RU63226U1 - COMBINED NASOESOPHAGAL PROBE FOR LONG-TERM ESVAGE INTUBATION - Google Patents

Abstract

The combined nasoesophageal probe refers to medical subjects and can be used to treat chemical burns of the esophagus and prevent the development of cicatricial stenosis. The probe consists of two plastic tubes of different diameters, hermetically connected to each other by a smooth transition. The thick tube of the probe in diameter corresponds to the width of the lumen of the esophagus (12-14 mm). The lower end of the tube is rounded and has a side hole. The diameter of the thin (nasopharyngeal) part of the probe is 6-7 mm - two times less than the esophagus. The probe tube is intubated with a thick tube for 3-6 weeks. A thin portion of the probe is brought out through the nasal passage. The probe carries out the feeding of the patient with liquid food, which eliminates the need for gastrostomy. The growth of granulation and then fibrous tissue on the wound surface of the esophagus is limited to a thick tube located in the esophagus. As a result, the lumen of the esophagus, equal to the outer diameter of the tube, is preserved, and the development of cicatricial stenosis is prevented.

Description

The proposed probe relates to medical subjects and is intended for prolonged therapeutic intubation (stenting) of the esophagus with its chemical burn in order to prevent the development of cicatricial stenosis.

It is known that chemical burns of the esophagus, especially deep ones, inevitably lead to the development of cicatricial stenosis with increasing dysphagia until the complete cessation of food passage through the esophagus. In order to prevent cicatricial narrowing of the esophagus, its early bougienage is currently the most widely used [Weiman P.A. Prophylactic bougie with chemical burns of the esophagus. // Diss. Ph.D., Alma-Ata, 1991], [Ormantayev KS, Kotakanov KK, Jackson V.L. and others. Prolonged intubation is a method of treating deep chemical burns of the esophagus in children. // Health of Kazakhstan. 1989, No. 10, p. 42-44], [Rassudov P.M. Clinic and therapy of esophageal burns caused by caustic soda in children. // Diss. Doct., M., 1949].

However, esophageal bougienage is often complicated by perforation of the esophagus with the development of purulent mediastinitis. The treatment itself is burdensome for the patient and has a long duration (often 1-4 years).

Another quite effective method of treatment is the long-term drainage (intubation) of the esophagus. A probe inserted into the esophagus through the nose prevents the development of excessive granulation and subsequent cicatricial narrowing of the lumen of the esophagus. Compared with bougieurage, the duration of treatment is significantly reduced [Dolzhenko S.V. Comparative characteristics of treatment methods for burns of the esophagus with caustic substances. // Diss. Cand., Kharkov. 1949], [Novik E.N. Treatment of cicatricial strictures of the esophagus with stationary elastic bougie. // Diss. Doc. - Rostov-on-Don. - 1951], [Ormantaev K.S., Kotakanov K.K., Jackson V.L. and others. Prolonged intubation is a method of treating deep chemical burns of the esophagus in children. // Health of Kazakhstan. 1989, No. 10, p. 42-44].

For prolonged intubation of the esophagus, a thick gastric tube is usually used. However, it causes a very unpleasant sensation in the nose, nasopharynx. Pressure from a thick gastric tube often develops swelling of the arytenoid cartilage, larynx and epiglottis, which contributes to the development of pneumonia. A more gentle intubation of the esophagus with a thin gastric tube does not make sense, since when the granulation tissue growing around it ripens in the esophagus, a narrow fibrous tube forms along which only liquid food passes. In connection with the listed negative properties, this essentially effective method of treating chemical burns and preventing subsequent cicatricial stenosis of the esophagus has not been widely used. It is advisable to develop a probe of such a design that would eliminate or significantly reduce the likelihood of developing these complications.

As a prototype, a well-known thick gastric tube [Bazak V.I. Medical instruments and equipment. // M. - Medicine. - 1969. - S.55-56]. This probe is inserted into the esophagus for a long time.

with its chemical burn, it helps preserve the lumen of the esophagus during the granulation of the burn wound and the formation of fibrous tissue. This prevents the development of cicatricial stenosis of the esophagus. The probe provides the patient with liquid food.

Criticism of the prototype.

1. A thick gastric tube, conducted through a narrow nasal passage, causes the patient prolonged unpleasant, sometimes painful sensations. Unable to withstand them, patients sometimes pull out the probe themselves.

2. A thick probe compresses the surrounding tissue and causes the development of swelling of the arytenoid cartilage and larynx, atrophy of the nasal mucosa, paresis of the epiglottis, which causes the occurrence of aspiration pneumonia.

In order to eliminate the above disadvantages of the prototype, we proposed a combined nasoesophageal probe for long-term intubation of the esophagus, consisting of two tubes. The appearance of the probe is shown in figure 1. The thick tube of the probe (1) corresponds to the lumen of the esophagus. Its outer diameter is 12-14 mm, length 260-280 mm. The thin part of the probe (2) corresponds to the width of the nasal passage and is represented by a tube with an outer diameter of 6-7 mm and a length of 280-300 mm. Both tubes are tightly interconnected by a smooth transition. The free (lower) end of the thick tube is rounded. Above it in the probe there is a side hole.

The method of practical application of the proposed probe

Long-term intubation of the esophagus is carried out 7-8 days after the burn, when the patient's condition stabilizes, and the immediate threat to life has passed. Local anesthesia of the mucous membrane of the mouth, pharynx, esophagus and nasal passage is made by instillation of a liquid anesthetic or spraying it in the form of an aerosol. Fibroesophagoscopy is performed to determine the width of the esophagus and the condition of the mucous membrane, the degree of chemical burn. Select a probe with a diameter of 3-4

mm smaller than the normal lumen of the esophagus in places of its natural narrowing, given also the inflammatory swelling of its walls.

A thick tube of a combined probe is inserted through the mouth into the esophagus without violence. A thin tube remains in the mouth and protrudes outward. A urethral catheter (or a thin tube, conductor) is passed along the nasal passage, the end of which is caught by a clamp through the mouth and controlled by a laryngoscope and brought out. Then the end of the catheter is inserted into the lumen of the thin tube of the probe and fixed to it with a circular ligature. Sipping a catheter, a thin tube is removed through the nasal passage from the oral cavity to the outside. With wide nasal passages, the esophagus can be intubated with the proposed probe immediately through the nose. Before this, it is advisable to introduce a thin nasogastric tube (thin tube) and through it, like a conductor, a combined probe is inserted through the nose.

Under the control of the laryngoscope, the probe is installed so that the upper end of its thick part is located at the entrance to the esophagus. The lower end of the probe is located in the stomach 5-10 centimeters below the cardiac pulp. In this position, the probe is securely fixed to a thin tube with a ligature, passed through the soft tissue of the nasal septum. The probe feeds the patient with liquid food, which eliminates the need for a gastrostomy. Intubation of the esophagus lasts 3-5 weeks, depending on the depth of the chemical burn. With burns of the 2nd degree, this period is shortened, with burns of the 3rd degree it lengthens.

We successfully used the described probe in 7 patients. There were no serious complications associated with this treatment. All patients recovered and could take regular food by mouth. There was no need for subsequent esophageal bougienage.

The positive structural qualities of the proposed combined probe and the results of clinical trials allow us to recommend

its for practical use. It is possible to express confidence that with the acquisition of experience in using this probe, the method of prolonged intubation (stenting) of the esophagus with chemical burns will find wider clinical application.

Claims (1)

A combined naso-esophageal probe for long-term intubation of the esophagus, made in the form of a plastic tube having a rounded distal end with a lateral opening, characterized in that it consists of two parts of different diameters connected to each other, and the diameter of the nasopharyngeal part is half that of the esophagus.