RU163692U1 - DEVICE FOR SYMPTOMATIC TREATMENT OF ASCITIS IN WOMEN - Google Patents

Abstract

A device for the symptomatic treatment of ascites in women, intended for installation in the posterior vaginal fornix, which is a silicone drainage tube 10 cm long with a diameter of 0.5 cm, equipped with an antireflux valve at the end of the drainage tube.

Description

A device for the symptomatic treatment of ascites in women.

The technical field to which the utility model relates.

The utility model relates to the field of medicine, in particular, to a device for the symptomatic treatment of ascites in women with ovarian cancer, and can be used in oncology, gynecology and surgery.

State of the art

A known method of treating ascites by introducing the proximal ends of the drainage tubes 20 into the abdominal cavity, and their distal ends into the subcutaneous fat, characterized in that, in order to completely drain the ascitic fluid, the proximal ends of the tubes are inserted into the right and left iliac regions, and the distal ends they are introduced into the subcutaneous tissue of the right and left thighs, respectively (see US Pat. SU 888950, IPC A16B 17/00, publ. 12/15/1981).

The disadvantages of the above treatment method is inconvenient for the patient and the circulation of atypical cells in the circulatory system.

There is a method of treating liver failure in patients with ascites by evacuating ascitic fluid and its subsequent sorption and reinfusion in a volume of two liters, characterized in that the ascitic fluid is evacuated simultaneously in full, and after sorption lyophilized and dissolved before reinfusion in such a way that two liters the resulting fluid correspond to eight liters of ascitic fluid, while the remaining fluid is administered fractionally every other day (see US Pat. RU 2092107, IPC A61B, publ. 10.10.1997 g).

The disadvantages of this method is inconvenient for medical personnel, the patient, the complexity of the treatment, the patient is in the hospital and the circulation of atypical cells in the circulatory system.

There is a method of treating cirrhosis of the liver complicated by diuretic-resistant ascites, including taking ascitic fluid from the abdominal cavity and reinfusing it into the venous channel until complete regression and stopping ascites on the background of conventional conservative therapy, characterized in that the sampling and reinfusion is carried out through a fully implantable peritoneal system which is installed in the subcutaneous tissue, while the port system catheter is inserted into the abdominal cavity, the working end of the catheter is installed in the iliac fossa, implantation of a catheter to the rectus muscle by the cuff, connecting it to the port, connect the transfusion system through an infusomat to the port system, connect the venous end of the transfusion system to the subclavian vein, and additionally, before and during reinfusion, ascitic fluid is irradiated with low-energy helium-neon a laser with a laser output of 10 mW, an exposure of 10-15 min, a wavelength of 0.63 μm in continuous mode, and ascites fluid reinfusion is carried out at a speed of 15-20 ml per minute, fractionally 500-700 ml per interval ohm in 5-7 minutes, daily in a volume of 1.5-2.5 liters with a decrease in the initial volume to 1.05-0.55 liters (see US Pat. RU 2376039, IPC A61M 5/14, A61N 5/067, publ. 12/20/2009).

The disadvantages of this method of treatment is its low efficiency in cancer patients, inconvenient for medical personnel and the patient.

A known method for the surgical treatment of diuretic-resistant ascites in cirrhosis of the liver, including the formation of a shunt between the abdominal cavity and the venous system, characterized in that the shunt is placed between the femoral vein and the abdominal cavity, and the patient’s own large saphenous vein with the saved valve apparatus is used as a shunt (see Pat. KZ (13) A4 (11) 24812, IPC A61B 17/00, publ. 15.11.2011, bull. No. 11)

The disadvantages of the above method is its low efficiency in cancer patients, the inconvenience of use 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 a method of performing laparocentesis (puncture of the abdominal cavity) in cancer patients. Laparocentesis is often performed as a palliative intervention that can significantly alleviate the patient's condition. It can result in the installation of drainage tubes for long-term evacuation of fluid. As a rule, this procedure is performed every 3-4 weeks, taking into account the patient's condition and the rate of accumulation of ascitic fluid. Rapid unloading of the abdominal cavity from excess pressure created by ascitic fluid leads to secondary deformations of internal organs, disruption of their structure (architectonics) and nutrition (trophic), the occurrence of ischemia and the development of fibrosis, (see Savelyev BC et al. Guide for emergency organ surgery abdominal cavity. M, 2004. Clinical surgery. National management. Edited by BC Savelyeva, AI Kirienko / Publisher: GEOTAR-Media, 2008).

