RU57123U1 - Cylinder catheter with tags for intraoperative endobiliary dilatation - Google Patents

Abstract

The utility model relates to medicine, namely to surgery. The technical result consists in the possibility of efficient use and accurate location of the balloon in the narrowing zone of the biliary tract during the "open" operation on the extrahepatic biliary tract due to the presence of ring marks on the catheter located 1 cm apart and starting from the proximal end of the balloon. Intraoperatively, through the stump of the cystic duct or choledochotomy opening, an audit of the biliary tract is performed to determine the localization of the stricture and the distance from the choledochotomy opening to it. Knowing the distance in centimeters to the stricture, a balloon catheter with marks is inserted into the extrahepatic biliary tract so that the distance along the marks on the balloon corresponds to the measured distance to the stricture. After that, guided by the marks on the balloon, we pull it back and position it so that the stricture is located approximately in the center of the balloon, and the distal and proximal parts of it extend beyond the narrowing. The stricture is then dilated and the balloon catheter is removed.

Description

The utility model relates to devices used in medicine, namely in surgery.

Since the early 1990s, several research groups have simultaneously studied the possibilities of balloon dilatation of strictures of the biliary tract and the zone of the large papilla of the duodenum (BSDPC) (Huibreqtse K. Biliary sphincter ball dilation; who, when and how? Can J Gastroenterol, 1999 Jul-Aug; 13 (6): 499-500.). At the same time, there is no consensus on the duration of dilatation (exposure by a dilated dilator), the diameter of the balloon catheter, the design features of the instruments used (in terms of reliability, effectiveness), methods of completing the procedure (Nakazawa T., Suzuki K., Kobayashi I. Efficacy and safety of endoscopic papillary ball dilation for removal of common bile duct stones in the elderly. Nippon Ronen Igakkai Zasshi 1999 Sep; 36 (9): 644 - 7 .; AE Borisov, N. A. Borisova, BC Verkhovsky. Endobiliary interventions in the treatment of obstructive jaundice St. Petersburg: “Aesculapius, 1997. 152 p.). The authors believe that the rational use of balloon dilatation of the biliary tract strictures, the terminal section of the common bile duct and the BSDPK zone with obstructive jaundice in cases where other methods are more dangerous or not feasible is justified and quite effective. In this case, transfistular or retrograde (with duodenoscopy) access to the stricture zone is used.

Based on the analysis of literature data and our own clinical material, we believe that the indications for the use of endobiliary balloon dilatation should be expanded, which is facilitated by our model.

For the prototype, we selected a double-lumen biliary balloon catheter manufactured by Wilson-Cook (Diagnostic and therapeutic endoscopic accessories. 2003 Product Guide, p.37) (see Figure 1, where 1 is a balloon catheter, 2 is an X-ray positive label in the balloon) .

A balloon catheter is intended for dilatation of strictures of the biliary tract during duodenoscopy and retrograde cannulation of the BSDPK by conducting a catheter through the working channel of the duodenoscope. It is used in the x-ray room, and the position of the balloon in the narrowing zone is determined by two x-ray positive marks located in the distal and proximal parts of the balloon itself, which allows you to correctly determine its exact location. But during an “open” operation on the extrahepatic biliary tract, if necessary, it is difficult to dilate the biliary tract stricture, it is difficult to use a balloon catheter for angioplasty, since there is no possibility of using x-ray control of its position. In this regard, we offer a balloon catheter with tags for intraoperative endobiliary dilatation.

The technical result consists in the possibility of efficient use and accurate location of the balloon in the narrowing zone of the biliary tract during the "open" operation on extrahepatic biliary tract due to the presence of ring marks

on a catheter located 1 cm apart and starting from the proximal end of the balloon.

The proposed device (see Figure 2) consists of 1) a balloon catheter, 2) x-ray positive marks in the balloon, 3) annular marks on the catheter.

The sequence of operations when working with a balloon catheter with tags for intraoperative endobiliary dilatation.

Intraoperatively, through the stump of the cystic duct or choledochotomy opening, an audit of the biliary tract is performed to determine the localization of the stricture and the distance from the choledochotomy opening to it. Knowing the distance in centimeters to the stricture, a balloon catheter with marks is inserted into the extrahepatic biliary tract so that the distance along the marks on the balloon corresponds to the measured distance to the stricture. After that, guided by the marks on the balloon, we pull it back and position it so that the stricture is located approximately in the center of the balloon, and the distal and proximal parts of it extend beyond the narrowing. The stricture is then dilated and the balloon catheter is removed.

