RU2363504C1 - Way of extraction of nephrostomic drainage, extractor for realisation of way and extractor mode of operation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions concern medicine, urology and medical equipment. At extraction of nephrostomic drainage, a nephrostomic drainage tube curl is straightened. The tube is moved on a fistulous tract of an organism outside for limits of a fistulous tract. Thus before tube moving on its extremity a radiographic cone is put on. A radiographic cone on a tube is entered into a fistulous tract against the stop in a tube curl. Tube transposition is performed in radiographic cone. For nephrostomic drainage extraction realisation, in the channel of a radiographic cone with possibility of rotation and longitudinal moving the extractor is located. On one extremity of an extractor the handle of mainly round form is executed, and on other extremity of an extractor screw cutting is executed. Cutting includes an extreme first screw site and interfacing to it the second screw site. The radiographic cone is executed with an end face the rounded off form for sliding of a tube and with the handle placed on the extremity, mainly round form which has a flute under fingers of the operator on perimetre. The flute is located under the extractor handle. Extract is executed with d1<d2>dh<dt>db, where d1 - diametre of the first site of screw cutting of an extractor; d2 - diametre of the second site of screw cutting of an extractor; dh - diametre of the channel of the nephrostomic drainage tube; dt - diametre of the channel of a radiographic cone; db - external diametre of the nephrostomic drainage tube. At work with an extractor, at first the handle of a radiographic cone is connected to the handle of an extractor and fixed in this position. Rotation of the handle of an extractor together with the handle of a radiographic cone or separately from it is performed. Screw cutting of an extractor is screwed up in the tube channel of nephrostomic drainage. The handle of a radiographic cone is disconnected from the handle of an extractor and a radiographic cone is moved aside from the extractor handle on the nephrostomic drainage tube to depth of a fistulous course against the stop in the nephrostomic drainage tube curl. Then the radiographic cone is pressed to the tube curl of nephrostomic drainage and simultaneously with it the extractor handle is moved aside from the handle of the radiographic cone till the moment of its excision from a fistulous course of an organism.

EFFECT: reduction of time of operation of excision of a nephrostomic drainage tube, depression of expenses for excision of hard-to-remove nephrostomic drainages, exception of harmful influences on the patient from a tube friction about tissues of a fistulous course, reduction of influences of harmful factors of the x-ray control.

3 cl, 7 dwg

Description

These technical solutions relate to the field of medicine, in particular, to surgical means for removing hollow hard-to-remove objects of artificial origin from the human body, for example, nephrostomy drainages made in the form of flexible elastic tubes with curls at the end to fix the tubes in the renal pelvis of the kidneys. Technical solutions are designed primarily to remove stubborn nephrostomy drainage tubes that have been in fistulous passages for a long time, when the latter are already formed and loosely fit nephrostomy drainage tubes.

From the patent documentation there are known methods and devices for removing various foreign bodies from the body, each of the known devices including a guide tube in which the rod is mounted with the possibility of its movement in the tube.

Such devices include, for example, a craniotomy device containing an outer tube and a rod in the tube with a cone-shaped screw at the end, the device comprising a mechanism for mutual movement of the tube and the rod (SU 566577, A61B 17/46, 07/30/1977).

Also known is a device for removing foreign non-magnetic bodies from tubular organs, comprising a tube with a holder and a rod located in the tube with a working part, which is made in the form of a collet interacting with a tip mounted on the rod, the holder is made with a side bevel, the end of the tube has a handle with a recess under the fingers, the rod at the end has an annular handle (SU 400320, АВВ 17/50, 10/01/1973).

A device for removing foreign bodies from a cavity is known, comprising a tubular body with a fitting, the body has a collet tip with an elastic cover, and a spring-loaded axially movable rod that interacts with the collets is located inside the tubular body (SU 1609471, АВВ 17/22, 30.11 .1990).

A known extractor for removing foreign bodies from hollow organs, containing a guide tube in which a pusher is installed, which is connected to a rod having a trap, while the tube and pusher have handles (RU 2164093, АВВ 17/50, 20.03.2001).

