RU2715745C1 - Device for haemorrhage arrest during adenotomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to otorhinolaryngology, and can be used in stopping haemorrhage accompanying adenotomy in adults and children. Apparatus for stopping bleeding during adenotomy is presented in the form of a tube made of rubber with a balloon at a distal working end. Tube is bent along the anatomical nasopharyngeal structure and has at distance of 150 mm a straight distal working end with length of 30 mm, oriented at angle of 90° to its longitudinal axis. On the proximal end of the tube there is a connecting element for filling the balloon. Tube is equipped with a rigid base-conductor allowing inserting the device transorally during the operation.

EFFECT: achieved with the implementation of the above device technical result is the possibility of fast stopping of nasopharyngeal bleeding in a simple, in terms of implementation, transoral by performing surgical treatment, haemostasis of all hard-to-reach areas of the nasopharynx (arch nasopharynx, an area of the mouth of the auditory tube, a plowshare bone).

1 cl, 1 dwg

Description

The invention relates to medicine, in particular to otorhinolaryngology, and can be used to stop bleeding during an adenotomy in adults and children.

Stopping bleeding during an adenotomy operation is one of the most important tasks of an otorhinolaryngologist surgeon. A bleeding patient needs immediate medical attention.

Temporary nasopharyngeal tamponade with gauze balls on the clamp is widely known (Sokolov - abstract on the dissertation "The clinical results of the use of endoscopic adenoidectomy" Novosibirsk 2004). This method is used everywhere. It is easy to use and has a good effect on minor bleeding that stops quickly. The disadvantage of this technique is that with massive bleeding, the effectiveness of this technique is reduced.

A known method of repeated adenotomy to remove residual adenoids. In the case of residual adenoid tissue after surgery, bleeding may be due to incomplete removal of the adenoid tissue. (Bogomilsky MR, Chistyakova VR Children's otorhinolaryngology: A guide for doctors. In 2 volumes. T. 1. M: Medicine, 2005). The disadvantage of this technique is its narrow application - the method is effective only in the presence of residues of adenoid tissue. The use of parenchymal go vascular bleeding this technique is not possible.

Also known is the method of bipolar coagulation of the wound surface in the nasopharynx after surgery. (Kryukov A.I., Palchun V.T. Otorhinolaryngology, a guide for doctors 2017, M. publishing house); The disadvantage of this technique is the formation of a coagulation scab in the coagulation zone, which can lead to massive relapses of bleeding from the nasopharynx.

There is a known method for conducting posterior nasopharyngeal tamponade, which is performed with massive profuse bleeding (Kryukov A.I., Palchun V.T. Otorhinolaryngology, a guide for doctors in 2017, M. Publishing House). The method is performed if it is impossible to stop the bleeding with the above methods. It provides a stop of bleeding, but causes severe discomfort in patients: severe headache, stuffy ears, discomfort when swallowing, etc.

The known method used for massive bleeding is ligation of the external carotid artery (Palchun V.T. Magomedov M.M., Luchikhin L.A. Otorhinolaryngology 2016 GEOTAR-media). The method is used in extreme cases. Among the shortcomings, it is worth noting the need for external access surgery and the risk of cerebral ischemia caused by ligation of a large main vessel.

The known method is balloon inflating with a YAMIK-catheter through the nasal cavity into the nasopharynx for 10-15 minutes. The JAMIC sinus catheter is inserted into the nasal cavity up to the nasopharynx, the adenotomy is plugged by inflating the posterior balloon, the balloon is blown off and the sinus catheter is pulled out, while the patient continues bleeding, the sinus catheter is extubated. The disadvantage of this method is the insufficient size of the posterior balloon for effective nasopharyngeal tamponade, as well as the difficulty of using patients with a curved nasal septum. We take this method as a prototype.

In connection with the foregoing, we were tasked with developing a device for stopping bleeding during an adenotomy operation that does not have the disadvantages of analogues.

The technical result achieved by the device we developed is the ability to quickly stop bleeding from the nasopharynx by a simple, from the point of view of implementation, transoral route during surgical treatment, hemostasis of all hard-to-reach areas of the nasopharynx (nasopharynx arch, region of the mouth of the auditory tube, opener).

