UA76763C2 - Method, system, and device for ultrasonic action on blood vessel or cavernous body - Google Patents

Abstract

The inventive device for ultrasonic action on a blood vessel or a cavernous body comprises a concentrator-waveguide having a pointed end for piercing the wall of the vessel or cavernous body and a working part which is introduced into said vessel or cavernous body through the puncture thereof. Said ultrasonic device is incorporated into a system which additionally comprises an ultrasonic generator, a channel or channels for transferring a liquid phase and a unit for supplying and evacuating said liquid phase provided with a push-and-pull drive. Said drive operates in such a way that it collects the liquid phase through the channel or channels for transferring said liquid phase during the direct motion and evacuates it through the channel or channels for transferring said liquid phase during the reverse motion.

Description

Description of the invention

The invention relates to medical technology, namely to the technology used in vascular surgery, 2 proctology and other areas of medicine, in which the operative effect is detected on a blood vessel or cavernous body.

A known method of surgical treatment of hemorrhoids, which are a type of corpus cavernosum, consists in the imposition of vascular sutures (see "Manual on coloproctology", V.L. Ryvkin, F.S. Bronshtein, S.N. Fine, M.,

Medical practice, 2001)|. When implementing this method, stitching and ligation of the leg 70 of the hemorrhoidal node are performed, the internal and external hemorrhoidal nodes are cut out, after which the mucosal defect is sutured with various types of sutures. Traditional surgical instruments (Luer clamp, Kocher clamp, Allis clamp) are usually used to implement this method. The disadvantage of this method is the time-consuming operation, as well as a high degree of traumatization of the mucous membrane of the anal canal, which is accompanied by significant blood loss. The consequence of the high degree of traumatization is, in particular, a long period of rehabilitation of 72 operated patients.

A known method of influencing the inner surfaces of veins and cavernous bodies, which consists in |injection sclerosing, carried out by introducing a sclerosing substance (sclerosant) into the lumen of a vascular formation (vessel or cavernous body), described (for example, in the publication "Sredstva, prymenyaemye for the treatment of vein diseases": A manual for doctors / Edited by V.S. Savelyeva - Moscow: A.N. Bakulev State Medical University of the Russian Academy of Sciences, 1999, -32 p., as well as in the abstract of the dissertation of Solov'ev O. .L. "Sclerosis therapy in the outpatient treatment of hemorrhoids". Volgograd, 1996, 23 p. | This method is not effective enough due to the limitation of one-time administration of the sclerosant, as it requires the introduction of a deliberately excessive volume of the sclerosant to improve its chemical interaction with the vascular wall However, the sclerosant itself is a chemically aggressive medium, and its overdose causes tissue necrosis. p

From the description of the invention to (author's certificate ZO 1158196 A), a known device for phonophoresis containing (3 multi-half-wave ultrasonic concentrator with a working part made in the shape of a ball. Such a device for phonophoresis is intended for internal ultrasonic treatment of blood vessels, which allows introducing a medicinal substance into the vessel wall. When using such a device in order to introduce it into the vessel, it is necessary to temporarily exclude the vessel from the blood flow and create a hole in the vessel wall with a special surgical instrument, sufficient for the passage of the working part. The disadvantages of the known device for He) phonophoresis are the need to perform complex surgical access to a blood vessel or cavernous body, which involves a major violation of the integrity of the tissues surrounding the vessel or the body, including the skin. -

Such surgical access is accompanied by significant traumatization of the surrounding tissues and large blood loss. "at

Extensive traumatization of tissues leads to a long process of their postoperative regeneration (restoration). 3o The labor intensity and time duration of the operation itself is also great, since making a hole with a surgical instrument involves temporarily excluding the operated vessel from the blood flow with the use of an additional technical device, for example, vascular clamps.

The task of the invention is to create a method, system and devices for ultrasonic impact on the inner cavity of a vessel or cavernous body, which ensures a reduction in traumatization of tissues, a reduction in blood loss C 50 when an instrument is introduced into a vessel or a cavernous body, and eliminates the need for the use of means that exclude the vessel from blood flow, as well as increasing the effectiveness of the sclerosant on the inner cavity of a vessel or cavernous body.

