Surgical ultrasonic instrument for ablation of pathological mass from biological tissue, device for ablation of pathological mass from biological tissue and method with application thereof

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to means of carrying out low-invasive surgical operations. A surgical ultrasonic instrument contains coordinating and conducting elements for the transmission of an ultrasonic signal and a working end connected to the conducting element. The conducting element and/or working end have at least one section with different physical and/or mechanical properties, obtained by performing its thermal and/or mechanical treatment or made from a material, different from the material of adjacent section(s). A device for the ablation of a pathological mass additionally contains a generator of ultrasonic fluctuations and an acoustic unit. The method of the pathological mass ablation from a biological tissue consists in the application of the device for the pathological mass ablation.

EFFECT: improvement of transmission of ultrasonic fluctuations, provision of sufficient dynamic stability of the ultrasonic instrument and control of the curvature of a trajectory of elastic deformation of the conducting element and working end of the ultrasonic instrument.

27 cl, 13 dwg

 

The technical field

The invention relates to medicine and medical technology and relates to ultrasonic surgical instrument for removal of pathological entities of biological tissue, the device for removal of pathological entities of biological tissue, which includes this ultrasonic surgical instrument and method of using them. The invention can find application in cardiovascular surgery, Oncology, urology, gynecology, and other areas for impacts on biological tissue of various organs to remove tumors and other pathological entities when performing minimally invasive surgery using endoscopic or laparoscopic methods of treatment, including effects on tubular and hollow organs, deep and superficial wounds and cavities. The invention can also be used as intravascular methods and means for restoring the patency of the blood vessels in yockleton-stenotic pathological lesions.

Prior art

Modern medicine is committed to the use of minimally invasive surgical tools, providing a minimal trauma during surgical operations, using surgical instruments that can be entered in dostavleny to pathological education through the natural cavity of the body, tubular bodies or through punctures or incisions minimum size. Such methods can operate on various organs, including the treatment and disposal of various tumors, as well as the removal of foci of abnormal formation of internal cavities of tubular organs and lesions of atherosclerotic occlusion of the internal cavities of the blood vessels, allowing recovery of openings of tubular organs and blood vessels.

In cardiovascular surgery along with bypass surgery and prosthetics widely used operation for reconstruction of the inner lumen of the vascular bed, which can be divided into two groups. The first group includes operations that are based on application of methods endarterectomy or thrombectomy, the restoration of the lumen of the blood vessel in which occurs by removal of the pathological substrate of the vascular lumen. The second group includes the operation, dubbed "angioplasty", the restoration of the lumen of the blood vessel in which occurs mainly through seal (dilatation) of the pathological substrate in the lumen.

The advantage of endovascular reconstruction is, on the one hand, in its physiology, so as to restore the natural channel of the circulatory system, and, with drugoystorony in the possibility of minimal trauma, due to the fact that the restoration of the patency of the vessel is at a considerable distance from the site of surgical access.

Mechanical endarterectomy based on the muscular efforts of the surgeon, was proposed in 1947 by the Portuguese surgeon DOS Santos (DosSantos), and since then endarterectomy has experienced repeated periods of rise and fall of interest from practical medicine. This is associated with a high degree of postoperative complications and poor long-term outcomes. At the same time, endarterectomy, not requiring the use of biologic and synthetic vascular prostheses, is constantly in the field of view of the specialists involved in developing technologies angiosurgery, primarily because it has such advantages as the relative ease of surgical technique and physiology reconstruction of vessels. Improving methods of operation aimed at the development of tools and application in addition to the muscular effort of the surgeon of different types of physical agents that help restore natural channel vessels and removal of the pathological substrate of the lumen of the blood vessel, the most effective of which is the ultrasound. Ultrasonic endarterectomy which allows you to remove occluding the substrate from the lumen of the vascular bed length over 500 mm in a closed or semi-closed methods (through one or two arteriotomy holes in the wall of the vessel). The application of ultrasonic methods angiosurgery when intravascular reconstruction provides a higher level of quality of life of patients, even compared to the "gold standard" vascular surgery - autovenous bypass (see Ultrasonic angiography under. edit Pokrovsky, A. C., Savrasov, V. and others, 2004).

However, the disadvantages of the methods endovascular reconstruction of the first group in any performance, including the use of ultrasound should include the need to restore the integrity of the vascular wall, and wounds in places surgical access after removal of the substrate. This is reflected in the complexity and degree of trauma surgery.

This disadvantage is missing intravascular methods of reconstruction of the second group, which are implemented using minimally invasive surgical access by percutaneous puncture of the vascular wall with a special device.

These methods are widely and successfully used in surgery of the coronary arteries through the femoral artery by percutaneous puncture in the coronary artery is delivered to the device by means of which the restoration of the lumen of the artery either by balloon dilatation or methods rotary or ultrasonic angioplasty, laser ablation, etc., (see the Barceloneta beaches L. A. the other Essays on the history of coronary surgery, 2002). In recent years these methods have been applied during the reconstruction of the aorta-iliac-femoral segment of the main arteries of the lower extremities.

The disadvantage of the methods intravascular reconstruction using minimally invasive surgical approach is that pathological focus fully or partially remains in the vascular wall and may be a source of re-closure of the lumen (thrombosis, restenosis, occlusion), and limiting the length of the zone of reconstruction (not more than 50 mm). To prevent postoperative complications on the site of reconstruction of artery stent is installed, which is a metal mesh tube frame, which enables the preservation of the lumen in the area of reconstruction. However, the presence of a foreign body, which is a stent, is a frequent cause of rethrombosis blood vessel.

Another disadvantage of the methods endovascular reconstruction of the second group, which should be performed under x-ray control, is that the patient and surgeon before the operation is subjected to irradiation by x-rays, which are used for visual control of the vascular bed in the area of surgical intervention in a blood vessel. Moreover, if the patient is exposed region is to obtain x-rays once, the surgeon repeatedly that negatively affects the health of the surgeon.

From the description of the patent RU 2214193 a device for ultrasonic treatment on the blood vessel or the cavernous body. The device has an ultrasonic instrument in the form of a hub-waveguide with a pointed end, which is the puncture of the vessel wall and the introduction of the working part of the tool into the lumen of the vessel. This ultrasonic instrument is used in a system comprising a generator of ultrasonic vibrations, the channel or channels of the moving liquid phase and means for supplying and evacuating the liquid phase with reverse drive, allowing you to direct the direction of movement of the fence of the liquid phase through the channel or channels of the moving liquid phase, and in the reverse direction to the output of the liquid phase through the channel or channels of the moving liquid phase.

The disadvantages of the known device for ultrasound treatment are severe restrictions diameter of the working end, is inserted through the puncture, since an increase in the diameter of the working end, commensurate with the lumen of the vessel, will cause significant trauma to the vascular wall at the site of access and greater blood loss. These limitations are reflected in the efficiency of the ultrasonic treatment of the inner surface of the trunk the vessels by increasing their level at minimally invasive surgical access by percutaneous puncture of the vascular wall.

Another disadvantage of the known device for ultrasound treatment is associated with the specifics of the design decisions of the hub-of the waveguide. The hub is a waveguide that is part of the ultrasonic tool, designed to influence the blood vessel is a flexible rod that enables the movement of the tool along the anatomic course of the blood vessel over a large area. Known ultrasonic instrument according to the author's certificate of the USSR (SU 1224016 And class. B06B 1/00, 1982) in which to improve dynamic stability along the length of the rod is made grooves in the form of holes, the axes of which are arranged with an angular offset relative to each other. This solution is suitable for rods of limited length, but does not apply to the elongated flexible rod systems, as grooves in the form of holes will be stress concentrators and can lead to mechanical failure of instrument, having a considerable length.

Known ultrasonic instrument with a flexible part, which is to improve dynamic stability of the links of the half-wave length arranged with an angular offset (SU 680734, A61B 17/32, 1979). Ultrasonic instrument is an ultrasonic endarterectomy and may be injected into the lumen of the blood vessel through artery tonicheskoe hole in the vessel wall with surgical access. But this solution is of limited use in percutaneous puncture of the vascular wall due to the strict limitations of the cross-section of the flexible section.

