RU137670U1 - DEVICE FOR RETURNING BILES TO THE DIGESTIVE TREATMENT IN PATIENTS WITH MECHANICAL JAUNDICE - Google Patents

Abstract

A device for returning bile to the digestive tract in patients with obstructive jaundice, containing transdermal transhepatic biliary drainage and a tube for percutaneous gastrostomy, interconnected, characterized in that it is additionally equipped with a roller clamp, antireflux valve and silicone balloon, sequentially mounted on the tube between the b drainage and a tube for percutaneous endoscopic gastrostomy, and the roller clamp and antireflux valve are installed on the tube between the percutaneous hepatic and biliary drainage balloon silicone, and the silicone balloon mounted to its entrance tube of percutaneous transhepatic biliary drainage tubes and percutaneous endoscopic gastrostomy.

Description

The technical field to which the utility model relates.

The utility model relates to medicine, in particular, to a device for returning bile to the digestive tract in patients with obstructive jaundice and can be used in gastroenterology and surgery.

State of the art

A device and method for the treatment of obstructive jaundice are known, which includes the enteral administration of a drug in complex therapy, and a pharmacological composition consisting of the following ingredients, wt. %:

xymedon 0.25-0.3 magnesium sulfate 1.15-1.25 bile rest

In the method, the composition is administered in fractions 3-4 times, 100-150 ml after or during meals (see US Pat. RU No. 2349322, IPC A61K 31/505, A61K 35/413, A61K 33/00, A61P 1/16, published on December 27, 2007).

The disadvantage of this device and method of treatment is its low efficiency.

A device is known for the return of bile to the digestive tract, which has a high role of bile components in the function of digestion, bacterial contamination, and drainage of the bile ducts, since it is necessary to return bile to the intestinal lumen through a thin nasoenteric probe, but more often, bile is returned orally (see Joseph M. Henderson., Physiology of the digestive system. M: Binom - 1997. - 221 s).

However, this procedure causes patients discomfort, vomiting, and frequent refusal to take bile (see Pugaev A.V., Lidov P.I., Achkasov E.E., Negrebov M.G., Pokrovsky K.Α., Aleksandrov L.V. Enteral nutrition in the complex treatment of patients with obstructive jaundice in gallstone disease. Clinical medicine. No. 1., 2008 .. S. 51-53).

A known method and device for this method of returning bile to the digestive tract by laparotomic access, while draining the gall bladder or common bile duct. Perform puncture gastroduodenostomy. Pumping up pressure in the bile duct with a Richadson balloon, bile is passed through the filter and injected through a puncture gastroduodenostomy into the patient's duodenum 3-5 times a day before meals (see Popov A.P., Izmailov S.G., Izmailov G.A., Parshikov V .V. Treatment and Prevention of Acholia Syndrome. Textbook. - Kazan, 2003).

The disadvantage of this method and the device for it is the long preparation of bile, which is inconvenient for medical personnel and the patient.

The closest in technical essence and the achieved positive effect and adopted by the authors for the prototype is the device used for the method of returning bile to the digestive tract, including biliary drainage, gastrostomy, installed endoscopically and interconnected using a tube, while conducting external drainage 12-finger intestines through a microgastrostomy, then drain the bile ducts, drain the bile ducts and 12 duodenal ulcers with a glass tee for 4-5 days (see Popov A.I., Izmailov S.G., Izmailov G.A., Parshikov V.V. Treatment and Prevention of Acholia Syndrome. Textbook. - Kazan, 2003).

However, this method causes infection of the biliary tract, a combination of obstructive jaundice with purulent cholangitis is noted in 20-30% of cases, while postoperative mortality in patients with this pathology is 15-45% (see Altyev B.K., Nazyrov F.G. ., Vakkasov M.Kh., Sadykov Kh.T. Comprehensive treatment of purulent cholangitis in patients with non-tumor obstruction of extrahepatic bile ducts // Annals of Surgical Hepatology. - 1988. - T. 3. - No. 3. - p. 30; Babadjanov B. R., Kuryazov BN Magnetic laser therapy for cholangiolithiasis // Annals of surgical hep atology. - 1988. - T. 3. - No. 3. - p. 34), the main cause of mortality is progressive liver failure, and the development of cholangiogenic purulent complications aggravates the course of the disease and increases mortality (see V. Lupaltsov, Sennikov I.Α., Khadzhiev A.Ch. On the issue of surgical tactics of treatment of patients with acute cholangitis // Annals of surgical hepatology. - 1998. - V. 3. - No. 3. - P. 80 - 81 .; Hishaw DB Acute Obstructive Suppurative Cholangitis. // Surg. Clin. N. Amer. - 1973. - No. 53. - Vol. 5. - P. 1089-1095 .; Borisov Α.Ε., Borisova Η.Α., Verkhovsky B.C. Endobiliary interventions in the treatment of obstructive jaundice. - St. Petersburg: Aesculapius, 1997 .-- 152 s).

