SU1537229A1 - Method of removing biliary calculus - Google Patents

Abstract

The invention relates to medicine, more specifically to methods for treating diseases of the gallbladder by external drainage and destruction of gallstones. The aim of the invention is to eliminate complications from contact of the bladder wall with a destructive factor and incomplete removal of fragments. Stones are enclosed in a capsule, the capsule's shell isolates the tissues of the body from the factors that destroy the stones, stones are destroyed inside the capsule, and fragments or sediment are evacuated along with the capsule. When crushing concrements by a shock wave arising from electric discharge, the shell is made of an elastic electrically insulating material, when the concrements dissolve with ether, from an elastic polymer that does not swell and does not lose elasticity from exposure to ether. The size of the loop and the shells are chosen so as to allow them to pass through the catheter. Percutaneous transhepatic microcholecystostomy is performed under the control of echo sonography. Then a conductor and a drainage tube are inserted. Control the position of the stones relative to the loop on the screen of the echo chamber, rotate the loop and change the position of the patient before the stones fall into the capsule. Thereafter, a loop with a capsule is inserted into the catheter. After checking the encapsulation, a means for the destruction of calculi is inserted into the capsule, and on the screen the echo chambers monitor the progress and destruction. Stone fragments washed out with water

Description

1

The invention relates to medicine, specifically to methods for treating gallstone disease by external drainage of the gallbladder and the destruction of calculi.

The purpose of the invention is to prevent complications from incomplete removal of fragments and contact of the bladder wall with a destructive factor.

This goal is achieved by introducing an insulating capsule into the bladder under the control of echo sonography for drainage, enclosing the calculus, performing the destruction inside the capsule, and evacuating the fragments together with the capsule.

FIG. 1 shows the capsule before entering the catheter, general view; in fig. 2 - capsule in the catheter; in fig. 3 - capsule, disclosed in the gall or bladder after exiting the catheter; in fig. 4 - isolating calculi inside the capsule and sealing the catheter with the capsule shell; in fig. 5 is a schematic of a device for breaking concretions while simultaneously dissolving and crushing with an electro-hydraulic shock wave.

The capsule for carrying out the method comprises a flexible conductor 1, an elastic loop 2 and a sheath 3 fixed to the loop from a material resistant to the action of destructive calculi.

When crushing concrements by a shock wave arising from electric discharge, the shell is made of an elastic electrically insulating material; when the concrements are dissolved by ether, they are made of an elastic polymer that does not swell and does not lose elasticity from exposure to ether. The dimensions of the loop 2 and the sheath 3 are selected so that it is possible for them to pass through the catheter 4. The distal end of the conductor 1 passes through the stopper 5, equipped with a safety valve 6.

The device for crushing stones with a shock wave, in addition to these elements, contains two contacts 7 and 8, made of refractory material, for example of tungsten, and connected respectively to the central core 9 and the braid 10 of the coaxial cable 11. Charged to the coaxial cable 11 are on the outside. bottom devices 12, capacitive storage device 13 and high-voltage switch 14. FIG. 3 also shows the anterior abdominal wall 15, the liver 16, the gallbladder 17, stones 18 in the gallbladder.

The method is carried out as follows.

Under the control of echo sonography, percutaneous transhepatic microcholestostomy is performed. Then the conductor 1 is inserted into the catheter 4. In this case, the loop 2 is compressed by the walls of the tube and passes through it, the wire through the catheter sheath 3 capsules. After you

The loop 2 catheter travels out and unwraps the sheath of 3 capsules. Control the position of the stones 18 relative to the loop on the screen of the echocamera, turn

loop and change the position of the patient before the stones hit 18 in the capsule, or a flexible tube connected to the suction is inserted through the catheter and, sucking the stones, they are inserted into the capsule. After that, the conductor 1 is pulled in, the loop 2 and partially the capsule are inserted into the catheter 4. Since there are stones in the capsule, it cannot fully enter the tube and its sheath 3 presses against the walls of the catheter, hermetically isolating its internal cavity from the tissues of the body .

After checking the sealing, the means for the destruction of calculi are introduced into the capsule and on the screen the echocameras monitor the progress of their destruction. The calculus fragments are washed out with water through a catheter, and the unwashed fragments together with the capsule through a catheter.

To dissolve the stones, ether is introduced into the capsule and the entrance to the catheter is closed with a stopper with a safety valve. As the ether boils at 34.5 ° C, which is lower than body temperature, the ether vapor increases in

5 volume 200 times, inflate the capsule shell, seal sealing. This prevents penetration of ether droplets or vapor into the gallbladder. Regulation of the degree of swelling of the capsule shell and the elimination of its rupture is ensured by

0 stopper safety valve.

The time of dissolution depends on the composition and size of the stones and is within the limits indicated in the table.

When reducing fragments to sizes smaller than the inner diameter of the catheter,

5, the dissolution process is stopped by removing the plug from the catheter. After the release of ether vapor, the capsule is washed with water, partially washing out the fragments of stones and sediment, after which the capsule is withdrawn from the catheter together with the unwashed fragments left in its sheath. To destroy the remaining stones, these techniques are repeated.

