RU57603U1 - GRAVING DEVICE FOR INSTALLING A CYSTEENTERAL STENT - Google Patents

Abstract

An exciting device for installing a cystoenteric stent relates to medicine, namely minimally invasive surgery, endoscopy and can be used to treat patients with pancreatic pseudocysts. The technical result of the invention is the capture and reduction of the cystoenteric stent through a fibrogastroduodenoscope from the cavity of the stomach into the cavity of the distal duodenum in patients with pancreatic pseudocysts. The device consists of an external flexible casing and a flexible handle controlled by a handle located at the proximal end passing through it, a pusher actuating the articulated mechanism of the working part, which is made in the form of elastic opening / closing jaws in the form of an ellipsoid contour 4 mm long and an inner diameter of 2, 2 mm, while the inner surface of the branches has oblique multidirectional hooks (Fig. 5).

Description

The invention relates to medicine, namely minimally invasive surgery, endoscopy and can be used to treat patients with pseudocysts of the pancreas.

At present, exciting tools for flexible endoscopes with various forms of OLIMPUS working parts (prospectus 2003) are known, consisting of an external flexible casing and a flexible controlled handle located at the proximal end passing through it, a pusher, which in turn leads an articulated mechanism with a working part at the distal end in the form of opening / closing jaws.

However, the drawback of these gripping devices for flexible endoscopes is the lack of adaptation of the working part to capture the stent (insufficient length and non-congruent shape), which does not allow rigid capture of the drainage and creates a risk for mucosal injury during the movement of drainage in the lumen of the gastrointestinal tract.

The technical result of the invention is the capture and reduction of the cystoenteric stent through the fibrogastroduodenoscope from the cavity of the stomach into the cavity of the distal duodenum.

The technical result is achieved by the fact that the working part is made in the form of elastic opening / closing jaws in the form of an ellipsoidal contour with a length of 4 mm and an inner diameter of 2.2 mm, while the inner surface of the jaws has multidirectional oblique hooks.

The invention is illustrated by the following figures:

- figure 1. view of the capturing device for the installation of a cystoenteric stent:

- figure 2. horizontal section of a gripping device for installing a cystoenteric stent;

- figure 3. view of the device in the open jaws position;

- figure 4. sweep of the upper branch of the device with hooks;

- figure 5. scan of the lower branch of the device with hooks;

The device consists of an external flexible casing (1) and a flexible pusher (2) passing through it and controlled by a handle located at the proximal end, which in turn drives the hinge mechanism (3) with the working part at the distal end in the form of elastic opening / closing jaws in the form of an ellipsoidal contour with a length of 4 mm and an inner diameter of 2.2 mm (4), while the inner surface of the jaws has multidirectional oblique hooks (5).

The device operates as follows.

During endoscopic examination, in particular with fibrogastroduodenoscopy, the proposed device is inserted through the biopsy channel of the endoscope into the cavity of the stomach or into the cavity of the duodenum. Using the handle, using a flexible wire pusher we translate the articulated mechanism by translating, which in turn reveals the jaws of the device. Then, with the help of an endoscope, we bring the instrument to the drainage located in the stomach cavity by returning the handle of the device by closing the jaws, thereby capturing the drainage. After installing the drainage in the desired section of the duodenum, we open the branches of the instrument, we remove the endoscope

from drainage, close the branches in the manner described above and make the extraction of the instrument from the endoscope.

Thus, the technical result is achieved in that the working part is made in the form of elastic opening / closing jaws in the form of an ellipsoid contour with a length of 4 mm and an inner diameter of 2.2 mm, while the inner surface of the jaws has multidirectional oblique hooks.

An example of a specific application: Patient K., 36 years old (medical history No. 587485), was treated in the purulent surgery department of Kursk Design Bureau

with complaints of paroxysmal moderate pain in the epigastric region with radiation to the back and left hypochondrium, accompanied by nausea and vomiting, fever up to 38.1.

He considers himself ill for about a year and a half, when, six months after suffering pancreatic necrosis, there were complaints of paroxysmal pain in the epigastric region with radiation to the back and left hypochondrium, accompanied by nausea, a temperature increase of up to 37.9. Recently, he was repeatedly treated in a hospital where the diagnosis was made: Formed post-necrotic infected pancreatic pseudocyst. Surgical treatment was carried out: pseudocyst cavity drainage. Recently, the above complaints appeared, pains tended to intensify, weakness, dyspeptic phenomena, hyperthermia increased. He was not independently treated. After seeking medical help, he was hospitalized in the purulent surgery department.