To achieve this technical result, the ultrasonic instrument containing the concentrator-waveguide has a pointed end and a protruding working part designed to transmit mechanical vibrations of the ultrasonic frequency to affect the walls and inner cavity of the vessel or 7 cavernous body.

Ge") The sharp end of the ultrasonic tool allows you to make a hole in the vessel wall directly with the ultrasonic tool itself, and with the additional use of ultrasonic influence, which facilitates and significantly reduces traumatization of the skin and surrounding vessels when making a hole

Gee! 20 fabrics. The ultrasound field, concentrating on the sharp extremity, in a fraction of a second locally destroys the skin, tissue surrounding the vessel and the wall of the vessel itself, and practically without extensive traumatization. c» The close location of the working part and the sharp end limb allows the user to visually control the penetration of the working part into the tissues and into the lumen of the vessel or cavernous body, and also allows to ensure the correspondence of the dimensions of the hole being made and the working part. Practically simultaneous execution of the hole and 22 introduction of the working part through it into the vessel or cavernous body minimizes blood loss and eliminates

HF) the need to exclude a vessel or cavernous body from the bloodstream.

The working part of the ultrasonic tool has a convex, convex-concave shape or is made in the form of a geometric body of rotation. The pointed limb has the shape of a body of rotation or a polyhedral shape.

The waveguide concentrator is made continuous or has channels for the passage of the liquid phase in the concentrator itself, the working part or additionally contains at least one channel in the pointed limb.

The waveguide concentrator is rigid or flexible. The cross-section of the concentrator-waveguide has the shape of a rectangle or a rectangle with rounded edges, or a circle, or an ellipse.

The longitudinal axis of the pointed limb in a separate case of the device does not coincide with the longitudinal axis of the working part. because In the system for ultrasonic impact on a vessel or cavernous body, an ultrasonic tool is used, containing a waveguide concentrator with a pointed end and a protruding working part, designed to transmit mechanical vibrations of the ultrasonic frequency to affect the walls and internal cavity of the vessel or cavernous body. The system includes an ultrasonic signal generator that provides a signal to the ultrasonic instrument, a means of supplying and evacuating the liquid phase, which has at least one channel for moving the liquid phase, and the means of supplying and evacuating the liquid phase includes a reverse drive that ensures liquid phase intake in the direct direction of movement through at least one channel of moving the liquid phase, and in the reverse direction of movement - the removal of liquid Through at least one channel of moving the liquid phase. 70 The presence of a reverse drive allows for a metered supply of the liquid phase into the inner cavity of the vessel.

Intake and withdrawal of the liquid phase are carried out through the same channel for moving the liquid phase or through different channels.

The means of supplying and evacuating the liquid phase is actuated by a manual drive when performing this means, /5 for example, in the form of a syringe, or by an electromechanical drive, for example, when performing a means of supplying and evacuating the liquid phase in the form of a piston or rotary electromechanical supercharger.

When using an ultrasonic tool, in which the concentrator-waveguide has channels for the passage of the fluid in the concentrator itself, the working part, or additionally contains at least one channel in the sharp-end limb, at least one channel of the movement of the liquid phase is performed with the possibility of connection with 2o Corresponding channel in the ultrasonic tool, and the connection of the channel for moving the liquid phase with the channel in the ultrasonic tool is realized, for example, by means of connecting the ultrasonic tool.

The above-mentioned technical result is also achieved in the method of ultrasonic impact on a blood vessel or cavernous body, in which an ultrasonic instrument containing a concentrator-waveguide with a pointed end and a projecting working part designed to transmit mechanical vibrations of an ultrasonic frequency to affect the walls and internal the cavity of a vessel or cavernous body, i) mechanical vibrations of the ultrasonic frequency are applied, a puncture is made with the pointed part of the instrument of the wall of the vessel or cavernous body, and through this puncture a working part is introduced into the vessel or cavernous body, which provides an ultrasonic effect on the inner cavity of the vessel or cavernous body. Ultrasonic impact on the inner cavity of a blood vessel or cavernous body is performed directly with an ultrasonic instrument or additionally using a liquid phase fed by x-rays to the inside of the vessel or cavernous body to provide an intermediate liquid medium between the ultrasonic instrument and the inner cavity of the vessel or cavernous body.