A device is known for removing foreign bodies from a cavity, comprising a tubular body with a telescoping tip and a clip movably mounted in it, a sliding mechanism with a spacer tube (RU 2021767, A61B 17/50, 10.30.1994).

Known extractor for extracting stones from the ureters, containing a probe in the guide tube, a means of capturing stone, a trap and a basket (RU 202121828/14, АВВ 17/22, 2004.08.07).

All of the above devices for removing foreign bodies from the body cannot be used to remove nephrostomy drainage tubes with a curl at the end.

In medical practice, the removal of nephrostomy drainage in the form of a tube with a curl at the end in some cases is associated with significant problems. Firstly, the removal of the drainage tube is associated with its friction on the tissue of the fistulous course of the human body and causing mechanical damage to the tissues. Secondly, in some cases, as a result of existing salt deposits on the inner and outer surfaces of the drainage tube, as well as as a result of “aging” and fatigue stresses of the tube material, after a certain period of time, it loses its original flexibility and elasticity, becomes stiff and hard to remove.

A device is known from world practice for introducing nephrostomy drainage tubes with a curl at the end into the fistulous canal or for removing from the fistulous canal (Surgical products for urology. Product catalog. SOOK, 2006, p.30).

The known device is made in the form of a rigid cannula (rod) inserted into the channel of the tube, while the cannula has a means for its fixed connection with the end of the tube located outside the fistulous course.

In case of removal of the tube from the fistulous passage and from the kidney using the specified cannula, the cannula is first introduced into the tube, while the end of the cannula straightens the curl of the tube located in the renal pelvis of the kidney. Next, the cannula is connected to the end of the tube outside the fistulous passage, and then the tube with a straightened curl is removed from the fistulous passage and from the kidney.

Before the operation of introducing the cannula into the fistulous canal, the cannula is inserted into the tube, while the curl at the end of the tube is straightened by the cannula, and then the tube and cannula along the guiding string are inserted into the fistula and the kidney. After this, the cannula is disconnected from the tube and removed from the tube, while the end of the tube located in the kidney is curled into a curl, and the tube is fixed in the kidney.

Thus, the known device is intended for installation in fistulous passages and removal from them of nephrostomy drainage tubes having curls at the ends that fix the tubes in the renal pelvis.

The known device provides a method for removing a nephrostomy drainage tube or a method for extracting a nephrostomy drainage, which includes straightening the curl of the nephrostomy drainage tube and moving the tube along the fistulous passage outward.

In this method, the tube during its removal from the fistulous course is moved along the cannula (along its rigid shaft), while the tube rubs against the walls of the fistulous course.

This method of removing drainage tubes and a device for implementing the method do not solve these problems. As practice shows, the channels of the removed nephrostomy drainage tubes during their long-term presence (standing) in the body often turn out to be clogged with organic and chemical compounds. In this case, it is not possible to introduce the cannula shaft into the blocked channel of the drainage tube, while the curl of the drainage tube located in the renal pelvis remains not straightened. In this regard, in order to straighten the curl of the drainage tube, additional funds and time are required.

The solved problem of the technical solutions presented in this description is to reduce the time of the nephrostomy drainage tube removal operation, reduce the cost of removing hard to remove nephrostomy drainage, eliminate the harmful effects on the patient from friction of the nephrostomy drainage tube on the fistulous tissue, and also reduce the impact on the patient and medical staff of harmful X-ray factors during X-ray inspection of the tube removal operation.

The indicated result was obtained by the method of extraction of nephrostomy drainage, including straightening the curl of the nephrostomy drainage tube and moving the tube along the fistulous passage of the body outward beyond the fistulous passage, and before the tube is moved, a tube is put on its end, which is then inserted into the fistula through the tube until it stops into the curl of the tube and the movement of the tube is carried out in the channel of the tube.