The disadvantages of installing a drainage tube in the abdominal cavity are its leakage, migration, and the most common is the requirement for constant care of the catheter, the possible development of peritonitis and clogging of the catheter. One of the complications of repeated puncture is the fusion of the greater omentum or intestine with the anterior abdominal wall, which will greatly impair intestinal function and create the threat of serious complications during subsequent punctures.

Utility Model Disclosure

The objective of the proposed utility model is to develop a device for the symptomatic treatment of ascites in women with ovarian cancer, which eliminates massive compression of the internal organs, normalizes intra-abdominal pressure, lymph drainage, respiratory, heart failure disappears and the patient's quality of life improves.

The technical result that can be obtained using the proposed utility model is reduced to a constant, smooth removal of ascitic fluid from the abdominal cavity, which leads to an improvement in the quality of life of the patient.

The technical result is achieved using a device for the symptomatic treatment of ascites in women with ovarian cancer, containing a drainage tube, while it is additionally equipped with an antireflux valve and a clamp, and a drainage tube is installed in the posterior vaginal fornix, while the antireflux valve is installed at the end of the drainage tube with the possibility of the movement of ascitic fluid in one direction, and the retainer - with the possibility of fixing the drainage tube with antireflux valve in the posterior vaginal fornix .

The fixture uses a purse string suture as a retainer. In ovarian cancer, ascites begins to develop when there is dissemination of metastases along the peritoneum, in which numerous lymphatic and blood vessels are located. The immediate cause of ascites in ovarian cancer is blockage by metastatic tumors of the lymphatic vessels and nodes located on the peritoneum and in the abdominal cavity. The accumulation of fluid in the abdominal cavity (sometimes more than 20 l) leads to an increase in intra-abdominal pressure and the diaphragm is pushed into the chest cavity. As a result, respiratory movements of the lungs are significantly limited (up to the development of respiratory failure), cardiac activity is impaired, and blood flow resistance in the abdominal organs increases, and their functions are also impaired. With long-term ascites, a violation of the drainage of the lymphatic system occurs due to excessive fluid pressure. As a result, in the area of the connection of the lymphatic system of the lower extremities and the organs of the abdominal cavity there is a violation of the lymphatic flow and, as a result, edema of the lower extremities. In addition, there is a return flow of lymph from the main lymphatic vessel - the thoracic lymphatic duct - to the internal organs.

The protein concentration in serous ascitic fluid is relatively low, but its total loss with massive ascites can be significant, especially with frequent repeated fluid removal by puncture of the abdominal cavity (in this case, protein loss is combined with loss of salts), which leads to the development of protein deficiency.

Ascites against the background of oncology causes great inconvenience and functional impairment, especially if the patient has the last stage of the disease. Ascites is inherently a serious problem, the removal of which will not only help to improve the patient's quality of life, but can also prolong his life.

Thus, the achievement of the technical result is achieved by installing a drainage tube with an antireflux valve in the posterior vaginal fornix and fixed with a purse string suture.

The essence of the device for the symptomatic treatment of ascites in women with ovarian cancer is as follows. A gynecological chair examines the external and internal genital organs in the mirrors, bimanually and rectovaginally. In the mirrors, the posterior lip of the cervix is taken on bullet forceps. Puncture of the posterior vaginal fornix is performed with a syringe. Ascitic fluid is evacuated. Using a metal conductor with a diameter of 0.1 cm, a silicone drainage tube with a length of 10 cm and a diameter of 0.5 cm with an anti-reflux valve is installed to move ascites fluid in one direction. Under local anesthesia in the posterior vaginal fornix, a purse string suture is performed with a vikril thread. The drainage tube with the antireflux valve is fixed with vikrilovymi threads.

Brief description of drawings and other materials

In FIG. 1, a device is provided for the symptomatic treatment of ascites in women with ovarian cancer, general view.

In FIG. 2, too, the installation of a device for the symptomatic treatment of ascites in women with ovarian cancer in the posterior vaginal fornix.

In FIG. 3, too, a drainage tube with an antireflux valve, fixed with vikrilovym threads in the posterior vaginal fornix.

