RU2310400C1 - Method for catheterization of biliary duct - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should place a cylinder of 3 mm diameter, its length being equal to the diameter of a biliary duct into the catheter introduced into the drained area; then this catheter and the cylinder should be guided towards the area of obstruction to withdraw the cylinder into the lumen of biliary duct. The cylinder has got two ligatures - one fixes the cylinder's center, the second - one of its peripheral ends. Both ligatures should be withdrawn outwards through the catheter. Having been confident that the cylinder is completely in the duct one should tighten the ligature fixed to the central part to place it perpendicular to the catheter and biliary duct. In case of no necessity in drainage or alteration of the catheter's position it is necessary to remove the cylinder due to liberating the fixation of both ligatures and weaken the central ligature. Under roentgen control one should fulfill the traction peripheral ligature and remove the cylinder out of the duct's lumen. Then it is necessary to remove the catheter itself. The innovation provides reliable and simple fixation in the area under drainage, excludes the necessity to apply additional instruments during guiding and removing the catheter; exclude the danger in the migration of the catheter's distal end and perforation of biliary ducts' walls.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, more specifically to surgery, and can be used if necessary, drainage of the bile ducts.

A known method of fixing a catheter in patients with occlusion of the bile ducts by applying to the distal part of the catheter an angular section of the wall, fixed with a fishing line. The ends of the fishing line are connected at the distal outlet. When the nodule is moved with a pointed clip to the side of the proximal opening, the cut of the wall rises in the distal part of the catheter. To remove the catheter, it is necessary to move the nodules to the distal opening with a pointed clamp (Ivshin V.G., Yakunin A.Yu., Lukichev O.D. Transdermal diagnostic and bile duct interventions in patients with obstructive jaundice. Tula, 2000. 312 p.).

The method of catheter fixation proposed by the author undoubtedly has advantages. The catheter can be fixed in its distal part. However, the presence of an acute-angled cut of the catheter wall constantly poses a threat of injury to the wall of the bile duct, even its perforation when the patient's position changes. In addition, salts of bile acids are deposited on the fishing line located in the lumen of the catheter, making the fishing line stationary, which prevents the angular section of the catheter wall from returning to its original position.

A known method of fixing a pigtail catheter ("pigtail"), having a bend in the distal part, through the distal and proximal openings of which the thread is held. The catheter is fixed by traction at both ends of the fishing line until the distal end of the catheter is completely folded, tying the ends of the fishing line on the catheter (Endobiliary interventional oncoradiology / Dolgushin B.I., Avaliani M.V., Buidenok Yu.V. et al., Ed. B. I. Dolgushina. - M.: Medical Information Agency LLC, 2004. - 224 pp., Ill.).

The described known method of fixation is more perfect, however, it is not without drawbacks. The bending of the distal part of the catheter does not take into account the diameter of the bile duct, therefore, in the vast majority of cases, such a catheter is not applicable, since it is impossible to roll the catheter into the ring due to the limited diameter of the bile duct (up to 1-1.5 cm). In addition, there is a risk of rupture of the bile duct due to the constant pressure of the tube, rolled in the form of a ring.

The aim of the invention is the reliable fixation of the catheter in the drainage site.

The goal is carried out by the fact that they perform contrasting of the bile ducts, evaluate the level of the block and the internal diameter of the biliary tract. An angiographic guide is inserted through a needle of an appropriate diameter into the lumen of the biliary tract. A catheter is placed on the needle and conductor. The needle and the conductor are removed, a cylinder with a diameter of 3 mm is placed in the catheter, the length of which depends on the diameter of the bile duct, the catheter with the cylinder is advanced to the obstruction zone in the distal direction, and the catheter is led into the cavity of the bile duct. The cylinder has two threads - one fixes the center of the cylinder, the second one of the peripheral ends. Both threads through the catheter are brought out. Under x-ray control, making sure that the cylinder is completely in the duct, pull up the central part and install it perpendicular to the catheter and bile duct. The ends of the threads are fixed on the outside of the catheter. After the expiration of the need for catheterization, the cylinder is removed, freeing both threads from fixation, weaken the central thread. Under the control of the x-ray, traction of the peripheral filament is carried out, the cylinder and then the catheter are removed.

Analysis of known methods of drainage with fixation of the catheter allows us to talk about the novelty and significant differences of the proposed.

