RU2607155C1 - Method of cannulation of peripheral lymphatic vessels for obtaining of lymph - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to lymphology. On inner surface of upper or middle third of shin under local anesthesia cross cut of skin is made, in subcutaneous fat main lymphatic vessel for cannulation is found. Then it is separated from subcutaneous fat in distal direction below place, where it is formed by fusion of two or three smaller lymphatic vessels. At place lower than fusion of two or three smaller lymphatic vessels, wall of one of which forms bifurcation or trifurcation of vessels it is dissected with skew cut. Then into lumen of vessel with thin end model cone-shaped tube with valves is introduced, which is smoothly expanding from thin end to opposite one. Then tube is slightly advanced in central direction, valves flaps of lymphatic vessel are opened and tube is pressed to walls of lymphatic vessel. Wherein at movement of thin tube end in main lymphatic vessel it is transected, and central end of main lymphatic vessel is ligated with circular ligature. Thereafter further movement of tube in central direction is performed by drawing it by tip. Occurrence of problems at displacement of tube indicates that increasing outer diameter of input part of tube equals to lumen diameter of canulated lymphatic vessel. Then free distal part of introduced tube is cut off near wound in wall of lymphatic vessel, through which tube is introduced. Then it is pulled in central direction, that its distal end is located above mouth of fusion of two lymphatic vessels forming main vessel. Tube is fixed in main lymphatic vessel with one circular ligature of absorbable material, which is located above expanding part of tube end. Wound on lymphatic vessel, through which tube was introduced, is closed or vessel is ligated. As result lymph is released through tube, which is brought by another lymphatic vessel, free end of tube is brought out between sutures on skin wound. Tip of tube is cut off. Free end of remaining part of tube is connected to drain tube, from which released lymph flows into container.

EFFECT: method enables improving results of examination and treatment of patients suffering from lymphatic system and metabolic disorders.

6 cl, 3 dwg

Description

The present invention relates to medicine, in particular to methods for cannulation of peripheral lymphatic vessels to obtain lymph for the purpose of detoxification.

.Known cannula, including an elongated body having at least two ends, while the portion adjacent to one of the named ends is the connecting part of the cannula, and the portion adjacent to the second of these ends is the working part of the cannula, and in the elongated body is made through the channel so that it enters the fluid from the end adjacent to the connecting part of the cannula, and exits from the end adjacent to the working part of the cannula, characterized in that its working part is made in IU helix such that the ratio of spiral diameter size and the size of its step provides the ratio of the rotational velocity of the fluid to the magnitude of its velocity as a translational

.

With this known vascular cannula, it is not possible to cannulate peripheral lymphatic vessels, since due to its spiral design it is difficult to introduce into the lumen of the vessel; practically such a cannula is used exclusively for intravenous infusions produced by the venesection method.

Also known is a set of telescopic cannula with a lock containing a plurality of telescopic tubes, made in aggregate with such shape and dimensions as to reach a predetermined position relative to the anatomical region, with each tube having a blocking shape, and a structure of an inner tube inserted inside the outer tube , contains a gap between the outer surface of the inner tube and the inner surface of the outer tube to allow rotation of the inner tube and the outer tube, the outer surface The inner tube and the inner surface of the outer tube are blocked with each other in the gap [2].

The aforementioned set of telescopic cannula with blocking is an extremely complex device that is difficult to use in everyday medical practice, in particular for cannulation of peripheral lymphatic vessels in order to obtain lymph.

There is also known a method of cannulation of the thoracic duct, which consists in cutting the skin and subcutaneous tissue in the region of the left clavicle, dividing the sternum and clavicular parts of the sternocleidis with a blunt and sharp path, exposing the venous angle formed by the internal jugular and subclavian veins, isolating the thoracic duct, cutting the wall of the thoracic lymphatic duct and enter into this incision one end of the cannula of polymer material, the second end of which is fixed to the skin surface with a fixing suture, characterized in that the duct is wound and with stitches, put a twisted seam over the thread, tighten it to seal the duct around the cannula and bring both ends of the thread through a skin incision that is sutured, and the thread is tied on a gauze ball on the skin surface, after which a lymph detoxification course is carried out, and after this course of treatment is fixed the suture is cut, the cannula is removed, the twisted suture thread is additionally tightened and tied on a gauze ball on the skin surface until the wound heals, after which the suture is cut and removed [3].