The indicated result was also obtained by the extractor for implementing the method, containing a tube, in the channel of which the extractor is movably rotated in the longitudinal direction of the channel, the handle is predominantly round in shape at one end of the extractor, and a screw thread is made at the other end of the extractor, including the extreme first the screw section and the second screw section adjacent to it, the tube is made with a handle at the end, mainly round in shape, having a perimeter groove for the fingers of the operator a, the handle of the tube is located under the handle of the extractor, with d1 <d2> dn <dt> dv, where d1 is the diameter of the first section of the screw thread of the extractor, d2 is the diameter of the second section of the screw thread of the extractor, dn is the diameter of the channel of the nephrostomy drainage tube, dt is tube channel diameter, dв - outer diameter of the nephrostomy drainage tube.

The indicated result was obtained by the method of operation of the extractor, which consists in first connecting the handle of the tube to the handle of the extractor and fixing them in this position, rotate the handle of the extractor together with the handle of the tube or separately from it, screw the screw thread of the extractor into the channel of the nephrostomy drainage tube, disconnect from the handle of the extractor the handle of the tube and move the tube to the side from the handle of the extractor along the nephrostomy drainage tube to the depth of the fistulous course until it stops in the curl of the tube Frostomy drainage, then squeeze the tube to the curl of the nephrostomy drainage tube and at the same time move the handle of the extractor away from the handle of the tube until it is removed from the fistulous course of the body.

Figure 1 shows an extractor for extraction of a drainage tube of nephrostomy drainage; figure 2 - installation diagram of a tube of nephrostomy drainage in the fistulous course and renal pelvis; figure 3 - extractor when it is screwed into the channel of the tube nephrostomy drainage; figure 4 - diagram of the extractor when moving the tube along the tube of nephrostomy drainage to its curl; figure 5 - diagram of the extractor when moving the tube nephrostomy drainage along the channel of the tube, removing the tube from the fistulous passage; figure 6 - the relative position of the tube, extractor and tube nephrostomy drainage (fragment); 7 shows the end face of the tube.

The extractor for extraction of the drainage tube of the nephrostomy drainage (hereinafter referred to as the tube) contains a tube 1 (Fig. 1), in the channel 2 of which the extractor 3 is movable in the longitudinal direction of the channel and rotatably rotated in it. At one end of the extractor is a handle 4 of a predominantly round shape and, on the other end part 5 of the extractor, a screw thread is made, including an extreme first screw section 6 and an adjacent second screw section 7.

The tube is made with a handle 8 at the end, mainly round in shape, having along the perimeter a groove 9 for the operator’s fingers. The handle 8 of the tube is located under the handle 4 of the extractor. The ratio of the diameters of the elements of the extractor was selected, in particular d1 <d2> dn <dt> dv, where d1 is the diameter of the first section of the screw thread of the extractor, d2 is the diameter of the second section of the screw thread of the extractor, dn is the diameter of the channel 10 (Fig.6) of the tube 11, dt is the diameter of the channel 2 of the tube 1, dv is the outer diameter of the tube 11.

Having a complex shape, the removable tube 11 (Fig.2-5) at the end is made with a curl 12 for fixing the tube in the renal pelvis 13 of the kidney of the body. The tube 11 is installed in the conditionally shown fistulous course 14 of the body.

At least at the end, the tube 1 has a shape tapering to its end 15 (FIG. 6), which does not exclude the tube being able to taper along its entire length in order to increase its strength and reliability. The butt end 15 of the tube in one of its execution (Fig.7) has a rounded shape in order to improve the sliding of the nephrostomy drainage tube during its removal from the kidney. In another design, at the end 15, the tube 1 has a bulge 16, which also has a rounded shape with a large radius of curvature. The thickening is performed by rolling the wall of the tube 1 into its channel 2.

The described device may have a set of tubes and extractors for various lengths and diameters of nephrostomy drainage tubes. Due to the presence of two sections 6 and 7 of the screw threads of the extractor, one extractor 3 can be used with two tubes 1 sequentially mounted on the extractor 3 (not shown in the drawings).

The above methods are illustrated by the operation of the extractor.

First, a tube and an extractor are selected from a set of tubes and extractors depending on the diameter of the tube 11 and its length. It should be borne in mind that one extractor 3 is designed to remove tubes of various diameters. Therefore, one diameter d1 of the screw portion 6 of the extractor is designed for a tube 11 of smaller diameter, and the other diameter d2 of the screw portion 7 is designed to remove the tube 11 of a larger diameter.

