SU1574206A1 - Method of diagnosis of abdominal cavity organs intramural blood flow disturbances - Google Patents

Abstract

This invention relates to medicine, in particular to endoscopic diagnostic methods. The aim of the proposed method is to improve the accuracy of diagnosis. Diagnosis of circulatory disorders in the abdominal organs is carried out by dopplerography of sites with the expected pathology and for monitoring from healthy sites. Impairment of the intraorganic blood flow is considered when the pulse wave amplitude decreases by 25%. Accuracy is increased by 58%.

Description

The invention relates to medicine, namely, to endoscopic diagnostic methods and to medical technology. designed to assess the state of blood circulation in the abdominal organs, and can be used to diagnose diseases of the abdominal organs during laparoscopy and laparotomy.

The aim of the invention is to improve the accuracy

The method is carried out as follows.

The essence of the proposed method is as follows. After visual inspection of the abdominal cavity organs with a laparoscope, if it is necessary to have an ultrasonic dopplerogram, in the projection of the abdominal organ under investigation, the abdominal wall is punctured by the trocar.

450 mm and outer lpame-gro, - 5 mm. Such a probe-probe design allows it to be led into the abdominal cavity through a trocar sleeve with a 6 mm lumen diameter and to investigate any part of the abdominal cavity, LH l.-; - under the control of a laparoscope, a dopplerography of the vessels is performed, im: h g tz various organs of the abdominal cavity. Recording is made on the recorder Endim 621.02 using the apparatus IPK-1. When conducting Doppler, the accuracy of the sensor installation on the vessel or organ is important, i.e. observance of magnitude: the angle between the direction of the ultrasound and the direction of the axis of the Redstock. The angle, as a rule, should be equal 50-60 °. The endoscopist finally refines the correctness of the sensor setting when receiving the corresponding curves on the recorder, Doppler sonography on the IPK-1 apparatus with the x5 keys. MvBCTBHTejibHOCTv, - sauspissia

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0.2 V / cm, belt speed 600 mm / min. The obtained Doppler patterns are subjected to quantitative and qualitative analysis. In a comparative analysis of Doppler patterns obtained from sites with suspected pathology and from normal sites, attention is paid to the nature of the Doppler curve, the amplitude of the pulse waves and their frequency. The presence of a disruption of the intraorganic blood flow of a mild degree is considered when the amplitude of the pulse waves decreases by 25-30%, of a moderate degree - with decreasing amplitude up to 50% and severe degree - up to 70% or more.

Example 1. Patient Sh., 60 years old, was admitted to the clinic of surgical diseases on December 26, 1986, with a diagnosis of peritonitis. Pain in the abdomen occurred 2 h t he called hell against the background of a full well-being. In 1985, he suffered an ischemic cerebral stroke, after 3 months. - myocardial infarction. Objectively: the patient’s condition is severe. The skin and visible mucous pale. Pulse 120 beats per 1 minute, rhythmic, weak filling, HELL 180/90 mm Hg. The abdomen is moderately flat, weakly involved in the act of breathing, painful in all departments during palpation, more in the mesogastric region, where the rigidity of the muscles of the anterior abdominal wall is determined. Hepatic dullness is preserved; Kurlov liver boundaries are within normal limits. The spleen is not enlarged. Complete blood count: HB 140 g / l, erythrocytes 4.4-10 (2 / l, leukocytes 11.210 g / l, ESR 2 mm / h. Blood coagulability according to Sukharev 3 min 20 s. Prothrombin index 80%, recalcification time 4 min 57 sec, fibrinogen 600mg%, plasma tolerance to heparin 3 min, 48 sec, thrombotest IV degree, differentiated fibrinogen B, an emergency laparoscopy was made to clarify the diagnosis. Liver, bladder, stomach and 12-duodenal ulcer without visible pathology. the small intestine in the right half of the abdomen is slightly cyatic, in some places covered with delicate films of fibrin and loose They are glued together. In the remaining sections, the small intestine is slightly edematous and hyperaemic, in the abdominal cavity 60 ml of unclear liquid. In order to reveal the nature of the pathological process

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In the small intestine, the state of intramural blood flow of the abdominal organs was determined using Doppler ultrasound. A probe probe (piezo sensor) was placed into the abdominal cavity of the trocar before contact with various parts of the small intestine loops, then the stomach, gallbladder and large intestine. The Dopplerogram showed a sharp decrease in intramural blood flow in the loops of the ileum (a decrease in the amplitude of the pulse waves was more than 70%). At the same time, the amplitude of pulse waves is normal in the jejunum loops. On this basis, the diagnosis was made: thrombosis of the branches of the mesenteric artery with incipient necrosis of the ileum, diffuse serous fibrous inository peritonitis. Considering that the process of necrotization is segmental, it was considered possible to perform the operation. During laparotomy, beginning ileal necrosis was detected over 1 m. With repeated UDH, already during a laparotomy, in a modified part of the intestine, the blood flow is sharply reduced, sometimes absent, and in other sections of the small and large intestine satisfactory. A 1.5 m ileum resection was performed with the introduction of an entero-enteroanastomosis side by side in a manual manner. In the postoperative period, the patient received intensive therapy with the inclusion of antibiotics, anticoagulants and fibrinolytic drugs. Has come recovery.