This method is designed exclusively for cannulation of the thoracic duct and it is impossible to carry out cannulation of peripheral lymphatic vessels using this technology to obtain lymph.

The applicants (authors) set themselves the task of developing a sustainable long-term, for example for several days, method for producing peripheral lymph of the subcutaneous lymphatic vessels on the inner surface of the upper and middle third of the leg, which are considered the most convenient for receiving it, while the method should provide the possibility of cannula sufficient depth in the distal direction despite the obstruction of the valves of the lymphatic vessel. The above positive technical result was achieved due to the combination of essential features of the proposed method of cannulation of peripheral lymphatic vessels to obtain peripheral lymph of the subcutaneous lymphatic vessels to obtain lymph, presented in the following claims: "a method of cannulation of peripheral lymphatic vessels to obtain lymph, which consists in the fact that the internal the surface of the upper or middle third of the leg under local anesthesia with a transverse incision they skim the skin, in the subcutaneous tissue they find a suitable (main) lymphatic vessel for cannulation and separate it from the subcutaneous tissue in the distal direction below the place where it is formed by the fusion of two or three smaller lymphatic vessels, retreating below the fusion of two or three smaller lymphatic vessels, the wall of one of the vessels forming a bifurcation or trifurcation is dissected obliquely and a specially modeled cone-shaped tube smoothly expanding from thin the opposite end due to the increase in the inner diameter and made of polypropylene or polyvinyl chloride, then the tube is easily advanced in the central direction, since the valve flaps of the vessel open and are pressed by the tube to the walls of the lymphatic vessel, after moving the thin end of the tube into the main lymphatic vessel, it is crossed, and The central end of the main lymphatic vessel is ligated with a circular ligature or cannulated if necessary for endolymphatic therapy. the tube is moved in the central direction by pulling it by its thin end, while the appearance of difficulties in moving the tube indicates that the increasing external diameter of the inserted part of the tube is compared with the lumen diameter of the cannulated lymphatic vessel, then the free distal part of the inserted tube is cut off at the wound on the wall lymphatic vessel through which the tube itself is inserted, and pull it in a central direction so that its distal end is located above the mouth of the fusion two lymphatic vessels that form the main vessel, and the tube is fixed in the main lymphatic vessel with at least one circular ligature of absorbable material, which is located above the expanding end of the tube, the wound on the lymphatic vessel through which the tube was passed is sutured or ligated a vessel, as a result of which a lymph is released through the tube, brought in by another lymphatic vessel, the free end of the tube is brought out between the sutures on the skin wound, the thin end of the tube is cut off, free the other end of the remaining part of the tube is connected to a drainage tube through which the secreted lymph flows into the container; a transverse section on the inner surface of the upper or middle third of the tibia is 1.5-2.0 cm long; the main lymphatic vessel for cannulation is chosen with a diameter of at least 0.8 mm; the thickness of a specially modeled tube is selected in the range of 0.1-0.15 mm, and its length in the range of 10-12 cm; "said tube expands smoothly from a thin end to the opposite by increasing the internal diameter from 0.5 mm to 1.2 mm."

The invention is illustrated by drawings, where in FIG. 1 shows a cross-section through an oblique section below the fusion of the wall of one of the bifurcation vessels and the insertion into the vessel lumen with the thin end of a specially modeled tube, performed according to the present method of cannulation of peripheral lymph vessels to obtain lymph; in FIG. 2 - operation stage, when the increasing external diameter of the inserted part of the tube is compared with the lumen diameter of the cannulated lymphatic vessel; in FIG. 3 is a diagram of a completed cannulation of a peripheral lymphatic vessel.

