RU2238057C2 - Method for removing polyps from gastrointestinal tract in endoscopic way - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves high frequency electric coagulation of polyps by means of endosurgical electrode manufactured as electrically insulated current-conducting rod having a segment of 10-20 mm on the working end part which is bent to at an angle of 32° relative to electrode rod axis by 0.1-1 mm from its surface. Electric polyp coagulation is carried out under visual control with high frequency electric arch discharge.

EFFECT: early stage polypectomy in the outpatient setting.

Description

The invention relates to medicine, namely to endoscopic removal of polyps of the gastrointestinal tract using high-frequency electrosurgery.

In the general structure of diseases of the gastrointestinal tract, polyps occupy a special place. This problem gains the greatest significance in the aspect of oncological alertness. It is shown that with a polyp size of up to 1 cm, the probability of its degeneration is about 1%, with a polyp size of 1 to 2 cm, this risk increases and ranges from 5 to 10%. With the size of the polyp over 2 cm, the probability of its degeneration is up to 50% (A.M. Garin, 1998).

The generally accepted management tactics for such patients is still the dynamic monitoring of small polyps (up to 1 cm), sometimes for several years. This affects the incidence of cancer of the stomach, rectum and colon. In particular, more than 40,000 new cases of colon cancer are registered annually in Russia, while mortality has increased compared to 1991 by 6.8% in men and 7.5% in women (N.N. Trepeznikov, E.M. Axel, 1997).

The growth of these indicators is causing increasing concern and requires a change in the management of such patients towards the activation of endoscopic methods of treating polyps with their small sizes and in the early stages of development.

Currently, there are many methods of endoscopic removal of polyps of the gastrointestinal tract, for example, injection of drugs into the base of the polyp, as a result of which it wrinkles and disappears; cryodestruction of the polyp; laser photocoagulation (RU 2078547 C1 of 05/10/1997).

The closest analogue of the claimed invention is a method of electrocoagulation of polyps (Doletsky S.Y. High-frequency electrosurgery, M., 1980, S.80-84, 142-143). In the known method, an apparatus for high-frequency electrosurgery is used, to which an endosurgical electrode is connected via a cable. The electrode is brought through the endoscope to the location of the polyp, brought into contact with the polyp and carry out electrocoagulation, activating the apparatus for high-frequency electrosurgery, which supplies alternating current with a high voltage.

The disadvantages of this method are the lack of complete visual control over the process of electrocoagulation and the inability to control the depth and area of necrosis around the base of the polyps. These shortcomings lead, on the one hand, to bleeding and perforation of the intestinal wall with the development of peritonitis. On the other hand, relapse of the polyp and its malignancy due to incomplete polypectomy are possible.

This makes surgeons refuse to perform polypectomy on an outpatient basis in the early stages of the development of polyps and with their small sizes (up to 1 cm).

Our proposed method for endoscopic removal of polyps of the gastrointestinal tract allows for complete visual monitoring of the positioning of the electrode and the process of electrocoagulation, as well as free movement of the electrode during endosurgical intervention. This is achieved by using an endosurgical electrode in the form of an electrically insulated conductive rod, a section of which is 10-20 mm long from the side of the working end, bent 32 ° relative to the axis of the electrode rod. This creates a ratio of the bending angle of the electrode and the length of the bent working end, at which a "sight" is formed, at which the impact point falls.

The proposed method also allows you to adjust the depth and area of tissue necrosis, having a pronounced hemostatic effect. This is achieved, in particular, by the fact that the working end of the electrode is brought to a removable polyp at a distance of 0.1-1 mm from its surface, a high-frequency electric arc discharge is created at the working end of the electrode and the electrode is held at this distance for the entire duration of the electric arc discharge.

Given the above advantages, the minimum size of the polyps to be removed by the proposed method is not limited. This allows you to perform polypectomy on an outpatient basis in the early stages of polyp development.

In the inventive method uses an electrosurgical high-frequency generator TAIK 468753.001. The device operates with a single-phase alternating current voltage of 220 V, frequency 50 Hz, and electrical safety corresponds to GOST R502670.92, class 11, type VG. Power consumption is not more than 90 W, the frequency of the output sinusoidal voltage is 60 Hz. The device can operate both in constant and in pulsed mode at a pulse repetition rate of 500 ⁺ / -50 Hz.

The specified apparatus for high-frequency electrosurgery works as follows. After switching on (pressing the pedal), the voltage is supplied from the stabilizer to the generator (with a frequency of 60 kHz). The signal through the divider and driver is fed to the gating circuit, at the output of which it acquires amplitude modulation. The change in output power is carried out by changing the supply voltage.

The optimal modes for polyp removal are the output power of 15 W when removing the tip of the polyp and the output power of 8 W when removing the part of the polyp that is closer to the unchanged tissues. Finer adjustment is carried out by adjusting the period of repetition of modulating pulses.

The endosurgical electrode used in the claimed method is made in the form of an electrically insulated conductive rod. A vinyl tube is used as insulation. The diameter of the cross section of the conductive rod is 2-5 mm, and its portion 10-20 mm long from the side of the working end is bent 32 ° relative to the axis of the electrode rod. A rigid electrode 400-600 mm long is used for a rectoscope, a flexible electrode 1500 mm long is used for a fibroesophagogastroduodenoscope or a colonoscope. The opposite end of the rod is connected to the cable of the apparatus for high-frequency electrosurgery.