Example 1. Patient G., 65 years old, was admitted to the surgical department about acute cholecystitis. The patient was examined clinically, laboratory, echo sonographically diagnosed: acute calculous cholecystitis. Due to the presence of severe cardiac pathology, the possibility of a radical operation was excluded. The patient underwent percutaneous transhepatic micro cholecystostomy and echo sonography. The next day, gallstones were removed by dissolving them with chloroform. 30 minutes before the start of the manipulation, the patient was injected with a 2% solution of medol pro (1 ml). Then, an elastic guide with a capsule sheath attached to it was inserted into the plastic catheter located in the lumen of the gallbladder. On eq0

In the wound, the echo chamber was controlled by the conductor entry and opening of the capsule loop in the gall bladder. Then they turned the loop and changed the position of the patient until the stones fell into the capsule. Twice a thin flexible tube connected to the suction was inserted through the catheter and, sucking stones, they were inserted into the capsule. All the manipulations associated with the loading of the capsule did not cause pain in the patient. Since the capsule shell is not visible on the screen of the echo chamber, the stones hit the capsule by controlling the conductor. At the same time, the position of the stones placed in the capsule changed. Then, pushing the guide, the capsule was partially inserted into the catheter before the lumen was closed with stones placed in the capsule. The tightness test of the capsule was performed by injecting air through the catheter into the capsule. When air enters the capsule, a bright light is observed within its borders. The appearance of light outside the capsule, in the organ cavity, indicates incomplete sealing. In this case, the air from the capsule was released, repeated manipulations to tighten the capsule into the catheter, and the leak test was performed again. After checking the sealing, 10 ml of chloroform was introduced into the capsule and the entrance to the catheter was closed with a stopper with a safety valve. The course of dissolution of the stones was monitored on the screen of the echo chamber. The time of dissolution of the stones depended on the composition and size of the stones. When the fragments were reduced to sizes smaller than the inner diameter of the catheter, the dissolution process was stopped by removing the plug from the catheter. The capsule was washed with saline, partially washing out fragments of stones and sediment. To dissolve all the stones, the above techniques were repeated three times.

In the process of dissolving the stones, the capsule did not move, which excluded the danger of its depressurization. However, even during this period, there was continuous observation of the appearance of glare outside the capsule shell. When such light appeared, the valve was opened and chloroform was released through a catheter. After the procedure, the patient was in the intensive care unit and she was prescribed antibiotics, painkillers and heart medications, was administered, detoxification therapy. The gallbladder was washed through the catheter with antiseptic solutions, then antibiotics were injected. The patient on the first day complained of moderate pain in the area of drainage, which was removed after the introduction of painkillers. There were no complications. After 12 days, drainage from the gallbladder is removed and the patient is discharged home.

Example 2. An experiment on the corpse of a woman (64 years old), who died of myocardial infarction, who had an echo sonographic test

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following were concretions in the gall bladder.

Four hours after the biological smear, percutaneous transhepatic microcholecystostomy was performed under echo-sonography. Then a resilient guidewire with a rubber capsule sheath attached to it and a thin flexible plastic tube connected to the suction were inserted into the plastic catheter located in the lumen of the gallbladder.

Sucking the calculi, they loaded the capsule shell. Capsule loading was carried out under the control of echo sonography. The capsule was filled with water, after which a coaxial cable was inserted into it with the contacts located at its front end. The cable was connected to the discharge circuit of the crushing plant. Under the control of echo sonography, the contacts of the coaxial cable were brought to the closest of stones in the capsule. The lock of the high-voltage switch, created a shock wave, crushing stones. The contacts were successively brought to each of the stones and the bits were repeated until all the stones in the capsule were crushed to sizes that ensured their removal through the catheter. After that, a high-voltage cable was brought out through the catheter and the capsule was washed with water. After washing, the fragments of stone crushing left with the capsule. Then the catheter was removed from the gallbladder, after which a laparotomy was performed. When viewed from the gallbladder wall were not damaged. Histological examination revealed chronic cholecystitis. No signs of injury to the gallbladder wall by electric current or shock wave were detected. The experiment confirmed the safety of crushing gallstones by the proposed method.

The use of the proposed method significantly increases the efficiency of destruction of stones, providing in a short time crushing or dissolving stones of various composition and size. This is achieved through the use of highly active solvents, the use of which has been excluded with known methods. At the same time, the side effects are completely excluded, since the tissues of the body are separated by the capsule shell from the effects of factors that destroy calculi, for example, from solvents and from high voltage electric spark discharges. The elastic capsule shell also absorbs the energy of the shock wave. This allows wide implementation of the method in clinical practice.

Claims (1)

Invention Formula A method for removing gallbladder stones, including external drainage, destruction and subsequent evacuation of fragments through drainage, characterized in that, in order to prevent complications from incomplete removal of fragments and contact of the bladder wall with a destructive factor, under controlling the echo sonography by drainage, an insulating capsule is introduced into the bladder, calculus is enclosed in it, destruction is performed inside the capsule, and fragments are evacuated together with the capsule. Thebes. 2 9, 77 ilD 4 i I I  ™ eight FIG. five