The liquid phase is fed into the vessel or cavernous body through a channel in the ultrasonic instrument or ISE) c5 Through an additional puncture in the wall of the vessel or cavernous body. Cha

Moreover, the liquid phase is fed inside the blood vessel or cavernous body during the ultrasonic exposure and after its end, the evacuation of the liquid phase from the vessel or cavernous body is ensured.

Evacuation of the liquid phase from the vessel or cavernous body is performed through a channel in the ultrasonic instrument or an additional puncture in the wall of the vessel or cavernous body. "

The liquid phase contains a sclerosing agent such as, for example, ethoxysclerol or thrombovar. in c When using a method to affect a blood vessel or a cavernous body filled with a thrombotic mass in whole or in part, the working part is introduced into that part of the vessel or cavernous body that is filled;" pathological tissue or thrombotic mass.

With long-term ultrasound exposure to pathological tissue and thrombotic mass, a Coagulation channel is formed in them, through which, with the additional use of the liquid phase fed into the vessel or -I cavernous body, this liquid phase is moved and the thrombotic mass is evacuated.

The liquid phase is fed into a vessel or cavernous body through a channel in an ultrasonic instrument or

Me. through an additional puncture in the wall of a vessel or cavernous body. -I The influence on the cavernous body is carried out before the formation of a coagulation channel with predetermined parameters, which, for example, are the predetermined shape of the cross-section of the channel, the angles of inclination

Me, the channel to the surrounding cavernous body tissues, the length of the channel and the spatial shape of the longitudinal axis of the channel. These parameters make it possible to form a connective apparatus that prevents the vessel or cavernous body from falling out.

An ultrasonic instrument, a system for ultrasonic exposure to a vessel or a cavernous body, and the stages of implementation of a method of ultrasonic exposure to a vessel or a cavernous body are presented in the drawings, in which:

F) Fig. 1 - a cross-section of an ultrasonic instrument containing a concentrator-waveguide with a sharp tip and a protruding working part;

Fig. 2(a-c) - different forms of working parts of the ultrasonic tool; in Fig. 3(a, b) - different forms of the pointed limb;

Fig. 4(a, 6) - an ultrasonic tool with internal channels for supplying the liquid phase;

Fig. 5 - an ultrasonic tool with internal channels for supplying and evacuating the liquid phase;

Fig. 6 - cross-sectional shape of the concentrator-waveguide;

Fig. 7(a, b) - variants of execution of a pointed limb with a longitudinal axis that does not coincide with the 65 longitudinal axis of the working part;

Fig. 8 is a functional scheme of the system for ultrasonic influence on a vessel or cavernous body;

Fig. 9U(a, b) - the appearance of options for the layout of a part of the system for ultrasonic impact on a vessel or cavernous body;

Fig. 10-13 - stages of implementation of the method of ultrasonic influence on a blood vessel or cavernous body.

Figure 1 shows an ultrasonic tool 1 containing a concentrator-waveguide 2 with a pointed limb 4 and a working part 3 protruding from the concentrator-waveguide 2, designed to transmit mechanical vibrations of an ultrasonic frequency to affect the walls and inner cavity of a vessel or cavernous body. The ultrasonic instrument 1 is made solid, and the longitudinal axis of the concentrator-waveguide coincides with the longitudinal axis of the pointed limb 4. The ultrasonic instrument 70 is usually made of biocompatible (biologically inert) materials, for example, titanium alloys of the VT-5, VT-6, OT-4 .

The working part C is generally made convex, and it can be given almost any shape, for example, the shape of a parallelepiped according to Fig. 2(a). The side edges of the working part C are rounded or unrounded, and the presence of unrounded edges does not significantly affect the distribution /5 of the ultrasonic field around the working part, but can be an additional source of mechanical traumatization of the inner surface of the vessel or cavernous body.

