Method of endoscopic treatment of barrett's esophagus
SUBSTANCE: invention relates to medicine, namely to surgery, and can be used for endoscopic treatment of Barrett's esophagus in surgical hospitals. For this purpose endoscopically ligated is section of metaplasma esophagus epithelium by means of ligator of varicose esophagus veins on 6 ligatures-rings of model "Shooter" by firm Wilson Cook MBL-6-PK. Ligatures are put onto distal end of endoscope by aspiration into ligator and mechanical clamping of metaplasma mucous by ligature-ring with further ischemisation and rejection of specified affected section of esophagus.
EFFECT: method allows to control complete grip of altered esophagus mucous membrane, avoid unhealing for a long time, thermally conditioned ulcer defect.
1 ex, 5 dwg
The invention relates to medicine, namely to surgery, and can be used for endoscopic treatment of Barrett's esophagus surgical hospitals.
Barrett's esophagus is the most serious complication of gastroesophageal reflux disease (GERD), is manifested by the appearance of metaproterenol epithelium in the mucosa of the distal esophagus, which is many times increases the risk of developing esophageal cancer. The development of medicine in General and, in particular, endoscopy, contributed to the emergence of new minimally invasive surgical treatment metaplasia of the epithelium of the mucosa of the distal esophagus. Previously known method of thermal coagulation areas of metaplasia of the esophageal mucosa.
Similar to the proposed method is the method of thermal coagulation areas of metaplasia of the epithelium of the mucosa of the distal esophagus using electrocautery or argon-plasma enhanced electrocoagulation and consists in the destruction of sites metaproterenol mucous membrane of the esophagus.
The disadvantages are the counterpart:
1. Uncontrolled depth of thermal effects on the mucous membranes and as a result, the development of different types of complications: esophageal strictures, perforation of the esophagus, phenomenon, dysphagia, fever, pleural effusion. The number of Oslon the deposits when performing this method reaches of 57.5% (Schulz N., Miehlke s, Antos D., et al.: Ablation of Barrett''s epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole. Gastrointest Endosc 2000, 51: 659-663).
2. As with all electrosurgical interference, this method with great caution must be used in patients with metallic implants and artificial pacemakers.
3. The high frequency of recurrences of from 22 to 30% (Grade AJ, Shah IA, Medlin SM, et al.: The efficacy and safety of argon plasrna coagulation therapy in Barrett''s esophagus. Gastrointest Endosc 1999, 50: 18-22).
The purpose of the invention is to develop new safe and effective minimally invasive method for the treatment of Barrett's esophagus by controlled removal of the modified metaproterenol mucous membrane of the esophagus.
The essence of our proposed method is that endoscopically are ligated plot metaproterenol the esophageal epithelium using ligature varicose veins of the esophagus 6 ligatures-rings model "Shooter" by Wilson Cook MBL-6-PK worn on the distal end of the endoscope, by aspiration in Ligator and mechanical clamping ligature-ring area metaproterenol mucosa, with subsequent semiseria and rejection of this affected area of the esophagus.
The method is as follows.
Figure 1 shows a General view of Ligator varicose veins of the esophagus 6 ligatures-rings - (A) the model of the "Shooter" by Wilson Cook MBL-6-PK worn n the distal end of the endoscope.
Figure 2 shows a fragment of the endoscopic examination of the esophagus with land - (B) metaproterenol epithelium lining of the esophagus.
The plot metaproterenol epithelium of the mucosa of the esophagus is supplied to the endoscope with a pre-mounted on the distal end of the silicone transparent cylinder that has ligatures-rings. Figure 3 by aspiration into the lumen of the transparent cylinder retracts plot metaproterenol epithelium of the mucous membrane of the esophagus, passing monitored the adequacy of retracting into the cylinder of the esophageal mucosa to the borders metaproterenol plot. As soon as the plot metaproterenol mucous (or its fragment) will completely fill transparent cylinder, by means of the transport device from the exterior of the transparent cylinder is reset ligature-ring - And on the basis of venutolo part of mucosa (Figure 4). This area of mucous membrane, in the form of a "mushroom"due to local insufficiency of tissues, rejected on the 3-4th day. Emerging at this place ulcerative defect - G (Figure 5) rubtsuyutza on day 5-7.
