RU2466690C1 - Apparatus for extraction of concrements from bile ducts - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: apparatus for extraction of concrements from bile ducts comprises a body, grip elements, a handle and an internal body with attached pins. An external body is presented in the form of a slotted hollow tube in a lumen of which there are four rods with ends concaved into a duct lumen. The rods are directed in the opposite direction with respect to bile passage and make the pins unfolding like an umbrella through the slots and coming back when moving the handle.

EFFECT: apparatus enables higher reliability of concrement gripping ensured by simplified design.

3 ex, 2 dwg

Description

The invention relates to medicine, abdominal surgery and can be used in the treatment of patients with cholelithiasis complicated by choledocholithiasis.

A device is known, including a plate-shaped grip controlled to remove stones from the bile duct, which contains a stone grip means connected to the pusher. The pusher is located in the catheter. The catheter is installed in the endoscope. The stone capture means is made in the form of an elastic plate. The plate has an edge for separating the stone from the walls of the duct, made for the passage between the stone and the wall of the duct and connected at one end to the pusher (patent No. 2317028, published 02.20.2008, IPC АВВ 17/221).

However, the known device is complex and not sufficiently reliable when capturing the calculus. In this case, the loss of stones between the plate and the rods during traction is possible, which complicates the process of lithoextraction.

The closest technical solution is a device containing a handle at one end and a gripping basket of cables at the other end, as well as a gripping device (patent No. 2284771, published on 10.10.2006, IPC АВВ 17/221).

The disadvantage of the prototype device is that the spring mechanism connected to the basket from the cable is not reliable enough when removing stones. In a spoon formed by cables with various sizes of stones, their loss at the time of evacuation is possible.

The technical result is to simplify the device and increase the reliability of the capture of calculus.

Technical solution. The inventive device for lithoextraction is a hollow tube - the outer casing, which is inserted into the choledochotomy opening. In the lumen of the tube in assembled form are four rods, the position of which is regulated by knitting needles. The latter are fixed to the inner case of the device. This tube ends with a handle on top. Changing the position of the handle down leads to the expansion of the rods as an "umbrella", and the handle up - to their return to their original position. These rods are concave into the lumen of the duct, which prevents damage to the walls of the latter during traction of the calculus.

In relation to the prototype, the claimed invention has the following distinctive features: for the operation of the device, a choledochoscope is not needed, the device consists of a hollow tube in which there are four opening rods, the fixation of the calculus occurs between the rods and the axial tube, and not between the gripping plates.

There is a causal relationship between the distinguishing features and the technical result: the device can be used without additional endoscopic equipment (a choledochoscope is needed only for control choledochoscopy, and not for direct capture capture), greater lithoextraction efficiency due to more reliable fixation of calculi, greater safety (less the probability of iatrogenic damage to the walls of the bile duct) due to the fact that the ends of the rods are concave into the lumen of the bile duct.

The invention is illustrated by technical materials, which depict:

Figure 1. Schematic illustration of the capture in a closed form.

1 - grip handle

2 - outer casing

3 - cuts through the housing through which the rods

4 - inner case

Figure 2 - Schematic representation of the capture in open form.

1 - grip handle

2 - outer casing

3 - cuts through the housing through which the rods

5 - knitting needles

6 - rods

The device operates as follows. When indications for surgery are performed, a minilaparotomy is performed in the right hypochondrium and provides access using the “mini-assistant” kit. The field of which choledoch take on the holders and perform choledochotomy. Based on the data of the preoperative examination, the outer casing of the device 2 is inserted into the lumen of the common bile duct (proximal or distal part of it) 300 mm long and 4.5 mm wide. In total, there are four rods 6 assembled in the assembled lumen, the position of which is regulated by knitting needles 5. The latter are fixed to the inner case of the device 4. This tube (inner case 4) ends from the top of the handle of the device 1. Changing the position of the handle 1 down leads to the straightening of the rods 6 by type "Umbrella". Changing the position of the handle 1 up leads to their return to their original position. These rods 6 are concave into the lumen of the duct, which prevents damage to the walls of the latter during traction of the calculus.

When pulling the device outward, the calculus is tightly fixed between the rods 6 and the outer casing 2, which allows reliable lithoextraction. Control cholangiography or cholangoscopy is performed. In the absence of calculi in the common bile duct, the latter is drained. The wound is sutured.

The set of essential features characterizing the essence of the invention, in principle, can be repeatedly used in medicine to obtain the technical result of the treatment of patients with cholelithiasis complicated by choledocholithiasis, which allows us to conclude that it meets the criterion of "industrial applicability".

Example 1

Patient T., 56 years old, was hospitalized on an emergency basis with a diagnosis of cholelithiasis. Acute simple cholecystitis. Choledocholithiasis. Syndrome of obstructive jaundice. According to the ultrasound, a calculus of up to 1.3 cm was visualized in the common bile duct. Infusion, antispasmodic, anti-inflammatory therapy was started and carried out. Against the background of the treatment, the acute attack was stopped, biliary hypertension was resolved. Indications for surgical treatment. Performed minilaparotomy, cholecystectomy. Further, the choledoch was taken on the holders and performed choledochotomy. A device was inserted into the choledochotomy opening, with the help of which the calculus was removed. During the control choledochoscopy, no pathology was revealed. The choledoch drained by Ker. The wound is sutured. The patient was discharged on the 21st day after removal of the choledochostoma in a satisfactory condition.

Example 2

Patient B., 68 years old, was hospitalized with a diagnosis of Gallstone disease. Postcholecystectomy syndrome. Choledocholithiasis. Cholecystectomy from 2006. Attempts to retrograde endoscopic lithoextraction were ineffective due to the presence of a paraphaterial diverticulum in the patient. Indications for surgical treatment. Minilaparotomy was performed using a mini-assistant kit. The choledoch was taken on hold and a choledochotomy was performed. A device (capture) was introduced into the choledochotomy opening, with the help of which two calculi with a diameter of 0.4 and 0.7 cm were removed. During control choledochoscopy, no pathology was revealed. The choledoch drained by Ker. The wound is sutured. According to postoperative fistulography, the discharge of contrast into the duodenum is satisfactory; no shadows suspicious of calculi were found. The patient was discharged in satisfactory condition at 21 days after removal of the choledochostoma.

Example 3

Patient A., 38 years old, was hospitalized with a diagnosis of cholelithiasis. Destructive calculous cholecystitis. Indications for surgical treatment in an emergency. Performed cholecystectomy using a set of "mini-assistant" from the mini-access. However, during the audit, expansion of the common bile duct up to 1.3 cm was revealed. Indications for the audit of the common bile duct are exhibited. Produced choledochotomy. During choledochoscopy in the terminal part of the common bile duct, a calculus was visualized up to 1.0 cm in diameter. Attempts to wash the calculus, extract using a Dormin basket are unsuccessful. A device (capture) was introduced into the choledochotomy opening, below the obstruction zone, with which the calculus was removed. Drainage of the common bile duct. Suture of the wound. The patient was discharged in satisfactory condition on 21 days after removal of the choledochostoma.

Claims (1)

A device for removing calculi from the bile ducts, comprising a housing, gripping elements, a handle, characterized in that it further comprises an inner housing with attached knitting needles, while the outer housing is made in the form of a hollow tube with slots, in the lumen of which there are four rods concave into the lumen duct ends, and the rods are oriented in the opposite direction with respect to the bile current and are made with the possibility of opening the spokes as an "umbrella" through the slots and returning to the starting position when moving SRI handle.

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