The working part C of the ultrasonic tool 1 in a number of applications is expedient to be convex-concave, for example, similar to the one shown in Fig. 2(b), i.e. in the form of a concave hemisphere 5 with a pointed end 4 in the center of such a hemisphere. The edges of the hemisphere are sharp or rounded. Fig. 2(c) shows the working part C with a tapping b, as a special case of a convex-concave shape. The convex-concave shape provides the ability to control the direction of acoustic flows in the liquid phase.

It is most expedient to implement the working part C in the form of a geometric body of rotation, for example, an ellipsoid or a sphere. With this shape of the working part, the ultrasonic field around it is distributed most evenly, which ensures a uniform effect on the inner cavity of the vessel or cavernous body. with

An essential element of the ultrasonic tool 1 is the pointed limb 4, which serves to perform a puncture in the vessel wall, which ensures the passage of the working part C inside this vessel. High-frequency i) mechanical oscillations of the pointed limb 4 significantly reduce the effort required to make a hole (puncture) in the vessel wall and the tissues surrounding the vessel, as a result of the vibration impact effect, which significantly reduces the deformation zone of biological tissues at the point of application of the pointed limb of the ultrasonic instrument .

The pointed limb 4 is made in the form of a body of rotation, for example, a cone. The pointed limb 4 ise) can also be made multifaceted and pointed in shape, for example, in the form of a pyramid, as shown in M

Fig. 3 (b).

Since the ultrasonic impact in one of the variants of the implementation of the ultrasonic instrument is carried out according to ISE)

With the aid of the liquid phase, channels are provided inside the ultrasonic instrument, as shown in Fig. 4(a). uh-

Usually, one channel 7 inside the concentrator-waveguide 2 and one channel 8 inside the working part C are enough, however, for a more uniform supply of the liquid phase inside the treated vessel or cavernous body, the number of channels 7 and 8 can be increased. In a number of cases, it is advisable to provide at least one channel 9 inside the pointed limb 4, as shown in Fig. 4(b). Such a channel will facilitate the penetration of the tool into the tissues at the time of their puncture due to the effect of local cavitation and the reduction of friction between the tool and the tissues, as well as to enhance the effect of targeted delivery of the sclerosing substance to the vascular wall. The transverse dimensions of all channels are selected from the calculation of the provision;" unimpeded passage of the liquid phase.

As a liquid phase, solutions containing a sclerosing substance, for example, ethoxysclerol or thrombovar, are used. Examples of such solutions are given in the publications "Remedies used for treatment - and diseases of veins": Posobie dlya vrachei/Edited by. Savelyeva V.S. - M.: NSSSH named after A.N. Bakuleva National Academy of Medical Sciences, 1999. -32p. and "Chronic venous insufficiency" - M: Izdatelstvo "Bereg", 1999. -128p.4. Under influence

Me. of the ultrasonic instrument on the inner cavity of the vessel or cavernous body, the sclerosing substance in the -I liquid phase enters the lumen of the vessel and under the action of the sharp end of the ultrasonic instrument 5o is locally introduced into the wall of the vessel or cavernous body, thus ensuring targeted

Me, delivery of a sclerosing agent. Compared to traditional sclerotherapy, the consumption of sclerosant, which is introduced by such targeted delivery, decreases.

The waveguide concentrator can be made flexible to ensure passage of the working part along an anatomically located vessel bed or to ensure minimally invasive surgical access of the working part along non-rectilinear trajectories. At the same time, the waveguide concentrator can have a cross-section, for example, in the shape of a circle, as shown in Figb. This shape of the cross-section will not (Ф, interfere with the bending of the concentrator-waveguide. ka To facilitate minimally invasive surgical access of the working part along non-rectilinear trajectories or with lateral access to a vessel or cavernous body, the longitudinal axis of the pointed limb can be made not coinciding with the longitudinal axis of the working part . part at some deviation A from it. Preferable values of the angle A are in the range from 30 to 452, but practically the value of the angle A can lie in the range from 0.1 to 902. The preferred values of the deviations l are in the range from 0.01 to 0 .5 of the maximum transverse size of the working part.

