RU2261063C1 - Cryoinstrument - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has two moveable connected branches having ring-shaped handles. Their working parts are three-dimensional from the connection place to the distal ends allowing closing the working surfaces along closure plane. One of the branches is 2-3 times as large in volume as the other one. The working surface being closed, the working part of the branches has oval shape in instrument plane set in perpendicular to the closure plane. The distal part of the branches is sharpened at an angle of 30-35° in closure plane and maximum convex widening of branches corresponding to oval middle part is equal to 1/5 of branch working part length. The working surface of both branches are curved as arc-shaped waves with fully superposable wave crests of one working surface with recesses of the other one in closing. The waves are produced with deflection in distal part of the working surface towards the end and in the middle part with deflection towards convex widening of the branches. Wave slope directed towards working surfaces closure center is steeper as the slope directed towards the peripheral part of the closure surface. The branches are manufactured from high specific heat and good temperature conductivity material in thickness of working part of which capillary slit-shaped grooves directed to distal ends and maximum convexity working parts of the branches. The working parts of the branches are matt and have microscopic unevenness, their external surfaces are mirror-like finished. The branches are left-side- or right-side-convex relative to closure plane of their working surfaces. Proximal part of branch and rack mechanism fixed thereon are arch-shaped relative to longitudinal axis of instrument plane being set in perpendicular to the closure plane. The rack mechanism is elongated and has millimetric linear scale, moveable member for fixing branches. The rack mechanism teeth have small pitch.

EFFECT: enhanced effectiveness of treatment.

4 dwg

Description

The invention relates to medicine, namely to cryogenic passively cooled instruments, and can be used in cryosurgery and microcryosurgery for cryodestruction of benign neoplasms of the skin and mucous membranes (exophytic and flat surface) and for cryomassage, as well as in dermatology, cosmetology, gynecology, proctology, dentistry, otorhinolaryngology and oncology, including cryological preventive oncology.

Currently known among the various layers of the population are tumors on the skin and mucous membranes - both flat and exophytic (papillomas, polyps, small nodules on the mucous membranes, keratomas, granulomas, acrochords, skin horn, protruding nevi, angiofibromas) oncological diseases. Cryodestruction as a method of treating such neoplasms is most relevant in comparison with the known electrocoagulation, laser excision, and their combinations: it is bloodless, painless, there are no neoplasms insensitive to cryodestruction, wound healing occurs without scarring, with the restoration of specific epithelium and the appearance of antitumor immunity. For cryodestruction of malignant neoplasms, mainly large ones, quite a lot of actively cooled instruments and equipment have been developed, but there are practically no devices with the specifics of cryodestruction and cryotherapy of various small benign tumors.

A device is known for deep local cooling of a tissue (V. Kochenov - Device for deep local cooling of a fabric. - RF Patent No. 2018274. - Bull. No. 16 of 08.30.94), containing a cylindrical body with channels for supplying and removing coolant and an expansion chamber with an application surface made in the form of concentric waves. The slopes facing the center are made steeper, the ridges are parallel to them, and a groove is made radially from the center with side faces parallel to the longitudinal axis of the body and a groove depth greater than the wave amplitude.

The known device operates as follows. The applicator is brought into mechanical contact with the surface of the tissue, the circulation of the refrigerant begins. Between the crests of waves with notches and the surface of the fabric, adhesion occurs and cavities between the waves form. As the applicator is pressed against the tissue, the pressure rises in these annular cavities, and due to the groove, air leaves these cavities through the side opening to the outside. Further cooling and freezing of the tissue is accompanied by the expansion of the freezing tissue, its deeper immersion in the troughs of the wavy surface of the applicator and an increase in the heat transfer area. At the same time, the volume of the annular cavity in the cavity decreases. Throughout this period, the groove serves as a conductor for venting air from a decreasing annular cavity.