Decompression of the biliary tract with high bilirubinemia (more than 200 μmol / L) should be slow and smooth. Fast decompression of the biliary tract for the first 2-3 days leads to an increase in existing disorders and should not be used in patients with high bilirubinemia (Halperin E.I., 2011). Given the need for slow decompression of the bile ducts, there is a need for inclusion in the device for returning bile to the digestive tract clamp, allowing you to smoothly control the speed of movement of bile from jet to drip.

Utility Model Disclosure

The objective of the proposed utility model is the development of an optimal device for the return of bile to the digestive tract in patients with obstructive jaundice, in which, when draining the bile ducts in patients with obstructive jaundice, conditions are created for slow and smooth decompression of the biliary tract, infection of the biliary tract is eliminated, and the risk of postoperative complications, terms of hospitalization and the quality of life of the patient improves.

The technical result that can be obtained using the proposed utility model is to eliminate the infection of the biliary tract, reduce the risk of postoperative complications, the length of hospitalization and improve the quality of life of the patient.

The technical result is achieved using the device for the return of bile to the digestive tract in patients with obstructive jaundice, containing percutaneous transhepatic biliary drainage and a tube for percutaneous gastrostomy, interconnected, while it is additionally equipped with a roller clamp, antireflux valve and silicone balloon sequentially mounted on the tube between the biliary drainage and the tube for percutaneous endoscopic gastrostomy, moreover, the roller clamp and antireflux valve are installed They are placed on the tube between the percutaneous transhepatic biliary drainage and the silicone balloon, and the silicone balloon is installed with the possibility of entering the tube from the percutaneous transhepatic biliary drainage and the tube for percutaneous endoscopic gastrostomy.

Thus, the achievement of the technical result is achieved by installing a percutaneous endoscopic gastrostomy (PEG) and percutaneous transhepatic biliary drainage (BHP) of the bile ducts under ultrasound control and connecting them together using an antireflux valve, installing a roller clamp and a silicone balloon.

The essence of the device for the return of bile to the digestive tract in patients with obstructive jaundice is as follows.

Bile ducts are drained followed by percutaneous transhepatic biliary drainage under ultrasound control, percutaneous endoscopic gastrostomy is formed, followed by their connection through the tube using an antireflux valve with the ability to move bile in one direction into the digestive tract, and a roller clamp is installed that allows smooth to regulate the speed of movement of bile from jet to drip and a silicone balloon for dosed return of bile in the digestion flax path with food.

Brief Description of the Drawings

In FIG. a device is given for the return of bile to the digestive tract in patients with obstructive jaundice, a general view.

Utility Model Implementation

The device for returning bile to the digestive tract in patients with obstructive jaundice consists of percutaneous transhepatic biliary drainage 1, installed under the supervision of an ultrasound scan (not shown in Fig.), Percutaneous gastrostomy 2, installed endoscopically and interconnected using a tube 3, while it additionally contains an antireflux valve 4, a roller clamp 5 and a silicone balloon 6, sequentially installed between percutaneous transhepatic biliary drainage 1 and percutaneous endoscopic gastrostomy 2, p why between the percutaneous transhepatic biliary drainage 1 and the silicone balloon 6 on the tube 3 there is a roller clamp 5 and an antireflux valve 4, while the silicone balloon 6 is installed with the possibility of entering the tube 3 from percutaneous transhepatic biliary drainage 1 and tube 3 from percutaneous endoscopic gastrostomy moreover, the antireflux valve 4 is installed with the possibility of the movement of bile through the tube 3 in one direction into the digestive tract (in FIG. not indicated), the roller clamp 4 is installed with the possibility of smoothly controlling the speed of movement of bile through the tube 3 from jet to drip, and the silicone balloon 6 with the possibility of dosed return of bile to the digestive tract during meals.

Device for the return of bile to the digestive tract in patients with obstructive jaundice operate as follows.

Bile ducts are drained followed by percutaneous transhepatic biliary drainage 1 under ultrasound control, then percutaneous endoscopic gastrostomy 2 is formed, followed by tube 3 connection, and antireflux valve 4, roller clip 5 and silicone are sequentially installed balloon 6, which is installed between percutaneous transhepatic biliary drainage 1 and percutaneous endoscopic gastrostomy 2, and between percutaneous transcutaneous With a biliary drainage 1 and a silicone balloon 6, a roller clamp 5 and an antireflux valve 4 are installed on the tube 3, and a silicone cylinder 6 is installed with the possibility of the tube 3 entering from the percutaneous transhepatic biliary drainage 1 and tube 3 from the percutaneous endoscopic gastrostomy 2, and the antireflux valve 4 are installed with the possibility of movement of bile through the tube 3 in one direction into the digestive tract (not indicated in Fig.), The roller clip 4 is installed with the possibility of smoothly controlling the speed of movement of lchi the tube 3 from the jet to the drip and the silicone cylinder 6 with the possibility of dosing the return of bile into the digestive tract with food.

