RU2139744C1 - Method for performing lymphogenic detoxication - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves opening inferior pole of superficial inguinal lymphatic node. The pole is resected. Intranodular pulp is removed. Proximal end of truncated standard type subclavicular catheter is immersed 3 mm deep into the lymphatic node cavity. 5000 ED of heparin is introduced into catheter. The catheter is fixed on skin surface. Lymphatic tissular drainage is carried out by injecting intravenously 10% Mannitol solution in the amount of 400 m after applying preliminary aqueous loading. Optic polymer light of 0.5 mm diameter guide is introduced into the lymphatic node cavity 2 mm distant from proximal catheter end, 40 min later after injecting 10% Mannitol solution. Lymph is exposed to laser radiation using AROPAK 530 laser apparatus. 5000 ED of heparin is introduced into the subclavicular catheter and lymphatic node lumen. The procedures are administered once a day during 7-10 days. EFFECT: enhanced effectiveness of treatment; accelerated detoxication method. 1 dwg

Description

 The invention relates to medicine, namely to surgery, and is intended for lymphogenous detoxification, a general corrective effect on the patient’s body and reduction of treatment time for patients.

 A known method of lymphogenous detoxification, including exposure to helium lymph by a neon laser through a light guide inserted into the lymph vessel of the lower third of the leg, with a power of 2-3 mW for 50 to 45 minutes, 1 time per day. The patient is injected with a monofilament optical fiber through a catheter, which is inserted into a peripheral lymphatic vessel, and a fiber with a diameter of 50 μm is injected to a depth of 10 - 12 cm, irradiation is carried out by laser radiation with a wavelength of 632.8 nm, a power of 2 - 3 mW for 30 - 40 minutes 1 time per day for 5-8 days (see RF patent N 2005511, class A 61 N 5/06, 1990).

The disadvantages of the method:
1. The application of the method is impossible in patients with thrombobliterative diseases of the lower leg due to deformation of the lymphatic vessels of the lower leg, their hypoplasia, increased permeability, lymphangiospasm and thrombosis of the lymphatic vessels.

 2. High perforating ability of the lymphatic vessel of the lower leg when performing the method.

 3. A high risk of irritation of the intima of the lymphatic vessel of the lower leg with the appearance of inflammatory phenomena in it when performing the method, especially in conditions of increased lymphotoxicity.

 4. High risk of thrombosis of the lymphatic vessel of the leg with the method and the absence of prevention of lymphothrombosis.

 5. When performing the method, the circulation of lymph in the distal part of the lymph vessel of the leg is disturbed.

 6. To perform the method, appropriate microsurgical instruments are necessary.

 7. When performing the method, the effectiveness of lymphogenous detoxification is insignificant due to the low speed of lymph flow in the lymph vessel of the lower leg, the small volume of lymph that is exposed to laser exposure, the low dose of laser radiation, the longer the concentrated toxins are in the lymphatic channel, because inhibited lymphatic drainage of tissues.

 8. The application of the method requires special skills in the detection and catheterization of the lymphatic vessel of the lower leg.

 9. The application of the method is impossible in patients with amputated lower extremities at the hip level.

 10. The method is contraindicated in diseases in which laser therapy is contraindicated.

 The purpose of the invention is the conduct of lymphogenous detoxification, a general corrective effect on the patient’s cut and the reduction of the treatment time for patients.

 The goal is achieved by exposing the lower pole of the superficial inguinal lymph node, resecting the lower pole, removing the intranodular pulp, trimming the tubular part of the standard polyvinyl chloride subclavian catheter with an inner diameter of more than 0.5 mm to the length of the tubular part 6 cm from the catheter socket, checking its patency, immersion the proximal end of the truncated catheter by 3 mm into the cavity of the lymph node, fixing it to the capsule of the lymph node, introducing 5000 U of heparin into the catheter, fixing the catheter to the skin, lymphatic drainage of tissues by intravenous administration of 10% mannitol solution in an amount of 400 ml after a preliminary "water load", introduction after 40 minutes from the beginning of intravenous administration of 10% mannitol solution of a polymer optical fiber with a diameter of 0.5 mm into the cavity of the lymph node 2 mm from the edge the proximal end of the catheter, laser irradiation of the lymph with a laser device AROPAK 530 with a wavelength of 0.63 μm and a power of 2 mW for 50 minutes, removing the fiber, introducing into the lumen of the subclavian catheter and lymph cal unit 5000 U of heparin 1 times a day for 7 - 10 days.