From patent application U.S. 2011/0238083 known ultrasonic device for the treatment of vascular stenosis and prevent restenosis, containing elements for transmitting ultrasound and delivery of medicines to pathological education, with ultrasonic treatment is used to enhance the penetration of the drug in the walls of blood vessels. This tool is intended for medical treatment of the stenosis, but not capable of removing abnormal formation of the lumen of the vessel.

Known ultrasonic device for removing pathological formation of blood vessels according to the U.S. patent 5342292 containing elongated flexible catheter, a wire guide element, passing in the catheter, and an elongated element for transmitting ultrasonic vibrations to the place of impact, made in the form of wire, placed in the lumen of the catheter and having a working end at the distal end.

But the elongated elements to transmit ultrasonic vibrations used in these technical solutions, in particular, made in the form of a wire having a uniform p is pepper-section and uniform along the length of the property, do not provide the necessary dynamic stability of the ultrasonic tool and effective removal of pathological entities of biological tissue.

The closest analogue of the claimed invention is a device for therapeutic ultrasonic field on biological tissue according to the patent of the Russian Federation 2160138 comprising a generator of ultrasonic vibrations made with the possibility of forming an ultrasonic field with a frequency of 20-30 kHz, the acoustic node and ultrasonic instrument representing the replaceable element with the working end. Ultrasonic instrument also contains a system flow of the liquid phase, and the shape of the working end of the ultrasonic instrument conforms to the shape of the receptive surface of the biological tissue is described by cubic splines. With regard to the design of the ultrasonic tool in this technical solution solves the problem of creating the most effective forms of radiating surface of the working body of the ultrasonic tool for creating evenly affecting biological tissue of a uniform ultrasonic field. But this solution is also not solved the problem of providing sufficient removal efficiency abnormal formation of tissue, increasing dinamicheskoi sustainability of the ultrasonic instrument and control curvature of the trajectory conductive element and the working end of the ultrasonic instrument with elastic deformation. As mentioned above, loss of the ultrasonic instrument dynamic stability leads to the output of the ultrasonic tool from the work of the resonant mode and to the emergence of large Flexural vibrations of flexible tools that can cause mechanical destruction of the ultrasonic tool, and also to the appearance of noise in the audible range of sound impinging on the procedure surgical operation.

The invention

Object of the invention is a device and ultrasonic surgical instrument for removing abnormal formation of tissue, the method of using them, providing minimal trauma during surgical operations due to the introduction and delivery of a surgical instrument to pathological education through the natural cavity of the body, the tubular bodies, punctures or incisions minimum size. The technical result of the invention is the provision of minimally invasive effective removal of abnormal formation of the biological tissue while improving the transmission of ultrasonic vibrations, providing sufficient dynamic stability of the ultrasonic tool and the management of curvature of the trajectory conductive element and raboteg the end of the ultrasonic instrument with elastic deformation.

Surgical ultrasonic instrument according to the invention can be used for treatment of a biological tissue of various organs for effective removal of pathological entities of different nature.

In particular, when using the invention as a means for restoring the patency of a blood vessel, a tool, a device and method according to the invention creates ultrasonic effect on the internal cavity of a blood vessel, for removing pathological focus over a large vessel through a minimally invasive surgical access, reduce trauma to the vascular wall and eliminate the need for means of saving the vessel lumen after reconstruction (stents, etc).

For effective removal of abnormal formation of the biological tissue of the claimed invention can optionally provide a combined effect on the pathological formation, comprising processing means of action, which provides the status of pathologic formation and processing mechanical vibrations of ultrasonic frequency for destruction, shredding and removal of abnormal formation of tissue.

Means of chemical and/or physical impacts delivered to pathologize the who education, provides the status of pathological education for translation tissue pathological education in the state, contributing to its destruction and subsequent removal, for example, a condition that causes embrittlement or degradation of pathological tissue formation, which facilitates the subsequent removal of pathological tissue formation under the influence of ultrasound.

Pathological education, for example, the inner surface of the blood vessel in the area of pathology can be pre-and/or simultaneously with the filing of ultrasound treated with additional chemical and/or physical agent that causes a change in properties, in particular embrittlement of atherosclerotic deposits in the area of the pathological focus. Embrittlement of atherosclerotic deposits helps them to remove during sonication.

One object of the claimed invention is an ultrasonic surgical instrument for removing abnormal formation of tissue, containing:

matching and conductive elements for transmitting an ultrasonic signal,

United with provodnikovym element of the working end, providing ultrasonic mechanical effect on the pathological formation in biological tissues, and wiring item, and/or working end have at least one site with different physical and/or mechanical properties.

Surgical ultrasonic instrument may also optionally contain at least one element for delivery means providing a change of state of pathological education, in particular, embrittlement or tissue destruction.

The item for delivery means providing a change of state of pathological formation, can be made with the possibility of delivery of at least one means providing electrocoagulation, laser processing, high frequency, radio frequency radiation, plasma, focused ultrasound, low or high temperatures, substances that cause coagulation and/or pathological destruction of education, drugs. As a means to change the pathological condition of education can be used to ensure that the embrittlement pathological education.

At least one site with different physical and/or mechanical properties of the conductor element and/or working end can be formed by conducting various thermal and/or mechanical processing the specified section.

At least one site with different physical and/or mechanical properties of the conductor element and/or the working end can also be formed by performing a section of material, other than the material adjacent(were) with him site(s) and having other physical and/or mechanical properties.

Conductor element and/or working end may have at least one part made of a material having a higher acoustic impedance than the adjacent areas.

Preferably a site with different physical and/or mechanical properties of the conductor element and/or working end placed in such a way that provides a predetermined nonuniform along the length distribution of physical and/or mechanical properties of the conductor element and/or the working end.

The working end of the ultrasonic tool is extensible and has managed a variable size, in particular the working end may be made of a material with shape memory. The working end can be made in the form of a spiral, in the form of an annular element in the form of multiple arcuate elements connected at the proximal and distal ends of the working element in the form of a sphere, spherical shell, or in the form of a mesh tube.

The tool has a tool to control the variable size of the expandable working end.

The working end may be provided with a sharp edge at the proximal side.

Ultrasonic instrument outdoornature to contain a tool for irrigation and means for aspirating particles destroyed pathological education, as well as a means of particulate destroyed pathological education.

For some applications of the conductive element is flexible, and ultrasonic instrument has a capability insertion through a natural body cavity, the tubular organs or blood vessels and automated handling of the ultrasonic tool in a natural cavity of a tubular organ or blood vessel to restore the lumen of the natural cavity of a tubular organ or blood vessel.

The invention also relates to a device for removing abnormal formation of tissue, containing:

the generator of ultrasonic vibrations

acoustic node

replaceable ultrasonic surgical instrument that contains:

the matching element connected with the acoustic node

coupled with the matching element conductive element for transmitting an ultrasonic signal,

United with provodnikovym element of the working end, providing ultrasonic mechanical effect on the pathological formation in biological tissues, and the conductor element and/or working end have at least one site with different physical and/or mechanical properties.

In the ultrasonic surgical instrument is ment may be additionally provided with at least one item for delivery means providing the pathological status of education.

The device may further comprise an automated system for automated handling of the ultrasonic tool to pathological education. In particular, when the restoration of the lumen of the blood vessel can be used for automated movement of the ultrasonic tool through the blood vessel and the ultrasonic effect on the pathological formation on the inner surface of the wall of the blood vessel.

Preferably the device further comprises an imaging system and a display device.

The generator of ultrasonic vibrations of the claimed device has a capability of forming an ultrasonic signal with a frequency from 20 kHz to 100 kHz.

The device may further comprise a system of irrigation and aspiration system of particles destroyed by ultrasonic impact pathological education, and/or particulate destroyed ultrasonic pathological effects of education.

The invention also relates to a method of removing abnormal formation of tissue, comprising stages are:

locate the abnormal formation of tissue,

provide introduction and AC is the establishment of a pathological formation of the ultrasonic surgical instrument contains:

matching and conductive elements for transmitting an ultrasonic signal and

United with provodnikovym element of the working end, providing ultrasonic mechanical effect on the pathological formation in biological tissues, and the conductor element and/or working end have at least one site with different physical and/or mechanical properties,

served on the ultrasonic surgical instrument mechanical vibrations of ultrasonic frequency for destruction and shredding pathological education, and

output of the ultrasonic surgical instrument of the biological tissue.

