RU156334U1 - DEVICE FOR AUTOMATIC RETURN OF BILES TO THE DIGESTIVE TREATMENT IN PATIENTS WITH MECHANICAL JAUNDICE - Google Patents

Abstract

A device for automatically returning bile to the digestive tract in patients with obstructive jaundice, containing biliary drainage installed under ultrasound control, a clamp, percutaneous gastrostomy, installed endoscopically, and connected in series with each other using a tube, characterized in that it is additionally equipped with an elastomeric pump, a filter and a bile flow rate limiter, while the elastomeric pump is installed in front of the biliary drainage and consists of an elastic membrane located inside its It was designed to fill the pump, allowing bile to be evacuated in one direction, and made with the possibility of introducing the necessary volume of bile by uniform expulsion by reducing the internal elastic membrane, and the filter and bile flow rate limiter were installed sequentially in front of the gastrostomy.

Description

The technical field to which the utility model relates.

The utility model relates to medicine, in particular, to a device for the automatic return of bile to the digestive tract in patients with obstructive jaundice and can be used in gastroenterology and surgery.

State of the art

A device is known for the return of bile to the digestive tract, which has a high role of bile components in the function of digestion, bacterial contamination, and drainage of the bile ducts, since it is necessary to return bile to the intestinal lumen through a thin nasoenteric probe, but more often, bile is returned orally (see Joseph M. Henderson., Physiology of the digestive system. M.: Binom - 1997., 221 s).

However, this procedure causes patients discomfort, vomiting, and frequent refusal to take bile (see Pugaev A.V., Lidov P.I., Achkasov E.E., Negrebov M.G., Pokrovsky K.Α., Aleksandrov L.V. Enteral nutrition in the complex treatment of patients with obstructive jaundice in gallstone disease. Clinical medicine. No. 1., 2008., S. 51-53).

There is a method and device for treating obstructive jaundice, which includes enteral administration of a drug in complex therapy, while a pharmacological composition consisting of the following ingredients is used as a medicine, wt.%:

xymedon 0.25-0.3 magnesium sulfate 1.15-1.25 bile rest

In the method, the composition is administered in fractions 3-4 times, 100-150 ml after or during meals (see US Pat. RU No. 2349322, IPC A61K 31/505, A61K 35/413, A61K 33/00, A61P 1/16, published on December 27, 2007).

The disadvantage of this device and method of treatment is its low efficiency, as well as long-term preparation of bile, which is inconvenient for medical personnel and the patient.

A known method and device for returning bile to the digestive tract, including biliary drainage, installed under the control of ultrasound, a gastrostomy, installed endoscopically and interconnected using a tube, carry out external drainage of the duodenum through microgastrostomy, then drain the bile ducts, for 4-5 days, drainage of the biliary tract and duodenum is connected with a glass tee (see Popov A.I., Izmaylov S.G., Izmaylov G.Α., Parshikov V.V. Treatment and prevention of acholia syndrome. . - Kazan, 2003).

However, this method causes infection of the biliary tract, a combination of obstructive jaundice with purulent cholangitis is noted in 20-30% of cases, while postoperative mortality in patients with this pathology is 15-45% (see Altyev B.K., Nazyrov F.G. ., Vakkasov M.Kh., Sadykov Kh.T. Comprehensive treatment of purulent cholangitis in patients with non-tumor obstruction of extrahepatic bile ducts // Annals of Surgical Hepatology. - 1988. - T. 3. - No. 3. - p. 30; Babadjanov B. R., Kuryazov BN Magnetic laser therapy for cholangiolithiasis // Annals of surgical hep atology. - 1988. - T. 3. - No. 3. - p. 34), the main cause of mortality is progressive liver failure, and the development of cholangiogenic purulent complications aggravates the course of the disease and increases mortality (see V. Lupaltsov, Sennikov I.Α., Khadzhiev A.Ch. On the surgical tactics of treating patients with acute cholangitis // Annals of surgical hepatology. - 1998. - T. 3. - No. 3. - P. 80-81; Hishaw D. AT. Acute Obstructive Suppurative Cholangitis. // Surg. Clin. N. Amer. - 1973. - No. 53. - Vol. 5. - P. 1089-1095 .; Borisov A.E., Borisova N.A., Verkhovsky B.C. Endobiliary interventions in the treatment of obstructive jaundice. - St. Petersburg: Aesculapius, 1997 .-- 152 s).

Decompression of the biliary tract with high bilirubinemia (more than 200 μmol / L) should be slow and smooth. Fast decompression of the biliary tract for the first 2-3 days leads to an increase in existing disorders and should not be used in patients with high bilirubinemia (Halperin E.I., 2011). Considering the need for slow decompression of the bile ducts, the need arises to include a clamp in the device for returning bile to the digestive tract, which makes it possible to smoothly control the speed of movement of bile from jet to drip.

