RU2470593C1 - Device for biopsy of tubular structures and method for its application - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to surgery and can be used for biopsy of intra- and extrahepatic bile ducts, urinary tract, etc. In case of present block of any tubular formation, tube is introduced into tubular structure by means of preliminary puncture and fixation of metal guide in tubular structure at the place of block. Biopsy tube, which is introduced into the place of occlusion, is brought into by means of guide. Guide is removed. Double-edged tube tip is pulled by passed through entire tube thread and sampling of cell material from obturated tubular structure is performed. Device of material sampling is removed. Sampled material is sent to histological and cytological analysis.

EFFECT: minimal trauma and high accuracy of histological and cytological material sampling.

2 cl, 5 dwg

Description

The proposed method relates to medicine, namely to surgery, and can be used for biopsies inside the tubular structures of the body (intra- and extrahepatic bile ducts, urinary tract, etc.), squeezed due to any formation.

The causes of occlusion inside the tubular structures of the body can be: 1) benign: a) lithiasis (stones in the ducts); b) postoperative strictures, 2) malignant a) the primary tumor of the tubular structures (hepatic ducts, ureters, etc.) b) the primary tumor of the parenchymal organ, c) the primary tumors of a certain area of the body (hepatobiliary, paranephral, etc.) d) metastatic processes.

Currently, the main method of biopsy of tubular structures is a tissue biopsy through the use of automatic and semi-automatic trepanbiopsy needles made of metal; the Trucut needle is also used. [one]

The use of a flexible device for the collection of cellular and histological material from the tubular structures of the body can significantly increase the percentage, verify pathology causing complete or partial obstruction of the tubular structures in the patient, and significantly reduce the number of complications after diagnostic manipulations.

It is known the use of a biopsy tool from the inner surface of tubular organs (RF patent No. 2222262) in abdominal surgery. This tool is close in technical essence and consists of a handle, a hollow tube and internal traction. The rod is installed inside the hollow tube and is connected to a handle and working elements that have a cutting edge. The working elements are deployed from the axis of the internal traction and are located at an equidistant distance from each other over the entire diameter. The working elements have the ability to open up to the inner diameter of the hollow organ by interacting with the conical surface and the inner rod, on which the supporting body is fixed. The housing is arranged to interact with the inner surface of each working element and return the working elements to their original position [2].

The technical result of the invention is the ability to conduct a biopsy from the inner surface of the tubular organ over the entire diameter simultaneously. However, this tool is a rigid structure and its use leads to damage to nearby organs and tissues and provokes an increase in the number of complications due to the lack of flexibility in the design of the tool, and this tool also does not allow sampling of material from certain places of the organ.

The closest in technical essence of the claimed device is the biopsy needle known from the description of the invention to the copyright certificate [4], comprising an external hollow needle with an oblique cut at the working end and an internal hollow needle with a handle, and the cutting edge of the internal hollow needle is made in the form of a spiral, a groove is made on the outer surface of this needle, in which a flat spring knife is mounted.

The disadvantage of this device is its complexity, and this tool is a rigid structure.

The technical result of the proposed device is the use of a tube of thermoplastic polyvinyl chloride (PVC) or Eurosilicon highly purified. The distal end of the tube is truncated at an angle of 30 degrees from the base. At the truncated end of the tube there is a thread fixed inside the tube, passed through the working end of the tube by a loop and exiting from it at the proximal end.

The proposed device for biopsy of tubular structures contains a tube and a conductor, while the conductor is made of soft material, and the tube is made of flexible polymeric material and has a pointed distal end, which is truncated at an angle of 30 degrees from the base, and a thread is fixed on the truncated end inside the base, held inside the tube by a loop and exiting from it at the proximal end to the outside.

The essence of the proposed method for biopsy of tubular structures is that with an existing block of any tubular formation (bile duct, ureter, etc.), a tube of this type is inserted into it (tubular structure) by preliminary puncture of this tubular structure and fixation in the tubular structure of the metal conductor at the site of the block, a biopsy tube is inserted along the conductor, it is introduced into the occlusion site, the conductor is removed, the double-edged tip of the tube is pulled over itself by a drawn All pipe thread, carrying cellular material fence obturated tubular structure. The device for collecting material is removed, the collected material is sent for histological and cytological examination.

