RU2456913C1 - Method of measurement of blood pressure in esophagus veins - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, hepatology and gastroenterology, and can be used in diagnostics of portal hypertension. Liquid is pumped into probe with rubber balloon, connected with Waldman apparatus via T-shaped conductor. Balloon is inflated with uniform action on all walls of esophagus. Veins are compressed until blood flow stops. Blood flow is visualised by means of ultrasonic scanner and Dopplerometry. At the moment of complete vein collapse level of pressure is fixed by height of water column of Weldman apparatus. Method is used without esophagogastroscope with constant monitoring.

EFFECT: method makes it possible to realise control over change of pressure in esophagus veins in case of portal hypertension in the course of treatment and disease course, estimate efficiency of conservative, operative treatment of varicose veins of esophagus, predict probability of bleeding.

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Description

The invention relates to medicine, in particular to surgery, hepatology and gastroenterology, and can be used in the diagnosis of portal hypertension.

Currently, with portal hypertension, a direct manometry method in the veins of the esophagus is used to measure pressure in the veins of the esophagus. (http://www.dialog.samara.ru/help/rus/help.htm; http://www.medicus.ru/cardiology/pats/?cont=article&art_id=376) This method is extremely rarely used in medicine, since the puncture of the vein is unsafe and can cause bleeding.

There is a method of direct portography in patients with portal hypertension with the aim of directly measuring portal pressure, evaluating options for collateral blood flow and the possibility of applying different types of portocaval anastomoses (http://www.med74.ru/infoprint681.html) [Patient MD Surgery of portal hypertension. - M .: Medicine, 1974. - 407 pp.], But this method requires surgical intervention and anesthesiology, measures the pressure in the portal vein and only indirectly allows you to evaluate the pressure in the esophageal veins ..

In the practice of medicine, it is known to use the ultrasonic method for measuring pressure in the veins of the esophagus (http://www.endoscopy.ru/view_news.html?id=5949; http://www1.fips.ru/fips_serv1/fips_serv1et?DB=RUPAT&rn= 6966 & DocNumber = 2355287 & ID = E9EE7CF0-7AЕE-4743-B2AB-8436CE4F73AB & TypeFile-html). However, this method requires complex mathematical calculations to evaluate the results.

The basis of the invention is the creation of a simple, affordable and quick way to measure pressure in the veins of the esophagus.

In the proposed method, for the first time, pressure measurement is performed using an endoscopic ultrasonic sensor and Waldman apparatus.

This problem is solved by the simultaneous use of an endoscopic ultrasound apparatus and Waldman instrument for measuring venous pressure. The inventive method allows to measure the pressure in the veins of the esophagus in patients with portal hypertension in order to predict the risk of bleeding and evaluate treatment outcomes. The use of a method for measuring blood pressure in the veins of the esophagus allows you to control the change in pressure in the veins of the esophagus with portal hypertension during treatment and the course of the disease.

The method is illustrated by the drawings: Fig. 1 - stage of installation of the balloon with an ultrasonic sensor in the lower third of the esophagus; Fig. 2 - stage of inflation of the cuff; Fig. 3 is a schematic illustration of a device; Fig. 4 - esophagus vein on the screen of an ultrasound machine.

The method of measuring blood pressure in the veins of the esophagus is as follows: the patient lies on the left side during the procedure. The zero level of Waldman's apparatus is located at the level of the projection of the lower third of the esophagus.

During esophagogastroduodenoscopy, varicose veins are determined, the degree of their expansion, the level of location in the esophagus are assessed. After removing the endoscope, a balloon catheter with a rubber cuff at the end (Fig. 1) is inserted into the lower third of the esophagus, in the lumen of which an ultrasound probe is located. The catheter is connected via a tee to a syringe and Waldman apparatus. Under the control of ultrasound determine the wall thickness of the vein, the diameter of the vessels. Next, deaerated water is pumped into the balloon, as a result of which the veins of the esophagus are compressed and the blood flow stops (Fig. 2), which is visually determined on the monitor screen (Fig. 4). At the time of complete retraction of the veins, the pressure level is fixed along the height of the water column of the Waldmann apparatus (Fig. 3).

During the dynamic observation of patients with portal hypertension, pressure measurement in the varicose veins of the esophagus was successfully performed before treatment and after without any side effects. The proposed method differs from existing minimally invasive (does not require venous puncture, surgical access). The combination of the use of the ultrasound method and Waldman's apparatus avoids complex mathematical calculations, reliably determine the pressure directly in the veins of the esophagus, and not in the entire portal system.

Example 1

Patient X., 54 g. Diagnosis: liver cirrhosis in the outcome of hepatitis B. Child-Pugh class B. Portal hypertension. Varicose veins 3 tbsp.

When measuring blood pressure in the veins of the esophagus, a result of 550 mm of water was obtained. The operation was performed distal spleno-renal shunting. In the postoperative period, the pressure decreased to 210 mm of water.

Example 2

Patient F., 32 g. Diagnosis: Cirrhosis in the outcome of hepatitis B, C. Child-Pugh class B. Portal hypertension. Varicose veins 3 tbsp. When measuring blood pressure in the veins of the esophagus 580 mm of water. Art. Surgery: endoscopic sclerotherapy. Measurement of pressure in the veins of the esophagus in the postoperative period of 550 mm of water. Art.

Thus, the proposed method for measuring pressure in the veins of the esophagus is a simple, affordable and objective method that allows you to timely determine the treatment tactics and evaluate the effectiveness of the treatment. This method has a number of significant differences from prototypes: low invasiveness, simplicity, reliability and accuracy of the results. Obtaining measurement results directly during the procedure. Assessment of pressure in the immediate area of interest - in the veins of the esophagus. Allows you to evaluate the effectiveness of conservative, surgical treatment of varicose veins of the esophagus, to predict the likelihood of bleeding from them.

Claims (1)

A method of measuring blood pressure in the veins of the esophagus, which consists in the fact that when the fluid is injected into a probe with a rubber balloon, connected through a t-shaped conductor to the Waldman apparatus, introduced into the lumen of the esophagus, veins are compressed until the blood flow stops, which is visualized using an ultrasound scanner and dopplerometry, characterized in that the balloon inflates, acting uniformly on all walls, the pressure is fixed in all veins passing at this level, it is used without an esophagogastroscope, it is used When continuous monitoring.

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