The device for stopping bleeding during an adenotomy is made in the form of a tube made of rubber, which is curved along the anatomical structure of the nasopharynx and has a straight distal working end 30 mm long, oriented at an angle of 90 ° to its longitudinal axis, the tube is equipped with a rigid base-conductor, on the distal working at the end of the tube there is an inflatable balloon, at the proximal end of the tube there is a connecting element for filling the balloon.

This configuration is most anatomically suitable for dense nasopharyngeal tamponade by the transoral route and can be used in the presence of a curved nasal septum in the patient. The devices we studied in the literature do not have this form.

The device dimensions chosen by us are compact, they are inserted into the nasopharynx in a collapsed state, which allows the device to be inserted quickly, controlling, if necessary, with a transnasal endoscope.

Figure 1 - device for stopping nosebleeds during an adenotomy:

1 - the proximal end of the device, the outer diameter of 8 mm, the inner diameter of 4 mm;

2 - a connecting element for filling the balloon;

3 - conductor for introducing the device by transoral access, A - 150 mm, diameter B - 3 mm;

4 - 90 ° bend at the distal working end of the device at a distance of 150 mm, facing up, angle C - 90 °;

5 - distal working end of the device, equipped with an inflatable balloon, D - 30 mm;

Installation of a device to stop bleeding during an adenotomy is as follows.

After an adenotomy, the device is transorally administered under the control of an endoscope into the nasopharynx. Using a syringe, fill the device’s balloon with air or saline. After 10 minutes, the contents of the balloon are removed. The device is removed. An endoscopy of the nasopharynx is performed to confirm hemostasis.

This device configuration is most anatomically suitable for insertion into the nasopharynx. The available silicone at the end of the balloon allows for high-quality hemostasis. The dimensions of the elements of the developed device that we have chosen ensure its compactness, which allows for the introduction into the nasopharynx under the control of an endoscope quickly and easily.

Clinical example No. 1.

Patient K., 20 years old, turned to the clinic-diagnostic department of the Institute. L.I. Sverzhevsky. With complaints of congestion of the left ear, drainage of mucus along the back of the pharynx, nasal congestion in a horizontal position.

According to the patient, the patient notes frequent colds, accompanied by pain in the ears, stuffiness in the ears, constantly notes the flow of mucus along the back wall of the pharynx. The last exacerbation after an acute respiratory viral infection 2 weeks ago. Nasal breathing is difficult in a horizontal position.

On examination, the region of the paranasal sinuses is not changed, the mucous membrane of the nasal cavity is weakly swollen, weakly hyperemic, there is a mucous discharge in the common nasal passages. The lower nasal concha is enlarged due to edema, cyanotic, and decreases during adrenalization. The septum of the nose is in the middle position. The mucous membrane of the oropharynx is pink. Palatine tonsils are not enlarged, gaps are free. The mucous membrane of the larynx is pink, the vocal folds are mobile. Ears: The external auditory meatus is clear on both sides. On the left - the eardrum is not changed, the identification marks are contoured. Right - the eardrum is not changed, the identification marks are contoured. When conducting the Weber experiment, there is no lateralization. The Rinne experience is positive.

An endoscopic examination of the nasal cavity and nasopharynx was performed. When conducting endoscopy of the nasal cavity, the presence of mucous discharge in the nasal cavity, an increase in adenoid vegetation in the nasopharynx, closing by 2/3 of the choana, are noted. The mucous membrane of the nasopharynx is hyperemic, there is a pronounced amount of mucous discharge in the nasopharynx. Tubar rollers are not changed. The auditory tube is covered by adenoid vegetations on

Diagnosis: Adenoid vegetation of the II-III degree, vasomotor rhinitis, neurovegetative form.

The patient underwent surgical treatment of adenotomy, laser vaporization of the lower nasal concha. The operation was performed under combined endotracheal anesthesia. The first step was the laser vaporization of the lower nasal turbinates after their luxation medially. The holmium laser electrode is inserted into the thickness of the lower nasal concha on the left. Produced vaporization of the nasal conch, the latter decreased in size. Lateroconchopexy was performed. Similarly, laser vaporization of the lower nasal concha on the right was performed. The next step was an adenotomy using an adenotome, adenoid vegetation was removed from the nasopharynx fornix. Parenchymal bleeding from the nasopharynx is noted. An attempt was made to stop using tuphers. Bleeding persists. The next step is the installation of a device to stop bleeding during an adenotomy. The device is inserted into the nasopharynx transorally. Using a connector, a balloon of up to 10 ml is inflated. Produced hemostasis within 10 minutes. Cylinder filler removed, device removed. An endoscopy of the nasal cavity and nasopharynx was performed. There is no hemorrhage. The operation was completed without installing tampons in the nasal cavity and nasopharynx.

