RU2188580C1 - Method for applying intraoperation contrast ultrasonic diagnostic examination of uterine diseases - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying echographic examination in dynamic mode during surgical intervention concurrently using transrectal ultrasonic gauge having working frequency of 5.0 MHz and laparoscopic ultrasonic gauge having working frequency of 5.0-7.5 MHz introduced through trocar into abdominal cavity until contact to organ area under investigation is achieved. 400-600 ml of liquid is to be preliminarily introduced into the small pelvis area to create acoustically contrasting window. The obtained echographic histeroscopic and laparoscopic images are used for making more accurate evaluation of localization, dimensions and boundaries of pathological process in the organ under study. EFFECT: high accuracy of diagnosis; enhanced effectiveness of surgical intervention. 2 cl

Description

 The invention relates to medicine, namely to intraoperative ultrasound diagnosis of uterine diseases.

 Endoscopic reconstructive plastic surgery in gynecological patients of reproductive age have important medical and social significance, since they allow not only to remove the pathological focus, but also to restore the disturbed functions of the woman's reproductive system. Fundamentally important for organ-preserving operations is the adequate removal of the pathologically changed part of the organ. The success of the complete removal of pathological formations depends on the accuracy of determining the localization, the severity of the pathological process, as well as on the capabilities of the surgical method. In general, all this allows us to determine the correct surgical tactics and scope of the operation.

 The traditional preoperative diagnosis of many gynecological diseases is often not sufficiently informative during surgery.

 Diagnosis of small sizes of myomatous nodes located in the thickness of the organ and not changing their contour is quite complicated, even with direct visualization during laparoscopy or hysteroscopy. Endoscopic diagnostic methods are informative only with an intracavitary arrangement of formations. Very often, it is not possible to completely remove the lesions due to an inferior diagnosis during surgical interventions in an endoscopic way.

 One of the main indicators characterizing the effectiveness of reconstructive operations is the frequency of disease recurrence. In this regard, an intensive search is underway for new methods of diagnosis and surgical treatment. Despite the great attention of clinicians and researchers to this problem, the frequency of recurrence of many gynecological diseases to date remains quite high.

 Ultrasound examination (ultrasound), nuclear magnetic resonance (NMR), computed tomography (CT) are more informative in the presence of intraorgan formations. Of all the diagnostic research methods, mainly used during surgical interventions, ultrasound deserves the most attention.

 Intraoperative ultrasound monitoring during surgical hysteroscopy ensures the correct direction of the instruments in relation to the uterine wall, which avoids intraoperative complications and simultaneous control laparoscopy.

 Sarkisov S.E. and Azieva A.A. (1998) [1] used intrauterine ultrasound imaging during hysteroscopy and concluded that this technique allows you to clearly visualize the functional layer of the endometrium.

 Lipitz S. and Seidman D. in 1996 [2] conducted a study that evaluated the benefits of using ultrasound for laparoscopic removal of cysts.

 In the work of Yang W. and Full S. (1999) [3], considered as a prototype, an ultrasound intraoperative diagnostic method is considered, in which an echographic study is performed by introducing a laparoscopic ultrasound sensor during operative access into the abdominal cavity, benign and differentiated by the received image malignant formations of the female genital organs and choose the scope of surgical intervention. This method, as previously mentioned, is necessary in operative gynecology, however, it is not sufficiently informative in the differential diagnosis of pathological conditions of the uterus and is not used in hysteroscopic and hysteroresectoscopic operations, which does not completely remove the formation and adequately plan surgical tactics.

 The alleged invention is aimed at increasing the possibility of endoscopic surgical interventions, obtaining additional accurate diagnostic information, improving ultrasound imaging.

 The essence of the invention lies in the fact that in the method of intraoperative contrast ultrasound diagnosis of uterine diseases, an echographic study is carried out in dynamics, introducing a laparoscopic ultrasound sensor during laparoscopy and analyzing the image obtained, while 400-600 ml of liquid are previously injected into the pelvic area during hysteroscopy for creating a contrast acoustic window, followed by a transrectal ultrasonic sensor with an operating frequency of 5.0 MHz and laparoscopic ultrasound an ultrasonic transducer with operating frequencies of 5.0 and 7.5 MHz, inserted through the trocar into the abdominal cavity before contact with the investigated area of the organ through the acoustic window, simultaneously conduct research and obtain ultrasound hysteroscopic and laparoscopic images, which specify the location, nature and boundaries of the pathological process of the investigated organ.

 In addition, in the proposed method, the analysis of the study can be supplemented by the introduction of a third visual laparoscopic image, obtained simultaneously with ultrasound.

 As a free fluid introduced into the abdominal cavity, physiological saline can be used. At the same time, in the uterine cavity with a hysteroscopic and hysteroresectoscopic intervention, there is always a liquid forming a second contrasting acoustic window. Thus, in an ultrasound examination, the uterine wall is between two fluid media that have the properties of contrasting acoustic windows, which significantly improves sound conductivity, visualization quality and, in general, increases the information content of the method.