The closest in technical essence and the achieved positive effect and adopted by the authors for the prototype is a device for returning bile to the digestive tract in patients with obstructive jaundice, containing percutaneous transhepatic biliary drainage and a tube for percutaneous gastrostomy, interconnected, while it is additionally equipped with a roller clamp , an antireflux valve and a silicone balloon sequentially mounted on the tube between the biliary drainage and the tube for percutaneous endoscopic gastrostomy, and the roller clamp and antireflux valve are installed on the tube between the percutaneous transhepatic biliary drainage and the silicone balloon, and the silicone balloon is installed with the possibility of entering the tube from the percutaneous transhepatic biliary drainage and tube for percutaneous endoscopic gastrostomy (see US Pat. IPC A61B 17/00, A61B1 / 00, published on 02.27.2014).

The disadvantage of this device is the automatic return of bile to the digestive tract and a bulky device, which is inconvenient for medical personnel and the patient.

Utility Model Disclosure

The objective of the proposed utility model is the development of a device for the automatic return of bile to the digestive tract in patients with obstructive jaundice, which eliminates infection of the biliary tract, reduces the risk of postoperative complications, the duration of hospitalization, creates conditions for the convenient use of the model, and improves the patient's quality of life.

The technical result that can be obtained using the proposed utility model is reduced to the automatic feeding of bile into the digestive tract, eliminating biliary tract infections, reducing the risk of postoperative complications, hospitalization, ease of use of the device and improving the quality of life of the patient.

The technical result is achieved using a device for the automatic return of bile to the digestive tract in patients with obstructive jaundice, containing biliary drainage, installed under the supervision of ultrasound, a clamp, percutaneous gastrostomy, installed endoscopically and connected in series with each other using a tube, while it is additionally equipped with an elastomeric pump, filter, and bile flow rate limiter, while the elastomeric pump is installed in front of the biliary drainage and consists of an internal three of its elastic membranes and valves for filling the pump, allowing bile to be evacuated in one direction, and is configured to enter the required volume of bile by uniform expulsion by reducing the internal elastic membrane, and the filter and bile flow rate limiter are installed in series in front of the gastrostomy. Thus, the achievement of the technical result is carried out by installing a percutaneous endoscopic gastrostomy (PEG) and percutaneous transhepatic biliary drainage (BHP) of the bile ducts under ultrasound control and connecting them together using an elastomeric pump, clamp, filter, and fluid flow rate limiter.

The essence of the device for the automatic return of bile to the digestive tract in patients with obstructive jaundice is as follows. They perform drainage of the bile ducts under the control of ultrasound, form an endoscopic gastrostomy, and then connect them together using an elastomeric pump, a clamp that allows you to smoothly control the speed of bile, a filter, and a bile flow rate limiter to automatically return bile to the digestive tract during meals.

Brief Description of the Drawings

In FIG. a device is given for the automatic return of bile to the digestive tract in patients with obstructive jaundice, a general view.

Utility Model Implementation

A device for automatically returning bile to the digestive tract in patients with obstructive jaundice, contains biliary drainage 1, percutaneous gastrostomy 2, tube 3, elastomeric pump 4, valve 5, clamp 6, filter 7 and bile flow rate limiter 8, and the device is additionally equipped with elastomeric pump 4, filter 7 and bile flow rate limiter 8, while biliary drainage 1, installed under ultrasound control (not shown in Fig.), clip 6, percutaneous gastrostomy 2, mounted endoscopically connected in series flax to each other using a tube 3, and an elastomeric pump 4 is installed in front of the biliary drainage 1 and consists of an elastic membrane located inside its membrane (not shown in Fig.), a valve 5 for filling the elastomeric pump 4, allowing bile to be evacuated in one direction, and made with the ability to enter the required volume of bile by uniform expulsion by reducing the internal elastic membrane, and the filter 7 and the limiter 8 of the flow rate of bile are sequentially installed in front of percutaneous gastrostomy 2.

Elastomeric pump 4 is a device that allows you to enter the required amount of bile into the digestive tract, consisting of a two-layer elastic membrane. In this case, the main - the inner layer (not shown in Fig.) Is made of a special polymer that does not contain latex. Outer - latex-containing layer (not shown in Fig.) Does not come into contact with bile or with the patient’s body, thereby completely eliminating possible allergic reactions to this material. A two-layer membrane ensures accurate, accurate introduction of bile and increases the reliability of the elastomeric pump 4 from rupture. In the process, the size of the pump 4 is reduced, which makes the device invisible to others and increases the degree of comfort for the patient. With the help of the clamp 6, located on the extension line, it is possible to temporarily stop the introduction of bile. Filling of the elastomeric pump 4 is done through valve 5, which allows the bile to be evacuated in one direction to the digestive tract. The operation of the device is ensured by uniform expulsion by reducing the internal elastic membrane. After filling the elastomeric pump 4, through the tube 3, bile at a given speed continuously enters the digestive tract. The supply of bile occurs due to the positive pressure created by the elastic membrane of the device. In this case, the predetermined injection rate is determined by both positive membrane pressure and a fluid flow rate limiter 8 located in the extension line. At the same time, unlike ordinary “droppers”, which require gravitational forces, as well as pumps operating on the mains, the elastomeric pump 4 is independent of gravity or electricity, the device is also ideally suited for outpatient treatment.