Example 2. Patient I., 61 years old, was admitted to the clinic on December 25, 2007, with a diagnosis of chronic cholecysto-pancreatitis. The general state of admission to the moderate body complains of pain in the right hypochondrium and in the epibastric region. Pulse 88 beats per 1 min, blood pressure 140/80 mm Hg. Art. The abdomen is soft, painful in the right hypochondrium and in the epigastric region. The gallbladder is not palpable. The liver protrudes 2 cm from under the costal arch. The spleen is not enlarged. Complete blood count: HB 128 g / l; red blood cells 4, leukocytes 6.9 YU9 g / l, ESR 34 mm / h. Total blood bilirubin 19 mmol / l; urea 5.7 mmol / l; timolovy test of 3,6 units; sublimate sample 1,94 ml sul .; total serum protein 6.7%, AsAT 0.86 mmol / gl,

ALT 0.5 mmol / g l .; blood sugar 4.9 mmol / l; prothrombin index of 82%. 01/08/88, laparoscopy was performed for diagnostic purposes. The liver is enlarged, the surface is finely hilly, the Glisson capsule is thickened in places, the edge of the liver is rounded. Gall bladder without visible pathology. The stomach and intestines without features. Spleen enlarged 1.5 times. Its surface is smooth, glossy schA. Vessels of the abdominal cavity ectasized. Although there was no doubt about the presence of an inflammatory process in the liver during a visual examination of the liver, the determination of the degree of inflammation and the possibility of its transition to the stage of cirrhosis is impossible, and this is important for treatment tactics. Therefore, laparoscopic Doppler ultrasound was performed. The decrease in the amplitude of the pulse waves by 30% was determined on the dopplegramme of the liver.

At the base of a more pronounced reduction of intraorgan hemodynamics, which is characteristic of the inflammatory process of the liver on going to the stage of initial cirrhosis, a diagnosis is made: chronic hepatitis in the cirrhosis stage, portal hypertension, splenomegaly. This made it possible, in combination with liver laser therapy, hepatotropic and general strengthening therapy, to perform laparoscopic omentohepatodiaphragmopexy with glue.

After the complex treatment, the patient's condition improved, and the functional parameters of the liver normalized. Discharged in a satisfactory condition for further outpatient treatment by a therapist.

Considering the serious condition of the elderly patient and the large extent of damage to the small intestine, it was decided to carry out complex therapy with antibiotics, intravenous infusion of fluids with heparin and fibrinolysin. The patient died 3 days after laparoscopy. At autopsy: thrombosis of the superior mesenteric artery, necrosis almost

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throughout the small intestine, spilled purulent peritonitis.

Doppler ultrasound (UDH) of the abdominal cavity was performed in 34 patients. In 10 patients with chronic hepatitis, laparoscopy did not resolve clinical doubt. To establish the diagnosis, the severity of the inflammatory process in the liver and to clarify the tactics of treatment, they were used by the UDH. At the same time, in 3 patients, Doppler sonography recorded a decrease in intraorganic hemodynamics in the liver with a decrease in the amplitude of pulse waves by 50%, and in 2 patients, the decrease in pulse waves reached 70%, with ischemia of the abdominal cavity (in particular, the liver) - by 25%. In 5 patients, the diagnosis of chronic hepatitis was established during a review laparoscopy, however, a visual inspection did not allow to establish the severity of the inflammatory process in the liver and the possibility of transition to the stage of cirrhosis, which was important for determining therapeutic tactics. The performance of UDG in all these patients revealed a significant impairment of intraorgan hemodynamics, expressed as a decrease in the amplitude of the pulse waves to 52 ± 5.7%.

Using the proposed method allows the diagnosis to be clarified by 58%.

Claims (1)

Invention Formula A method for diagnosing a violation of the intramural blood flow of the abdominal cavity by laparoscopic Doppler ultrasound, characterized in that, in order to improve accuracy, during laparoscopy into the abdominal cavity through. An additional puncture of the abdominal cavity is introduced by a probe sensor, the working end of which is applied to the surface of the test organ, a dopplerography is performed, and if the amplitude of the pulse waves is reduced by 25% or more, the intramural blood flow is diagnosed.