UA12470U - Technique for restoring passage through esophagus and cardiac part of stomach - Google Patents

Abstract

The technique for restoring the passage through the esophagus and the cardiac part of the stomach comprises several sessions of laser destruction. The laser beam is provided by fibrogastroscope for irradiating the tumors. Prior to laser destruction, the proteolytic enzymes are injected into the tumor. After each session, the esophagus and the cardiac part of the stomach are subjected to the bougieurage under the control of fibrogastroscope.

Description

Description of the invention

The useful model refers to medicine, namely to surgery, and it can be used in the treatment of patients 2 with inoperable obturating malignant tumors of the esophagus and the cardiac part of the stomach.

A known method of restoring the patency of the esophagus and the cardiac part of the stomach includes laser endoscopic recanalization with the introduction of proteolytic enzymes into the tumor | Patent SHA Mo9738 A - Method of restoring the patency of the esophagus. Publ. September 30, 1996 Bul. MoZ)|.

The disadvantage of the analogue is the longer recanalization period due to the expectation of rejection of necrotized tissues between sessions.

The task of a useful model is to develop such a method of restoring the patency of the esophagus and the cardiac part of the stomach, which, due to additional buoyancy, would ensure a reduction in the recanalization period and improve the quality of life of patients.

The task is solved by the fact that in the method of restoring the patency of the esophagus and the cardiac 72 part of the stomach, which includes several sessions of destruction of neoplasms with laser radiation through a fibrogastroscope with the introduction of proteolytic enzymes into the tumor before each session, according to a useful model, after each session of destruction of neoplasms, bulging of the esophagus and cardiac parts of the stomach under the control of a fibrogastroscope.

Additional bulging of the esophagus and the cardiac part of the stomach under the control of the endoscope allows to speed up the restoration of patency, as the passage of the esophagus is improved with the help of mechanical advancement of the bulging.

The method is performed as follows.

With the help of a fibrogastroscope, a quartz polymer light guide is inserted through the instrument channel to introduce the radiation of a neodymium laser on an aluminum yttrium garnet ("Raduga" device) with a wavelength of 1.064 μm and a maximum output power of 55 W. Under visual control, tumor destruction is performed with short pulses (pt). At the end of each session of laser endoscopic recanalization, the light guide is removed and a special catheter is inserted, which has an adapter for connecting a syringe at the proximal end and with the help of an injection needle at the distal end, through which 3-5 injections of 5 mg of chemopsin per ml are administered into the tumor physiological solution to each point (on average 7-8 points). After a day, the session is repeated with the following oesophageal stimulation until the esophagus is completely restored. The distal end of the fibrogastroscope can be used as a bouge.

Example 1 in

Patient A., 63 years old, medical history No. 2029, admitted on April 5, 2005. was admitted to the department of esophageal, stomach and intestinal surgery of the institute with complaints of poor passage of food, weight loss. He has been sick for about 1.5 months. 39 The patient's condition is of medium severity. The skin and visible mucous membranes are pale pink in color. Pulse - 72bpm, -- arterial pressure - 130/7Omm Hg. Heart tones are rhythmic. Clean breath in the lungs. The abdomen is of the correct shape, soft and painless on palpation. Pasternacki's symptom is negative on both sides. General blood analysis (04/06/05): erythrocytes - 3.7x1012, Hb 108Hg/l, color indicator - 0.8, leukocytes - 8.4x109, POP - 24mm/h. « 20 04/06/2005 EGDFS: The esophagus is open to the level of ZOsm from the incisors. In the future, its incision is obturated up to 0.5 cm with a tuberous tumor in diameter, located circularly and impassable by the endoscope. Tumor tissues bleed easily on contact. Conclusions: Cancer of the middle third of the esophagus. :з» The patient underwent 4 sessions of laser endoscopic recanalization with esophageal embolization, as a result of which the passage of food through the esophagus improved significantly. The patient began to take not only liquid, but also solid food, which improved the quality of his life. 04/15/2005 the patient was discharged home in satisfactory condition. - 15 Example 2

Patient D., 78 years old, medical history Mo2509, admitted on 04/27/2005. to the Department of Esophagus, Stomach and Intestine Surgery of the Institute with complaints of moderate pain in the epigastric region, difficulty in swallowing liquid food, pronounced weight loss in a short time, anorexia, general asthenia, dyspeptic disorders.

He considered himself sick for 4 months, when for the first time difficulty in swallowing solid food appeared. The condition of the 50th patient is severe, with reduced nutrition. The skin and visible mucous membranes are pale, gray in color. Peripheral lymph nodes are not enlarged. There are no swellings. The tones of the heart are muffled, rhythmic. Pulse 74 bpm, satisfactory properties, blood pressure 125/7/5 mm Hg. Breathing is vesicular in the lungs, there are no wheezes. Abdomen of an irregular shape - drawn in, takes part in the act of breathing, moderately painful on palpation in the epigastric region, where a dense neoplasm is palpated. Pasternacki's symptom is negative on both sides. General blood analysis (April 28, 2005): erythrocytes - 3.vx1072, Hb 102g/l, color index - 0.8, leukocytes - 11.0x109, CO2 - 25mM/h. from 04/27/2005 EGDFS: the esophagus is open to the level of Zbsm from the incisors, then the slit is narrowed to O,Zsm by a tuberous tumor and is impassable with an endoscope, the tumor tissues bleed easily on contact, a biopsy was taken. Conclusions:

Cancer of the lower third of the esophagus and cardia, complicated by stenosis. Cancer cachexia. The patient underwent 5 sessions of laser endoscopic recanalization with embolization of the esophagus and cardiac part of the stomach, as a result of which pronounced recanalization was achieved at the level of the lower third of the esophagus and cardia. The patient can take both liquid and solid food, which has improved his quality of life. 13.05.2005 the patient was discharged in satisfactory condition under the supervision of the district oncologist.

Using the proposed method, 56 courses of recanalization of the esophagus and the cardiac b5 part of the stomach were carried out. Restoration of esophageal patency was achieved in 52 patients. The average duration of the recanalization course would be days, while in 52 patients from the control group, in whom bougie was not used, it was 11 days.

Thus, the comparison with the analogue shows that the use of the proposed method allows to reduce the time of laser endoscopic recanalization.

Claims (1)

The formula of the invention is a method of restoring the patency of the esophagus and the cardiac part of the stomach, which includes several sessions of 70 destruction of neoplasms with laser radiation through a fibrogastroscope with the introduction of proteolytic enzymes into the tumor before each session, which is distinguished by the fact that after each session of destruction of neoplasms, the esophagus and the cardiac part of the stomach are ablated under control of fibrogastroscope. - «c) cha « s yo - with . and? - name) sh» -I (42) s 60 b5