Surgical ultrasonic instrument may be further provided with at least one element for delivery means providing a change of state of pathological education, and using it can additionally serve to pathological formation of at least one lever, providing the pathological status of education.

At least one lever to change the pathological condition of education can be submitted to pathological education before application to pathological formation of mechanical koleblyuschiysya frequency and/or simultaneously with the application thereto of mechanical vibrations of ultrasonic frequency.

Additionally, the method may be carried out irrigation and aspiration of particles destroyed pathological education and/or capture particles destroyed ultrasonic pathological effects of education.

Surgical ultrasonic instrument can be moved to pathological education through the natural body cavity, the tubular organ or blood vessel using the system for automated movement of the ultrasonic instrument for the implementation of ultrasonic influence on the pathological formation on the inner wall surface of a natural body cavity, the tubular organ or blood vessel.

The invention may also be used for minimally invasive surgery of BPH and/or soft tissue tumors.

In the method using ultrasonic surgical instrument having an expandable working end with a controlled variable in size, and after the introduction and movement of the ultrasonic surgical instrument prior to contact with pathological education provide extension of the working end of the tool, and before removal of the ultrasonic surgical instrument returns to the working end of the original form.

Brief description of drawings

Fig.1 is a conventional diagram of the steps of the method combined osdate the pathological formation.

Fig.2 is a block diagram of the processing of pathologic formation using the device to remove the abnormal formation of biological tissue according to the invention.

Fig.3 is a block diagram of an ultrasound system, which is part of the claimed device for removing pathological education.

Fig.4 is a schematic view of an ultrasonic instrument according to the invention.

Fig.5 is a view of the various forms of the working end of the ultrasonic instrument.

Fig.6 is a block diagram of the system of the exposure to changes in the physical state of pathological education.

Fig.7 is a diagram of the interaction of the ultrasonic tool with various systems that are part of the device.

Fig.8 - three different ways of combining working bodies of the ultrasonic system exposure and pre-exposure, shown in place of the cross section A-A in Fig.7.

Fig.9 is an example implementation of a system of particles or fragments of the decay products of pathological education.

Fig.10 is a block diagram of the system of movement of the ultrasonic tool.

Fig.11 is a schematic representation of the process of ultrasonic recanalization of a blood vessel in combination with electrocautery used as a means to change the state of pathological education.

Fig.12 - schematic and the imagination of ultrasonic recanalization of a blood vessel in combination with physico-chemical effects.

Fig.13 is a schematic representation of the method according to the invention, implemented in minimally invasive surgery BPH.

Detailed description of the invention

In Fig.1 shows the diagram of a method of the combined hybrid influence the pathological formation, in this example shown as pathological atherosclerotic education 1 on the wall of the blood vessel 2. The method includes the preliminary exposure to changes in the pathological state of education and the main impact. Preliminary impact on the pathological formation of 1 by using the 3 influence providing the pathological status of education, in the form of any suitable chemical and/or physical agent that can cause changes in the physical and mechanical properties of pathological education 1, in particular, can cause embrittlement of tissue pathological education to facilitate the removal of krupjanoj tissue under the influence of ultrasound. The main impact of the changed pathological education 1 is carried out using ultrasound 4, leading to the collapse of education 1 fine fraction to be evacuated from the lumen of the blood vessel. This diagram shows the sequential phased impact sredstva impact, providing the pathological status of education, and ultrasound 4, but in the process we can also carry out processing using the 3 exposure and exposure to ultrasound 4 simultaneously on the same stage.

In Fig.2 presents a block diagram of the processing of pathological education 1 using the device to remove the abnormal formation of biological tissue according to the invention, intended for realization of the combined hybrid influence the pathological formation. The device consists of a combination of ultrasound system 5, which is designed to disperse an abnormal formation under the influence of mechanical vibrations of ultrasonic frequency, and system 6 impact on pathological education designed to change the physical state and properties of pathological education and includes at least one element for delivery means providing a change of state of the tissue pathological education, for example, a channel for delivering at least one means providing electrocoagulation, laser processing, high frequency, radio frequency radiation, plasma, focused ultrasound, low or high temperatures, substances, izvolski coagulation and/or pathological destruction of education, medicines that can be used individually or in any reasonable combination.

In addition, in the shown embodiment, the device according to the invention contains a system 7 irrigation designed to supply solutions of drugs or drilling fluids into the impact zone, the system 8 aspiration of particles destroyed ultrasonic pathological effects of education for the evacuation of products of disintegration of the pathological formation of 1 from the impact zone, the system 9 particulate destroyed ultrasonic pathological effects of education to collect particles and fragments of the decay products of pathological education, for example, to capture fragments of collapse, trapped in the blood stream. The device also contains an automated system 10 travel ultrasonic instrument, ultrasonic system 5 and item delivery means providing a change of state of pathological education system 6 exposure to pathological education, for example robotic system move through the bloodstream working bodies of the ultrasound system 5 and system 6 the impact.

In Fig.3 shows the main blocks of the ultrasonic part or ultrasound system 5, intended for the primary in the effects of education 1, part of the claimed device for removing abnormal formation and containing a generator 11 of ultrasonic vibrations, acoustic node 12 and a replaceable ultrasonic surgical tool 13, which is a direct main effect on the pathological education 1.

In Fig.4 shows a schematic view of the ultrasonic instrument 13, consisting of multiples of the wavelength matching element 14, the conductive element 15, which provides a flexible rod connected to the proximal end of the matching element, the length of the flexible rod conductor element can vary from tens to thousands of millimeters, and the working end 16 with controlled geometrical and physical properties connected to the distal end of the flexible rod. Conductor element 15 can consist of links 17, 18, which form at least one portion conductive element with different physical and/or mechanical properties.

Outside of the initial state before the introduction of the ultrasonic tool and the introduction of the working end 16 has a diameter commensurate with the diameter of the conductor element 15. The working end 16 may have a different configuration corresponding to the shape of the processed surface of the biological the maternal tissue and as a rule, made in the form of a body of rotation. In various embodiments the invention, the working end can be made in the form of a spiral, in the form of an annular element in the form of multiple arcuate elements connected at the proximal and at the distal ends of the working element in the form of a ball or rounded shell or in the form of a mesh tube.

In working condition, the diameter of the working end in a controlled manner increases depending on the size of the body and abnormal formation that is to be processed, for example, to the diameter of the lumen of the blood vessel when used for removal of atherosclerotic plaque and restore the patency of the blood vessel. As a means of control variables size expandable working end can be used to heat the working end or at least one parcel by use of the heating medium and/or other heating means, including by performing at least one portion of the working end of a material with high acoustic impedance, the temperature of which increases with the application of ultrasonic vibrations.

In Fig.5 presents three illustrative examples of the implementation of the working end in the initial state in the introduction and in the extended condition. the first embodiment, the working end in the initial state has the form of a rod, and in working condition - helix shape. In the second embodiment, the working end in the initial state has the form of a helix of small diameter, and in working condition - form helix, the diameter of which is increased. Another geometric shape of the working end having multiple arcuate elements connected at the proximal and at the distal ends of the working element, and generally resembling the shape of a "Chinese lantern", shown on the example of the third variant shown in Fig.5. In the initial state when the introduction of the arcuate elements are compressed, and in working condition they are disclosed to increase the overall diameter of the working end.

Management geometrical and physical properties of the working end of the ultrasonic instrument is possible by using materials with shape memory, which when heated above 40 degrees Celsius will take the form of a working condition of the instrument. In addition, a heat source working end to translate it into a working state can serve as the energy absorption of ultrasonic oscillations material of the working end.

According to the invention the conductor element and/or working end have at least one site with different physical and/or mechanical properties of the material of the conductor element or working end. Thus, the material from which made at least one site conductive element and/or working end has a physical and/or mechanical properties, which differ from the corresponding physical and/or mechanical properties adjacent areas. Conductor element 15 along its length may consist of at least two parts 17, 18, physical and/or mechanical properties are heterogeneous and differ from physical and/or mechanical properties of other areas, and the heterogeneity of the physical and/or mechanical properties of the links corresponds to a predetermined distribution parameters along the length of the conductive element.