 Double contrasting during echography during surgical interventions on the uterus significantly increases the effectiveness of the operation, that is, it allows you to accurately differentiate the nature of the pathological process, identify, clarify the location, boundaries and nature of the formation, determine the operative access and control the absolutely full removal of the formation.

 Intraoperative ultrasound is especially highly informative when separating adhesions and removing large formations and in cases where there is a violation of the anatomy of the pelvis.

 The method makes it possible to intraoperatively determine the volume and tactics of the operation, reduces the total duration of the operation, reduces the invasiveness of the intervention, intraoperative blood loss, the frequency of postoperative complications and repeated surgical interventions, generally reduces the frequency of disease recurrence, increasing the effectiveness of surgical treatment.

The proposed method is as follows:
ultrasound is performed, for example, by installing SIEMENS SIENA using transrectal and laparoscopic sensors operating at frequency characteristics of 5.0 and 7.5 MHz, simultaneously during endoscopic surgical interventions. 400-600 ml of fluid is injected into the abdominal cavity. A liquid is also injected into the uterine cavity with a hysteroscope. A 10 mm bi-directional laparoscopic sensor is inserted through the wound hole into the abdominal cavity through the trocar until it contacts the uterus. At the same time, the surgeon works in the uterine cavity. Ultrasound examination through acoustic media and the resulting high-quality image clearly define and clarify the boundaries, sizes and nature of the pathological process.

The method is illustrated by the following examples:
Example 1. Patient B., 43 years old. Diagnosis: multiple uterine fibroids with submicose node location. At the final stage of the conservative myomectomy operation (hysteroresectoseopia and laparoscopy), transrectal and laparoscopic echography was applied according to the presented method and the remains of the myomatous node 1.3 cm in diameter were found, which were not visible either during hysteroscopy or laparoscopy. The diagnosis was verified by histological examination of a macrodrug.

 In this case, the localization of a part of the incompletely removed myomatous node that was not visualized by standard hysteroscopic and laparoscopic examinations was revealed and accurately determined. Thus, intraoperative contrast laparoscopic and transrectal ultrasound imaging allowed us to control absolutely complete removal of the formation.

Example 2
Patient B., 25 years old. Diagnosis: adhesive process in the small pelvis, synechia of the uterine cavity, bone remnants in the uterine cavity and myometrium. Echography according to the proposed method clarified the localization and amount of bone tissue and controlled the absolutely complete removal of the pathological formation.

 Example 3

 Patient B., 32 years old. Diagnosis: adhesive process in the pelvis, synechia of the uterine cavity, uterine fibroids. During hysteroscopy revealed a thickening of the posterior wall of the uterus. Initially, during a laparoscopic and hysteroscopic examination, the diagnosis was incorrectly made - uterine fibroids with centripetal growth.

 Using the proposed method, the nosology was clarified: internal endometriosis in a focal form with lesions of the posterior wall, while the surgical tactics - hysteroresectoscopy (conservative myomectomy) for curettage of the uterine mucosa were changed. The application of the method made it possible to intraoperatively determine the scope of the operation and change the surgical tactics.

 Thus, the method expands the possibilities of endoscopic interventions, allows you to accurately differentiate the nature of the pathological process, identify, clarify the location, boundaries of the pathological process, determine the operative access and controls the complete removal of the formation, which generally reduces the frequency of postoperative complications, the frequency of recurrence of diseases and repeated surgical interventions, increasing the effectiveness of surgical treatment.

Literature
1. Sarkisov S. E., Aziev A. A., Kuznetsov R. E. The first experience of using intrauterine ultrasound. Ultrasound diagnostics. 1998.2, p. 22-26.

 2. Lipitz S., Seidman D., Achion R. Laparoscopic surgical managment of ovarion cysts assisted by simultaneous transvaginal ultrasography. J. Reprod Med. 1996. V. 41, 5, p. 304-306.

 3. Yang WT. Full S. Comparison of laparoscopic sonography with surgical pathology in the evaluation of pelvic lymph nodes in women with cervical cancer. Am J Roentgen. 1999. V.172, 6, p. 1521-1525. (Prototype).

Claims (2)

 1. The method of intraoperative contrast ultrasound diagnosis of uterine diseases by conducting an echographic study in dynamics through the introduction of a laparoscopic sensor during operative access and analysis of the obtained image, characterized in that 400-600 ml of liquid is injected into the pelvic area during hysteroscopy or hysterectomy to create a contrast acoustic window, followed by a transrectal ultrasonic sensor with an operating frequency of 5.0 MHz and laparoscopic ultrasound a probe with operating frequencies of 5.0 and 7.5 MHz, inserted through the trocar into the abdominal cavity before contact with the organ’s area of interest, is simultaneously examined through an acoustic window and echographic hysteroscopic and laparoscopic images are obtained, which specify the location, nature and boundaries of the pathological process of the investigated organ.  2. The method according to p. 1, characterized in that in addition when conducting research using laparoscopic visual image.