Next, connect the handle 8 of the tube 1 (figure 3) with the handle 4 of the extractor 3 and fix them in this position. The handle 4 of the extractor is rotated together with the handle 8 of the tube or separately from it. Screw the screw thread of the first screw section 6 or the second screw section 7 of the extractor into the channel 10 of the tube 11 (Fig.3 and 6) and disconnect the handle of the tube from the handle of the extractor.

After screwing the screw section 7 into the channel 10 of the tube 11 (Fig.6) move the tube 1 in the direction of the arrow (Fig.4) to the side from the handle 4 of the extractor 3 along the tube 11 to the depth of the fistulous passage 14 until it touches or until the end face 15 or thickening 16 tube 1 into curl 12 of tube 11.

After performing the above operations, in the indicated sequence, the end face 15 or the thickening 16 of the tube 1 is pressed against the curl 12 and at the same time the handle 4 (Fig. 5) of the extractor 3 is moved in the direction from the handle 8 of the tube 1. At the same time, the tube 11 moves along channel 2 of tube 1 until it is removed from the fistulous passage 14 of the body.

In the process of moving the tube 11 from the fistulous passage 14, the curl 12 of the tube 11 straightens from the impact of a rounded end 15 or thickening 16 of the tube 1 without damaging the kidney tissue and fistulous passage, which eliminates their ruptures and bleeding when the tube is removed.

Thus, the method of extraction of the drainage tube of nephrostomy drainage involves straightening the curl 12 of the tube 11, moving the tube 11 beyond the fistulous passage in the channel of the tube 1.

In this case, the rounded end 15 or rounded thickening 16, which is made on the end face 15 of the tube (in another version thereof), eliminates the engagement of the curl 12 of the tube 11 for the tube, which reduces the force required to straighten the curl 12 of the tube 11, reduces the possibility of damage to the removed tube 11 and the appearance in it of cracks and gaps from the concentration of stresses at the bend of the curl in contact with the end face 15 of the tube 1.

The movement of the tube 11 and the straightening of its curl 12 during the movement of the tube 11 is the most essential part of the process of removing the tube, since the wall of the tube and its curl, as a result of prolonged standing, loses its flexibility and acquires significant rigidity, as a result of which the curl 12 of the tube is pressed to butt end 15 of the tube and tends to catch on him.

Claims (3)

1. A method of extraction of nephrostomy drainage, including straightening the curl of the tube of nephrostomy drainage and moving the tube along the fistulous passage of the body outside the fistula, and before putting the tube on its end, put on a tube, which is then inserted through the tube into the fistula to the stop in the curl of the tube, and the movement of the tube is carried out in the channel of the tube. 2. An extractor for implementing the method according to claim 1, comprising a tube, in the channel of which the extractor is movably rotated in the longitudinal direction of the channel, the handle is predominantly round in shape at one end of the extractor, and a screw thread is made at the other end of the extractor, including an extreme first screw portion and a second screw portion adjacent thereto, the tube being made with an end face of a rounded shape for sliding the tube and with a predominantly round-shaped handle located at the end, having the perimeter groove of the operator's fingers, which is located under the handle of the extractor, with d1 <d2> DH <dt> DB where
d1 is the diameter of the first section of the screw cutting of the extractor;
d2 is the diameter of the second section of the screw thread of the extractor;
dн is the diameter of the channel of the tube nephrostomy drainage;
dт - tube channel diameter;
dv is the outer diameter of the nephrostomy drainage tube. 3. The method of operation of the extractor according to claim 2, which consists in first connecting the handle of the tube to the handle of the extractor and fixing them in this position, rotate the handle of the extractor together with the handle of the tube or separately from it, screw the screw thread of the extractor into the channel of the nephrostomy tube drainage, the handle of the tube is disconnected from the handle of the extractor and the tube is moved to the side of the handle of the extractor along the nephrostomy drainage tube to the depth of the fistulous course until it stops in the curl of the nephrostomy drainage tube Then tube to draw in curl tube nephrostomy tube and simultaneously moving the extractor handle away from the grip of the tube until it is removed from the fistula body stroke.

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