Examples of specific applications of the device for the return of bile to the digestive tract in patients with obstructive jaundice.

Example. Patient L., 57 years old, with a diagnosis of obstructive jaundice, percutaneous transhepatic drainage of the bile ducts is performed, percutaneous transhepatic biliary drainage 1 is installed under ultrasound control, using the common method according to the Seldinger technique. The study is performed on an empty stomach, 30 minutes before the transdermal transhepatic procedure, the patient is intramuscularly injected with 1.0 ml of a 2% solution of promedol and relanium, with the help of a Chiba needle, the bile ducts are tightly filled with contrast medium and, without removing the needle, one from segmental ducts with a long needle with a diameter of 1.5-1.7 mm, along which a wire conductor is then passed, the end of the conductor is tended to be distal to the narrowing, and only then, the narrowing point of the bougie is enlarged and installed along it the tube 3 is infused, this manipulation is completed by fixing the drainage tube 3 to the skin and washing the bile ducts with sterile solutions (physiological saline, 0.25% novocaine solution, etc.).

For 1-2 days after percutaneous transhepatic biliary drainage 1, percutaneous endoscopic gastrostomy 2 is performed, after checking the kit for damage, the patient is placed in the “on the back” position, the endoscope is inserted into the stomach with simultaneous air isufflation, the front wall of the stomach is maximally lifted by the gastroscope, with In this shaded room, the assistant fixes the place of the most pronounced diaphanoscopy, the endoscopist should see a pronounced depression of the anterior wall of the stomach, after determining this area They treat the skin with antisepticemia in place of the alleged percutaneous endoscopic gastrostomy 2, paste a sterile surgical sheet with a round neckline, local conduction anesthesia of the skin, subcutaneous fat and aponeurosis are performed here. A scalpel makes a skin incision 0.5-1 cm long, a polypectomic loop is made through the endoscope instrument channel, its distal part is placed in the area of the most pronounced diaphanoscopy, a special needle with a trocar with a stylet 1.25 mm in diameter aponeurosis and anterior are pierced through the incision on the anterior abdominal wall the wall of the stomach, the trocar enters the lumen of the stomach, the stylet is removed and a wire loop with a plastic coating is introduced through the needle of the trocar into the lumen of the stomach, it is captured by a polypectomy loop. The endoscope and polypectomy loop are removed by dragging the wire loop behind it, which remains in the stomach, esophagus and oral cavity and is brought out, onto the end of the wire loop (by the loop-to-loop method), percutaneous endoscopic gastrostomy (CHEG) is fixed. 2. Pointed tip of CHEG 2 treated with antibacterial ointment, the oral cavity sanitized with an antiseptic. The wire loop is gradually pulled out of the abdominal wall, while ChEG 2 slowly immerses the patient in the mouth and stretches through the esophagus into the stomach, after the pointed part of ChEG 2 contacts the front wall of the stomach, with a stronger movement it is brought to the front abdominal wall (piercing the front wall stomach and anterior abdominal wall). The distal part of CHEG 2 (the “basket” of the ChEG “Entristar” or the “fungus” of the CHEG “Dobhoff”) is pressed from the inside to the front wall of the stomach.

The appropriate location of the tube 3, depending on the thickness of the abdominal wall, is determined using the marks placed on the tube, the tube 3 is fixed on the outside with a hold-down silicone disk, CHEG 2 is cut with scissors to the required length. A double port with caps is attached to CHEG 2, the caps are closed. The disk is pressed against the anterior abdominal wall for 3-5 days for adequate healing of tissues around the gastrostomy tube, then the fixation of the disk is somewhat weakened in order to prevent the development of pressure sores. Within one day after the operation, antibiotic therapy is carried out.

On the same day, the percutaneous transhepatic drainage 1 of the biliary tract is connected and the CHEG 2 is connected using the antireflux valve 4. Thus, bile is evacuated in one direction: from the bile duct to the digestive tract.

Install a roller clamp 5, which allows you to smoothly control the speed of movement of bile from jet to drip and a silicone balloon 6 for dosed return of bile to the digestive tract during meals. During meals, 100-300 ml of bile is injected, depending on the amount of food consumed.

The invention in comparison with the prototype and other known technical solutions has the following advantages:

- low invasiveness;

- elimination of biliary tract infection;

- creating conditions for slow and smooth decompression of the biliary tract;

- short hospitalization;

- cosmetic effect (scars from punctures of 5-10 mm are almost invisible);

- improving the quality of life of the patient;

- faster recovery of disability;

- reduction in the frequency of complications.