Fig. 8 shows the structural diagram of the system for ultrasonic impact on a vessel or cavernous body using an ultrasonic tool 1 with a waveguide concentrator, which has a sharp end and a protruding working part, designed to transmit mechanical vibrations of an ultrasonic frequency to affect the walls and internal cavity of a vessel 314 (cavernous body) The system also includes an ultrasonic signal generator 13, which provides a signal to the ultrasonic instrument using an acoustic unit 12, as well as means 15 for supplying and evacuating the liquid phase, which has at least one channel for moving the liquid phase, and the means 15 for supplying and evacuation of the liquid phase contains a reverse drive 16, which provides, in the forward direction of movement, the removal of the liquid phase through at least one channel 17 of the movement of the liquid phase, and in the reverse direction of movement - the intake of the liquid phase through at least one channel 17 of the movement of the liquid phase.

The intake and removal of liquid is carried out through the same channel 17 for the movement of the liquid phase or through different channels, and for the intake and removal of the liquid phase through different channels in the ultrasonic instrument, at least two channels 17 and 17 are performed. Channels 17 and 177 for supply and evacuation of the liquid phase can be made with different cross-sectional areas.

Means 16 for supplying and evacuating the liquid phase is performed with a manual drive, for example, in the form of a syringe, or with an electromechanical drive, for example, in the form of a piston or rotary compressor. Fig.U(a, b) schematically presents a piston supercharger to simplify the drawings.

Channel 17 of moving the liquid phase is performed with the possibility of connection with the corresponding channel in the ultrasonic instrument, for example, channel 7 in Fig. 4 (a), however, in a number of applications, the movement of the liquid phase is carried out through a separate channel 17", which is connected to the inner cavity of the vessel 14 or the cavernous body directly, that is, not through the channel in the ultrasonic instrument 1. The separate channel 17" is used together with the channel 17 or channels 17 and 17" or instead of them.

To connect the channel 17 of the movement of the liquid phase to the channel in the ultrasonic tool 1, a means of connecting the ultrasonic tool is used. with

In this case, the channel 17 is connected either to the channel in the acoustic node 12, with which the ultrasonic instrument 1 is connected, as shown in Fig. 8 and 9 (a) reference point 17", or directly with i) ultrasonic tool 1, as shown in Fig. 9(b) reference point 17.

As an example of the implementation of the method according to the present invention, an example of applying ultrasound to a hemorrhoidal node is given. Fig. 10 shows a schematic representation of the anal canal 19 with a hemorrhoidal node 14. To affect the hemorrhoidal node, an ultrasonic tool 1 is used, which contains a waveguide concentrator with a sharp end and a working part designed to transmit mechanical vibrations of the ultrasonic frequency to influence on the walls and internal cavity of the hemorrhoidal node M 14, which is a type of corpus cavernosum. Mechanical vibrations of the ultrasonic frequency are applied to the ultrasonic tool 1 from the generator and the acoustic unit (not shown). With the pointed end of the tool 1, a puncture is made in the wall of the hemorrhoidal node 14, and through this puncture, the working part C is introduced into the hemorrhoidal node 14, which provides an ultrasonic effect on the hemorrhoidal node 14 from the inside, as shown in Fig. 11. At the same time, the sclerosant 20 supplied from the dosing device (not shown) is fed into the hemorrhoidal node 14 through the channel in the tool 1. Under the influence of ultrasound, the sclerosant is deeply introduced into the walls of the hemorrhoidal node 14. With the help of a waveguide concentrator "

Tissues in contact with the surface of the concentrator-waveguide are heated to the coagulation temperature of these 7-3 s tissues. As a result of coagulation, a channel 21 is formed with non-descending, i.e., that retain the lumen, after removal. tool walls, as shown in Fig.12. Such a channel 21 is called a coagulation channel. According to coagulation and? channel 21 after pulling out the tool 1 ensures the outflow of excess sclerosing substance into the free lumen of the rectum, as shown by arrow 22 in Fig.12. Removal of excess sclerosing substance prevents the possibility of chemical necrosis of the hemorrhoidal node. In another variant, the excess sclerosing substance -I before pulling out the tool 1 is forcibly evacuated through the channel in the working part and the waveguide concentrator.