The patient was discharged the day after the operation under the supervision of a doctor of the clinic at the place of residence. The patient was examined on the 3rd, 7th and 14th day. Nasal breathing during examinations improved, hemorrhage was not observed. At endoscopic examination, the nasopharyngeal arch is free, tubular ridges are not changed, the mouth of the auditory tubes is free. The nasal passages are wide, without pathological discharge. Nasal breathing is free.

Clinical example No. 2.

Patient T., 16 years old, turned to the clinical diagnostic department of the Institute. L.I. Sverzhevsky. With complaints of nasal congestion throughout the day, intensifying in a horizontal position.

According to the patient, the patient notes a constant nasal congestion since childhood, suffers frequent colds. Frequent otitis media in childhood. Nasal breathing is difficult in a horizontal position.

On examination, a slight puffiness of the face is noted, the lower jaw is constantly open, breathing mainly through the open mouth. The area of the paranasal sinuses is not changed, the mucous membrane of the nasal cavity is slightly swollen, cyanotic, there is a mucous discharge in the common nasal passages. The lower turbinates are not enlarged at the time of inspection. The septum of the nose is in the middle position. The mucous membrane of the oropharynx is pink. Palatine tonsils are not enlarged, gaps are free. The mucous membrane of the larynx is pink, the vocal folds are mobile. Ears: The external auditory meatus is clear on both sides. On the left - the eardrum is not changed, the identification marks are contoured. Right - the eardrum is not changed, the identification marks are contoured. When conducting the Weber experiment, there is no lateralization. The Rinne experience is positive.

An endoscopic examination of the nasal cavity and nasopharynx was performed. When conducting endoscopy of the nasal cavity, the presence of a mucous discharge in the nasal cavity is scarce, an increase in adenoid vegetation in the nasopharynx is observed, covering more than 2/3 of the choanas. The mucous membrane of the nasopharynx is hyperemic, there is a pronounced amount of mucous discharge in the nasopharynx. Tubar rollers are not changed. The auditory tube is covered by adenoid vegetations on

Diagnosis: Adenoid vegetation III-IV degree.

The patient underwent surgical treatment of adenotomy. The operation was performed under combined endotracheal anesthesia. Using an adenotome, an adenotomy was performed under the control of an endoscope, and adenoid vegetations were removed from the nasopharynx fornix. Parenchymal bleeding from the nasopharynx is noted. An attempt was made to stop using gauze toppers. Bleeding persists. Electrocoagulation of the bleeding zone was performed, parenchymal bleeding from the operation zone is preserved. The next step is the installation of a device to stop bleeding during an adenotomy. The device is inserted into the nasopharynx transorally. Using a connector, a balloon of up to 10 ml is inflated. Produced hemostasis within 10 minutes. Cylinder filler removed, device removed. An endoscopy of the nasal cavity and nasopharynx was performed. There is no hemorrhage. There is no dripping of blood on the posterior pharyngeal wall. The operation was completed without installing tampons in the nasal cavity and nasopharynx.

The patient spent the night calmly, hemorrhage was not observed. Discharged the day after the operation under the supervision of a doctor at the clinic at the place of residence. The patient was examined on the 3rd, 7th and 14th day. Nasal breathing during examinations improved, hemorrhage was not observed. At endoscopic examination, the nasopharyngeal arch is free, tubular ridges are not changed, the mouth of the auditory tubes is free. The nasal passages are wide, without pathological discharge. Nasal breathing is free.

Claims (1)

A device for stopping bleeding during an adenotomy, made in the form of a tube of rubber with an inflatable balloon at the distal working end, characterized in that the tube is curved along the anatomical structure of the nasopharynx and has a straight distal working end 30 mm long at 150 mm, oriented at an angle of 90 ° to its longitudinal axis, at the proximal end of the tube is made a connecting element for filling the balloon, while the tube is equipped with a rigid base-conductor, allowing you to enter the device transorally into operation time.

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