SU1736450A1 - Device for endoscopic papillosphincterotomy - Google Patents

Abstract

The invention relates to medical technology, in particular, instruments for endoscopic papillosphincterotomy. The aim of the invention is to reduce the trauma during therapeutic and diagnostic manipulations on the large duodenal nipple, reducing the number of postoperative complications and treatment time. For this purpose, a flexible tube 3 made of a polymer resin to the conductor material, inside which the conductor is held to the structure 4, is attached to the handle 1 by means of a tee 2 with a fitting 10 under a syringe for inserting a contrasting substance into which the structure 4 is held, one end attached to the slider 6 by the handle 1, and the other end, provided with a restrictor 13 of a non-conductive polymeric material, exits the opening 12 on the side wall of the cone-shaped tapered working part of the flexible tube 3.

Description

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The invention relates to medical technology, in particular to endoscopic instruments, and can be used in patients with obstructive jaundice due to choledocholithiasis and stenosis of the duodenal papilla, or a combination of these pathologies.

There are known devices for performing endoscopic papillosphincterotomy by means of a konation method, which is used by Demling-Klaassen papillot, which is based on a fluoroplastic probe, in the lumen of which a conductive string extends outward in the region of the distal part of the probe and is fixed directly to at the end of it. When the string is pulled by a handle, a string is formed, which is the cutting part of the papillotome. When a high frequency current is passed through it, it becomes a kind of electrocautery.

The COMA-papillotte loop is also used for cannulation papillosphincterotomy, performed in the same way, however, it works on extending the conductive string to form an arcuate cutting part.

These devices have a significant drawback: in cases of severe stenosis of the large nipple of the duodenum, it is not possible to insert the instrument into its mouth to perform endoscopic pillotomy.

It is also known a device for performing endoscopic papillotomy by a non-invasive method — end papillotum, the basis of which is

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a fluoroplastic probe with a conductive string protruding from the distal section.

However, this device has a significant disadvantage: when performing endoscopic papillosphincterotomy, perforation of the posterior wall of the duodenum is possible, as well as damage to the virsungian duct and pancreatic tissue.

The purpose of the invention is to reduce the trauma of surgical interventions during therapeutic and diagnostic manipulations on the large duodenal nipple, reducing the number of postoperative complications and shortening the terms of treatment of patients.

The goal is achieved by connecting a tube made of a flexible polymer non-conductive material, inside which a conductive string is inserted, provided at the distal end with a current-conducting polymer limiter, through a tee with a syringe nipple. There is a slider on the handle with a clip-clamp, which fixes the proximal end of the conductive string. The distal end of the flexible tube is conically tapered and has a hole in the side wall to exit the conductive string.

FIG. 1 shows the proposed tool; fig 2 is its working part.

The tool consists of a handle 1 connected by means of a tee 2 to a tube 3 made of a flexible polymer non-conductive material, within which a current-conducting string 4 is drawn. The handle 1 has guides 5 which the slider 6 can move along rings 7. In addition, it has a terminal-clamp 8 for fixing the proximal end of the conductive string 4 and connecting the conductor from the high-frequency medical electrosurgical apparatus. For ease of manipulation, the handle 1 is provided with an end ring 9. The plastic tee 2 has a fitting 10 under the syringe to bring the contrast material to the distal open section 11 of the cone-shaped tapered flexible tube 3. The conductive string 4 comes out of the hole 12 on the side wall of the distal end of the flexible tube 3. Hole 12 on the side wall of the flexible tube 3 may be 0.2 cm or more from the distal section, depending on the severity of stenosis of the mouth of the large duodenal nipple. In addition, at the free end of the conductive string

4, a limiter is installed, made of a non-conductive polymer material 13, which prevents it from going completely into the lumen of the flexible tube 3. The outer

The diameter of the flexible tube 3 is no more than 0.2 cm, which allows it to be passed through the endoscopic biopsy channel to perform an endoscopic papillosphincterotomy.

0 The proposed tool works as follows.

During endoscopic examination, a duodenoscopy instrument, connected through a conductor through a terminal-clamp 8 to a high-frequency medical electrosurgical apparatus, is conducted through the endoscope biopsy channel until the distal (working) end is advanced in the field of view of the manipulator. After

In this cone-shaped narrowed distal end 11 of the flexible tube 3, an endoscopic retrograde pancreatocholian 5 hygrograph is performed to the possible depth, and through a fitting 10 of the plastic tee 2 a contrast agent is introduced into the biliary tract, which enters the distal open section of the section of the slit. flexible tubing 3. When a pathology requiring papillosphincterotomy is detected, the doctor inserts the index and middle fingers of the right hand into the side rings. and 7 of the slider 6, and the thumb — into the front ring 9 of the knuckle 1. With the index and middle fingers move the slider 6 from itself along the guides 5, and with it the conductive string 4 extending from the hole 12 lateral surface of the distal end of the flexible tube 3 before contact with the object of electrosurgical intervention (longitudinal fold of the duodenum). Oriented extended conductor string 4 along

5, the midline of the longitudinal fold of the duodenum, by applying current to it and, gradually advancing the flexible tube 3 forward, dissect it to the required length, which is determined individually.

0 If necessary, to control the position of the instrument in the hepatic-icing-lumen lumen, the bile ducts are re-contrasted. At the same time, the posterior wall of the duodenum, the Wirsun5 hyanum duct and pancreatic tissue are prevented from damage by the cone-shaped narrowed end 11 of the flexible tube 3, and the limiter at the end of the conductive string 4 made of polymeric current-nonconducting material

13, prevents electrical damage to the duodenal mucosa. If it is impossible to perform endoscopic retrograde pancreatic-cholangiography using a typical method, first dissect the ampulla of the large duodenal nipple using the method described above, after which the bile ducts are contrasted.

The proposed instrument was used in 23 patients with obstructive jaundice caused by choledocholithiasis and stenosis of the large duodenal nipple or a combination of these pathologies. No complications were noted, which reduced the treatment time from 3 to 7 days. When performing endoscopic papillosphincterotomy by non-cannulative method in 13 patients, complications were noted in 2 patients (15%), and the treatment period ranged from 7 to 28 days.

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Claims (1)

The invention The device for endoscopic papillosphincterotomy, containing sequentially connected handle, tee with a side fitting under the syringe and a flexible tube made of a polymer non-conductive polymer material, while on the handle there is a slider with an electrical terminal on which one end of the conductive strings passing through a tee and a flexible tube, characterized in that, in order to reduce the morbidity during therapeutic and diagnostic manipulations on the large nipple of the duodenal ulcer intestine, reducing the number of postoperative complications and terms of treatment, the working end of the flexible tube is made cone-shaped with a hole in the wall through which the conductor is pulled out a string provided with an end stop made of a polymeric current-conductive material.