Me, The formed coagulation channel 21 initiates the concentration of fibroblasts around it with the subsequent formation of a connective tissue cord 23 or a connective apparatus that passes through the hemorrhoidal node 14. 5r The cord 23 formed performs a supporting function similar to the ligament of Treitz boip), preventing me) from falling out of the node 14. 4) For the most effective further functioning of the connective apparatus that is being formed, it is preferable to choose the following parameters of the coagulation channel 21: - the length of the channel - from 15 to 4 Ohm with its end near the muscular wall of the rectus intestines; 5B - geometrically irregular shape of the cross-section of the channel; - angle of inclination of the canal to the wall of the anal canal - from 1592 to 459; (F, - non-rectilinear longitudinal axis of the channel; ko - exposure time of ultrasonic exposure - from 10 to 20 seconds.

During the practical application of the method, system and tool for ultrasonic impact on a blood vessel or cavernous body, stable positive results were obtained, in particular, in the treatment of the third and fourth stages of hemorrhoids, there are the following examples of application.

Example 1

Patient V., born in 1937, has suffered from hemorrhoids for 15 years. In the last 5 years, hemorrhoidal nodes fall out of the anal canal with each defecation and are exercised only with manual help. Bleeding 65 occurs 2-3 times a year, not abundant.

The examination revealed an increase in internal hemorrhoidal nodes up to 2.5 cm in diameter at 3, 7, and 11 o'clock.

External nodes are not hypertrophied. There is no hyperemia.

The patient underwent sclerotherapy using an ultrasonic instrument. 2.0 ml of thrombovar was introduced.

The sharp end of the tool punctures the wall of the node and the surrounding tissues, the concentrator-waveguide is brought to the muscular wall of the rectum and after exposure to ultrasound for 15 seconds. the tool has been removed. The manipulation was carried out at 3, 7 and 11 o'clock simultaneously. There is no pain syndrome, the patient started work (electrician fitter) the next day.

According to the results of a control examination after a month objectively - in the anal canal at 3, 7 and 11 o'clock, a slight accumulation of hemorrhoidal tissue up to 0.8 cm in diameter is determined; there is no hyperemia. Subjectively - 7/0 Defecation is daily, independent, there are no prolapse of hemorrhoidal nodes and bleeding.

Example 2

Patient L., born in 1948, has suffered from hemorrhoids for 20 years. In the last 6 years, hemorrhoids bleed and fall out of the anal canal - with every defecation and are exercised only with manual help. Bleeding has been abundant for the past year.

The examination revealed an increase in internal hemorrhoidal nodes up to 2.5 cm in diameter at 3, 7, and 11 o'clock.

The mucous membrane is swollen, hyperemic.

The patient underwent sclerotherapy using an ultrasonic instrument. 2.0 ml of thrombovar was introduced.

There was no pain syndrome, the patient did not take leave from work.

According to the results of the control examination after a month objectively - in the anal canal at 3, 7 and 11 o'clock, hemorrhoidal nodes are determined, reduced by 1.0 cm and painless; there is no mucosal hyperemia. Subjectively - bowel movements are daily, independent, there are no prolapse of hemorrhoidal nodes, bleeding has not recurred.

Example C

Patient G., born in 1965, has suffered from hemorrhoids for 10 years. Hemorrhoid nodes fall out of the anal canal during defecation, often swell. Bleeding has been abundant for the past year. He was treated in a hospital with acute blood loss.

During the examination, an increase in internal hemorrhoidal nodes up to 2.5-3.0 cm in diameter was detected, the nodes bleed when i) contact, and become external.

The patient underwent sclerotherapy using an ultrasonic instrument. The manipulation was carried out at 3, 7 and 11 o'clock alternately. The pain syndrome is moderate, it was easily stopped with the use of Ketanov tablets. co

The patient did not take leave at work.

