RU2212915C1 - Laser-assisted method for producing removed intracerebral hematoma hemostasis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing inert gas of argon into the cavity under 0.2 atm pressure after removing intracerebral hematoma. The next treatment action is carried out in one stage during 20-25 s spread over the whole surface of the formed cavity by applying defocused diode laser radiation of 805 nm wavelength and power of 19-21 W delivered into the cavity by means of quartz light guide threaded as screw on its working end. The quartz light guide has cap for avoiding contact with the treated cavity medium. EFFECT: enhanced effectiveness of hemostasis. 2 cl, 2 dwg _

Description

 The invention relates to medicine, more specifically to neurosurgery, traumatology and neurology, and can be widely used in the treatment of patients with traumatic brain injury, intracerebral hemorrhage, etc. as a method of reliable hemostasis of the cavity formed after removal of the intracerebral hematoma.

 A known method of hemostasis of the intracerebral hematoma cavity after its open removal, involving the use of bipolar coagulation (see Prince N. M. Chebotareva. Surgical treatment of intracerebral hemorrhages caused by arterial hypertension. M: Medicine, 1984, p.127-128).

 This method makes the manipulation more gentle compared to previously known methods of treatment, for example using hemostatic sponges, etc.

 However, this method cannot be used for diffuse bleeding of the hematoma cavity.

 In addition, this method has serious disadvantages.

 Firstly, this is the need for contact exposure and the almost complete inability to dose the biological effect.

 Secondly, in clinical conditions this is manifested by the resumption of bleeding during the forced removal of the “sticking” electrode at the time of coagulation (together with the electrode, the coagulation scab is removed from the surface of the bleeding area).

 These deficiencies are exacerbated if coagulation has to be carried out in conditions of severe bleeding, when the source is covered with a layer of blood. Existing equipment does not make it possible to eliminate these shortcomings.

 There is a method of laser hemostasis of the intracerebral hematoma cavity formed after its endoscopic removal, which includes the sanitation of the cavity and subsequent exposure to laser radiation (see LM Auer, P, Holzer, P, W, Ascher and F, Heppner "Endoscopic Neurosergery", Acta Neurochir (Wien ) (1988), 90.1-14).

 This method consists in contact laser coagulation of bleeding vessels in the wall of the cavity of an endoscopically removed hematoma. Laser coagulation of bleeding vessels is carried out after irrigation of the surgical field.

 A YAG-Nd laser with 600 μm quartz glass fiber is used as a laser source.

The lens at the end of the fiber allows you to distribute energy in the form of a cone with an angle at the apex of 30 ^o . The wavelength of the laser radiation is 1.06 microns. The radiation power is 15-25 watts.

 This method is also not effective for diffuse bleeding of the hematoma cavity.

 In addition, he has all the disadvantages of the contact method of hemostasis.

 Like any contact method, all the more carried out with such a radiation power (15-25 W) it can cause deep heating of the brain tissue, which causes changes in the brain tissue at a distance.

 Thus, the technical result to which this invention is directed is to increase the effectiveness of hemostasis and the safety of the method for its implementation.

 The specified technical result is achieved by the fact that in the known method of laser hemostasis of the cavity of the removed intracerebral hematoma, providing for the sanitation of the cavity and subsequent exposure to laser radiation, according to the invention, inert argon gas is additionally introduced into the cavity under pressure of 0.2 atm, and the subsequent exposure is performed once in within 20-25 seconds on the entire surface of the cavity formed by defocused radiation of a diode laser with a wavelength of 805 nm and a power of 19-21 W, dos molded into the cavity using a quartz fiber equipped with a screw thread at the working end.

 In this case, the quartz fiber can be additionally equipped with a ∩-shaped cap.

 An additional introduction of inert argon gas into the hematoma cavity under the pressure of 0.2 atm before the onset of exposure helps to significantly increase the effectiveness of hemostasis and ensure the safety of the proposed method.

 This is due to the fact that due to the injection of 0.2 atm argon, the cavity of the intracerebral hematoma is completely straightened, the walls of which fell after removing blood from it. Moreover, the authors experimentally established that the best results are achieved precisely at a pressure of 0.2 bar.

 In addition, argon eliminates the burning of atmospheric oxygen in the operating area, which contributes to uniform irradiation of the walls of the cavity, and also prevents the burn of the irradiator and carbonization (charring) of brain tissue.

 The authors experimentally established that the best results, i.e. The best hemostasis is achieved precisely when exposed to radiation from a diode laser with a wavelength of 805 nm and a power of 19-21 W, and it is within 20-25 seconds.

 The authors found that with these exposure modes the method is safe.

 The use of a quartz fiber equipped with a screw thread at the working end for delivering laser radiation further enhances the efficiency of hemostasis and increases the safety of the method.

 This is due to the fact that it is the presence of a screw thread at the working end of the fiber that ensures maximum dispersion of laser radiation, which ensures that radiation reaches any point in the treated cavity.

 The additional supply of a fiber with a screw thread with a ∩-shaped cap further increases the safety of the method and, as a result, its efficiency, since this cap completely excludes the contact of the fiber irradiator with the medium in the treated cavity.