In the context of this application under different physical and/or mechanical properties are such physical properties as electrical conductivity, thermal conductivity, the ability to transfer and absorption of ultrasonic vibrations, the ability of heat in the transmission of ultrasonic vibrations, and such mechanical properties as elasticity, stiffness, hardness.

The alternation of sections conductive element with different physical and/or mechanical properties can improve transmission of ultrasonic vibrations, that is to reduce losses in the transmission of vibrations and increase the amplitude of the transmitted ultrasonic vibrations, th is provides the ability to control the curvature of the trajectory guiding element 15 when the elastic deformation when promoting tool 13 to pathological formation and prevents loss of dynamic stability ultrasonic instrument characteristic elongated flexible a lot of the half wavelength (nλ/2) oscillatory systems. Preferably the length of the sections or parts of a multiple of half the wavelength of the ultrasonic vibrations (λ/2). Similarly, to improve transmission of ultrasonic vibrations, control the curvature of the trajectory of the working end under elastic deformation and increase dynamic stability of the working end of the different sections may have different physical and/or mechanical properties.

The heterogeneity of the mechanical properties of the various sections or parts of the conductor element and/or working end can either be created by conducting various selective heat treatment of their plots and/or by treatment of the surface in the manufacture of the ultrasonic tool, or by use in the manufacture of the tool for different sections or parts of conductor element and/or working end of different materials having different physical and/or mechanical properties.

For example, when using the ultrasonic tool 13 to restore the patency of the blood vessel alternating links 17 and 18, shown in Fig.4, the length of which is a multiple of half the wavelength of ultrasonic vibrations (λ/2), have different hardness, toolspecific sufficient dynamic stability of the elongated ultrasonic tool and the desired curvature of the trajectory guiding element 15 when elastic deformation during movement of the tool 13, to the bloodstream.

The following are specific examples of various embodiments plots conductive element.

Example 1

The links 17 and 18 of the conductor element are made of titanium alloy, capable of heat treatment. The link 18 is exposed to heating and cooling mode hardening, which will increase the stiffness of the link 18 and, as a consequence, there would be differences in elastic deformation.

Example 2

The link 17 is made of a titanium alloy, and the link 18 is made of an alloy with shape memory (e.g., titanium alloy with Nickel). In operation, the tool is heated to the link 18 and deformation on a given path.

Example 3

One of the links, such as 17, is a combination of two different metals (biocomposite): metal shape memory metal with a high acoustic impedance (e.g., stainless steel). With the passage of ultrasonic vibrations (UV) through the link 17 will be heating and deformation on a given path.

Variants of examples 1-3 can also be used for the design of various sections of the working end 16 of the tool.

In one preferred examples to ensure the destruction of the nidus by ultrasound exposure working end should be made of a material with high acoustic impedance, for example, from chromium-Nickel alloys. In this case, the transmission of ultrasonic vibrations will be intense heating of the working end to the temperature exceeding the threshold of thermal properties of biological tissues.

System 6 impact, designed to change the physical condition of abnormal formation 1, consists of a source 19 of the impact and the working body 20 (Fig.6), which represents at least one element for delivery means providing a change of state of pathological education. As a source 19 of effects can be used at least one tool, providing electrocoagulation, laser processing, high frequency, radio frequency radiation, plasma, focused ultrasound, low or high temperatures, substances that cause embrittlement, coagulation and/or destruction of tissue pathological education, drugs, or various combinations thereof.

In Fig.7 shows a diagram of the interaction of the ultrasonic tool with various systems that are part of the claimed device, in particular, the system 6 impact on pathological education designed to advance changes in the physical state and properties of pathological images of the deposits before ultrasonic treatment or ultrasonic treatment, system 7 irrigation to supply solutions of drugs or wash solutions, system 8 suction for evacuation of the decay products of pathological education, also with a generator 11 of ultrasonic vibrations through the acoustic node 12.

The working body 20 system 6 effects can be combined with an ultrasonic tool 13. In Fig.8 presents three different ways of combining working bodies of the ultrasound system 5 and system 6 impact made in the form of a single design. As shown in the first embodiment, when used as an energy source electrocautery (HDTV) or radio frequency source of ultrasonic tool 13 at the same time performs the function of a conducting electrode connected to a source 19 6 exposure to changes in the pathological condition of education. The conductor 15 of the tool 13 is placed in the tube 21 made of polymeric material (e.g., PTFE), protecting the vascular wall from the effects of the length of immersion of the tool into the bloodstream. The transfer of energy from the source 19 to pathological formation 1 is carried out directly through the working end 16 of the tool 13.

When using as a source 19 of the laser, as shown in the second embodiment in Fig.8, the delivery of laser energy) is implemented in the area of the working end 16 of the tool 13 is carried by a flexible fiber optic conduit 22, located in the space between the conductor 15 and the tube 21. In the third embodiment shown in Fig.8, the optical fiber guide 22 has a dual function: it conveys the energy of ultrasound and laser, that is, the optical fiber conductor also functions as a conductor 15 of the ultrasound. Space, forming a channel between the fiber guide 22 and the tube 21 can be used for medicinal solutions liquid 23, the transferred irrigation system 7 in the area influence the pathological formation 1.

In the irrigation system 7, which is designed to supply solutions of drugs and drilling fluids in the impact zone and the aspiration system and evacuation 8 of the decay products of pathological formation of 1 from the zone of influence can be used different ways to fluid supply and evacuation of the decay products, for example, fluid flow and evacuation of the decay products through different channels, placed in the conductive element, the fluid flow through the channel in the conductor element and the evacuation of the decay products through the space between the conductor 15 and the tube 21, the flow of liquid through the space between the conductor 15 and the tube 21 and the evacuation of the decay products through the lumen of the blood vessel.

According to the invention can additionally be used, the system 9 is boron and trapping of particles or fragments of the decay products of pathological education 1, designed to capture small fragments 33 of the decay products in the blood stream. One example of its implementation is shown in Fig.9 and contains the capacity of the variable size of the mesh of polymeric material acting as a filter, cell, ensures retention of the fragments that can cause an embolism in the capillary vessels (less than 5 microns). System 9 is installed before working end 16 and in the initial state has a cross-sectional dimension commensurate with the size of the working end 16. In working condition, the system 9 is disclosed to the size blocking the lumen of the vessel, and provides a collection of fragments of tissue destroyed crushed pathological education. At the final stage system 9 using a purse-string node 34 is reduced to a size commensurate with the diameter of the hole in the vessel wall to enter the instrument and displayed through this hole. At the stage of working condition in the internal cavity system 9 can optionally be entered working end for maximum grinding fragments 33 (Fig.9 not shown).

Fig 10 shows the block diagram of the system 10 move through the bloodstream working body 13 of the tool and the working bodies of the 20 system impact 6 on the pathological formation of 1. Transfer system 10 consists of a control unit displaced is eat 24 and Executive body 25. The control unit 24 is a remote control system Executive body 25 and includes a remote control 26 for the surgeon operator. The Executive body 25 is designed to move the tool 13 and the working body 20 system 6 exposure to the bloodstream.

Moving the ultrasonic tool can be implemented using the robotic arm, which moves installed in an exciting instrument device 13 and the working body 20 system 6 exposure to the bloodstream in an automatic mode. The control system move is performed remotely by a surgeon operator, which in this case is not under the influence of x-ray radiation control and visualization system used during surgical operations.