Literature:

1. Joseph M. Henderson. Physiology of the digestive system. M .: Binom. - 1997. - 221 p.

2. Pugaev A.V., Lidov P.I., Achkasov E.E., Negrebov M.G., Pokrovsky K.A., Aleksandrov L.V. Enteral nutrition in the complex treatment of patients with obstructive jaundice in gallstone disease. Clinical medicine. No. 1., 2008. Page 51-53.

3. Popov A.I., Izmaylov S.G., Izmaylov G.A., Parshikov V.V. Treatment and prevention of acholia syndrome. Tutorial. - Kazan, 2003

4. Altiev B.K., Nazyrov F.G., Vakkasov M.Kh., Sadykov Kh.T. Comprehensive treatment of purulent cholangitis in patients with non-tumor obstruction of extrahepatic bile ducts. // Annals of surgical hepatology. - 1998. - v. 3. - No. 3.- S. 30.

5. Babadjanov B.R., Kuryazov B.N. Magnetic laser therapy for cholangiolithiasis. // Annals of surgical hepatology. - 1998. - T. 3. - No. 3. - S. 34.

6. Lupaltsov V.I., Sennikov I.A., Khadzhiev A.Ch. On the issue of surgical tactics for the treatment of patients with acute cholangitis. // Annals of surgical hepatology. - 1998. - T. 3. - No. 3. - S. 80-81.

7. Hishaw D.B. Acute Obstructive Suppurative Cholangitis. // Surg. Clin. N. Amer. - 1973. - No. 53. - Vol. 5. - P. 1089-1095.

8. Borisov A.E., Borisova H.A., Verkhovsky B.C. Endobiliary interventions in the treatment of obstructive jaundice. - St. Petersburg: Aesculapius, 1997 .-- 152 p.

9. Borisova N.A., Borisov A.E., Kareev A.V. Endobiliary methods of correction of obstructive jaundice // Guide to surgery of the liver and biliary tract / Ed. Borisova A.E. T.2. - St. Petersburg: Scythia, - 2003. - S. 254-281.

10. Gusev A.V., I.N. Borovkov, C.T. Martins, Guseva E.V., Pokrovsky E.Zh., Evtikhova E.Yu. New technologies for obstructive jaundice of benign origin. Annals of Surgical Hepatology, 2008, Volume 13, No. 1. Page 72-75

11. Briskin, B.S., Demidov D.A. Endoscopic debridement of the common bile duct and cholangioenterosorption in the treatment of cholangitis and obstructive jaundice. Endoscopic Surgery, 4, 2005. Pp. 3-8.

12. Kinoshita H., Hirohashi K., Igawa S., Nagata F., Sakai K. Cholangitis. // World I. Surg. - 1984. - No. 8. - Vol. 6. - P. 963-969.

13. Zhuraev Sh.Sh., Teleuov M.K., Baymakhanov BB et al. Percutaneous endoscopic gastrostomy // Thes. doc. 2nd Moscow Int. Congr. by endoscope, chir. - M., 1997. - S. 165-166.

14. The basics of clinical nutrition: Materials of lectures for courses of the European Association of Parenteral and Enteral Nutrition / Ed. L. Sobotka; Per. from English G.P. Tikhova, G.I. Yusupova. - 2nd ed. - Petrozavodsk: IntelTech, 2004.-416 p.

15. Haggle J.A. Laparoscopic tube gastrostomy // Ann. R. Coll. Surg. Engl. 1992. - Vol. 74. - P. 258-259.

16. N.E. Chernekhovskaya, V.G. Andreev, D.P. Cherepyantsev, A.V. Povalyaev Therapeutic esophagogastroduodenoscopy. 2009 year

17. Simbirtsev S.A. The basics of operative surgery. - SPb .: Hippocrates Publishing House, 2002. - 632 p.

18. Halperin, E.I. Obstructive jaundice: the state of "imaginary stability", the consequences of the "second stroke", the principles of treatment / E.I. Halperin // Annals of a surgeon, hepatology. - 2011. - No. 3. - S.16-25.

Claims (1)

A device for returning bile to the digestive tract in patients with obstructive jaundice, containing transdermal transhepatic biliary drainage and a tube for percutaneous gastrostomy, interconnected, characterized in that it is additionally equipped with a roller clamp, antireflux valve and silicone balloon, sequentially mounted on the tube between the b drainage and a tube for percutaneous endoscopic gastrostomy, and the roller clamp and antireflux valve are installed on the tube between the percutaneous hepatic and biliary drainage balloon silicone, and the silicone balloon mounted to its entrance tube of percutaneous transhepatic biliary drainage tubes and percutaneous endoscopic gastrostomy.

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