For better healing of the ulcer and normal mucosa of esophagus, the patient is assigned to receive proton pump inhibitors and enveloping drugs in high doses.
The operation is carried out either without preparation, or after administration of the drugs, oscestudy on mucous of esophagus to remove any existing inflammation and improve the results of operations.
The advantages of this method:
1. No uncontrolled thermal effects that can cause complications.
2. Controlled and complete capture of the modified mucous membrane of the esophagus.
3. The lack of a long time healing, thermally caused the ulcer.
The method was tested in MUSES GB No. 2 "CMLDA" in Krasnodar. In the period from may 2008 to April 2009, this method produced the treatment of 7 patients. Complications in the postoperative period. The adequacy of the removal of the affected mucous fully achieved in all patients. Signs of recurrence of the disease in any patient not identified.
Patient B., 24, enrolled in MUS GB No. 2 "CMLDA" Krasnodar 21.05.08, complaining of heartburn, sour belching, heaviness in the epigastrium, decreased appetite. From the anamnesis: considers himself to be patient since 2004, when the first symptoms of heartburn. Took enveloping means (Almagell, Maalox), prokinetic (Motilium). It was noted a temporary improvement. In 2008, the condition of the patient deteriorated. Appealed to the MUSES GB No. 2 "CMLDA" Krasnodar for examination and treatment.
When esophagogastroduodenoscopy (21.05.08 g): the Esophagus is freely pass, slimy pale pink. In n/3 is part of valueoptions mucous type of "flame" with a length of 1.5 cm from the card is I. From valueoptions of the esophageal mucosa biopsy. Cardia 39 cm gaping. From the side of the stomach and duodenum revealed no pathology.
Conclusion: Distal catarrhal reflux esophagitis. Hernia, complicated Barrett's esophagus. A biopsy.
PIP No. 55163-66: chronic, moderate esophagitis with elements of colonic metaplasia of the mucous membrane of the esophagus. Morphological picture does not contradict histologically, the diagnosis of Barrett's esophagus.
26.05.08, the patient produced endoscopic ligation site metaproterenol the esophageal epithelium using ligature under General anesthesia. On the affected area has been planned with two ligatures-rings. The postoperative period was uneventful. Was the prescribed treatment, coating agents, proton pump inhibitors, prokinetics in standard doses.
When the control fibrogastroduodenoscopy 3 day determined rejection of the very area with the formation of the surface of the ulcer, covered with fibrin. Esophagogastroduodenoscopy (29.05.08,): the Esophagus is freely pass, the elastic wall. The mucous membrane is pale pink in color, hyperemic in n/3. On the right wall n/a 3 esophageal ulcer after the ligation site metaproterenol mucous tinged with bright fibrin size of 0.7×1,0 see Cardia 39 cm, gaping. Signs of complications were found. Enclosed is e: Distal catarrhal reflux esophagitis. Hernia UNDER. Ulcer of the distal esophagus after the ligation site metaproterenol mucosa (Barrett's esophagus).
Dynamic monitoring of the patient during the period from 2008 to 2009 in the field of ligating celebrated fine n/I scar recurrence of Barrett's esophagus was not detected.
Medical social efficiency:
The treatment of this category of patients suitable for all patients with contraindications to electrosurgical effect: the presence of artificial pacemakers, artificial joints, metal inserts. The use of original technology for removal metaproterenol mucosa with Barrett's esophagus significantly improves the results of treatment of these patients. The proposed method, due to the rapid healing, absence of complications and small terms of the patient's stay in hospital, has a high economic efficiency
A method of endoscopic treatment of Barrett's esophagus in patients with complicated gastroesophageal reflux disease, characterized in that endoscopically are ligated plot metaproterenol the esophageal epithelium using ligature varicose veins of the esophagus 6 ligatures-rings model "Shooter" by Wilson Cook MBL-6-PK, worn on the distal end of the endoscope, by aspiration in Ligator and mechanical is the first clamping ligature-ring area metaproterenol mucosa with subsequent semiseria and rejection of this affected area of the esophagus.