However, the known device relates to cryotools of active action to achieve and maintain a negative temperature of the instrument using an additional cryogenic apparatus, while there is a loss of cold when it is delivered to the surface of the applicator and tissues. The device does not allow predicting and controlling adhesion during treatment, cooling tissues deeply without adhesion, and supporting the tumor in a frozen state in tight mechanical connection with a cryoinstrument. The device does not allow for metered pressing on the surface of the frozen tissue, that is, it does not provide any mechanism for enhancing cryodamage, to limit blood circulation in the pathological tissue, which reduces the efficiency of heat transfer.

A device is known in which, to reduce blood loss during tissue resection due to increased cooling, slots of capillary dimensions are provided on the working surface associated with a cavity for circulating liquid nitrogen (Arkharov A.M. et al. - Cryoscalpel. - A. S. USSR No. 950368 - Bull. No. 30 dated 08/15/82). The slots allow liquid nitrogen to spread over the surface of the lateral departments of the cutting part of the scalpel and cool the blade.

However, the working, that is, the cutting, surface of the tool is cooled only passively, due to the heat-conducting properties of the metal of which the tool is made, since liquid nitrogen evaporates before approaching the cutting edge of the scalpel. The exit of liquid nitrogen to the surface of the scalpel is needed rather to ensure non-adhesion of the scalpel in its lateral parts to the dissected tissue than to cool the tissues, the cutting edge itself is not cooled sufficiently when it comes into contact with the tissue. When dissecting tissues, the exposure to cryotherapy is too small to deeply freeze tissue. They instantly thaw, bleeding resumes, since the hemostatic effect of surface cooling occurs later. In real practice, the device is not applicable.

A device is known for local cryotherapy on head and neck tumors, skin integuments (Paches A.I. et al. - In the book: Cryogenic method for treating head and neck tumors. ”- Ch. 3: Cryogenic therapeutic technique, pp. 65-66 . - M., "Medicine", 1978), in which, with the aim of enhancing cryodestruction, it is possible to contact simultaneously in this operating area two cryotools with different tips, freezing the tumor from two poles simultaneously.

However, a pair of cryo-tips in the device is not fixed relative to each other, they move during operation, and it is impossible to create adequate compression of the tumor. In addition, with skin tumors, reliable long-term thermal and mechanical contact is not achieved. The device is not applicable for small tumors such as hemangiomas, papillomas, angiofibromas, polyps, as it is an active type instrument based on the circulation of liquid nitrogen.

For the prototype of the invention, a well-known cryovagotomy clamp (RU 2012255 C1, 05.15.1994) containing movably connected branches with annular handles, the working parts of which from the point of their connection to the distal extremity are made volumetric, with the possibility of closing the working surfaces along the closing plane, is selected. The known device can improve the quality of treatment by accelerating freezing and achieving the adequacy of cryoamage during cryodestruction, and also provides ease of use.

The objective of the invention is to improve the quality and accelerate treatment by enhancing cryo-damage and accelerate freezing, achieve the adequacy of cryo-damage during cryodestruction of various formations, and ensure ease of use.

This object is achieved by the fact that in the known cryotool containing movably connected branches with ring-shaped handles and a rack, the branches in the working part from the point of their connection to the distal extremity are volumetric, with one working branch 2-3 times larger than the other, with the proximal part of the tool is made refined, with closed working surfaces, the working part of the jaw in the plane of the tool perpendicular to the plane of closure has the shape of an oval, pointed in the distal terminal at an angle of 30-35 ° in the closing plane, with the largest expansion in the middle part of the oval being up to 1/5 of the length of the working part of the branches, the working surfaces of both branches along their entire length from the junction to the distal extremities are curved in the form of arcuate waves, moreover, when closing, the crests of one surface are fully aligned with the hollows of the other, while the waves are made in the distal part across the plane of closure with a deflection towards the tip and in the middle part along the plane of closure with a deflection towards the bulges jaw, moreover, the wave slope directed to the center of the plane of closure of the working surfaces is steeper than the slope directed to the periphery of the plane of closure, the branches are made of heat-absorbing and heat-conducting material, in the thickness of the working part the jaw is made to the maximum possible depth capillary slit-like grooves directed towards the distal the extremities and the most convex parts of the working jaws, the working surfaces of the jaws are made matte with microscopic irregularities, and the outer non-contacting surfaces of the working parts of the jaws mirror polished, jaws made left-handed or right-handed convex relative to the plane of closure of their inner working surfaces, the cremallera and the proximal part of the jaw on which it is mounted, are made arcuately curved relative to the longitudinal axis of the tool plane perpendicular to the plane of closure of the jaw, while the cremallera is elongated, equipped with a millimeter a linear scale and a movable jaw retainer, and the cloves of the kemalier are made with a very small step.