In the figures illustrated several examples of implementation of the method according to the present invention. In Fig.11 presents a schematic representation of the process of ultrasonic recanalization of a blood vessel in combination with electrocautery used as a means of action, which provides the status of pathological education. The pathological formation of 1, representing atherosclerotic occlusion, completely top the t the lumen of the vessel. Ultrasonic tool 13 having at least one site with different physical and/or mechanical properties according to the invention, through a minimally invasive surgical access by percutaneous puncture of the vascular wall is introduced into the lumen of the vessel and carried to the bloodstream to pathological education 1. The working end 16, is made of a metal with shape memory, is introduced into the occlusion on its entire length. On the ultrasonic tool 13 from the generator 11 and the acoustic head 12 serves mechanical vibrations of ultrasonic frequency. Prior to or simultaneously with the filing of ultrasonic vibrations on the tool, also functions as an electrode, the electrical signal from the source of electrocoagulation system 6 of the exposure to changes in the pathological condition of education, resulting in heating of the working end 16 and change its shape and size. In Fig.11 consistently shown the transformation of the working end of the rod in a spiral. In the electrocoagulation is the decomposition of occlusion, which under the action of ultrasound is dispersed into small fragments that are removed from the lumen of the vessel by evacuation systems 8. After electrocoagulation destruction of tissue pathological education system 6 off the contribute, and by ultrasonic impact the pathological focus to complete its destruction. At this stage you can use supplied in the area of ultrasonic influence on the pathological formation and vascular wall using irrigation 7 fluid (e.g. saline solution) to initiate (gain) hydrodynamic processes in the area of ultrasonic treatment to completely remove the occlusion of the lumen of the vessel by evacuation systems 8 and possibly using the system 9 capture fragments of decay. To modify the properties of the vascular wall can be optionally generated by ultrasonic impregnation solutions of medicinal substances into the vascular wall after removal of pathological education (for example, heparin to increase thromboresistance vascular wall and exclusions of postoperative thrombosis). After full recovery of the lumen of the blood vessel stops the supply of ultrasonic vibrations on the tool and the working end 16 is returned to its original state in the form of a rod to facilitate its removal and then removed from the lumen of the vessel.

Possible modification is shown in Fig.11 the way in which the source of the destruction of the nidus is ultrasound. In this case, the working okonchan the th 16 of the tool 13 has not only a shape memory, but also has a high acoustic impedance. Under the action of ultrasonic vibrations is heated working end to a temperature above threshold thermocoagulation of biostructures pathological education, resulting in a working end takes the specified form and occurs the decomposition and dispersion of the nidus. On the stages of the ultrasonic treatment may additionally be hydrobromide vascular wall, and irrigation in the zone of impact of the fluid will decrease the temperature of the working end below the threshold of thermocoagulation to values sufficient to keep working shape by ultrasound exposure. To return to the initial state stop flow of ultrasound on the instrument.

In Fig.12 presents a schematic representation of the process of ultrasonic recanalization of a blood vessel in combination with physico-chemical effects on the pathological formation of 1, representing atherosclerotic stenosis, which overlaps with the lumen of the vessel. Ultrasonic instrument 13 through minimally invasive surgical access by percutaneous puncture of the vascular wall is introduced into the lumen of the vessel and carried to the bloodstream to pathological education. The working end 16, is made of a metal with shape memory, is found in the stenosis for all its length. On the ultrasonic tool 13 from the generator 11 and the acoustic head 12 serves mechanical vibrations of ultrasonic frequency. Under the action of ultrasonic vibrations is heated working end that causes it to change its shape and size. At the same time in the impact zone with irrigation system 7 through the holes in the working end of the ultrasonic instrument is the liquid solution of 23 (for example, sclerosant) that causes chemical degradation of the pathological focus, strengthen the influence of hydrodynamic processes initiated by ultrasound in the liquid solution. After complete removal of the nidus stop flow in the zone of impact of the liquid solution, causing chemical degradation, and is replaced with a solution of a medicinal substance for hydrobromide the vascular wall. After full recovery of the lumen of the blood vessel stops the supply of the solution of medicinal substances into the impact zone and ultrasonic vibrations on the tool and the working end back to its original state in the form of a rod and is then removed from the lumen of the vessel.

As shown in Fig.13, the method according to the invention can be implemented also in minimally invasive surgery for BPH. This endoscopic method of treatment, which the making is in fact, the doctor enters the urethra of the patient urethroscopy which is a thin and flexible probe on the end of which there is a camera lens, light and ultrasonic surgical instrument 13 to influence diseased prostate tissue. In this case, the working end 16 of the tool 13 according to the invention not only has shape memory, but also has a high acoustic impedance. Under the action of ultrasonic vibrations is heated working end to a temperature above threshold thermocoagulation of biostructures, resulting in a working end takes the specified form and occurs the decomposition and dispersion of the diseased prostate tissue. To return to the initial state stop flow of ultrasound on the instrument.

Other modifications of the method, including in combination with a solution of liquids, depending on the destination, causing the destruction of pathological education, strengthen the influence of hydrodynamic processes initiated by ultrasound or impregnation of drugs in healthy prostate tissue. On the stages of the ultrasonic hydrobromide prostate irrigation in the zone of impact of the fluid will decrease the temperature of the working end below the threshold of thermocoagulation to values sufficient to maintain the extension of the Noah working shape by ultrasound exposure. Solution liquid 23 is fed into the impact zone with irrigation system 7 through the holes in the working end of the ultrasonic tool or through the natural channel of the urethra. After full recovery of the lumen of the urethra terminates the supply of the solution of medicinal substances into the impact zone and ultrasonic vibrations on the tool and the working end back to its original state in the form of a rod and is then removed from the canal of the urethra.

As example implementations of the claimed invention can also provide an example of the effect of radiofrequency ablation (RFA) and ultrasonic hydrobromide malignant soft tissue tumors of the abdominal cavity. The surgeon under ultrasound and/or x-ray installation selects the entry point and trajectory input of the surgical instrument. The surgeon then adscam the surface of the skin and enters the tool according to the claimed invention at the desired depth. Sets the mode of operation of the apparatus of the RFA and the processing procedure is started. Then there are two possible next actions:

option 1 - the simultaneous action of radiofrequency ablation (RFA) and ultrasound;

option 2 - serial radiofrequency ablation (RFA) and ultrasound.

After treatment of the tumor on the depth of the action for the selected option of ending the fast. Then, in accordance with the plan of operation of the surgical instrument down to the next insertion point. After treatment of the tumor in all points of the input is the control ultrasound or digital fluoroscopy. The surgeon operator evaluates the completeness of the treatment of the tumor. If a satisfactory processing operation completes.

To increase the amount of destructible fabric used ultrasonic instrument with a variable size of the working end. The increase in destroying tumors is achieved by increasing the area of interaction of the working end with the biological tissue pathological formation at the site of contact.

During the operation of the ultrasonic tool 13 according to the invention through a minimally invasive surgical access through a percutaneous puncture or incision) is introduced into the abdominal cavity and is held to the tumor. The working end 16, is made of a metal with shape memory to the tumor and the ultrasonic tool 13 from the generator 11 and the acoustic node 12 serves mechanical vibrations of ultrasonic frequency. At the same time (or previously) on the instrument, also functions as an electrode, the electrical signal from the source of radiofrequency ablation system impact 6, resulting in heating of the working end 16 and change it the shape and size of the rod in a spiral. In the radiofrequency ablation is the decomposition of the tumor, which under the action of ultrasound is dispersed into small fragments that are removed from the range by using the evacuation system 8 and system 9 data collection and capture fragments of pathological disintegration of education. After radiofrequency ablation system 6 is turned off, and by ultrasonic impact the pathological focus to complete its destruction. At this stage it is possible the use of a fluid (e.g. saline solution) to initiate (gain) hydrodynamic processes in the area of ultrasonic treatment for complete removal of the tumor.

Although the claimed invention was described in detail with reference to certain preferred embodiments of the, it is clear that the invention is not limited to these particular variants of execution. Above is described the best embodiments of the invention, and numerous possible modifications and variations without deviating from the invention, also included in the scope of this invention.

1. Surgical ultrasonic tool to remove abnormal formation of tissue, containing:
matching and conductive elements for transmitting an ultrasonic signal and
United with provodnikovym element of the working end,providing ultrasonic mechanical effect on the pathological formation in biological tissues,
moreover, the conductor element and/or working end have at least one site with different physical and/or mechanical properties obtained through its thermal and/or mechanical treatment, or is made of material different from material adjacent(were) with him site(s).

2. The instrument under item 1, characterized in that it additionally contains at least one element for delivery means providing embrittlement or degradation of tissue pathological education.

3. The instrument under item 2, characterized in that at least one item for delivery means providing embrittlement or degradation of tissue pathological education, configured to deliver at least one means providing electrocoagulation, laser processing, high frequency, radio frequency radiation, plasma, focused ultrasound, low or high temperatures, substances that cause coagulation and/or pathological destruction of education, medicines.

4. The instrument under item 1, characterized in that the conductor element and/or the working end has at least one portion made of a material having a higher acoustic impedance than the related participation is key.