The proposed method of cannulation of peripheral lymphatic vessels in order to obtain lymph and its subsequent detoxification is as follows. The skin is dissected on the inner surface of the upper or middle third of the lower leg under local anesthesia with a transverse section 1.5-2.0 cm long. In the subcutaneous tissue, a suitable (main) cannula for lymphatic vessel 1 with a diameter of at least 0.8 mm is found and it is secreted from the subcutaneous tissue in the distal direction just below, where it is formed by the fusion of two (rarely three) smaller lymphatic vessels 2, 3. Retreating 4-5 mm below the confluence, the wall of one of the vessels forming the bifurcation (or trifurcation) of the vessels is dissected by an oblique incision 4 and a specially modeled tube 5 is inserted into the lumen of the vessel with a thin end (Fig. 1). The tube 5 is made, for example, of polypropylene or polyvinyl chloride with a wall thickness of 0.1-0.15 mm and a length of 10-12 cm. It has a conical shape and gradually expands from the thin end to the opposite by increasing the inner diameter from ~ 0.5 mm to ~ 1.2 mm.

The advancement of the tube 5 in the central direction is easy, since the valve flaps 6 open and press the tube 5 against the walls of the lymphatic vessels 2, 1. As soon as the thin end of the tube 5 moves into the main lymphatic vessel 1, the latter intersects. The central end 7 of the main lymphatic vessel 1 is ligated with a circular ligature 8 or cannulated if necessary for endolymphatic therapy. Further movement of the tube 5 in the Central direction is mainly carried out by pulling it at the thin end. The appearance of difficulties in moving the tube 5 indicates that the increasing external diameter of the introduced part of the tube 5 is compared with the diameter of the lumen of the cannulated lymphatic vessel 1 (Fig. 2).

Next, the free distal part of the inserted tube 5 is cut off. After this, the tube 5 is pulled in the central direction so that its distal (inner) end is located above the mouth of the fusion of the two vessels 2 and 3, which form the main vessel 1. The tube 5 in the main lymphatic vessel 1 is fixed by one circular ligature 9 of absorbable material. The reliability of this fixation is explained by the fact that the circular ligature 9 is located above the expanding end of the cannula 10 (the remaining part of the tube).

The wound 4 on the lymphatic vessel 2, through which the tube 5 passes, the vessel 2 is sutured or ligated. In the latter case, the lymph is secreted through the tube 5, brought in through the other lymphatic vessel 3. The free end of the tube 5 is brought out between the sutures on the skin wound. The thin end of the tube 5 is cut off, the free end of the cannula 10 is connected to the drainage tube 11, through which the allocated lymph flows into the container 12. The circuit of the complete cannulation of the peripheral lymphatic vessel is shown in FIG. 3.

All surgical manipulations on peripheral lymphatic vessels are performed using a special set of surgical instruments for performing microsurgical operations at high magnification (surgical microscope, glasses with high magnification).

Complications during operations and in the postoperative period were not observed. The proposed method for cannulation of peripheral lymphatic vessels is introduced into the practice of the vascular departments of the FSBI “3 TsVKG im. A.A. Vishnevsky "and in other medical institutions. This method of cannulation of peripheral lymphatic vessels was performed in 24 patients. There were no unsuccessful attempts. In all cases, cannulation of the peripheral lymphatic vessels was discontinued due to the completion of the study or treatment. Peripheral lymphatic vessels were decanulated by simply pulling the cutting. The maximum term for the successful functioning of the cannula was 20 days.

The inventive method of cannulation of peripheral lymphatic vessels for therapeutic diagnostic purposes is characterized by high efficiency and can improve the results of examination and treatment of patients with pathology of the lymphatic system and metabolic disorders. The method can be recommended for widespread implementation in practice, including in military hospitals.

Information sources

[one]. Description of the invention to the patent of the Russian Federation No. 2233632 "Vascular cannula", A61B 17/34, A61M 25/00, filed December 26, 2002, published August 10, 2004.