The use of this type of device allows minimizing damage at the site of material and nearby tissue intake, taking cellular material from the zone of interest with a high degree of accuracy, and increasing the sensitivity and specificity of this diagnostic procedure. This combination of new features with the already known ones allows you to eliminate existing shortcomings of the previous instrument design, reduce the risks of complications after a biopsy, increase the sensitivity and specificity of the biopsy, and expand the range of access points in the organ.

The proposed method is illustrated by drawings.

Figure 1 shows a tool for biopsy (1 - a device for biopsy 2 - a thread of a polymer material).

Figure 2 shows the input of the Chiba needle to the zone of interest in the tubular structure (3 - the core of the Chiba needle; 4 - tubular structure; 5 - obstruction in the tubular structure).

Figure 3 shows the progression of the conductor into the zone of interest (6 - needle type "Chiba", 7 - soft metal conductor).

Figure 4 shows the progress of the biopsy device along the conductor to the zone of interest (8 - conductor; 9 - biopsy device).

Figure 5 shows the tissue intake through the obstructing tubular structure (11 - tissue inside the biopsy device; 12 - tissue in the tubular structure).

Figure 2-5 shows a diagram of a biopsy.

To assess the feasibility of the device and the implementation of the biopsy method, experiments were performed on 6 non-fixed human corpses (2 dolichomorphic, 2 mesomorphic and 2 brachymorphic physiques). A biopsy of extrahepatic bile ducts with an artificially created block proposed by the method was performed on each corpse [3].

The method is as follows. For the experiment, the liver and its bile duct system were chosen as an example. Under the control of ultrasound examination, setting the sensor in 8-9 intercostal spaces along the anterior axillary line, the right lobar bile duct is determined. The skin is incised with a scalpel at the point closest to the bile duct, the right lobar bile duct is punctured with a 20 cm diameter Chiba needle with a diameter of 18 G under the control of ultrasound. A soft metal conductor starts up on the needle to the place of interest. An open-ended biopsy device is conducted through the conductor under visual control. The device is introduced to the level of narrowing of the bile duct, after which the conductor is removed and the bile duct mucosa tissue is removed by slamming the movable part of the tube of the biopsy device by pulling the thread through the entire flexible tube of the device. The tube is made of flexible polymeric material and has a pointed distal end, which is truncated at an angle of 30 degrees from the base. Due to it, material is taken from the place of interest.

The tube is tightly pulled to the upper edge of the device due to the held thread through the upper edge of the device, which contributes to the smooth removal of the device. The device with the material is removed. The material is sent for cytological and histological examination.

The method of conducting a biopsy of the tubular structures of the body by introducing a hollow tube to the zone of interest is characterized in that the manipulation is performed percutaneously under the control of ultrasound by conducting a tube to the occlusion zone using a conductor, then the conductor is removed, the material is taken by tensioning the fixed thread through the proximal end of the tube and passing the cutting edge of the distal end of the tube through the zone of interest with the removal of the device with the selected material.

Information sources

1. S. Sherlock, J. Dooley. Diseases of the liver and biliary tract. M .: "GEOTAR", 1999, 86 pp.

2. Pat. RF invention №2222262 C1, A61B 10/00.

3. A.Yu.Sozon-Yaroshevich. Anatomical and clinical justification of surgical access to internal organs. Leningrad: Medgiz, 1954, pp. 17-23.

4. Copyright certificate SU No. 848016 A "Needle for biopsy", publ. 07/23/1981

Claims (2)

1. A device for biopsy of tubular structures containing a tube and a conductor, characterized in that the conductor is made of soft metal, while the tube is made of flexible polymeric material and has a pointed distal end that is truncated at an angle of 30 ° from the base, and at the truncated end inside the base, a thread is fixed, carried inside the tube by a loop and exiting from it at the proximal end. 2. A method for conducting a biopsy of the tubular structures of the body by introducing a hollow tube to the zone of interest, characterized in that the manipulation is performed percutaneously under the control of an ultrasound examination by conducting a tube to the occlusion zone using a conductor, then the conductor is removed, the material is taken by pulling the fixed thread through the proximal the end of the tube and the passage of the cutting edge of the distal end of the tube through the zone of interest with the removal of the device with the selected material.

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