RU2405463C1 - Method of intestinal polyps ablation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to surgery, and can be applied in ablation of polyps of digestive tract with size from 0.5 to 5.0 cm. Essence of method lies in electroexcision. After performing electroexcision, radio wave coagulation of tissue remnants, remaining from polyp, is carried out.

EFFECT: application of claimed invention allows to ensure radical ablation of polyps and minimise possible complications, such as bleeding and perforations.

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Description

The invention relates to medicine, namely to surgery.

A known method of treating polyps of the digestive tract, which consists in mechanically removing them using a metal loop and / or scissors, and / or conventional biopsy forceps. Biopsy forceps are used for polyps 3-4 mm in size, when a tumor is completely removed with a double or triple biopsy. Cutting off polyps with scissors is a technically difficult procedure, since the soft-elastic tissue of the polyp leg is poorly cut by the branches of the endoscopic scissors and bleeds. Mechanical cutting of the tumor with a loop is used when the thickness of the legs does not exceed 4-5 mm. For radicalism, maximally squeeze the loop into the mucous membrane and polypectomy is performed repeatedly by repeated sharp tightening of the loop in the form of “hooks” until the tumor legs intersect (Yu.M. Pantsyrev, Yu.I. Gallinger. Surgical endoscopy of the gastrointestinal tract.- M .: Medicine 1984, C.23-25).

With mechanical polypectomy, it is impossible to talk about the radical nature of the operation, since there always remains a substrate from which formation can recur; bleeding of varying intensity occurs, sometimes requiring surgical intervention. So, with a gradual tightening of the loop, often only the leg is squeezed without its intersection, and polypectomy is performed by forced traction of the loop into the instrument channel of the endoscope. Often, along with the polyp, the part of the mucous membrane surrounding it also comes off, as a result of which a significant traumatic defect forms and intense bleeding occurs.

A known method of treating polyps of the digestive tract, which consists in photocoagulation of polyps with a high-energy laser. The essence of the method is that in a non-contact way from a distance of 0.5-0.7 cm with a laser beam focused at the distal end of the fiber, the polyp is photo-degraded. When using this method, the polyp tissue is burned in layers, there is practically no bleeding due to reliable coagulation of blood vessels. However, only polyps up to 1 cm in size or polyps having a thin long leg are removed by laser photocoagulation (Vasiliev Yu.V., Zelenin S.A. Experience in the use of laser radiation to remove stomach polyps during endoscopy // Vestn. Surgery.- 1985.- T. 135, No. 5-6. - S.92-94).

The disadvantages of this method: the work of a high-energy laser in the lumen of the stomach is accompanied by high smoke, which reduces the visibility of the removed polyp, in addition, the stomach is constantly in a state of peristalsis, and since the method is non-contact, it is impossible to fix the laser beam in one position, as a result of which the peristaltic wave propagates iatrogenic linear coagulation of the surrounding mucosa occurs. With laser exposure, the entire polyp tissue is burned and it is impossible to extract an array of the removed tumor for morphological verification.

A known method of treating polyps of the digestive tract, which consists in coagulating them with a current of radio wave frequency. A ball coagulator is brought to the polyp through the biopsy channel of the endoscope. It is fed a current of radio wave frequency of 5.28 MHz, unipolar in mixed mode with a power of 3-4 Units (45 W), exposure time of 2-3 seconds. Since the depth of tissue destruction during radio wave exposure is up to 1-2 mm, the formation is removed gradually, under clear visual control, the necrotic tissue is white, there is no pronounced smoke (Pat. 02226363 RF IPC А61В 17/94, А61В 17/00, А61М 25/00. Method for endoscopic removal of a large duodenal papilla with adenomas / Budzinsky AA, Ivantsova MA applicant and patent holder Federal State Unitary Enterprise Ural Electrochemical Plant).

The disadvantage of this method is the inability to remove large (from 1 to 5 cm) polyps due to insufficient depth of penetration of the current radio wave frequency into the tissue of the mucosa of the digestive tract.

Known methods of treating polyps of the digestive tract, consisting in their electroexcision or electrocoagulation. Electrocoagulation is used to remove polyps of sizes up to 0.5 cm on a wide base. The essence of the method is that the polyp is captured in parts with forceps for a hot biopsy, after each capture, a high frequency current of 440 kHz is applied to the branches of the forceps, monopolar in the coagulation mode with a power of 30-35 W, exposure time of 2-3 s. There is a gradual burning of the polyp. In its place there remains a post-coagulation defect.