A month later, additional sclerotherapy was performed using an ultrasonic instrument. Manipulation ise) carried out at the node at 11 o'clock. There was no pain syndrome. The patient did not take leave at work. uh-

According to the results of the control examination after two months objectively - in the anal canal at 3, 7 and 11 o'clock there is an accumulation of dense hemorrhoidal tissue up to 0.8 cm in diameter; there is no mucosal hyperemia. External re)hemorrhoidal nodes tightened, reduced. Subjectively - bowel movements are daily, independent, they fall out - there are no hemorrhoidal nodes, bleeding has not been repeated.

Claims (48)

The formula of the invention "what | that | 1. An ultrasonic instrument containing a concentrator-waveguide with a pointed limb, made with the possibility of a puncture in the wall of a vessel or a cavernous body, and a protruding working part, "with" intended for the transmission of mechanical vibrations of the ultrasonic frequency and impact on the walls and internal vessel cavity or cavernous body. 2. Ultrasonic tool according to claim 1, which is characterized by the fact that the working part is convex. -AND 3. Ultrasonic tool according to claim 1, which is characterized by the fact that the working part is made convex-concave. 4. Ultrasonic tool according to claim 1, which differs in that the working part is made in the form of Me, a geometric body of rotation. - And 5. An ultrasonic instrument according to claim 1, characterized in that the pointed limb has the shape of a body of rotation. (2) b. Ultrasonic instrument according to claim 71, which differs in that the pointed limb is made "Fo" polyhedral. 7. An ultrasonic instrument according to claim 5 or 6, characterized in that the pointed limb has the shape of a needle. 8. Ultrasonic tool according to claim 1, which is characterized by the fact that the pointed limb is removable. 9. An ultrasonic instrument according to any one of claims 1-8, which is characterized by the fact that channels are made in the waveguide concentrator (F) to ensure the movement of the liquid phase. GI 10. Ultrasonic tool according to claim 9, which is characterized by the fact that at least one channel is made in the pointed limb. in 11. An ultrasonic instrument according to any one of claims 1-10, characterized in that the waveguide concentrator is flexible. 12. Ultrasonic tool according to claim 1, which is characterized by the fact that the longitudinal axis of the pointed limb does not coincide with the longitudinal axis of the working part. 13. A system for ultrasonic impact on a vessel or a cavernous body, containing an ultrasonic 65 tool, containing a concentrator-waveguide with a sharp end, made with the possibility of making a puncture in the wall of a vessel or a cavernous body, ITS projecting working part, an ultrasonic signal generator that provides sending a signal to an ultrasonic instrument, means for supplying and evacuating the liquid phase, which has at least one channel for the movement of the liquid phase, and the means for supplying and evacuating the liquid phase includes a reverse drive, which ensures, in the forward direction of movement, the intake of the liquid phase through at least one channel for the movement of the liquid phase, and in the case of the reverse direction of movement - the removal of the liquid phase through at least one channel of movement of the liquid phase. 14. The system according to claim 13, which is characterized by the fact that the intake and output of the liquid phase is carried out through the same channel for moving the liquid phase. 15. The system according to claim 13, which differs in that the means of supply and evacuation of the liquid phase is made with a manual 7/0 drive. 16. The system according to claim 15, which differs in that the means of supplying and evacuating the liquid phase is made in the form of a syringe. 17. The system according to claim 13, which differs in that the means of supply and evacuation of the liquid phase is made with an electromechanical drive. 18. The system according to claim 17, which is characterized by the fact that the means of supplying and evacuating the liquid phase is made in the form of a piston or rotary compressor. 19. The system according to claim 13, which is characterized by the fact that at least one channel for moving the liquid phase is made with the possibility of connection with the corresponding channel in the ultrasonic instrument. 20. The system according to claim 19, which is characterized by the fact that a means of connecting the ultrasonic tool is provided for connecting the channel for moving the liquid phase to the channel in the ultrasonic tool. 21. The system according to claim 13, which differs in that the working part is convex. 22. The system according to claim 13, which differs in that the working part is made convex-concave. 23. The system according to claim 13, which differs in that the working part is made in the form of a geometric body of rotation. with 24. The system according to claim 13, characterized in that the pointed limb has the shape of a body of rotation. 