weakness, nausea, belching air, itchy skin. Total bilirubin blood drawn 346 μmol/l, the body temperature of 37.8°C, complete blood count: HB - 115 g/l; ESR - 63 mm/g; Z - 13,2·109, duration of jaundice according to the patient and relatives amounted to 3 weeks. Twelve years ago, I had a cholecystectomy for acute destructive choledochus.

Held ULTRASOUND examination of the liver, pancreas and duodenum, which revealed the following changes - expansion of the choledochus to 1.8 cm in the lumen of hyperechoic including the giving d=1.2 cm, with acoustic shadow (calculus).

The patient survey was conducted of the duodenum using a probe of our design is to determine the status of the duodenum, which was defined indications for performing endoscopic papillosphincterotomy apst).

The patient in the sitting position was offered to swallow the probe of the proposed design. To achieve probe antrum (motion to small 65 cm) patient was asked to go, the doctor echotomography controlled the location of the metal ball. When the probe descending part of the duodenum was introduced through a tube of distilled water in a quantity of 500 ml with the purpose hydraulic stretching of the walls of the duodenum and improve its ultrasonic study. The patient was observed deformation of the contours of the upper horizontal part of the duodenum, which is associated with adhesive process in the right subhepatic space (after cholecystectomy). During the survey it was also found that the shape of the duodenum is C-shaped, due to the fixation and traction in the bowel wall, viscero-visceral binding between the bed of the gallbladder and bulbar and postbulbar departments of the duodenum.

It was also revealed infiltrat the I wall of the intestine due to concomitant chronic pancreatitis and inflammatory process in the terminal division of the choledochus.

The analysis of the layers of the wall of the duodenum, its thickness, the degree of dilatatie and elasticity of the duodenum, the speed of evacuation of fluid from the duodenum, the possibility of increasing the capacity of the duodenum.

It is revealed that pathological changes in the biliary tract significantly reduced the tone and elasticity of the duodenum, has been slowed by the speed of evacuation of fluid from the duodenum, which reduces the possibility of mechanical dilatatie when performing transpapillary manipulation. Given these studies were identified indications for performing endoscopic papillosphincterotomy. Held a special treatment for the preparation of the duodenum to transpapillary intervention. After therapy, the indicators characterizing the state of the duodenum, improved and was successfully performed endoscopic papillosphincterotomy. The stones went straight after papillosphincterotomy, and biliary tract entered purulent bile with fibrin films.

On day 7, jaundice and cholangitis was resolved and the patient at the end of the treatment, on the 11th day after endoscopic papillosphincterotomy was discharged home.

The usefulness of the proposed CSP is both and devices

The usefulness of the proposed object of the invention is the following: to reliably control the functionality of the duodenum with the aim of improving conditions for implementation of intraduodenal endoscopic interventions need to know how changed the capacity of the duodenum, are there any conditions to increase its capacity, the degree of conservation of elasticity of the walls of the intestine and its ability to stretch. These and other data can be obtained echotomography if inhaled proposed methodology under conditions of artificial probe hydraulic dilation of the duodenum.

Due to the expansion of the lumen of the intestine and the diligence of its walls to adjacent organs, the proposed method allows not only to identify pathological processes in the intestine, but also to judge on circumstantial evidence about the status of the head of the pancreas, common bile duct, retroperitoneal lymph nodes. The combination of these features allows it to achieve its goals.

1. Probe for ULTRASONIC examination of the duodenum, consisting of a tube, characterized in that it contains a metal ball, the ball is connected with a tube with threads, the distance between the end of the tube and the bulb is 1.5 cm, and the tube is made vinyl chloride with a wall thickness of 1 mm, glino the 1500 - 1600 mm, and the probe has 2 grades: distance from the antrum and the distance to the major duodenal papilla.

2. The probe according to claim 1, characterized in that the mark is made at a distance of 65 cm and 85 cm



 

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