Electroexcision consists in the introduction of a diathermic loop through the biopsy channel of the endoscope, throwing it on a polyp, lowering it to its base and slowly tightening. After tightening the loop, the polyp is lifted above the surrounding mucous membrane, a high frequency current of 440 kHz is applied to the loop, unipolar, with a power of 35-40 W, the polyp is cut off. Perform electroexcision in a mixed mode (automatic alternation of cutting and coagulation). After the polyp is cut off, its bed is carefully examined, the cut off polyp is extracted for morphological examination. This is currently the most common method for endoscopic removal of digestive tract polyps. (Chernomordinov V.G., Pavlov K.A., Stefanenko Yu.F. Endoscopic electroexcision of polyps of the stomach on an outpatient basis // Vestnik. Surgery. - 1985. - T.135, No. 10. - P.102-105. Lutsevich E.V., Astapenko V.G. Digestive tract polyps removal: Guide to gastrointestinal endoscopy / Edited by E.V. Lutsevich.- Minsk: Higher school, 1990.- P. 216-233). This method is selected for the prototype.

The disadvantages of this method: bleeding from the bed of a removed polyp and perforation of a hollow organ. Perforation occurs as a result of the formation of thermal tissue necrosis to the depth of the entire wall of the hollow organ due to the thermal effect of the high-frequency current, which is achieved by increasing the exposure exposure.

The objective of the invention is to increase the effectiveness of the treatment of polyps of the digestive tract.

Effect: radical removal of the polyp and minimization of possible complications (bleeding, perforation).

This is achieved due to the fact that after electroexcision perform radio wave coagulation of tissue residues related to the polyp.

Digestive tract polyps that are subject to endoscopic removal have sizes from 0.5 to 5 cm, a smooth, finely tuberous or villous surface, a clear but not always even contour; located on legs, wide bases, or simply spread along the mucous membrane. Polyps carry a precancerous potential, they are malignant up to 40% of cases. The main tumor mass of polyps is removed by a diathermic loop with a high frequency current of 440 kHz, monopolar, with a power of 35 W in a mixed cutting and coagulation mode. At the same time, the depth and width of coagulation necrosis reaches 3-5 mm, which is already extremely permissible for the walls of a hollow organ. With visual or chromoendoscopic detection of non-removed sections of polyp tissue, it is necessary to coagulate them.

It is proposed to carry out radio-wave coagulation of such areas to healthy tissues of the surrounding mucous membrane. Since the manipulation will have to be performed already on the tissues that are obviously affected by the high-frequency current, it requires a gentle mode. It is known that the radio-frequency current of 5.28 MHz, monopolar, with a power of 40 W in coagulation mode vaporizes the tissue, penetrating into the depth and around the electrode to a depth of not more than 1-2 mm. Therefore, for this purpose, it is optimal to conduct radio wave coagulation, and not, for example, electrocoagulation, in which the depth of thermal necrosis is much deeper, and this can cause perforation of the hollow organ.

The method is as follows.

After electroexcision of the polyp by a radiosurgical device, radio-wave coagulation of the remaining polyp tissues to healthy tissues of the mucous membrane surrounding them is performed.

Clinical example.

Patient K., 69 years old. And / b. No. 09102141.

Diagnosis: Polyposis of the stomach. Hospitalized at 1x.o. March 9, 2009 - March 17, 2009

EFGDS from 03/11/09: in all parts of the body, cardiac section and fundus of the stomach there are multiple polypous formations of 5-10 mm on wide bases, part of the formations with erosive apices. Produced vital staining of the gastric mucosa solution Indigocarmini 0.4%. Electroexcision of polyps of 7 mm, 8 mm and 8 mm was performed, followed by radio-wave coagulation of tissue residues removed polyps.

Biopsy of removed polyps No. 6028-29 / 09 of 03.20.09: hyperplastic polyps.

Endoscopic endoscopy on 03.17.09: condition after endoscopic polypectomy, at the site of the removed polyps there are post-coagulation defects of the mucous membrane from 3 to 5 mm, covered with white fibrin.

Endoscopic endoscopy on 05/26/09: complete epithelization of post-coagulation defects of the gastric mucosa.

Claims (1)

A method for removing polyps of the digestive tract from 0.5 to 5.0 cm by electroexcision, characterized in that after electroexcision, radio-wave coagulation of tissue residues left from the polyp is performed.