5. The instrument under item 1 or 4, characterized in that the at least one site with different physical and/or mechanical properties of the conductor element and/or working end placed in such a way that provides a predetermined nonuniform along the length distribution of physical and/or mechanical properties of the conductor element and/or the working end.

6. The instrument under item 1, characterized in that the working end is extensible and has managed a variable size.

7. The instrument under item 6, characterized in that the working end is made from a material with shape memory.

8. The instrument under item 6 or 7, characterized in that the working end is made in the form of a spiral, in the form of an annular element in the form of multiple arcuate elements connected at the proximal and distal ends of the working element in the form of a sphere, spherical shell, or in the form of a mesh tube.

9. The instrument under item 6, characterized in that the tool has a tool to control the variable size of the expandable working end.

10. The tool p. 1, wherein the working end has a sharp edge at the proximal side.

11. The instrument under item 1, characterized in that it further comprises means for irrigation and means for aspirating particles destroyed the pathologist is ical education.

12. The instrument under item 1, characterized in that it further comprises means particulate destroyed pathological education.

13. The instrument under item 1, characterized in that the conductive element is flexible, and ultrasonic instrument has a capability insertion through a natural body cavity, the tubular organs or blood vessels and automated handling of the ultrasonic tool in a natural cavity of a tubular organ or blood vessel to restore the lumen of the natural cavity of a tubular organ or blood vessel.

14. A device for removing abnormal formation of tissue, containing:
the generator of ultrasonic vibrations
acoustic node,
replaceable ultrasonic surgical instrument, comprising:
the matching element connected with the acoustic node,
coupled with the matching element conductive element for transmitting an ultrasonic signal and
United with provodnikovym element of the working end, providing ultrasonic mechanical effect on the pathological formation in biological tissues, and the conductor element and/or working end have at least one site with different physical and/or mechanical properties, obtained is through its thermal and/or mechanical processing, or made of material different from material adjacent(were) with him site(s).

15. The device according to p. 14, characterized in that the replaceable ultrasonic surgical instrument further comprises at least one element for delivery means providing embrittlement or degradation of tissue pathological education, and the specified element to the delivery means arranged to deliver at least one means providing electrocoagulation, laser processing, high frequency, radio frequency radiation, plasma, focused ultrasound, low or high temperatures, substances that cause coagulation and/or pathological destruction of education, medicines.

16. The device according to p. 14, characterized in that it further comprises an automated system for moving the ultrasonic tool to pathological education.

17. The device according to p. 16, wherein the device is configured to restore the lumen of a blood vessel by automated handling of the ultrasonic tool through the blood vessel and the ultrasonic influence the pathological formation on the inner surface of the wall of the blood vessel.

18. The device according to p. 14, is great for the different themes, which further comprises an imaging system and a display device.

19. The device according to p. 14, characterized in that the generator of ultrasonic vibrations is made with the possibility of the formation of the ultrasonic signal with a frequency from 20 kHz to 100 kHz.

20. The device according to p. 14, characterized in that it further comprises an irrigation system, aspiration system of particles destroyed ultrasonic pathological effects of education and/or particulate destroyed ultrasonic pathological effects of education.

21. The device according to p. 14, characterized in that it is made with the possibility of minimally invasive surgery BPH and/or soft tissue tumors.

22. Method of removing abnormal formation of tissue, containing the steps are:
locate the abnormal formation of tissue,
provide introduction and move to pathological formation of the ultrasonic surgical instrument, comprising:
matching and conductive elements for transmitting an ultrasonic signal and
United with provodnikovym element of the working end, providing ultrasonic mechanical effect on the pathological formation in biological tissues, and the conductor element and/or working OK nanie have at least one site with different physical and/or mechanical properties, obtained through its thermal and/or mechanical treatment, or is made of material different from material adjacent(were) with him site(s),
served on the ultrasonic surgical instrument mechanical vibrations of ultrasonic frequency for destruction and shredding pathological education, and
output of the ultrasonic surgical instrument of the biological tissue.

23. The method according to p. 22, characterized in that the ultrasonic surgical instrument further comprises at least one element for delivery means providing embrittlement or degradation of tissue pathological education,
the method further includes applying to the pathological formation of at least one means providing embrittlement or degradation of tissue pathological education, and
as a means for providing embrittlement or degradation of tissue pathological education, using electrocoagulation, laser processing, high frequency, radio frequency radiation, plasma, focused ultrasound, low or high temperatures, substances that cause coagulation and/or pathological destruction of education, medicines.

24. The method according to p. 23, characterized in that IU is greater least one lever for embrittlement or degradation of tissue pathological education serves to pathological education before application to pathological mechanical education vibrations of ultrasonic frequency and/or simultaneously with the application thereto of mechanical vibrations of ultrasonic frequency.

25. The method according to p. 22, characterized in that it further carry out irrigation and aspiration of particles destroyed pathological education and/or capture particles destroyed ultrasonic pathological effects of education.

26. The method according to p. 22, characterized in that the ultrasonic surgical instrument is moved to pathological education through the natural body cavity, the tubular organ or blood vessel using the system for automated movement of the ultrasonic tool, and by ultrasonic effect on the pathological formation on the internal wall surface of a natural body cavity, the tubular organ or blood vessel.

27. The method according to p. 22, characterized in that use ultrasonic surgical instrument having an expandable working end with a controlled variable in size, and after the introduction and movement of the ultrasonic surgical instrument prior to contact with pathological education provide extension of the working end of the tool, and before removal of the ultrasonic surgical instrument returns to the working end of the original shape.



 

Same patents:

Reverse evaporator // 2532502

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to medical equipment. It can be used for surgeries and postoperative care of wounds (including injuries, burns, freezing injuries and trophic ulcers), as well as soft tissues and mucous membranes for bleeding control, prevention and treatment of suppurative complications, infectious and dermatologic diseases. The object of the presented device is providing the local, targeted haemostatic and/or antiseptic preparation of biological tissues with an ozone-oxygen mixture in a combination with the effective aspiration and deactivation of ozone from the used gas mixture, staying within the maximum permissible ambient ozone concentration. The assigned object is solved by the fact that the device additionally comprises a motor and storage portions combined together into a one-piece working circuit. A tip in the form of an ozone handle and peripheral aspiration and release pumps connected by a plastic retainer; pump inlets and outlets are presented in the form of junction pipes provided with conical nozzles with adapters, are parts of the motor portion. The storage portion comprises a chain of cross-pieces coupled in the same direction by supplying pipes and provided on each side from each cross-piece with a pair of hermetic ozone-oxygen packages on the opposite crossarms.

EFFECT: presented reverse evaporator enables avoiding sophisticated, bulky, immobile treatment apparatuses and using the aggressive gas media, like ozone-oxygen mixtures.

3 cl, 4 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. Device contains cylindrical case element, plunger and cover, made with possibility f travel between closing position and dispensing position. Cover includes hole, which has specified dimensions to provide leaking of medication through cover, when cover is in dispensing position. Cylindrical case element has multitude of internal thread coils. Connection of cover and case is realised due to the fact that cover includes external wall and column, extending towards cylindrical case element, column includes external thread coils, or cylindrical case element includes multitude of external thread coils, and cover includes multitude of internal thread coils, which have such dimensions that they are capable of mating in thread coils of external thread of cylindrical case element, and/or cylindrical case element includes multitude of internal thread coils, and cover includes multitude of cogs, which have multitude of external thread coils, which have such dimensions that it is capable of mating in thread said coils of internal thread of cylindrical case element (12), or cylindrical case element includes flange part, passing from distal end, projection, formed near distal end, first groove and second groove, with cover including first holding bead, which has such dimensions that it is capable of interaction with flange part, and second holding bead, which has such dimensions that is capable of snapping shut in first groove, when cylindrical case element is in closing position, and has such dimensions that it is capable of snapping shut in second groove, when first holding bead interacts with flange part, in order to place cover in dispensing position. Device additionally contains holding means to hold cover on cylindrical case element, when cover is in dispensing position.

EFFECT: providing delivery of specified dose at any moment due to travel of case element between closing and dispensing position without separating cover from device.