SUBSTANCE: invention relates to surgical instruments and can be used in operations on pancreas. Instrument for plasma resection of pancreas contains handle and protective mirror with duct. On duct transaction of tissues with plasma scalpel is performed. Protective mirror is made for traction of pancreas during its transaction and is connected at angle with handle via conducting system for cooling liquid. Conducting system for cooling liquid has cannula, located from the side of handle.
EFFECT: instrument mirror with simultaneous supply of cooling solution reliable protects surrounding organs and tissues from thermal impact of plasma flow.
SUBSTANCE: invention relates to medicine and can be applied for surgical treatment of diabetic foot syndrome, complicated by purulent-necrotic process. Carried out are: opening of abscess or phlegmon of soft tissues of foot, revision of recesses and purulent leakages, excision of non-viable tissues. On the 2-nd day after surgery, 1-st cycle of additional treatment is realised: wound is successively influenced in stream manner by 0.06% solution of sodium hypochlorite (NaCLO) in concentration 800 mg/l, in combination with low-frequency ultrasound for 10-15 min, after which wound is isolated from environment by means of closed elastic container and in the same way in stream manner is influenced by proteolytic enzymes - tripsin and chimotripsin, with 50 mg of each enzyme dissolved in 200 ml of 0.9% physiological solution for 1.5 hours, after which above wound, for 3 hours, created is negative pressure 70-80 mm Hg with active vacuum-aspiration. After a 1-hour interval 1-st cycle is repeated, processing of wound with 0.06% solution of sodium hypochlorite in combination with low-frequency ultrasound being performed by active aspiration in the same conditions.
EFFECT: method allows to improve quality of wound purification, increase blood flow in wound walls, stimulate regenerative processes.
SUBSTANCE: invention relates to surgery and can be applied for prevention and treatment of purulent-septic complications in patients after radical operations because of colon and rectum cancer. Intraoperationally catheter is introduced into retriperitoneum of small pelvis through puncture of anterior abdominal wall in right iliac region. Into catheter in bolus manner introduced is 1 g of cefazolin diluted in 15 ml of 0.5% novocaine solution 2 times per day, during 6 days.
EFFECT: method allows to reduce risk of complications development, reduce treatment terms.
1 ex, 1 tbl
SUBSTANCE: invention relates to medicine, in particular to vascular surgery. Complete longitudinal median laparotomy is performed, abdominal aorta aneurysm and its bifurcation are isolated, aneurysm is opened, orifice of lumbar arteries is sewn and intralumen bifurcate prosthetics is carried out. Additionally carried out is mobilisation of intestine and isolation of external and internal iliac arteries from both sides. Prosthetics of aorta and iliac arteries is performed by two bifurcate prostheses: first, proximal anastomosis of main branch of first bifurcate prosthesis with aorta is formed, after that carried out is formation of distal anastomoses of bifurcate branches of prosthesis with external and internal iliac arteries on the right. After that formation of proximal anastomosis of main branch of second bifurcate prosthesis with main branch of first prosthesis is performed in "an end-to-side" manner and distal anastomoses of bifurcate branches of second prosthesis with external and internal iliac arteries are formed on the left.
EFFECT: method increases safety of operational process and improves perfusion of internal iliac arteries.
8 dwg, 2 ex
SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be used for reconstructive treatment of stumps of three-phalanx fingers. Essence of method lies in the following: at the first stage performed is complete transaction of extensor mechanism of finger stumps and walls of osteo-fibrous canal after transversal osteotomy of elongated phalanx. After that pins are passed intramedullarly through distal fragments of distracted stumps in distal direction. Proximal ends of pins are bent in form of hook, fixing in cortical part of distal fragments of fingers, transversal pins are passed through 2-3 and 4-5 metacarpal bones, as well as through radial and ulnar bones in distal third of forearm. After that mounted is external fixation device (AFD), consisting of two rings, connected by three bars, transversal bar, fixed to distal ring of the device by means of two bars and a number of pin-holders, corresponding to the number of elongated stumps. Distraction is carried out to required value of diastasis between fragments. At the second stage EFD is removed and interpositional bone autoplasty of osteal defect that formed is performed.
EFFECT: application of claimed invention allows to perform elongation of stumps of three-phalanx fingers for greater length during short terms, using convenient arrangement of EFD.