 The essence of the invention lies in the fact that when exposing the lower pole of the superficial inguinal lymph node, resecting its lower pole, removing the intranodular pulp, truncating the tubular part of a standard PVC subclavian catheter with an inner diameter of more than 0.5 mm to the length of the tubular part 6 cm from the catheter socket, checking its patency, immersing the proximal end of the truncated catheter by 3 mm in the cavity of the lymph node, fixing it to the capsule of the lymph node, introducing 5000 U of heparin into the catheter, fixing it Teter to the skin, lymphatic drainage of tissues by intravenous administration of 10% mannitol solution in an amount of 400 ml after preliminary “water loading”, 40 minutes after the start of intravenous administration of 10% mannitol solution of a polymer optical fiber with a diameter of 0.5 mm into the lymph node cavity 2 mm from the edge of the proximal end of the catheter, laser irradiation of the lymph with a laser device AROPAK 530 with a wavelength of 0.63 μm and a power of 2 mW for 50 minutes, removing the fiber, introducing into the lumen of the subclavich th catheter and lymph node of heparin 5000 U 1 times a day for 7-10 days, provided lymphogenous detoxification, obschekorregiruyuschee effects on the body of the patient and reduce the time of treatment.

 To implement the invention, additional material costs are not required.

 The method provides lymphogenous detoxification, a general corrective effect on the patient's body and a reduction in the treatment time of patients.

 The simplicity and effectiveness of the method allows it to be widely used in practical health care.

 The method is as follows.

 Palpation in a patient determines the largest superficial inguinal lymph node. Their sizes in adults are from 8 x 16 to 10 x 18 mm. Under local anesthesia with a 1% solution of novocaine in the amount of 15.0 ml by a longitudinal section 3.5 cm long in the projection of this superficial inguinal lymph node / 1 /, the skin and subcutaneous fatty tissue are dissected, its lower pole is exposed / 2 /. It is important not to damage the lymphatic vessels / 3 / (see drawing).

 Next, the lower pole of the lymph node / 2 / is cut off with a scalpel to 1/6 of its longitudinal size and intranodular pulp is carefully removed with a small Volkman spoon. Retreating 1 mm from the resected edge of the lymph node, along its perimeter with a 6/0 ligature, a purse string suture / 4 / on the capsule / 5 / of the lymph node is placed on the atraumatic needle. Then they take a standard polyvinyl chloride subclavian catheter with an inner diameter of more than 0.5 mm, truncate its tubular part with a scalpel to a length of 6 cm from the catheter’s socket, check its patency with a 1% novocaine solution and the proximal end of the truncated catheter / 6 / is immersed in the formed cavity of the lymph node on 3 mm and tie a purse string suture / 4 /. By introducing into the catheter 5000 IU of heparin standard solution in a volume of 1 ml, two are checked for leaks on a truncated catheter. Sutures are placed on the skin and subcutaneous tissue, the catheter is fixed to the skin.

 A session of intranodular laser exposure of lymph is combined with stimulation of lymphatic tissue drainage. The latter is carried out by intravenous administration of a 10% solution of mannitol in an amount of 400 ml after a preliminary "water load" in an amount of 1.5 - 2.0 liters, at a speed of 40 - 60 drops per minute. 40 minutes after the start of administration of the mannitol solution, observing all the rules of asepticism and introducing an injection needle through the subclavian catheter tube with a fiber in its lumen, a polymer optical fiber 0.5 mm in diameter is inserted through the truncated subclavian catheter tube into the cavity of the truncated subclavian catheter / 8 /. Visually determine the end of the fiber in the lumen of the catheter. Knowing the length of the installed truncated standard PVC catheter from the proximal end to the outer surface of its tube (8.7 - 8.8 cm), a part of the polymer fiber is 2 mm longer than the length of the installed truncated standard subclavian catheter / 9 / in the cavity of the subclavian catheter . The end of the fiber enters the cavity of the lymph node 2 mm from the edge of the proximal end of the catheter. Then, along the introduced fiber / 10 /, laser irradiation of the lymph (the "lymphatic lake") is carried out with the AROPAK 530 laser apparatus with a wavelength of 0.63 μm and a power of 2 mW for 50 minutes. Then the light guide is removed from the cavity of the lymph node and subclavian catheter and given for processing. Then, 5000 IU of a standard solution of heparin in a volume of 1 ml is injected into the lumen of the subclavian catheter and lymph node. A course of 7-10 sessions.