13 cl, 14 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to gynaecology, and can be used in treating such diseases as dysfunctional uterine bleeding, menorrhagia, dysmenorrhoea, endometriosis, uterine fibroid, menopausal disorders, osteoporosis and urogenital atrophy. That is ensured by presenting an urogenital system comprising a frame forming an internal cavity enclosing an insert with a therapeutically effective dose of a biologically active compound. The insert is form-stable and damage-resistant when in use. The frame has an open structure providing access to a main portion of an external portion of the insert. The frame comprises one or more retaining element for frame holding in the uterine. What is also presented is a method for making the above intrauterine system.

EFFECT: group of inventions provides an effective controlled release drug delivery for a long period of time, as well as easy and safe administration and proper removal of the preparation.

14 cl, 9 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology, orthopaedics, and can be used for supporting treatment in large joint replacement. That is ensured by determining a volume of involved joint contracture six months before the operation. That is followed by X-ray and magnetic resonant examination of the involved and collateral joints to specify their state. Besides, a quality of the bone tissue is assessed by osteodensitometry. If observing changes in the bone tissue quality, the complex of the drug therapy is added with the preparations Bivalos and Calcemin. A pain syndrome intensity is assessed by the visual analogue scale three months before the operation. That is followed by the complex therapy aiming at optimising the state of extremity joints with added local injection therapy (LIT). That is ensured by preliminary exposing the biologically active periarticular zones in the proximal and distal direction from the involved joint to the focused infrared laser light. A mixture containing solutions of the therapeutic preparations: chondroprotectors, Contrykal, Lidocaine, vitamin B12 is injected into the same zones. Besides, Arthrofoon is administered for the whole preoperative period. If the pain syndrome intensity is less than 4 points, Arthrofoon is administered in a dose of 4 tablets a day. If the intensity value is more than 4 points, the preparation is administered in a dose of 8 tablets a day in a complex with a short course of a non-steroidal anti-inflammatory preparations and a chondroprotector. The replacement operation is immediately followed by fixing a collateral joint with an orthesis for the period of 3 months. The complex of the postoperative supporting therapy started three weeks after the operation is added with a single intravenous introduction of the preparation Aklasta, the preparation Arthrofoon in a dose of 4 tablets a day for three months, alpha calcidole and Calcemin continuously. A pectoral girdle of the extremities is reinforced by means of an individually specified set of therapeutic exercises and electric walking myostimulation. The LIT of the collateral joint is performed three months after the operation. If observing a degenerative process in the adjacent joints, the LIT is performed alternatively in these regions. Vasodilators, chondroprotectors, and the preparation Milgamma are administered with underlying LIT. If observing psychoemotional changes in the patient, the preparation Tenoten is additionally administered. A postoperative medication regimen, including the LIT is repeated 3-4 times every 6 months.

EFFECT: method provides optimising the effect of the surgical management and preventing developing complications both in the operated joint, and in the adjacent and symmetrical joints after the replacement, preventing developing instability of the endoprosthesis components, preventing developing or aggravating degenerative process in the symmetrical and adjacent joints that reduces a risk of the recurrent operations.

1 ex

FIELD: medicine.

SUBSTANCE: after a colocolonic anastomosis is created 10-12 cm in a proximal direction from the anastomosis, a double tube is inserted into an intestinal lumen. After a transanal insertion of the tube, an infusion pump is used for dosed introduction of a rifaximin suspension at 0.01 mcg of an active substance per 1 kg of a patient's body weight a minute through one channel and a passive outflow through the second channel. The rifaximin suspension is introduced continuously for the first days, then 3 times a day for 3 hours until observing active intestinal peristalsis.

EFFECT: method provides effective prevention of colocolonic anastomotic leakage, reduces a probability of postoperative complications ensured by avoiding microbial contamination, infection and development of anastomositis, as well as promotes reducing the length of treatment and postoperative stay in hospital.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynaecology, reflexotherapy and pelotherapy. A method includes carrying out a course of antibacterial and/or antiviral therapy, which is started on 5-7 day of a menstrual cycle. From 5-7 day of the following menstrual cycle a course of pharmacopuncture is performed by introduction of homeopathic preparations into acupuncture points (AP). On 1, 3, 5, 7, 9, 11 and 13 days of the course Traumel C is introduced into points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2). On 2, 4, 6, 8, 10, 12, 14 days of the course Ovarium compositum is introduced in AP Rp6 (2). Simultaneously with the course of pharmacopuncture or starting from 5-7 day of the following menstrual cycle a course of pelotherapy is carried out. Introduction of gel, based on the Dead Sea mud, is performed rectally for 30 minutes, 1 time per day.

EFFECT: method ensures recovery of the two-phase menstrual cycle due to normalisation of endometrium and vagina biocenosis, improvement of local immune and vegetative status, increases duration of remission.

4 cl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, in particular to vascular surgery, and is intended for transfer of medications onto an internal surface of a vessel wall. A device for transfer of medications onto the internal surface of the vessel wall contains a matrix, made in the form of a polymer film, covered with medication and placed on a flexible framework. The matrix and the framework have specified standard sizes. They are made with a possibility of placement in them of a cellular knitted metal temporary stent and with a possibility to be inside the temporary stent of an inflatable balloon with a fixed diameter and length and a cylindrical or conic shape when blowing under high pressure or a latex balloon with a possibility of filling the entire internal space of the temporary stent when blowing under low pressure.

EFFECT: invention makes it possible to simultaneously perform long-term efficient transfer of medication into the vessel wall with preservation of blood flow and efficient diameter of the affected vessel.

4 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: there are performed beam therapy, intracavitary therapy and chemotherapy. For 5-7 days before the beginning of the radiation, Colagel-Beta with 1 β-interleukin 20 ml is introduced into a vaginal tube daily. Each session of the intracavitary therapy is preceded by introducing Colegel with 5-fluoruracil 20-25 ml into an uterine cavity and exposed for 30-40 minutes. Besides, from the beginning of the beam therapy 40-50 minutes after the radiation session, sodium alginate gel 20 ml containing methyluracil, dimethyl sulphoxide and hydrocortisone are introduced into a rectum and a bladder in a therapeutically effective amount. 5-10 procedures are performed.

EFFECT: providing faster regression of the tumour, reducing the rate and severity of radiation injuries of the rectus and bladder adjacent with the uterus with no risk of severe systemic toxic manifestations, including in senior patients with comorbid inoperable diseases and extended tumours.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and biotechnology, and may be used for the biocompatible polymeric structure formation in bone tissues. That is provided by a puncture approach to a filled cavity in the bone tissues. That is followed by filling the cavity with a polymeric gel compound containing 55-97.7 wt % of the biocompatible polymer polylactide of a particle size of 50 to 100 mcm, 0.3-45 wt % of magnetic nanoparticles of ferric oxide of a particle size of 10 to 100 nm, the gelling agent maltodexrin in the amount of 0.5 to 50 wt % of the weight of mixed polymer and magnetic nanoparticles, as well as distilled water in the amount of 0.5 to 100 wt % of the weight of a dry mixture of the polymer, magnetic nanoparticles and gelling agent. A solid three-dimension structure is formed. That is accompanied with heating the compound throughout by exposing to an alternating magnetic field at frequency 500 kHz and amplitude 500 E for 3-5 minutes. Where appropriate slow down the process of heating the compound, it is additionally exposed to a direct magnetic field at amplitude 1000 E applied either to the whole formed volume, or locally depending on the problem to be solved.

EFFECT: method enables forming the biocompatible three-dimension structure in the specified cavity of the bone tissue with minimum surgical intervention.

1 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurosurgery, resuscitation and neurology, and may be used for treating the permanent unconscious vegetative state. That is ensured by intratympanic streptomycin treatment with underlying common drug therapy of the state. The completion of the above is followed by the electric transcranial exposure on the brain. For the intratympanic treatment, streptomycin 1 g is dissolved in physiologic saline 1 ml. The preparation is introduced once a day from one side, and on the other day from the opposite side. The therapeutic course is 5-10 days. The electric transcranial exposure is presented by transcranial DC micropolarisation of intensity 200-400 mcA for 30-40 minutes daily for 16-24 days. The exposure is performed through 3-4 electrodes places on the areas of temporo-caudal projections and posterior associated cortical areas from both sides. For the first 6 days, such exposure covers the temporo-caudal projections, while on the other days the posterior associated cortical area projections are exposed. If required, the above therapeutic courses are repeated not earlier than in 3 months until the clear consciousness is reached.