Upon receipt, a moderate condition. The skin is pale. Body temperature 38.0. In the lungs, harsh breathing with coarse bubbling rales in all departments. Heart sounds are rhythmic, blood pressure 135/90 mm Hg Pulse 90

beats per minute The tongue is wet, coated with a white coating. The abdomen is somewhat swollen, participates in the act of breathing. Palpation of tension, painful in the epigastrium and left hypochondrium. The liver, spleen, gall bladder are not palpable. The symptom of Shchetkin-Blumberg is negative. Active peristalsis. Gases depart. Diuresis saved.

Laboratory studies: blood analysis - 4.1 * 10 ¹² g / l, hemoglobin - 110 g / l, c.p. - 0.94. White blood cells - 8.8 * 10 ⁹ g / l, pal - 6, seg - 76, lim - 12, mon - 6, ESR 16 mm / h, coagulability - 8, shelter - 45 sec, IPI - 95%, blood sugar 7.7 mmol / l. Total Urine: count 180.0, cloudy, density 1014, acid reaction, protein 0.064, no glucose, 10-15 leukocytes in sight. Biochemistry: amylase 118 IU / l., Urea 7.9 mmol / l., Creatinine 0.190 mg.%., Bilirubin 32.2 μmol / l., Direct 5.5 μmol / l., ALT 0.640 μkat / l., ACT 0.421 μkat / L.

Ultrasound revealed a formed post-necrotic pseudocyst of the head and body of the pancreas with signs of infection.

Diagnostic puncture of the formation was made under ultrasonographic control: the content was cloudy with hemorrhagic staining.

Diagnosis: Formed post-necrotic infected pseudocyst of the head and body of the pancreas on the background of chronic inductive obstructive pancreatitis.

Additionally, duodenoscopy was performed with endoscopic retrograde pancreatocholangiography, in which no pathology from the large papilla of the duodenum, as well as ductal systems of the liver, were detected.

After a short preoperative preparation, the patient was taken to the operating room. Under ultrasonographic control, the location of the transabdominal drainage was determined. Local layered produced

anesthesia of the tissues of the abdominal wall. The pseudocyst cavity is punctured, the infected cystic contents are obtained. Using a conductor, a drainage is installed in the cavity, which is then fixed to the abdominal wall by a ligature. Further, under local anesthesia according to the above method, transgastric drainage is installed in the pseudocyst cavity, which is also fixed by the ligature. Evacuated 150 ml. infected cystic contents. Through both drainages, the cavity is sanitized using antiseptic and antibacterial drugs. Control fistulography was performed in which the presence of a connection between the cystic cavity and the pancreatic ductal system was revealed.

In the postoperative period, the patient received complex conservative therapy. Daily, the pseudocyst cavity was washed with antiseptic solutions in which adequate rehabilitation was achieved due to the presence of two drains. In addition to ultrasonic monitoring of the state of the cavity, fistulography was performed, in which there was a clear positive dynamics, manifested in a decrease in the size of the cavity. Fibrogastroduodenoscopy was performed, in which a section of transgastric drainage is visualized, located from the front to the rear walls of the antrum. The drainage is captured by the device and brought into the lumen of the stomach, after which it is reduced to the second part of the duodenum. Three days later, a control fibrogastroduodenoscopy was performed: in the region of the anterior wall of the antrum, a surface coating of fibrin, gas intake into the abdominal cavity was not observed, which was confirmed by x-ray. When control fistulography, the residual cavity of the cyst is not determined, the contrast of the installed stent enters the duodenum. Transabdominal drainage removed. The patient was discharged under the supervision of a surgeon at the place of residence.

Claims (1)

An exciting device for installing a cystoenteric stent for pancreatic pseudocysts, consisting of an external flexible casing and a flexible controlled handle located at the proximal end passing through it, a pusher actuating the articulated mechanism of the working part, characterized in that the working part is made in the form of elastic opening / closing jaws in the form of an ellipsoidal contour with a length of 4 mm and an inner diameter of 2.2 mm, while the inner surface of the jaws has opposite directions oraspolozhennye hooks.