Method for visualization of biliary excretion

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with visualization of biliary excretion during laparoscopic cholecystectomy. For this purpose, one should introduce 10 ml 0.4%-indigo carmine blue solution intravenously, after cholecystectomy one should treat cholecyst bed with 3%-aqueous hydrogen peroxide solution diluted in 500 ml isotonic solution. Moreover, small open ducts should be stained into light-blue color, and additional ducts - into more intensive light-blue color. If necessary, the procedure mentioned should be repeated. The innovation provides the chance for qualitative implementation of electrocoagulation of biliary ducts and cholecyst bed and, thus, prophylaxis of biliary excretion in postoperational period.

EFFECT: higher efficiency.

1 ex

 

The invention relates to medicine, namely to surgery. Can be used during laparoscopic cholecystectomy for visualization geleistete during the operation.

There are attempts to introduce into the blood stream of the substances that are released together with bile, changing its color. For example, in the Institute. Topchibashev, Baku since 1997 Havo, Aguadulce, Remagen and Vasocon intraoperative use an aqueous solution of metavanadate ammonium. Ions of vanadium in this reagent are connected with bile, giving it a bright green color on the background of the surrounding tissues [1].

The disadvantage of this method is the unavailability of the drug. However, the problem of visualization of geleistete there[2, 3, 4].

In our work, we turned to the available drug with virtually no toxicity is Indigo Carmine blue [5]. When administered intravenously it displays not only the kidneys, but also together with bile. However, in liver Indigo Carmine is undergoing changes and is excreted bile ducts not the Indigo Carmine blue, and Indigo Carmine white. In this regard, the visualization geleistete using this dye was impossible. We faced the question of translating it again in the Indigo Carmine blue.

A method of visualization of geleistete during laparoscopic cholecystectomy.

When performing the cholecystitis is ecomii intravenously injected with 10 ml of 0.4%aqueous solution of Indigo Carmine blue. The Indigo Carmine excreted by the bile colorless. After cholecystectomy bed of the gallbladder is processed 3%aqueous solution of hydrogen peroxide diluted in 500 ml isotonic. When washing them gallbladder bed the places where there are small open ducts of the liver parenchyma and extra hepatic ducts are painted in blue color. This creates the possibility of purposeful electrocoagulation of the gallbladder bed. With repeated irrigation of the bed with a solution of hydrogen peroxide are those small streams that are not included in the zone of coagulation. When the blue color disappears, coagulation stops. So the conditions for the prevention of geleistete.

Just by this technique has operated 24 patients. Geleistete in the postoperative period was not recorded.

Example: the patient Moskaleva Tatiana Vasilievna, 47 years old, operated 4.05.05. for chronic calculous cholecystitis. During the operation, put 10 ml of 0.4%aqueous solution of Indigo Carmine blue. After removal of the gallbladder bed he was treated with 20 ml of 3%hydrogen peroxide, which was dissolved in 500 ml isotonic. Small open ducts of the gallbladder bed was painted blue and the additional ducts stained in a more intense blue color. Plots of the gallbladder bed,in which open these ducts, was subjected to electrocoagulation. With repeated irrigation of the bed are those small streams that are not included in the zone of coagulation. When the blue color disappeared, coagulation stopped. In operating the wound left drainage. In the postoperative period geleistete was not observed.

References

1. Movchan A.A., Abdullayev A.G., Agayev R.M., Movchan VA Diagnosis of lesions of the bile ducts in the liver echinococcosis. Surgery, 2004; 2: 28-32.

2. Tallyman IM surgery of the gallbladder and bile ducts. M., 1963.

3. Nechayev L.M. Surgical anatomy of blood vessels and bile ducts in the liver of man. Kazan, 1969.

4. The yupatov SR Anatomic rationale tamponade abdominal cavity after surgery on the biliary tract. Bulletin of surgery, 1967; 6: 57-61.

5. Owl AV, Markina L.M., Rybalkin SCI methods of chromoscopy at endoscopic studies of the upper gastrointestinal tract. St.-Petersburg, 2002.

The visualization of geleistete during laparoscopic cholecystectomy, including the introduction of chemicals and electrocoagulation of the gallbladder bed, characterized in that the patient is injected with 10 ml of 0.4%aqueous solution of Indigo Carmine blue, after cholecystectomy bed of the gallbladder treated with 3%aqueous solution of hydrogen peroxide diluted in 500 ml isotonics the second solution, this small open ducts are painted in blue color, and additional ducts are painted in a more intense blue color, then painted places electrocoagulator and if necessary, conduct a re-coloring of the gallbladder bed and electrocoagulation of the bile ducts.



 

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10 cl, 2 tbl, 7 ex

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2 ex, 1 tbl

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32 cl, 10 tbl, 129 ex

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10 cl, 1 tbl, 104 ex

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2 dwg, 2 ex, 2 tbl

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3 cl, 2 ex

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2 ex

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5 ex

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FIELD: veterinary science.

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EFFECT: higher efficiency of studying.

FIELD: medicine, radiology, pharmacy.

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EFFECT: valuable properties of agent.

3 cl, 9 ex

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EFFECT: non-toxic and effective agent for treatment of abovementioned diseases.

7 ex

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