EFFECT: method provides an immediate and convincing clinical effect without brain invasiveness, an ability to recover the clear consciousness in these patients, as well as a significant reduction of the pathologically increased muscle tone and as a result, achieved satisfactory level of the patient's self-service.

2 ex

FIELD: medicine.

SUBSTANCE: after a conjunctiva and a Tenon's fascia are exposed in the quadrant, where the perforation has been found; two adjoining rectus muscles are separated and held by traction sutures; an indirect binocular ophthalmoscopy is used to visualise the perforation, and an instrument is used to press in the scleral sections successively to localize a place therein the pressed-in section is found exactly above the perforation. The instrument used for pressing in the sclera is 20G light guide used in vitreoretinal surgery with its distal end bent at an angle of 100-110°. The place, where the pressed-in section is exactly above the perforation is shown by brighter light emission. The localized scleral section is marked.

EFFECT: method provides the faster and more reliable localisation of the perforation projection.

FIELD: medicine.

SUBSTANCE: ophthalmosurgical blade contains a body with a base from monocrystalline silicon and a cutting edge. The body base and the cutting edge are coated with silicon nitride 100-1000 E thick and titanium nitride 500-700 E thick.

EFFECT: higher strength, hardness and wear resistance.

1 dwg

FIELD: medicine.

SUBSTANCE: episcleral flap is cut out. A cavity of the anterior chamber is filled with sterile air. That is followed by creating an opening at the base of the cut-out episcleral bed. The above openings are created by pricking in and out with a curved non-traumatic needle through the cavity of the anterior chamber in parallel to a limb. That is followed by placing Alloplant biomaterial for the sponge drainage into the scleroscleral space. The episcleral flap is sutured to the periphery of the donor bed. Sawing motions are performed by enlarging the filter holes gradually. The sutures are removed. A conjunctival wound is closed.

EFFECT: method enables the higher clinical effectiveness of the surgical management of glaucoma by the graduated filtration of the chamber moisture, avoids an acute decompression of the anterior eye chamber that in turn prevents intra- and postoperative complications and scleroscleral adhesions.

5 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used in ophthalmology and ophthalmic oncology for the scleral bed treatment following endoresection of an intraocular new growth. After the endoresection of the intraocular new growth, electrodes are intraocularly applied on the surface of the scleral bed, and electrochemical lysis is performed. The electrodes are gradually moved along the entire area of the scleral bed. That is followed by intravitreal heat treatment covering the entire area of the scleral bed and surrounding tissues by 1.5 mm.

EFFECT: method enables avoiding an ability to preserve viable tumour cells on the scleral bed and in the sclera thickness, provides the absence of recurrent tumours and metastases in the remote postoperative period.

3 cl, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmic surgery, and can be used to determine an axial position of a toric intraocular lens before implantation. A mark, which is an output point from scleral vessels on the eyeball surface, is found on a keratotopogram. A strong corneal axis is localised in relation to the above mark. That is followed by an intraoperative localisation of the strong corneal axis guided by the visualised mark. The presented corneal axis is marked. The toric intraocular lens is implanted which is guided by its working axis in relation to the mark and aligned with the marked strong corneal axis.

EFFECT: method provides the accurate corneal axis marking, and respectively ensures the accurate lens guiding when implanted for the optimum refraction effect of the operation.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment and can be used in ophthalmic micro surgeries. A knife comprises a handle and a working part in the form of the first plate vertical in relation to a longitudinal axis of the handle. One of the vertical end faces of the plate represents a pointed wedge symmetrical about the longitudinal vertical axis. The first plate is installed perpendicular in the centre of the second plate and divides the plate into two symmetrical parts. Three side end surfaces of the second plate are wedge-shaped, pointed and inclined at an acute angle to a horizontal surface. The fourth side of the second plate is vertical.

EFFECT: improving drainage, reducing the injuries of the eye tissue, increasing conservation.

5 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology and otorhinolaryngology, and aims at surgical management of chronic dacryocystitis. An endoscopic examination covers the inferior concha, and a nasal canal is inspected from a transmaxillary approach to determine an involvement level: at the level of a distal portion and a valve of Hasner, at the level of a middle one-third of the nasal canal, and at the level of a proximal portion and a bed of the lachrymal sac. The involved levels are decompressed by a resection of narrowed or injured tissues and/or bone walls. The surgical effectiveness is endoscopically controlled with an intra-operative irrigation of the lachrymal passages from the maxillary sinus and under the inferior concha.

EFFECT: method provides the minimally invasive manipulations with reducing a recurrence rate of dacryocystitis and its postoperative complications, ensuring higher therapeutic effectiveness by using a differentiated approach to choosing a surgical technique depending on a causation of the disease and the height of the lachrymal passages obstruction.

6 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: invention refers to ophthalmosurgery and can be used for the fixation of a support apparatus of a crystalline lens accompanying a defect of the suspensory ligament of the lens of the eye. After an IOL is implanted into the defect of the suspensory ligament of the lens of the eye, a segment made of an inert polymer material is implanted, and a needle is grafted in the middle of the segment; the suture is delivered through a paracentesis; the capsular bag is brought in a projection of the defect of the suspensory ligament of the lens of the eye, and the needle is fixed to the sclera. In a specific case, a segment 6 mm long and 0.5 mm thick having a curvature radius of 9.7 mm is used.

EFFECT: method enables improving the IOL stability.

2 cl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmic surgery, and can be applicable for treating hyperactive inferior oblique muscle of the eye. That is ensured by separating the inferior oblique muscle. It is stretched between two muscle hooks. That is followed by vascular electric coagulation along the planned incision lines. Edge Z- or W-incisions are performed by 1/2-1/3 width of the separated muscle. The width and number of the incisions depends on the adducted eye hypertropia. The incisions are perpendicular to its axis; the incision distance makes 2-5 mm. It is the lateral incision that is performed first from a distal end of the muscle. The following incision is performed in a more medial perpendicular direction from the previous incision.

EFFECT: method provides higher effectiveness with reducing its injuries and the absence of postoperative complications.

5 cl, 2 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmic surgery, and can be used for treating secondary glaucoma caused by silicone emulsification after subtotal vitrectomy with introducing silicone oil in retinal detachment. That is ensured by forming conjunctival and superficial scleral flaps. Ex-PRESS microshunt is implanted into the sclera within the cornea to the sclera transition. Then, a hydrogel drain tube is laid on the scleral bed, under the scleral flap in parallel to a limb at 3 mm away in the distal direction from the microshunt . The scleral flap together with the hydrogel drain tube is fixed with one interrupted suture in the centre. One sclero-scleral suture is applied on each side of the scleral flap. Free ends of the hydrogel drain tube are smoothed in between the sutures. The surgical procedure is completed. On the first postoperative day, 5-fluoruracil 0.2-0.3 ml is introduced subconjunctivally into a filtering bleb. Further, once a week for 5-7 weeks, 5-fluoruracil is introduced in the above dose in the filtering bleb.

EFFECT: method provides recovering the intraocular fluid outflow tracts, enabling the more complete removal of emulsified silicone from the anterior eye chamber by creating the greater volume of the intrascleral cavity that ensures the more stable antihypertensive effect and preserving the visual functions.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, specifically phlebology. Before operation, a treated vessel is divided into segments. All varicose inflows are marked. With a probe inserted into the blood vessel, its tractive resistance is measured in all the segments. Measured longitudinal forces are plotted in all the segments along the full length of the vessel treatment. That is followed by ablation by executing reciprocating motions of a heating element at a certain segment of the vessel. That is combined with measuring an actual resistance to the probe motion, and the pre-measured tractive resistance is subtracted therefrom, and a difference of forces shows the quality of the vessel treatment. The probe operation is controlled by a computer. A device for endoluminal treatment of the blood vessel comprising the probe with the heating element provided with a heating temperature sensor and connected by a power cable inside a rod with a power source; a proximal end of the probe is mounted in a feeding guide mounted on a fixed support, and provided with a flexible protective guide channel, one end of which is fixed on the above guide, while another end - on the patient's body; the flexible end of the probe is placed inside the guide channel and placed between driving and measuring spring-loaded rollers.

EFFECT: group of invention enables providing higher quality of the vessel treatment, reducing a risk of complications by controlling an exposure temperature.

2 cl, 1 dwg

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