The proposed device meets the criteria of the invention of "novelty", as a result of the patent information research did not identify sources that discredit the novelty of the invention.

The proposed device meets the criteria of the invention "inventive step", as it is not revealed the presence of significant differences in the proposed device in similar solutions.

The device parameters are selected according to the results of experimental studies, taking into account their direct assessment in each patient.

The branches in the working part from the place of their movable connection to the distal extremity are volumetric, with one working branch 2-3 times larger than the other; moreover, during cryodestruction, a larger jaw is used as the upper one, since the cold spreads better downwards, including in the tissue of the captured tumor. The proximal part of the instrument, including the ring-shaped handles, is made refined to reduce the thermal conductivity of this part of the instrument and not to cause excessive cooling and frostbite of the surgeon's hands. It was experimentally established that in this case, even with prolonged cooling of the instrument in a vessel with liquid nitrogen, real cooling to a temperature that causes the surgeon's hands to cool does not occur, and in operation the low temperature of the proximal part is quickly leveled.

With closed working surfaces of the jaw, the working part of the jaw in the plane of the tool perpendicular to the plane of closure has an oval shape, pointed at the distal tip at an angle of 30-35 ° relative to the longitudinal axis of the plane of closure, with the largest expansion in the middle of the oval up to 1/5 of the length the working part of the branch. The proposed form was found experimentally; Multiple experiments have shown that it is the proposed oval shape with a given ratio of length and extension of the working part that satisfies the required characteristics of strength and thermal conductivity. The extremities of the closing branches are used to capture the smallest formations, so they are almost pointed. Practice has shown that in working with a small tumor with a sharpening angle less than 30 °, the extremities warm up quickly and do not provide thermal conductivity, and with a sharpening angle greater than 35 °, the grooves of the distal extremity do not come into contact with the surface of the frozen tissue. Convex, enlarged parts of the branches are used to capture the largest formations.

The contiguous working surfaces of both branches along their entire length from the junction to the distal extremity are curved in the form of arcuate waves, and when closing, the crests of one surface are fully aligned with the hollows of the other, while the waves are made in the distal part across the closing plane with a deflection towards the tip and in the middle part along the closing plane with the deflection toward the convexities of the branches, and the wave slope directed to the center of the working plane closure is steeper than the slope directed to the periphery Rhee clamping plane. The curvature was performed to improve the capture and fixation of the captured neoplasm, as well as to improve heat transfer in the process of tissue freezing.

The jaws are made of heat-sensitive and heat-conducting material (for example, solid titanium or tool stainless steel), which ensures rapid absorption of heat from the tumor and its rapid cooling, and are practically thermal batteries. The high thermal conductivity and heat capacity of the working jaws in combination with the shape of their working part (oval) provide a uniform redistribution of negative temperatures from the most voluminous part, which, due to the volume and mass, is the largest thermal accumulator to the distal extremities, and temperature stabilization in the entire volume of the jaws. At the same time, the pointed extremities, which are often used in work, gradually take away heat from the fabric and slowly warm up.

In the thickness of the working part, the jaws are made from the plane of the working surface to the maximum possible depth capillary slit-like grooves. The grooves are in the form of branches or rays, not necessarily converging at one point. They are directed to the distal extremities and to the most convex parts of the working branches, that is, to the areas of the most frequent application to tumors: respectively, either to a very small tumor or to the center of a large tumor. When working with a tumor, they try to arrange the tool so that the slots of the grooves are facing the tumor from above and below, while the liquid nitrogen flowing from the grooves to the warmest places on the applicator can increase cryo-damage and accelerate tumor freezing on both sides. Due to the presence of grooves, the implementation of a combined variant of cryo-cooling is achieved, that is, a combination of application effects and cryo-irrigation during edema of liquid nitrogen to the surface of a frozen tumor.

The working surfaces of the jaws are matte with microscopic irregularities to improve thermal contact and heat transfer with the frozen tissue: the surface of the fabric clings to these irregularities with a trend of lateral displacements at the time of icing during thermal expansion of water in the tissues. In addition, microthermal exchange is necessary if there is a difference in the coefficients of thermal expansion of the metal and the frozen tissue during their contact during prolonged exposures, especially for large tumors. The outer non-adjoining surfaces of the working parts of the jaw are mirror-polished, which helps to reflect heat from the outer surface of the applicators and maintain them in working condition, and also allows the use of external surfaces for massage (stroking) of skin pathological formations.

The jaws are made left-handed or right-handed convex relative to the plane of closure of the working surfaces for the convenience of the surgeon holding the tool with his right or left hand (right-handed or left-handed) so that the surgical field is open.

The cremallera and the proximal part of the jaw, on which it is fixed, are made arcuately curved relative to the longitudinal axis of the instrument plane perpendicular to the plane of jaw closure, while the cremallera is elongated. When placing the tool with the working parts of the jaw in a vessel with liquid nitrogen, the curved jaw and the curved and elongated cremallera serve as a stop and limiter of the tool to prevent immersion of it too deep, maintain equilibrium of the tool in the vessel, overcooling the handles and preserve the integrity of the vessel, while the choice of the vessel depends from the length of the rack. The cremallera is equipped with a millimeter linear scale to control the compression of the tumor in order to avoid crushing of the tumor or insufficient deformation. The cremallera is also equipped with a movable jaw retainer, which serves to fix the adjacent jaws in a certain position, necessary and sufficient for the deformation of the tumor without the threat of crushing it. At the same time, the cloves of the cremallera are made with a very small step, which makes it possible to have a smooth, gradual, metered increase in pressure on the tumor during its freezing.

The device was tested in the laboratory of medical cryology of the NGMA and in the Center of Medical Cryology “OnKolor” LLC for outpatient treatment in more than 100 patients with papillomas, polyps, keratomas, granulomas, acrochords, skin horn, protruding nevi, angiofibromas, small nodules on the mucous membranes. In all patients, an excellent cryosurgical and cosmetic effect was obtained as a result of treatment.

The device contains: 1 - working jaws, 2 - annular handles, 3 - cremallera, 4 - working surfaces (applicators), 5 - convex parts of the jaw, 6 - pointed distal extremities, 7 - arched waves, 8 - grooves, 9 - linear scale , 10 - clamp jaw.

Figure 1, 2, 3 shows the proposed device: figure 1 is a top view of the tool on a horizontal plane, figure 2 is a top view of the working surface of the jaw (applicator), figure 3 is a front view of the tool on a slice of the working part . Figure 4 shows the tool when immersed in a vessel 11 with liquid nitrogen 12.

The branches 1 in the working part from the place of their movable connection to the distal extremity 6 are volumetric (Figs. 1, 2, 3), moreover, one working branch is made 2-3 times larger than the other. The proximal part of the instrument, including the annular handles 2, is made sophisticated (figure 1).

With closed working surfaces 4 of branch 1, the working part of branch 1 in the plane of the tool perpendicular to the plane of closure (figure 1) has the shape of an oval, pointed in the distal tip 6 at an angle of 30-35 ° relative to the longitudinal axis of the plane of closure, with the greatest expansion in the middle of the oval is up to 1/5 of the length of the working part of the branch. The extremities 6 of the closing branches 1 are used to capture the smallest formations (figure 1, 2). Convex, expanded parts 5 (Fig.2, 3) branch 1 is used to capture the largest formations.

The abutting working surfaces 4 of both branches 1 along their entire length from the junction to the distal extremity 6 are curved in the form of arcuate waves 7 (Figs. 1, 2), and upon closing, the crests of one surface are fully aligned with the troughs of the other, while waves 7 are made in the distal part across the closing plane with a deflection towards the extremity 6 and in the middle part along the closing plane with a deflection towards the convexities of branch 5 (Fig. 2), and the wave slope 7, directed toward the center of the closing plane of the working surfaces, is steeper than the ramp directed to the periphery of the plane of closure (figure 1).

The branches 1 are made of heat-sensitive and heat-conducting material.

In the thickness of the working part, the jaw 1 is made from the plane of the working surface 4 to the maximum possible depth capillary slit-like grooves 8 (figure 2, 3). They are directed to the distal extremities 6 and to the most convex parts 5 of the working branch 1.

Working surfaces 4 of branch 1 are made opaque with microscopic irregularities. The outer non-contacting surfaces of the working parts 4 of the branch 1 are mirror-polished.

The jaws are made left-handed or right-handed convex (Fig.3, 4) relative to the plane of closure of the working surfaces 4.

The cremallera 3 and the proximal part of the jaw, on which it is fixed, are made arcuately curved with respect to the longitudinal axis of the plane of the tool perpendicular to the plane of closure of the jaw 1 (Figs. 1, 4). The cremallera 3 is also made elongated, equipped with a millimeter linear scale 9 and a movable latch 10 jaw 1. In this case, the teeth of the cremallera 3 are made with a very small step.

The device operates as follows.

Before work, the surgeon selects an instrument depending on the location of the neoplasm and on whether he will hold it with his right or left hand, either with a right-side or left-side bulge 5 of the working part of branch 1 with respect to the plane of closure of the applicators 4. Measure the tumor with a ruler.

The cryotool is immersed in closed working parts 4 of branch 1 in a vessel 11 with liquid nitrogen 12 (Fig. 4), while the proximal part of the curved branch 1 and the tip of the cremallera 3 fixed on branch 1 rest on the edges of the vessel 11, ensuring the instrument is balanced, preventing immersion in nitrogen 12 branches 1 above the point of their connection and thereby cooling the handles 2. Cool the tool until the boiling point of liquid nitrogen (-196 ° C). At the end of boiling, liquid nitrogen fills the grooves 8 of branch 1 and the capillary gap in the plane of contact of the working parts 4 of branch 1, which is formed by compression of the material of branch 1 during cooling. Remove tool from nitrogen.

When carrying out cryodestruction, the applicators are the inner surfaces of the 4 working parts of the jaw 1. The neoplasm is clamped between the working surfaces of the 4 jaws 1, while the tool is positioned so that the larger jaw is higher when working with the other jaw, that is, on top of the tumor. They provide the fullest coverage of the tumor with applicators 4, while if the tumor is very small, it is captured by the pointed distal extremities 6, and the larger - by the expanded section of branch 1 corresponding to its size, using the most convex parts of the 5 branch to capture large soft tissue neoplasms, so that the heat transfer area was adequate. In all cases, they try to capture the tumor in such a way that the slots of the grooves 8 are facing the tumor from above and below, while the deeper grooves 8 in the more voluminous jaw are on top.

The jaws 1 are brought together, producing a slight squeezing of the tumor by 1 / 3-1 / 2 of its diameter, which is necessary and sufficient to deform the tumor without the threat of crushing it (it is known from practice), and the greatest degree of compression is allowed in relation to soft-tissue tumors; 1 in this position, the latch 10 moving along the rack 3.

Gradually, as the captured tissue cools, tight mechanical contact occurs without adhesion between the surface of the fabric and the wave crests 7 of the applicators 4, while the fabric, expanding, fills the troughs of the waves 7. The tissue surface deforms, freezing, it becomes hard, fixed on the applicators 4. When In this case, the tumor is slightly delayed and rotated through an angle of up to 90 ° to limit blood circulation in it, which allows to increase cryo-damage and accelerate freezing, to reduce heat gain from surrounding healthy tissues protect them from damage. When pulling back, the tumor cannot slip out of the instrument due to the fact that the arc slope 7 has a slope greater than the slope directed toward the center of the closure plane of the applicators 4, than the slope directed toward the periphery of the closure plane. During freezing, liquid nitrogen flows out of the slit-like grooves 8, flows to the warmest places on the applicator 4, which enhances the tumor freezing and keeps the instrument in working condition so that even with prolonged exposure, the temperature of the instrument is -196 ° C. Observe the growth of the freezing zones, and when they reach 1/4 - 1/3 of the distance between the branches 1 on the side of each branch, the latch 10 is removed, the branch 1 is brought closer by 2-3 mm using a linear scale 9, and the branches 1 are fixed in new position. As the freezing zones approach, the pressure on the tumor is gradually increased, while the central part of the tumor is compressed by arrays of its frozen parts without additional deformation of the tumor.

When the freezing zone reaches the specified limits, the latch 10 is removed, the jaws 1 are pulled apart, the tool is taken away from the tumor, and can be made without additional cooling by immersing it in liquid nitrogen due to the high heat capacity of the working parts of branch 1 and the presence of liquid nitrogen in the grooves 8 .

The external polished non-working surfaces of the closed branches 1 can massage (stroking) the surface of the skin pathological foci, taking into account the physiological characteristics of their reliefs, while they can use both the outer surfaces of the distal extremities 6 and the most expanded volume parts 5 of branch 1.

The proposed device provides:

- increased cryo damage;

- acceleration of freezing;

- the implementation of the combined cryotherapy option (application and cryoirrigation with flowing liquid nitrogen) during treatment;

- increasing the multifunctionality of the tool and achieving the adequacy of cryo-damage during cryodestruction of various formations;

- an increase in the duration of cryotherapy for large tumors;

- implementation of cryodestruction of small formations;

- acceleration of treatment with increasing time of continuous operation without immersing the instrument in liquid nitrogen;

- massage (stroking) of superficial pathological foci;

- convenience in work.

Examples confirming the possibility of using a utility model.

Example 1. Patient R-on AF, 35 years old, amb. card No. 920, turned on 03.06.2002 to the cryology laboratory with a complaint about the presence of a pigmented brown papilloma in the neck area on a thin leg with a diameter of 1-1.5 mm. The patient was offered cryogenic treatment.

Before working as a right-handed surgeon, an instrument with a left-handed convexity of the instrument was chosen for the convenience of work and ensuring good visibility of the working field.

The cryotool was immersed in closed thermocouple 4 jaws 1 in a thermos with liquid nitrogen, while the proximal part of the curved jaw 1 and the tip of the cremallera 3 fixed on the jaw 1 rested on the edges of the thermos, ensuring the balance of the instrument, preventing immersion in the jaw 1 above the junction point and thereby thereby cooling the handles 2. The tool was cooled to the end of boiling liquid nitrogen (-196 ° C). At the end of boiling, liquid nitrogen filled the grooves 8 of branch 1 and the capillary gap in the plane of contact of the working parts of 4 branch 1. The cryo-tool was removed from the thermos.

The treatment was performed without anesthesia. The pointed tips of 6 instruments on both sides grabbed the exophytic part of the papilloma, squeezed into half the volume, set the clamp 10 of the instrument by 0.5 mm. In the first 2-3 seconds, the papilloma became icy and whitened, but the effect was continued by moving the tool holder 10 and turning the tool together with the captured papilloma by an angle of about 90 °. At the same time, the tumor along with the leg was pulled up. When pulling back, the tumor did not slip out of the instrument due to the fact that the slopes of the arcuate waves 7 directed to the center of the plane of the applicators 4 are steeper than the slopes directed to the distal tip 6. During freezing, liquid nitrogen flowed out from the slit-like grooves 8, flowed to the surface of the papilloma , which intensified its freezing. The tissues surrounding the papilloma leg were deformed, became convex, raised above the surface of the skin, which protected healthy surrounding tissues from contact with the instrument. The zone of attachment of the legs and the growth of the freezing zone beyond its boundaries with access to healthy tissues were well visualized. At the same time, the freezing zone extended along the stem to the sprout zone with its deep freezing.

After spontaneous thawing of the papilloma, its freezing was repeated 3 times without additional cooling of the tool by immersion in liquid nitrogen due to the high heat capacity of the working parts of branch 1 and the presence of liquid nitrogen in the grooves 8.

At the same time, after each thawing, an increase in swelling of the tissue formation was observed, and the leg became more and more tense, which in each subsequent cycle facilitated the capture of the exophytic part of the tumor by the instrument. At the end of the freezing, the brown color of the formation and a slight swelling of the surrounding healthy tissues were noted.

The patient was recommended to treat papilloma at home with a 70% alcohol solution or calendula tincture 2-3 times a day without limiting water procedures. It is not recommended to tear off the cryonecrotic tissue before the regeneration of the skin under the leg. On the 2nd day, blackening of the papilloma was noted, on the 3rd – 4th days, its complete drying out, on the 7th day, the dried necrosis was spontaneously rejected, and a delicate pink skin without scar appeared on the site of attachment of the leg. After 3 weeks, the localization of the papilloma was not determined.

Example 2. Patient M-in B.N., 50 years old, amb. map. No. 921, went to the cryology laboratory on 03.06.2003 with a complaint about the presence of one large formation on the leg on the skin in the left inguinal region and two small formations on the leg in the left axillary region. Diagnosis: volume angiofibroma, the diameter of the legs at the place of attachment is about 1 cm, the size of the exophytic part is 2 × 3 × 2 cm, two papillomas are about 1.5 mm in size. The patient was offered cryogenic treatment.

Before working as a right-handed surgeon, 3 cryotools with left-sided convexity of the working parts were chosen for the convenience of work and ensuring good visibility of the working field.

Cryo-tools were immersed in 3 thermoses with closed working parts 4 of branch 1 in liquid nitrogen, with each of them the proximal part of the curved branch 1 and the tip of the cremallera 3 mounted on the branch 1 resting on the edges of the thermos, ensuring equilibrium of the instrument, preventing the branch 1 from being immersed in nitrogen above their place connections and thereby cooling the handles 2. The instruments were cooled to the end of boiling liquid nitrogen (-196 ° С). At the end of boiling, liquid nitrogen filled the grooves 8 of branch 1 and the capillary gap in the plane of contact of the working parts of 4 branch 1. Cryo-tools were removed from the thermos.

The treatment was performed without anesthesia. They grabbed the leg of angiofibroma with the pointed tips of one instrument, squeezed it slightly, pulled it to the side and turned it about 40 ° through the rotary movement around the axis of the leg. When pulling back, the tumor did not slip out of the instrument due to the fact that the slopes of the arcuate waves 7 directed to the center of the plane of the applicators 4 are steeper than the slopes directed to the distal extremity. In the process of freezing, liquid nitrogen flowed out from the slit-like grooves 8 in the distal extremity 6, flowed to the surface of the leg, which intensified its freezing. Expected to exit the freezing zone beyond the legs for 35-40 seconds.

Without removing the first instrument, the second instrument was placed with its most voluminous, extended parts 5 on both sides of the exophytic part of the angiofibroma, while the tumor was captured between the working surfaces of the 4 jaw 1 so that the more voluminous jaw was on top of the tumor, providing full coverage of the tumor with applicators 4, so that the heat transfer area is adequate. They removed the first tool from the legs. As the captured tissue cools, tight mechanical contact occurs without adhesion between the surface of the fabric and the wave crests of the 7 applicators 4, while the expanding fabric fills the troughs of the waves 7, the surface of the fabric deforms, freezing, it becomes hard, is fixed on the applicators 4. Volumetric branches -heat accumulators provided rapid absorption of heat from the tumor and its rapid cooling, thermal contact and microthermal exchange intensified microscopic irregularities on the surface of the applicators, for which the tissues cling. In this case, the slots of the grooves 8 were facing the tumor from above and below, and the deeper grooves 8 in the more bulky jaw were on top. During freezing, liquid nitrogen flowed out of the slit-like grooves 8 above and below, heading to the warmest places on the surface of the applicator, which accelerated and intensified freezing. When pulling back, the tumor did not slip out of the instrument due to the fact that the longitudinal slope of the arc-shaped waves 7 in the middle part of the applicators 4 has a slope greater than the slope directed to the periphery of the closure plane towards the center of the closure plane of the applicators 4. The exposure of cryotherapy was only 20 seconds, and the exophytic part froze faster also due to the blocking of blood flow and heat influx to it from the skin due to freezing of the leg. The growth of the freezing zone of the exophytic part continued until it merged with the first freezing zone. The instrument was not removed for several seconds, during which freezing deep into the growth zone of the tumor took place.