The novelty of the proposed method consists in the possibility of fixing the distal part of the catheter due to the hollow cylinder held by the threads on it. A monofilament thread, the ends of which are brought out to the skin, allows the cylinder to be fixed in the direction perpendicular to the catheter and duct and removed. The distal end of the catheter becomes less mobile and eliminates the possibility of injury to the drained area.

In accessible open sources of information from Russia, the CIS countries and foreign indications of a similar method could not be found.

A method for catheterization of the bile ducts is industrially applicable. It can be reproduced and repeated many times in the departments of surgery.

The method is as follows.

An ultrasound scan of the right upper quadrant of the abdominal cavity is performed. Assess the topography of the intrahepatic tubular structures, the relative position of the intrahepatic bile ducts and the branches of the portal and hepatic veins, determine the position of the gallbladder, right pleural sinus, and colon. Find out the level of obstruction, the cause of the block of the biliary tract. The optimal trajectory of puncture of the biliary tract, passing through the skin in the 7-8-9 intercostal space, is chosen. Puncture and contrast of the bile ducts are performed, the level of the block and the internal diameter of the bile ducts are evaluated. An angiographic guide is inserted through the puncture needle. A catheter is placed on the needle and conductor. The needle and the conductor are removed, a cylinder with a diameter of 3 mm is placed in the catheter, the length of which depends on the diameter of the bile duct, the catheter with the cylinder is moved as close to the obstruction zone as possible and the cylinder is brought into the lumen of the bile duct. The cylinder has two threads - one fixes the center of the cylinder, the second one of the peripheral ends. Both threads through the catheter are brought out. After performing an X-ray examination and making sure that the cylinder is completely in the duct, pull the thread fixed to the central part, installing it perpendicular to the catheter and bile duct. The threads are fixed to the proximal part of the catheter. After the expiration of the need for drainage or the need to change the position of the catheter, the cylinder is removed by releasing both threads from fixation, and the central thread is weakened. Under the control of x-ray, traction of the peripheral filament is carried out, the cylinder is removed from the lumen of the duct. Next, the catheter itself is removed.

An example of a specific implementation of the method can serve as an extract from the medical history.

Sick Sargsyan A.A., born in 1933. Case history No. 22038 / f. He entered the thoracoabdominal department on November 18, 2005 with a diagnosis of pancreatic head cancer with metastases in the liver, obstructive jaundice. The patient underwent puncture of the segmental duct of the right lobe of the liver, after which the bile ducts were contrasted, the level of the block and the internal diameter of the bile ducts were evaluated, which is 8 mm in this case. An angiographic guide was introduced through a needle of the appropriate diameter into the lumen of the biliary tract. A catheter was placed on the needle and guide. The needle and guide were removed, a cylinder 3 mm in diameter, 8 mm long was placed in the catheter, the catheter and cylinder were moved distally to the obstruction zone, and the catheter was removed into the bile duct cavity. The cylinder has two threads - one fixes the center of the cylinder, the second one of the peripheral ends. Both threads through the catheter brought out. Under X-ray control, making sure that the cylinder is completely in the duct, we pulled the central part up and set it perpendicular to the catheter and bile duct. The ends of the threads were fixed on the outside of the catheter. On the 5th, 12th day of the postoperative period, cholangiography was performed, which showed the absence of catheter displacement in the bile duct.

The inventive method was carried out drainage of 14 patients. In no case was displacement of the distal part of the catheter or damage to the walls of the bile ducts was noted.

The technical and economic efficiency of the method lies in the possibility of reliable and relatively simple fixation in the drained area; elimination of the need for additional instruments when conducting and removing a catheter; eliminates the risk of migration of the distal end of the catheter and perforation of the bile duct wall.

Claims (1)

A method for catheterization of the bile duct, including the introduction of a catheter into the drained zone under the control of x-ray, characterized in that a 3 mm diameter cylinder is placed in the catheter, the length of which is equal to the diameter of the bile duct, the cylinder has two threads - one fixes the cylinder in the center, and the second one from the peripheral ends of the cylinder, both threads are led out through the catheter to the outside, after the catheter with the cylinder is brought to the obstruction zone, the cylinder is brought into the lumen of the duct, making sure that the cylinder is completely in the duct, lyayut pulling the central portion of the cylinder and place it perpendicularly and the catheter duct, the ends of the filaments are fixed on the outside of the catheter.