RU2550303C1 - Method for percutaneous transhepatic biliary drainage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method is implemented by reducing the intraductal pressure over the use of a dual-lumen catheter: a base catheter is used to outflow the bile duct content, while an additional low catheter is applicable to administer an antiseptic solution. Using the presented modified catheter enables performing the effective sanitation of the bile ducts without increasing the intraductal pressure. The technical simplicity and availability of the method enables using them in surgical hospitals.

EFFECT: more effective percutaneous transhepatic biliary drainage and improving the outcome in the patients suffering from acute cholangitis accompanying obstructive jaundice.

1 dwg

Description

The invention relates to medicine, namely to surgery, and is intended for percutaneous transhepatic drainage of the bile ducts with subsequent sanitation of the biliary tract with antiseptic solutions.

The following types of catheters are known for percutaneous transhepatic cholangiostomy:

- Direct polyethylene catheter (1);

- A modified device for percutaneous transhepatic drainage of the bile ducts (2);

- Drainage for decompression of the intrahepatic ducts with obstructive jaundice caused by central liver cancer (3).

All of the above analogues have the following disadvantage, namely, they do not allow for the adequate rehabilitation of the biliary tree without increasing intraductal pressure.

The purpose of the invention is to increase the effectiveness of percutaneous transhepatic cholangiostomy and, as a result, to improve the treatment results of patients with acute cholangitis with obstructive jaundice.

This goal is achieved by reducing the intraductal pressure by creating a catheter with two lumens: the main catheter serves to drain the contents of the biliary tract, and an additional, small, for the introduction of an antiseptic solution.

Figure 1 shows:

1. Locking ring of a direct polyethylene catheter;

2. Direct polyethylene catheter;

3. Single channel catheter;

4. The fixing thread;

5. Cannula of a single-channel catheter;

6. The locking ring of a single channel catheter;

7. A plot for applying medical glue;

8. Cannula of a direct polyethylene catheter.

The method of percutaneous transhepatic cholangiostomy, characterized in that a direct polyvinyl chloride catheter is installed in the bile ducts, in its distal part at a distance of 5-7 mm from the cannula, an additional hole is inserted with a scalpel through which a single-channel catheter of smaller diameter is inserted inside the catheter, fixed with BF medical glue -6 or its analogue and kapron thread to the external catheter, carry out the reorganization of the biliary tract.

Example No. 1

Patient F., 67 years old, with a diagnosis of a tumor in the head of the pancreas, obstructive jaundice, acute cholangitis. Received 2 weeks from the onset of the disease. On the second day from the moment of receipt, percutaneous transhepatic cholangiostomy was performed by the indicated method, cholangiography. Conducted daily sanitation of the biliary tract with a solution of sodium hypochlorite 0.06% through the proposed catheter, for 10 days. The following dynamics of laboratory indicators was observed: a decrease in the level of total bilirubin in the first 7 days from 428.3 μm to 67.5 μm, and a level of direct bilirubin from 357.2 to 39.1 μm, respectively. Bacterial contamination of bile - 107 at the first sampling of bile, immediately after percutaneous transhepatic cholangiostomy, the control culture of bile on the 7th day is sterile. When washing the bile ducts of the pain syndrome, there was no deterioration in the general condition of the patient, no catheter migration was noted. After 15 days from the moment of hospitalization, radical surgical treatment was performed - extended gastropancreatoduodenal resection. The patient was discharged on the 17th day after the operation in satisfactory condition under outpatient monitoring by an oncologist.

 Example No. 2

Patient V., 53 years old, with a diagnosis of Klatskin tumor type 2, obstructive jaundice, acute cholangitis. Hospitalized on an emergency basis after 5 days from the onset of obstructive jaundice. On the first day from the moment of hospitalization, percutaneous transhepatic cholangiostomy was performed by the indicated method, cholangiography. Conducted daily sanitation of the biliary tract with sodium hypochlorite solution 0.06%. Dynamics of laboratory indicators: a decrease in the level of total bilirubin in the first 7 days from 336.8 μm to 102.4 μm, and the level of direct bilirubin from 248.2 to 56.4 μm, respectively. Bacterial contamination of bile - 107 at the first sampling of bile, immediately after percutaneous transhepatic cholangiostomy, control sowing of bile on day 7 - 102. When washing the bile ducts of the pain syndrome, there was no deterioration in the general condition of the patient, no catheter migration was observed. On the 20th day from the moment of hospitalization, radical surgical treatment was performed - extended right-sided hemihepatectomy. The postoperative period corresponded to the severity of the operation. The patient was discharged on the 23rd day after the operation in satisfactory condition under outpatient observation by an oncologist.

Using the proposed method allows for the effective rehabilitation of the biliary tract without a significant increase in intraductal pressure. The technical simplicity and accessibility of the method allows its use in surgical hospitals.

 Information sources

1. Device for percutaneous drainage of cavity formations: US Pat. 2019200 Russian Federation: IPC 51 A61M 25/08, A61M 27/00 / V.G. Ivshin, V.N. Korolev; Applicant and patent holder Vladislav Gennadevich Ivshin. - No. 4941011/14; declared 06/03/1991; publ. 09/15/1994.

2. Modified device for percutaneous transhepatic cholangiostomy: utility model patent No. 132331 Russian Federation: IPC АВВ 17/00 (2006/01) / А.В. Kovalev, R.A. Pakhomova, D.E. Zdzitovetsky; applicant and patent holder State budgetary educational institution of higher professional education "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky of the Ministry of Health of the Russian Federation". - No. 2012152163/14, declared 12/04/2012, publ. 09/20/2013.

3. Drainage for decompression of the intrahepatic ducts with obstructive jaundice caused by central liver cancer: US Pat. 132997 Russian Federation: IPC A61M 27/00 (2006.01), A61M 25/10 (2013.01) / I.S. Malkov, M.I. Shakirov, A.P. Kirshin, V.A. Filippov, M.I. Malkova, L.V. Skurlatova; applicant and patent holder Federal State Budgetary Educational Institution of Higher Professional Education "Kazan National Research Technical University named after AN Tupolev - KAI", M.I. Shakirov - No. 2013108461/14, declared 02/26/2013; publ. 10/10/2013.

Claims (1)

Method of percutaneous transhepatic cholangiostomy, characterized in that a direct polyvinyl chloride catheter is installed in the bile ducts, an additional hole is inserted with a scalpel in its distal part at a distance of 5-7 mm from the cannula, through which a single-channel catheter of smaller diameter is inserted into the catheter, fixed with medical adhesive BF- 6 or its analogue and kapron thread to the external catheter, carry out the sanation of the biliary tract.

Images