Expecting complete spontaneous thawing of the formation, without cooling the tool in liquid nitrogen, we performed one cycle of freezing two papillomas one after another (as in Example 1), which was carried out due to the high heat capacity of the working parts of branch 1 and the presence of liquid nitrogen in the grooves 8. After that, the instruments were placed in liquid nitrogen and cooled.

After thawing, significant edema and an increase in the volume of the exophytic part of angiofibroma were observed. We started the second freezing cycle.

First, one instrument was placed with the widest part 5 on the distal part of the tumor, which amounted to about 1/5 of the volume of the entire exophytic part. After an exposure of 10 seconds, a second instrument was placed with a less expanded part on the tumor site located closer to the leg, while they retreated from the border of the formed freezing zone by a distance equal to its width from the edge of the applicator to the border. They removed the first tool. The third instrument was placed on the leg with the pointed tips 6 and the second and third instruments turned the leg and exophytic part by an angle of about 30 °. After that, they expected the freezing zone along the leg beyond its limits to the surrounding healthy tissues with simultaneous freezing deep into the growth zone of the tumor. They removed the instruments from the tumor.

One tool was cooled in liquid nitrogen, after spontaneous thawing by papillomas, they were subsequently frozen again, and the third cycle was performed without immersing the tool in liquid nitrogen, while maintaining its working state due to the high heat capacity of the working parts of branch 1 and the presence of liquid nitrogen in the grooves 8.

The patient was recommended to treat the formation with a 70% alcohol solution or calendula tincture 2-3 times a day without limiting water procedures. It is forbidden to forcibly tear off a cryonecrotic tissue before regeneration of the skin under it. Until day 5, wet formation cryonecrosis was observed, on day 14, cryonecrosis dried out, and on day 20, dried necrosis was spontaneously rejected. At the site of formation, delicate pink skin without a scar was observed.

Claims (1)

A cryotool containing movably connected branches with ring-shaped handles, the working parts of which from the place of their connection to the distal end are made voluminous with the possibility of closing the working surfaces along the closing plane, characterized in that one branch is made 2-3 times larger than the other in volume, when closed working surfaces, the working part of the jaw in the plane of the tool perpendicular to the plane of closure has an oval shape, while the distal tip of the jaw is pointed at an angle of 30-35 ° in the plane of closure and the largest convex extension of the jaw corresponding to the middle of the oval is up to 1/5 of the length of the working part of the jaw, the working surfaces of both branches are curved in the form of arcuate waves with the possibility of full combining of the crests of one working surface with the troughs of the other when closing, while in the distal part of the working the wave surfaces are deflected to the tip, and in the middle part, with the deflection towards the convex expansion of the branches, while the wave slope directed to the center of the plane of closure of the working surfaces, made more it is steeper than a ramp directed to the periphery of the closure plane, the branches are made of heat-resistant and heat-conducting material, in the thickness of the working part of which there are made capillary grooved grooves directed to the distal extremities and the most convex working parts of the branch, the working surfaces of the branch are matte with microscopic irregularities, and their outer surfaces are mirror polished, the branches are made left-sided or right-sided convex relative to the plane of closure of their working surfaces, proxim The main part of the jaw and the clamp attached to it are made arcuate with respect to the longitudinal axis of the plane of the tool perpendicular to the plane of closure of the branches, while the lock is made elongated and equipped with a millimeter linear scale movable by the jaw retainer, and the teeth of the rack are small.

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