1 ex, 7 dwg
SUBSTANCE: invention relates to field of surgery, namely to herniology and can be used for implementation of surgical access in treatment of white line of stomach hernias. Skin, subcutaneous fat is cut in transversal direction at the level of umbilical ring middle, for not more than 3 cm from its right and left edges. After that cut is continued inside umbilicus on its upper edge, indenting from the latter not more than 2 mm with further mobilisation of white line of stomach and anterior leaves of sheaths of recti muscles of abdomen from the cut to xiphoid process.
EFFECT: invention allows to preserve anatomical structure of anterior abdominal wall due to preservation of umbilicus as organ, as well as to improve cosmetic effect of operation due to camouflaging a third of post-operational scar.
1 ex, 4 dwg
SUBSTANCE: invention relates to medicine and can be applied for surgical correction of expressed nasolabial fold in case of rhytidectomy. Incision is made in temporal, prootic and postotic-occipital regions. Cellulocutaneous flap is cut out in lateral part of face and neck. Skin of nasolabial sulcus is undercut with formation under it of isolating inerlayer. In order to form isolating interlayer in projection of undercut skin remaining after excision of adipose tissue excess stump of subcutaneous fat in form of strip along corrected sulcus is tucked and untucked (turned), moving it medially and fixed on skin of upper lip. In projection of upper third of greater zygomatic muscle L-like incision of superficial musculo-fascial layer is made, horizontal line of cut 13-15 mm long is placed indenting 8-10 mm from lower edge of zygomatic bone, vertical line of cut being located along upper lateral edge of said muscle. Superficial musculo-fascial layer of cheek is detached and drawn upwards and fixed to periosteum of zygomatic bone.
EFFECT: method allows to reduce risk of blood supply disturbance, even the relief of skin surface in nasolabial zone.
1 ex, 8 dwg
SUBSTANCE: invention relates to medicine, namely to cardiac surgery, and can be used for recovery of disturbed coronary blood flow in patients with ischemic heart disease For this purpose right and left internal thoracic arteries are exposed in situ Ends of both internal thoracic arteries, shortened 1.5-2 cm above bifurcation, are anastomosed to each other Left internal thoracic artery is transected in place of its supposed anastomosis with anterior interventricular artery with formation of transplant, which elongates right internal thoracic artery.
EFFECT: method allows to eliminate interference in other anatomical area, ensure homogeneity of structure of elongated right internal thoracic artery, reduce probability of its spasm with good patency of bypass, simplify application of anastomosis between two internal thoracic arteries, use sections of donor artery with reverse orientation to blood flow
SUBSTANCE: invention relates to medicine, namely to cardiovascular surgery. For this purpose, performed is cutting off of superior vena cava from right auricle in region of its opening, through opening of superior vena cava interatrial septum is cut out. After that wall of right auricle is sewn. Right pulmonary artery is longitudinally dissected for 1-1.5 cm and anastomosis between upper vena cava and right pulmonary artery is applied in "an end-to-side" manner. Trunk of pulmonary artery is transversally opened for Ѕ of circumference on anterior wall 0.5 cm higher than fibrous ring of pulmonary artery valve, cusps of pulmonary artery valve are excised. After that by single-row blanket suture round patch from Gore-tex material is sewn in across pulmonary artery trunk at the level of transverse incision.
EFFECT: method allows to block the direct flow of blood through pulmonary artery trunk efficiently with the least surgical risk, increase safety of operation and carry out prophylaxis of intra-operational and post-operational complications.
1 ex, 1 dwg
SUBSTANCE: invention relates to field of medicine, namely to surgical gastroenterology and endocrinology. Essence of method is in introduction into biopsy canal of endoscope of flap of collagen sponge "Trombocol", corresponding to ulcer size and shape, bringing endoscope to ulcer, pushing sponge out of biopsy canal, its application on ulcer and holding with endoscope end or biopsy forceps with open cups, as well as in control endoscopic examination. First, into biopsy canal of endoscope placed is mini-tampon, which is pushed out first. On two sides of sponge mucous- muscular sutures are applied. After that endoscope is taken out with intake of mini-tampon, applied sutures being removed at control endoscopic examination after 8 hours.
EFFECT: application of claimed invention ensures formation of stable thrombus in ulcer and bleeding vessels, prevents sponge displacement, reduces number of manipulations in region of ulcer defect.
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
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex