RU66931U1 - Cholangiomanometer - Google Patents

Abstract

The device relates to medicine, in particular to surgery, can be used in the diagnosis of the degree of biliary hypertension and patency of the terminal section of the common bile duct and sphincter of Oddi in patients with obstructive jaundice.

A device for cholangiomanometry is proposed, characterized in that they use a liquid pressure sensor, for example, MPXV4006GP CASE 1369 from Motorolla, a measurement indicator, connecting tubes, a catheter, and a syringe, which combine into a single system and a tripod that allows you to position the device at the level of Faterov nipple; fluid pressure sensor has the following parameters: range of measured pressure 0-6 kPa; a catheter is inserted through the cystic duct into the lumen of the common bile duct and, through a system of connecting tubes, it is connected to a fluid pressure sensor.

Description

The device relates to medicine, in particular to surgery, can be used in the diagnosis of the degree of biliary hypertension and patency of the terminal section of the common bile duct and sphincter of Oddi in patients with obstructive jaundice.

Cholangiomanometry is most often used in combination with operating cholangiography.

The known Mallet-Guy method, which separates gauge and cholangiographic studies and using an air gauge connected to a recording drum, allows you to make a graphical record of pressure stabilization after hyperpressure up to 400-600 mm. water column. (Shalimov A.A., Domansky B.V., Klimenko G.A., Shalimov S.A. Surgery of the liver and bile ducts. - Kiev: Zdorovya, 1975. - P.48).

However, this method allows you to determine only the residual pressure in the common bile duct, which, according to the author, is 80-140 mm. water column.

The known method of Z.A. Tskhakai and V.P. Zakharov, which consists in the fact that the drainage of the common bile duct is connected to a glass graduated manometric tube (tube length 75 cm, diameter 7 mm.) And a syringe designed to create excess pressure in the bile ducts with a tee and rubber tubes. (Shalimov A.A., Domansky B.V., Klimenko G.A., Shalimov S.A. Surgery of the liver and bile ducts. - Kiev: Zdorovya, 1975. - P.48-49).

However, the equipment for this method is rather bulky and fragile, which creates certain inconveniences in its use and sterilization.

The well-known method of A.A.Shalimov, in which the Waldman device is used for debitometry, designed to determine the residual pressure in the bile ducts, which is located at the level of Vater's nipple, which corresponds to the middle of the lateral surface of the patient’s body lying on his back. After cholecystectomy without excessive trauma, the choledochus is intubated with a vinyl chloride tube with a diameter of 2-3 mm. Then the bile ducts are filled with saline under a pressure of 300 mm. water column and make a threefold measurement of residual pressure. Pressure equal to 150-160 mm. water column indicates the presence of obstruction to the outflow of bile and requires further investigation. Pressure above 160 mm. water column indicates the presence of biliary hypertension, requiring surgical correction. For debitometry, a graduated vessel with physiological saline in relation to the scale of the device is set so that the liquid level in it corresponds to a mark of 300 mm. Opening the valve on the vessel, give a free outflow of saline into the bile ducts. Vessel as it flows

fluids are moved upward along the scale so that the fluid level is always 300 mm. The volume of fluid in milliliters flowing from the vessel in one minute is called flow rate. A flow rate below 20 milliliters per minute indicates difficulty in the outflow of bile and requires cholangiography. A flow rate below 15 milliliters per minute indicates a violation of the outflow of bile, requiring surgical correction. (Shalimov A.A., Domansky B.V., Klimenko G.A., Shalimov S.A. Surgery of the liver and bile ducts. - Kiev: Zdorovya, 1975. - P.50).

However, this technique and equipment for its implementation are quite difficult to use.

The famous method of G.A. Klimenko, which is an improved method of A.A. Shalimov (Klimenko G.A. of choledocholithiasis, - M: Medicine, 2000. - S.95-98).

Cholangiomanometry and debitometry are very sensitive to various external factors (surgical trauma of the common bile duct and BDS, chemical and drug exposure), therefore, the study is carried out immediately after cholecystectomy before cholangiography, revision of the bile duct by probes. The use of medications that affect the tone of the sphincter of Oddi is unacceptable.

The technical result of the invention is to increase the accuracy of measuring pressure in the bile ducts, reducing equipment costs, reducing operation time.

The technical result is achieved using an original device for measuring pressure in the bile ducts, as well as determining the time of pressure drop, as an indicator of the patency of the Vater's nipple.

The proposed device for cholangiomanometry (Figure 1) consists of a liquid pressure sensor, for example, MPXV4006GP CASE 1369 from Motorolla, operating in the range of 0-6 kPa or 0-612 mm of a water column consuming 12 V voltage (Figure 1-1); voltage stabilizer (Figure 1-2) combined in a plastic case (Figure 1-3); devices for indicating measurement indicators (Figure 1-4); disposable silicone connecting tubes (Figure 1-5) with a diameter of 4 mm with a tee (Figure 1-6); standard disposable silicone catheter (Figure 1-7) with a diameter of 2 mm; 20 ml disposable syringe (Figure 1-8); a tripod for positioning the device for cholangiomanometry at the level of Vater's nipple.

The device is mounted on a tripod at the level of Vater's nipple to exclude measurement errors. From an autonomous power source (12 V battery) through a voltage stabilizer (Figure 2-2), electric current is supplied to a liquid pressure sensor (Figure 2-1), which is filled with silicone tubes (Figure 2-5) and a silicone catheter (Figure 2-7) ) through the cystic duct (Figure 2-9) are connected with the lumen of hepaticoholedoch (Figure 2-10). Through the tee (Figure 2-6) to the system

connect a 20 ml syringe (Figure 2-8). The tube system (Figure 2-5) is pre-filled with sterile saline to prevent air from entering the bile ducts. The sensor (Figure 2-1) senses the pressure in the choledochus and directly proportionally converts its changes into electric potentials, which are displayed on the display device of the measurement indicators (Figure 2-4) in mm of water.

The method is as follows: immediately after cholecystectomy, avoiding gross manipulations with the bile ducts, until they are revised with a probe and cholangiography, the bile duct (Figure 2-10) is drained through the cystic duct (Figure 2-9) with a silicone catheter (Figure 2-7) with a diameter of 2 mm to a depth of 1.5-2 cm. All this is necessary in order not to cause a spasm of the sphincter of Oddi, which may affect the accuracy of the measurements. A catheter through a tee (Figure 2-6) and a system of connecting tubes (Figure 2-5) pre-filled with sterile physiological saline are connected to a fluid pressure sensor (Figure 2-1) and a 20 ml syringe (Figure 2-8), also filled saline solution. The next step is to measure the residual pressure in the common bile duct 3 minutes after its catheterization (which is necessary to obtain more reliable indicators. Using a 20 ml syringe (Figure 2-8), excessive pressure is created in the hepatic choledoch (Figure 2-10) (300 mm water column) , time of pressure drop is recorded (from 300 mm water column to a value equal to the residual pressure). The measurement is repeated three times. The circuit diagram of the proposed device for cholangiomanometry is shown in Figure 3.

It is generally accepted that, normally, the residual pressure in the bile ducts ranges from 80 to 140 mm water column. Raising it to 150 mm water column indicates a violation of the outflow of bile and requires cholangiography. A residual pressure of more than 170 mm water column indicates a pronounced violation of the bile duct, requiring surgical correction. The time of pressure drop (from 300 mm of water to the residual) also allows us to judge the patency of Vater's nipple.

The device was introduced into the operation of the surgical department No. 1 GO of Voronezh City Clinical Hospital No. 10.

The advantages of using the proposed device are that it is a modern, portable, high-precision device for measuring pressure in the bile ducts, as well as the simplicity of the method, which reduces the operation time and low equipment costs, which makes it possible to increase the efficiency of diagnosing the degree of bile hypertension and terminal patency Department of choledochus and sphincter of Oddi in patients with obstructive jaundice.

Comparative evaluation of debitometry according to Shalimov and cholangiomanometry using the proposed device Debitometry according to Shalimov Cholangiomanometry using the proposed device Number of studies twenty 22 The percentage of confirmation of the diagnosis during intraoperative cholangiography and surgery one hundred% one hundred% The average duration of the study, min fifteen 5

Claims (3)

1. Device for cholangiomanometry, characterized in that they use a liquid pressure sensor, for example, MPXV4006GP CASE 1369 from Motorolla, a measurement indicator, connecting tubes, a catheter, a syringe, which combine into a single system and a tripod that allows you to position the device at a level Vater's nipple. 2. The device according to claim 1, characterized in that the liquid pressure sensor has the following parameters: the range of the measured pressure is 0-6 kPa. 3. The device according to claim 1, characterized in that the catheter is inserted through the cystic duct into the lumen of the common bile duct and, through a system of connecting tubes, connect it to the fluid pressure sensor.