25. The system according to claim 13, which is characterized by the fact that the pointed limb is multifaceted. and) 26. The system according to claim 24 or claim 25, characterized in that the pointed limb has the shape of a needle. 27. The system according to claim 13, which is characterized by the fact that the pointed limb is removable. 28. The system according to any one of claims 13-27, which is characterized by the fact that channels are made in the waveguide concentrator of the ultrasonic tool to ensure the movement of the liquid phase. 29. The system according to claim 28, which is characterized by the fact that at least one channel is made in the pointed limb. ise) 30. The system according to any of claims 13-29, which is characterized by the fact that the waveguide concentrator is made flexible. M C1. The system according to claim 13, which is characterized by the fact that the longitudinal axis of the pointed limb does not coincide with the longitudinal axis of the working part. re) 32. The method of ultrasonic influence on a blood vessel or cavernous body, which consists in using an ultrasonic tool that contains a concentrator-waveguide with a sharp end and a working part designed to transmit mechanical vibrations of the ultrasonic frequency to affect the walls and the inner cavity of the vessel or cavernous body, mechanical oscillations of ultrasonic frequency are applied, the vessel or cavernous body wall is punctured with the sharp end of the tool, and through this puncture a working part is introduced into the vessel or cavernous body, which provides an ultrasonic effect on the inner cavity of the vessel or cavernous body. . 33. The method according to claim 32, which is characterized by the fact that a liquid phase is additionally used, which is fed inside a vessel or cavernous body. 34. The method according to claim 33, which differs in that the liquid phase is fed inside the vessel or cavernous body through an additional puncture in the wall of the vessel or cavernous body. -AND 35. The method according to claim 33, which is characterized by the fact that the liquid phase is fed into a vessel or cavernous body through a channel in an ultrasonic instrument. Me, 36. The method according to claim 33, which differs in that during the ultrasonic exposure or after its end -I ensure the evacuation of the liquid phase from the vessel or cavernous body. 37. The method according to claim 36, which differs in that the liquid phase is evacuated from a vessel or a cavernous body Me. through an additional puncture in the wall of a vessel or cavernous body. 4) 38. The method according to claim 36, which is characterized by the fact that the liquid phase is evacuated from the vessel or cavernous body through the channel in the ultrasonic instrument. 39. The method according to any one of claims 33-38, which is characterized in that the liquid phase contains a sclerosing substance. 40. The method according to claim 39, which differs in that ethoxysclerol or thrombovar is used as a sclerosing agent. F) 41. The method according to claim 32, which differs in that the working part is introduced into the part of the vessel or cavernous body that is filled with pathological tissue or thrombotic mass. 42. The method according to claim 41, which differs in that the ultrasonic impact is carried out before the formation of a coagulation channel in a pathological tissue or thrombotic mass. 43. The method according to claim 41, which is characterized by the fact that a liquid phase is additionally used, which is fed into a vessel or a cavernous body. 44. The method according to claim 42, which differs in that the movement of the liquid phase and the evacuation of the thrombotic mass are carried out through the coagulation channel. 65 45. The method according to claim 43, which differs in that the liquid phase is fed into the vessel or cavernous body through an additional puncture in the wall of the vessel or cavernous body. 46. The method according to claim 43, which is characterized by the fact that the liquid phase is fed into a vessel or cavernous body through a channel in an ultrasonic instrument. 47. The method according to claim 41, which is characterized by the fact that the ultrasonic impact is carried out before the formation of the coagulation channel with parameters that ensure the formation of a connective apparatus that prevents the vessel or cavernous body from falling out. 48. The method according to claim 47, which is characterized by the fact that the parameters are selected from the group, which includes the shape of the cross-section of the channel, the angle of inclination of the channel to the inner wall of the vessel or cavernous body, the length of the channel, the spatial shape of the longitudinal axis of the channel, and the exposure time of ultrasonic exposure , as well as 7/0 any combination of these parameters. s schi 6) (ze) to te cha (Se) m. - with . and? -I (o) -I FO syu» ime) 60 b5