In our opinion, the advantages of the method are as follows:
1. Easy enough to use.

 2. Reliable in practical use.

 3. Does not require any additional material costs.

 4. Increases the effectiveness of lymphogenous detoxification of the body due to laser irradiation of a larger volume of lymph.

 5. Provides a general corrective effect on the patient's body.

 6. It can be used in the complex therapy of various diseases, where laser therapy is indicated.

 7. Reduces the treatment time for patients.

 8. Helps to stimulate both cellular and humoral immunity.

 9. Provides increased lymph formation, dilution of toxins and accelerates the elimination of cellular poisons from the tissues and lymphatic system with lymph.

 10. It is much easier to find and catheterize the inguinal lymph node than the lower leg lymph vessel.

 11. The application of the method is possible in patients with thromboobliterative diseases of the leg.

 12. The perforating ability of the capsule of the lymph node is negligible compared to the perforating ability of the lymph vessel of the lower leg.

 13. The depulped lymph node is little susceptible to the development of inflammatory phenomena in it when performing the method in comparison with the intima of the lymphatic vessel of the lower leg, even in conditions of increased lymphotoxicity.

 14. The risk of thrombosis of the lymph node ("lymphatic lake") is low compared to the lymph vessel of the lower leg, because lymphatic drainage of tissues, lymphatic drainage of the lymph node and lymphatic system are carried out, the diameter of the "lymphatic lake" (depulped cavity of the inguinal lymph node) is much larger compared to the diameter of the lymphatic vessel of the lower leg, lymphothrombosis with a standard heparin solution is prevented.

 15. When performing the method, the lymph circulation in the distal parts of the lymphatic system of the lower extremities is not disturbed.

 16. To perform the method does not need microsurgical instruments and catheters. To perform the method, general surgical instruments and a standard polyvinyl chloride catheter are used.

 17. The application of the method does not require special skills in the detection and catheterization of the superficial lymphatic inguinal node.

 18. The application of the method is possible in patients with amputated lower extremities at the hip level.

 The method is contraindicated in all diseases in which laser therapy is contraindicated.

In the drawing, the numbers indicate
1. Superficial inguinal lymph node.

 2. The lower pole of the superficial inguinal lymph node.

 3. Lymphatic vessels.

 4. A purse string suture.

 5. Capsule of the superficial inguinal lymph node.

 6. The proximal end of the truncated polyvinyl chloride standard subclavian catheter.

 7. The resulting cavity of the lymph node after removal of the pulp ("lymphatic lake").

 8. Cavity truncated polyvinyl chloride standard subclavian catheter.

 9. Truncated polyvinyl chloride standard subclavian catheter.

 10. A polymer fiber in the lumen of a truncated PVC standard subclavian catheter.

Claims (1)

 A method of lymphogenous detoxification, including laser irradiation of lymph with a helium-neon laser, characterized in that, in order to conduct lymphogenous detoxification, general corrective effect on the patient’s body and reduce the treatment time of patients in a hospital, the lower pole of the superficial inguinal lymph node is exposed, its lower pole is resected, remove the intranodular pulp, truncate the tubular part of a standard polyvinyl chloride subclavian catheter with an inner diameter of more than 0.5 mm to a length of tubular part 6 cm from the catheter’s bell, check its patency, immerse the proximal end of the truncated catheter 3 mm into the cavity of the lymph node, fix it to the capsule of the lymph node, introduce 5000 U of heparin into the catheter, fix the catheter to the skin, conduct lymphatic drainage of tissues by intravenous injection of 10% mannitol in an amount 400 ml after the preliminary “water load”, injected after 40 minutes from the start of intravenous administration of 10% mannitol solution, a polymer optical fiber with a diameter of 0.5 mm into the cavity of the lymph node 2 mm from the edge of the prox of the small end of the catheter, laser irradiation of the lymph with a laser apparatus AROPAK 530 with a wavelength of 0.63 μm and a power of 2 mW for 50 minutes is carried out, a fiber is removed, a 5000 IU of heparin is inserted into the lumen of the subclavian catheter and lymph node 1 time per day for 7 - 10 days.