The method is as follows. In accordance with the location of the polyp, an electrode is introduced through an endoscope (fibroesophagogastroduodenoscope, colonoscope or rectoscope), made in the form of an electrically insulated conductive rod with a cross-sectional diameter of 2-5 mm, a portion of which is 10-20 mm long from the side of the working end bent relative to the axis of the electrode rod by angle 32 °. The working end of the electrode is brought to the removed polyp at a distance of 0.1-1 mm from its surface and the apparatus for high-frequency electrosurgery is activated (TAIK 468753001), creating a high-frequency electric arc discharge at the working end of the electrode. Hold the electrode at a distance of 0.1-1 mm from the surface of the polyp during the entire time of exposure to an electric arc discharge.

Removal of the polyp is carried out by a single or multiple exposure to an electric arc discharge. The entire process of electrode positioning and polyp removal is visually monitored through the aforementioned endoscope.

Clinical example 1.

Patient S., 71 years old, complained of moderate pain in the epigastric region, dyspepsia. Similar complaints are noted periodically over the past 15 years. Previously not examined and not treated. Of concomitant diseases of grade II GB, chronic cholecystitis. As a result of studies, including esophagogastroduodenoscopy, ultrasound of the abdominal cavity, the diagnosis was made: a polyp of the stomach up to 0.8 cm in diameter, chronic gastritis. After preliminary anti-inflammatory therapy and additional examinations, the patient was hospitalized as planned in the bed of a day hospital to remove the identified polyp.

Polypectomy was performed according to the claimed method through an esophagogastroduodenoscope. During the control study after three hours, there were no signs of complications. The patient was discharged from an outpatient hospital and, accompanied by relatives, was sent home.

In control studies after 1, 3, 6, 12 months, polyp recurrence was not detected.

Clinical example 2.

Patient T., 42 years old, complained of constipation, episodic scarlet blood in a meager amount with stools, periodic discomfort in the anus. Considers herself a patient for more than 10 years. Conclusion of a colonoscopy from 1997 - chronic catarrhal colitis. It was treated independently without a lasting positive effect. From the data of the anamnesis it is known that the father had a malignant tumor of the rectum.

As a result of the examination, the diagnosis was established: rectal polyps (2 polyps), chronic catarrhal colitis, chronic hemorrhoids 2-3 tbsp., Chronic gastroduodenitis without exacerbation. Rectal polyps up to 0.3 cm in size were localized at a distance of 9 and 13 cm from the anus, respectively.

After preliminary conservative therapy and additional studies, the patient was hospitalized in the hospital bed. Produced simultaneous removal of both polyps of the rectum in accordance with the claimed method from the top to the base through a sigmoidoscope.

A control study after three hours showed no signs of complications. The patient was discharged from an outpatient hospital. When conducting control studies after 1, 3, 6, 12 months, polyps recurrence was not detected.

Clinical example 3.

Patient S., 58 years old, applied for a control colonoscopy. From the anamnesis it is known that colonoscopy from 1999 revealed polyps of the colon polyps of the splenic angle up to 0.4 cm in diameter, two forming polyps of the transverse colon. Complaints of moderate abdominal pain. I did not receive treatment. Concomitant diseases chronic prostatitis without exacerbation.

After conducting related studies, the diagnosis was established: multiple colon polyps, chronic catarrhal colitis, chronic hemorrhoids 1-2 tbsp. The polyp of the hepatic angle on the leg is up to 0.7 cm in diameter, the polyps of the transverse colon on a wide base are 0.5 and 0.3 cm, respectively. An emerging polyp of the splenic angle, a sigmoid colon polyp up to 0.3 cm in diameter. Biopsy data showed the adenomatous structure of polyps.

After conducting a course of anti-inflammatory therapy and performing an additional examination, the patient was hospitalized in the bed of a day hospital to remove polyps according to the claimed method. In the first stage, a polyp of the hepatic angle, one of the polyps of the transverse colon (0.3 cm in size), and a splenic angle polyp were removed through a colonoscope. Two weeks later, the second stage was carried out: a 0.5 cm transverse colon polyp and a sigmoid colon polyp were removed.

In a control study performed in both cases three hours after removal, there were no signs of complications.

In control studies after 3, 6, 12 months, polyps recurrence was not detected, new growth was not detected. The patient was prescribed preventive courses of anti-inflammatory therapy.

Thus, our proposed method opens up new possibilities for the treatment of patients with polyps of the gastrointestinal tract and allows us to review the management tactics of these patients. The inventive method is intended for use in outpatient practice, which gives wider prospects for the development of hospital-replacing forms in coloproctology, especially relevant in the last decade.

Claims (1)

A method for endoscopic removal of polyps of the gastrointestinal tract, including high-frequency electrocoagulation of polyps using an endosurgical electrode, characterized in that they use an endosurgical electrode made in the form of an electrically insulated conductive rod, a portion of which is 10-20 mm long from the working end, bent relative to the axis of the electrode rod at an angle of 32 °, the working end of the electrode is brought to a removable polyp at a distance of 0.1-1 mm from its surface and, creating an electron at the working end and a high-frequency electric discharge, polyp electrocoagulation performed under visual control.