RU2485924C1 - Electrode for electrochemical lysis of intraocular neoplasms - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and medical equipment, and can be applied in ophthalmology and ophthalmo-oncology for intraocular electrochemical lysis of intraocular neoplasms. Electrode for electrochemical lysis of intraocular neoplasms is made in form of needle 32 G with curved intratumoral part and limiter and placed in blunt-pointed cannula 23 G, which contains window for limiting movement of electrode limiter. Radius of curvature and length of intratumoral part of electrode is selected individually by data of ultrasonic examination depending on tumor size in supposed place of electrode introduction, in such a way, that when introduced into tumor structure from one side, intratumoral part of electrode does not go out from the other side, and is totally placed inside tumor.

EFFECT: invention provides possibility of electrode introduction into intraocular neoplasm intravitreally under visual control into zone, optimal for carrying out ECL procedure.

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Description

The invention relates to medicine and can be used in ophthalmology and ophthalmic oncology for intraocular electrochemical lysis of intraocular neoplasms.

Electrochemical lysis (ECL) has been used quite successfully to treat breast cancer. According to Xin Yu Ling (China-Japan Friendship Hospital, Beijing), from 1987 to 1998. in 168 clinics in China, 644 patients with breast cancer were treated, mainly with stages III and IV of the disease, and the five-year survival of patients was 50.5%. In addition, ECL is performed for malignant neoplasms of the liver and liver metastases from various primary tumors, for benign prostatic hyperplasia, for cancer of the esophagus, lungs, pancreas, and skin. In these cases, equipment (an apparatus for ECL) and instruments (sets of electrodes, trocars and cannulas for their introduction) were developed for conducting ECL.

The use of ECL in ophthalmology is complicated by the inaccessibility and small size of neoplasms. Another problem is the lack of tools adapted for conducting ECL of intraocular tumors.

In the available literature, the authors were not able to find data on the electrodes for intraocular electrochemical lysis of intraocular neoplasms.

It is known that the vessels that feed the tumor are located mainly near its base, closer to the sclera. Accordingly, for the effective destruction of the tumor blood supply system, the epicenter of the electrochemical destructive effect should be located in this zone. Obviously, for targeted introduction of electrodes into the zone of interest, visual control is necessary, therefore it is advisable to introduce electrodes intravitreal.

The objective of the invention is the creation of electrodes for intraocular electrochemical lysis of intraocular neoplasms.

The technical result is the possibility of introducing an electrode into the intraocular neoplasm intravitreal under visual control into the zone that is optimal for the ECL procedure. The technical result is achieved due to the fact that:

1. The electrode is made with a limiter and is located in a blunt cannula 23 G, containing a window for restricting the stroke of the electrode limiter;

2. The electrode is a 32 G needle with a curved intrat moral part intended for insertion into the tumor;

3. The radius of curvature and the length of the intratumoral part of the electrode are selected individually according to ultrasound, depending on the transverse size of the tumor at the proposed site of introduction of the electrode so that when the intratumoral part of the electrode is inserted into the structure of the tumor on one side, it does not come out of it on the other, but is completely inside the tumor;

4. At the extreme upper position of the limiter, the electrode is completely in the cannula; at the extreme lower position of the limiter, the electrode is advanced from the cannula by the value of the intratumoral part;

5. The electrode is made of a conductor, allowing the intratumoral part in a straightened position is inside the cannula and take a curved shape when exiting it.

The electrode for electrochemical lysis of intraocular neoplasms is made in the form of a 32 G needle with a curved intratumoral part and a limiter in the form, for example, of a pin head. The radius of curvature and the length of the intratumoral part of the electrode are individually selected according to ultrasound, depending on the transverse size of the tumor at the proposed site of insertion of the electrode so that when the intratumoral part of the electrode is introduced into the structure of the tumor on one side, it does not come out of it on the other, but is completely inside the tumor . The electrode, with the exception of the intratumoral part, is coated with a bioinert electrical insulating material, for example fluoroplast-4. The electrode is located in a blunt cannula 23 G, containing a window to limit the stroke of the electrode stop. The length of the cannula should be sufficient so that the window to limit the stroke of the electrode stopper when using the electrode is completely extrascleral. At the extreme upper position of the limiter, the electrode is completely in the cannula; at the extreme lower position of the limiter, the electrode is advanced from the cannula by the amount of the intratumoral part. The electrode is made of a conductor, allowing the intratumoral part in a straightened position is inside the cannula and take a curved shape when exiting from it, for example from an alloy Fe-Mn-Si or Fe-Ni, or Cu-Al, or Cu-Mn, or Co-Ni or Ni-Al.

To conduct an ECL session, the electrode is introduced into the tumor structure as follows.

Preliminarily, according to the ultrasound data, the area of the greatest blood supply to the tumor and the depth of its location from the top of the tumor are determined.

At the preparatory stage for ECL, if necessary, rectus muscles are cut off to provide access. Transsclerally diaphanoscopically clarify the location and size of the tumor, determine the boundaries of the projection of the base of the tumor on the sclera and outline them with a coloring matter, for example, 1% aqueous-alcoholic solution of brilliant green. A surface electrode is applied to the sclera in the area of projection of the base of the tumor and hemmed with 2 interrupted sutures to the sclera.

Then perform a 3-port 25 G vitrectomy, after which - retinotomy, exposing the tumor, conduct a liquid-air exchange. Next, a pars plana, 3.5 mm from the limb in the quadrant, which provides the most convenient access to the tumor, depending on its location, after the conjunctival incision, sclerotomy is performed through which a 23G cannula is inserted intravitreal with the electrode inside, while the electrode limiter is at the extreme top position. The distal end of the cannula under visual control is brought to the tumor, the electrode limiter is moved to its lowest position and the intratumoral part of the electrode is introduced into the tumor structure through its lateral surface (slope) in the place optimal for ECL, usually at the base of the tumor in the zone of the highest blood supply according to ultrasound.

ECL of the tumor is carried out with a charge of 27-50 cells. At the end of ECL, the electrode is removed, the retina is applied, the endolasercoagulation of the retina is performed, the vitreous cavity is filled with silicone oil. Remove the surface electrode. When the muscles are cut off, they are hemmed into place.

The invention is illustrated by the following clinical data.

ECL with the proposed electrode was performed in 3 patients with choroid melanomas. In all cases, the electrode was introduced under visual control through the lateral surface (slope) into the area with the highest blood supply to the tumor according to preliminary ultrasound, optimal for the ECL procedure.

Thus, the present invention provides the possibility of introducing the electrode into the intraocular neoplasm intravitreal under visual control in the zone that is optimal for the ECL procedure.

Claims (4)

1. The electrode for electrochemical lysis of intraocular neoplasms is made in the form of a 32 G needle with a curved intrata moral part and a stopper and is located in a blunt cannula 23 G containing a window to limit the stroke of the electrode stopper; the radius of curvature and the length of the intratumoral part of the electrode are selected individually according to ultrasound, depending on the transverse size of the tumor at the proposed site of insertion of the electrode so that when the intratumoral part of the electrode is inserted into the structure of the tumor on one side, it does not come out of it on the other, but is completely inside the tumor. 2. The electrode according to claim 1, characterized in that it is made of a conductor, allowing the intratumoral part in a straightened position is inside the cannula and take a curved shape when exiting it. 3. The electrode according to claim 2, characterized in that it is made of an alloy of Fe-Mn-Si, or Fe-Ni, or Cu-Al, or Cu-Mn, or Co-Ni, or Ni-A1. 4. The electrode according to claim 3, characterized in that, with the exception of the intratumoral part, is covered with bioinert electrical insulating material.