 The method is illustrated by drawings. Figure 1 shows a diagram of a method; figure 2 is a plot of a quartz fiber with a ∩ -shaped cap.

 The method is as follows. Under intramuscular anesthesia, after processing the surgical field, a Y-shaped cannula 2 with a diameter of 2 mm is inserted through the milling hole 1 in the hematoma area.

 The hematoma is aspirated with brain detritus.

 The walls of the resulting cavity 3 fall.

 Cavity 3 of the removed intracerebral hematoma is washed with saline (sanitized). If hemorrhage is detected from the cavity 3 of the removed hematoma, a quartz fiber 4 with a diameter of 0.6 mm is inserted through the cannula 2 into the cavity 3.

 The light guide 4 at its working end has a screw thread 5, made on its outer surface.

 The light guide 4 can be additionally equipped with a ∩-shaped cap 6.

 Before irradiation begins, an inert argon gas is introduced into the cavity 3 through the channel 7 in the cannula under a pressure of 0.2 atm. Cavity 3 hematomas straightens.

 After that, the walls of the cavity 3 of the removed intracerebral hematoma are irradiated with defocused radiation of a diode laser with a wavelength of 805 nm and a radiation power of 19-21 W. The exposure time is 20-25 seconds.

 The method is illustrated by examples.

 Example 1. A biological object weighing 20 kg. Diagnosis: experimental hematoma of the frontoparietal region.

 Under intramuscular anesthesia (ketamine 5% 4 ml + sibazon 0.5% - 2 ml), after treating the skin with iodine, a Y-shaped cannula with a diameter of 2 mm was introduced through a milling hole to a depth of 6-8 mm. A hematoma with brain detritus up to 6 ml is punctured. The brain is sunken, throbbing.

 A fiber guide 0.6 mm in diameter was inserted through the cannula into the hematoma cavity, the working end of which has a screw thread.

 Before irradiation, inert argon gas is introduced into the cavity of the removed intracerebral hematoma under a pressure of 0.2 atm. The cavity is straightened. After that, the hematoma cavity was irradiated with defocused radiation of a diode laser with a wavelength of 805 nm, the radiation power was 20 W, and the exposure time was 20 seconds.

 During the control washing of the cavity of the removed hematoma with physiological saline, hemorrhage was not noted.

 Cannula removed, sutures on the wound, iodine, aseptic dressing.

 The postoperative period was uneventful. Sutures were removed after 10 days.

 Example 2. A biological object weighing 24 kg. Diagnosis: experimental hematoma of the left frontal lobe.

 The sequence of operational transitions is similar to example 1.

 The radiation power is 19 watts. The exposure time is 25 seconds.

 The operation was performed with a light guide equipped with a ∩-shaped cap.

 One day after the operation, the animal was withdrawn from the experiment. At autopsy, hematoma recurrence was not observed. The walls of the cavity of the removed intracerebral hematoma have a brown coagulation film.

 Example 3. Patient K., 65 years old. Diagnosis: parenchymal bleeding in the right hemisphere as a mixed hematoma. left-side hemiporesis. Hypertension of the III degree.

 By intubation anesthesia, the integument of the skull was dissected with a small linear incision (length 3.5-4 cm), a milling hole was formed in the underlying bone with a diameter of 1 cm, and then through a Y-shaped cannula with a diameter of 3.7 mm (inserted through the incision of the dura mater into the cavity hematomas to a depth of 3 cm) performed puncture removal of the hematoma with brain detritus up to 80 ml. Decreased hematoma cavity was noted.

 The cavity of the removed hematoma was washed with saline, hemorrhage from the cavity was noted.

 An inert argon gas was supplied through a Y-shaped cannula into the hematoma cavity under a pressure of 0.2 atm. The sitenas of the cavity straightened. After that, a fiber with a screw thread at the working end was inserted into the hematoma cavity through a Y-shaped cannula: the diameter of the fiber was 0.6 mm.

 The defocused radiation of a diode laser with a wavelength of 805 nm and a radiation power of 21 W was irradiated.

 The exposure time is 25 seconds.

 During the control washing of the cavity of the removed intracerebral hematoma, hemorrhage was not noted.

 On the control computed tomography recurrence of hemorrhage was not detected.

 The postoperative period was uneventful. Sutures were removed after 10 days.

Claims (2)

 1. The method of laser hemostasis of the cavity of the removed intracerebral hematoma, providing for the sanitation of the cavity and subsequent exposure to laser radiation, characterized in that, in addition to the start of exposure, an inert argon gas is introduced into the cavity under a pressure of 0.2 atm, and the subsequent exposure is performed once for 20-25 with the entire surface of the cavity formed by the defocused radiation of a diode laser with a wavelength of 805 nm and a power of 19-21 W, delivered to the cavity using a quartz fiber equipped with a screw howling at the working end.  2. The method according to p. 1, characterized in that the laser radiation is delivered using a quartz fiber with a screw thread, additionally equipped with a cap that eliminates contact with the medium of the treated cavity.

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