The implementation of the invention

The device for the symptomatic treatment of ascites in women, suffering from ovarian cancer, consists of a drainage tube 1, while it is additionally equipped with an antireflux valve 2 and a clamp 3, and the drainage tube 1 is installed in the posterior vaginal vault 4, while the antireflux valve 2 is installed at the end drainage tube 1 with the possibility of ascitic fluid movement in one direction, and the retainer 3, which is used as a purse string suture, vikrilovy thread, with the possibility of fixing the drainage tube 1 with antireflux valve m 2 in the back vault of the vagina 4. On gynecological chair (Fig. not shown) is performed inspection of external and internal genitalia speculum (Fig. not shown), and rectovaginal bimanual. In the mirrors, the posterior lip of the cervix 5 is taken onto the bullet forceps 6. The posterior vaginal fornix 4 is punctured with the syringe 7. The ascitic fluid 8 is evacuated (see Fig. 2). Using a metal (wire) conductor (not shown in Fig.) With a diameter of 0.1 cm, a silicone drainage tube 1 with a length of 10 cm and a diameter of 0.5 cm 1 is installed, at the end of which an antireflux valve 2 is installed for the purpose of movement of ascitic fluid 8 in one direction. Under local anesthesia in the posterior vaginal fornix 4, a purse string suture is performed with a vikril thread, which is a retainer 3, that is, the drainage tube 1 is fixed with an antireflux valve 2 with vikril threads (see Fig. 3).

A device for the symptomatic treatment of ascites in women with ovarian cancer is operated as follows.

An example of a specific application of the method of symptomatic treatment of ascites in a woman with ovarian cancer.

Patient N., 65 years old, with a cytologically verified diagnosis: ovarian cancer. According to the ultrasound scan, tumors in the ovaries, abdominal carcinomatosis, pelvis, and ascites fluid in large quantities were detected. Of the concomitant diseases, hypertension, type 2 diabetes mellitus is noted. At the first stage of treatment, the patient is recommended to conduct neoadjuvant chemotherapy with a further assessment of the treatment and to decide on the possibility of surgical treatment and evacuation of ascitic fluid as it accumulates in the abdominal cavity at the place of residence.

Objectively: the skin is pale pink, dry, spider veins on the chest. In the lungs, weakened breathing. The abdomen is increased in volume due to ascites (circle - 108 cm), a pronounced venous pattern on the skin of the abdomen, edema on the lower extremities. In blood tests: HB - 106 g / l; ESR - 42 mm / h; white blood cells 7.9 / 10/9 g / l; platelets - 134 thousand; total bilirubin - 18 mmol / l; direct - 16 mmol / l; urea - 4.3 mmol; albumin - 47; total protein 56 μmol / L. In the urine: white blood cells - 20-30 in n / a.

A gynecological chair performs a gynecological examination of the external and internal genital organs in the mirrors, bimanually and rectovaginally. In the mirrors, the posterior lip of the cervix 5 is taken onto the bullet forceps 6. The posterior vaginal fornix is punctured with 4 syringes. 7. Ascitic fluid is evacuated 8. Using a metal (wire) conductor with a diameter of 0.1 cm, a silicone drain tube 1 with a length of 10 cm and a diameter of 0 is installed , 5 cm 1, at the end of which an antireflux valve 2 is installed for the purpose of movement of ascitic fluid 8 in one direction. Under local anesthesia in the posterior vaginal fornix 4, a purse string suture is performed - fixative 3 with a vikril thread. The drainage tube 1 is fixed with an antireflux valve 2 with vikrilovymi - clamp 3.

After installing the drainage tube 1 through the posterior vaginal fornix 4, the patient constantly exits ascitic fluid 8. In this case, the use of diapers for adults is necessary. The world's leading manufacturers give them comfort, environmental friendliness, reliability and minimal harm to health.

When the patient is discharged in the analyzes: HB - 112 G / l; ESR - 32 mm / h; white blood cells - 5,4 / 10/9 l; platelets - 176 thousand total protein - 67 μmol / l; albumin - 58; globulins 42; urea - 3.6; in the urine, leukocytes 2-3 in the field / vision. The condition improved, sleep normalized, body temperature was within normal limits, vesicular breathing in the lungs, edema on the lower extremities went away. Abdominal circumference 89 cm. Daily diuresis - 1.5-2 liters.

The proposed utility model in comparison with the prototype and other well-known technical solutions has the following advantages:

- smooth and automatic evacuation of ascitic fluid;

- installation of a drainage tube at the lowest point of the abdominal cavity;

- compactness and usability of the device;

- low invasiveness;

- improving the quality of life.

Claims (1)

A device for the symptomatic treatment of ascites in women, intended for installation in the posterior vaginal fornix, which is a silicone drainage tube 10 cm long with a diameter of 0.5 cm, equipped with an antireflux valve at the end of the drainage tube.

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