Clinical example.

Egorova Galina Aleksandrovna, 53 years old, medical history. No. 984. Received in the surgical department of 7 city hospital in Ivanovo 04/14/2003. with complaints of girdle pain in the upper abdomen, nausea, dark urine, light feces from 04/13/2003. She became acutely ill on 12.04.2003 at about 11.00 after eating fatty foods, when herpes zoster appeared.

Clinical diagnosis: cholelithiasis, acute calculous cholecystitis, choledocholithiasis, stenosis of the terminal portion of the common bile

duct (LLF). Obstructive jaundice. Concomitant disease: hypertension II Art.

Surveyed. UZS from 04.14. the pancreas is normal in size, homogeneous, the duct is not enlarged. Liver of normal size, homogeneous. The choledoch is expanded to 11 mm, the distal section is not visible, the visible lumen is free. The gallbladder is normal in size, the wall is not thickened, the accumulation of stones up to 7-8 mm.

Complete blood count and general urine analysis before surgery without features, urine diastasis - 8 units. Bilirubin total from 04.14. - 58 μmol / L, direct - 22 μmol / L. Protein 69 g / l, urea - 4.99 mmol / l. Bilirubin total from 04.21. - 12.9 μmol \ l. Blood group A (II), Rh-positive. Coagulogram without features, blood sugar 4.63 mmol \ l. ECG: EOS with a tendency to the left type. Sinus rhythm 75 per minute. Hypertrophy of both ventricles with overload of the left and a decrease in coronary circulation in the region of the lateral wall of the left ventricle according to the type of chronic coronary insufficiency. Extracardial effects on the myocardium.

04/23/03. urgently operated on: cholecystectomy, choledocholithotomy, endobiliary balloon dilatation of stricture LLH, draining of the common bile duct according to Keru, drainage of the abdominal cavity.

Operation progress: The gall bladder is enlarged, there are a lot of small stones in the lumen. Choledoch 1 cm in diameter. Cholecystectomy A small stone was removed from the cystic duct. Through the stump of the cystic duct, intraoperative cholangiography - the contrast enters the duodenum (duodenum), the shadows of calculi are not determined, but the LLST is narrowed. His stenosis is suspected. The cystic duct is bandaged. Choledochotomy. Removed stone from the common bile duct 0.5-0.3

see. A probe inserted into the common bile duct, determined the distance to the stenosis zone. A balloon catheter with marks was inserted into the extrahepatic biliary tract so that the distance along the marks on the balloon corresponded to the measured distance to the narrowing zone. After that, the balloon is pulled back 3 divisions (which corresponds to 3 cm), being guided by the marks on it, and positioned so that the distal part of it is in the duodenum, and the proximal part in the common bile duct. A balloon dilatation of the LLA stricture was performed with a balloon catheter with tags with a diameter of 10 mm in a swollen state, an exposure of 5 minutes, after which a thick probe passes freely into the duodenum. Drainage Kera. Drainage in the subhepatic space. Layer wound closure tightly.

Diastasis of urine from 04.23 (after surgery) - 4 units. Transfistular cholangiography - there are no shadows of calculi, contrast freely enters the duodenum, extrahepatic bile ducts are not expanded. 14 days after surgery, the drainage of Kera was removed. Discharged in satisfactory condition with recovery

Thus, when using the proposed balloon catheter with ring marks, intraoperative use of balloon dilatation becomes possible, the possibilities of performing alternative interventions for patients with obstructive jaundice due to stenotic lesions of the BSDPC zone, strictures of other localizations, choledocholithiasis, which is especially important when it is impossible to perform EPST and retrograde interventions (parapapillary diverticula, severe stenosis of BSDPK, resected Billroth-II type stomach, high risk of developing

bleeding). We did not observe any complications associated with balloon endobiliary dilatation.

Claims (1)

A balloon catheter with marks for intraoperative endobiliary dilatation, comprising a double-lumen balloon catheter, characterized in that there are also annular marks on the catheter located 1 cm apart and starting from the proximal end of the balloon.