[2]. Description of the invention to the patent of the Russian Federation No. 2550659 “Telescopic cannula with blocking”, АВВ 17/00, claimed October 12, 2009, published December 20, 2005, Bull. Number 35.

[3]. Description of RF patent No. 2266059 “Method for cannulation of the thoracic duct (3 Options)”, АВВ 17/00, filed March 26, 2004, published December 20, 2005, Bull. Number 35.

[four]. Description of the invention to the patent of the Russian Federation No. 2043776 "Method of ileo-inguinal-femoral lymphadenectomy for cancer metastases in the lymph nodes of the inguinal region", А61В 17/00, claimed 10.17.2014, published on 10.20.2014.

[5]. US patent No. 4957484 "Lymph access catheters and methods of administration", A61M 25/01 (604/53), published 09/19/1990

[6]. Description of the patent of the Russian Federation No. 412665 "Method for drainage of the petracheostomy space", А61В 17/00, filed January 11, 2009, published July 20, 2010

[7]. US patent No. 6849061 "Lymph access catheters and methods of administration", A61M 29/00 (604 / 99.02), published 01.02.2005

[8]. US Patent No. 4874378 "Catheter sheath introducer", A61M 25/00 (604/167), published October 17, 1989.

Claims (6)

1. The method of cannulation of peripheral lymphatic vessels to obtain lymph, which consists in the fact that on the inner surface of the upper or middle third of the lower leg under local anesthesia, a skin is cut through a transverse incision, the main lymphatic vessel for cannulation is found in the subcutaneous tissue and distal from the subcutaneous tissue in the distal direction below the place where it is formed by the fusion of two or three smaller lymphatic vessels, retreating below the fusion of two or three smaller lymphatic vessels, the wall of one one of the vessels forming a bifurcation or trifurcation is cut obliquely and a simulated cone-shaped tube with valves is inserted into the lumen of the vessel with a thin end, gradually expanding from the thin end to the opposite by increasing the inner diameter and made of polypropylene or polyvinyl chloride, then the tube is easily advanced in the central direction , the valve flaps of the lymphatic vessel open and press the tube against the walls of the lymphatic vessel, while moving the thin end of the tube into the main they cross the phatic vessel, and the central end of the main lymphatic vessel is ligated with a circular ligature, the further movement of the tube in the central direction is carried out by pulling it at the thin end, while the appearance of difficulties in moving the tube indicates that the increasing external diameter of the inserted part of the tube is compared with the diameter lumen of the cannulated lymphatic vessel, then cut off the free distal part of the inserted tube at the wound on the wall of the lymphatic vessel, black without the tube itself, and pulling it in a central direction so that its distal end is located above the mouth of the confluence of the two lymphatic vessels that form the main vessel, and the tube is fixed in the main lymphatic vessel with at least one circular ligature made of absorbable material, which is located above the expanding end of the tube part, the wound on the lymphatic vessel through which the tube was passed, the vessel itself is sutured or ligated, as a result of which a lymph is released along the tube rugomu lymphatic vessels, free end of the tube is discharged outside the skin between sutures on the wound, the thin end of the tube is cut, the free end of the remainder of the tube is connected to a drain pipe, through which the lymph flows allocated to the container. 2. The method according to p. 1, in which the Central end of the main lymphatic vessel is cannulated for endolymphatic therapy. 3. The method according to p. 1, in which a transverse section on the inner surface of the upper or middle third of the leg is made 1.5-2.0 cm long. 4. The method according to claim 1, in which the main lymphatic vessel for cannulation is selected with a diameter of at least 0.8 mm. 5. The method according to p. 1, in which the wall thickness of the simulated tube is selected in the range of 0.1-0.15 mm, and its length in the range of 10-12 cm 6. The method according to claim 1, wherein said tube expands smoothly from the thin end to the opposite by increasing the inner diameter from 0.5 to 1.2 mm.

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