A device for the automated return of bile to the digestive tract in patients with obstructive jaundice is operated as follows.

Examples of specific applications of the device for the return of bile to the digestive tract in patients with obstructive jaundice.

Example. Patient N., 52 years old, with a diagnosis of obstructive jaundice, has percutaneous transhepatic drainage of the bile ducts under ultrasound guidance, using a common method according to the Seldinger technique. The study is performed on an empty stomach, 30 minutes before the transdermal transhepatic procedure, the patient is intramuscularly injected with 1.0 ml of a 2% solution of promedol and relanium, with the help of a Chiba needle, the bile ducts are tightly filled with contrast medium and, without removing the needle, one from segmental ducts with a long needle with a diameter of 1.5-1.7 mm, along which a wire conductor is then passed, the end of the conductor is tended to be distal to the narrowing, and only then the narrowing point of the bougie is enlarged and installed pour biliary drainage 1, complete this manipulation by fixing the drainage tube to the skin and washing the bile ducts with sterile solutions (physiological saline, 0.25% novocaine solution, etc.).

For 1-2 days after biliary drainage, percutaneous endoscopic gastrostomy 2 is performed, after checking the kit for damage, the patient is placed in the “on the back” position, the endoscope is inserted into the stomach with simultaneous air isufflation, the front wall of the stomach is maximally lifted by the gastroscope, while in the shaded indoors, the assistant fixes the place of the most pronounced diaphanoscopy, the endoscopist must see a pronounced depression of the anterior wall of the stomach, after determining this area, they are treated ozhi antiseptikamii gastrostomy to place the proposed 2, paste a sterile operating sheet with a round neck, are held in the local conduction anesthesia of the skin, subcutaneous fat and fascia solution. A scalpel makes a skin incision 0.5-1 cm long, a polypectomic loop is made through the endoscope instrument channel, its distal part is placed in the area of the most pronounced diaphanoscopy, a special needle with a trocar with a stylet 1.25 mm in diameter aponeurosis and anterior are pierced through the incision on the anterior abdominal wall the wall of the stomach, the trocar enters the lumen of the stomach, the stylet is removed and a wire loop with a plastic coating is introduced through the needle of the trocar into the lumen of the stomach, it is captured by a polypectomy loop. The endoscope and polypectomy loop are removed by dragging the wire loop behind it, which remains in the stomach, esophagus and oral cavity and is brought out, to the end of the wire loop (by the loop-to-loop method), the gastrostomy 2 is fixed. The pointed tip of CHEG 2 is treated with an antibacterial ointment, an oral the cavity is sanitized with an antiseptic. The wire loop is gradually pulled out of the abdominal wall, while ChEG 2 slowly immerses the patient in the mouth and stretches through the esophagus into the stomach, after the pointed part of ChEG 2 contacts the front wall of the stomach, with a stronger movement it is brought to the front abdominal wall (piercing the front wall stomach and anterior abdominal wall). The distal part of CHEG 2 (the “basket” of the ChEG “Entristar” or the “fungus” of the CHEG “Dobhoff”) is pressed from the inside to the front wall of the stomach. The appropriate location of the tube 3, depending on the thickness of the abdominal wall, is determined with the help of marks placed on the tube 3, the tube 3 is fixed on the outside with a clamping silicone disk, CHEG 2 is cut with scissors to the required length. A double port with caps (not shown in FIG.) Is connected to the CHEG 2, the caps are closed. The disk is pressed against the anterior abdominal wall for 3-5 days for adequate healing of tissues around the gastronomic tube, then the fixation of the disk is somewhat weakened in order to prevent the development of pressure sores. Within one day after the operation, antibiotic therapy is carried out.

On the same day, the percutaneous transhepatic biliary drainage 1 of the bile ducts is connected with the CHEG 2 using the tube 3, while it contains an elastomeric pump 4, which includes a valve 5 to fill the elastomeric pump 4, which allows the bile to be evacuated in one direction into the digestive tract, clamp 6, filter 7, bile flow limiter 8. After filling the pump 4 with bile, the inner elastic membrane of the elastomeric pump 4 is reduced, the necessary amount of bile is evenly allocated to the digestive tract.

The proposed utility model in comparison with the prototype and other well-known technical solutions has the following advantages:

- automatic feeding of bile into the digestive tract

- compactness and usability of the device;

- low invasiveness;

- elimination of biliary tract infection;

- reduction of hospitalization;

- quick recovery of disability;

- reduction in the frequency of complications.

Claims (1)

A device for automatically returning bile to the digestive tract in patients with obstructive jaundice, containing biliary drainage installed under ultrasound control, a clamp, percutaneous gastrostomy, installed endoscopically, and connected in series with each other using a tube, characterized in that it is additionally equipped with an elastomeric pump, a filter and a bile flow rate limiter, while the elastomeric pump is installed in front of the biliary drainage and consists of an elastic membrane located inside its It was designed to fill the pump, allowing bile to be evacuated in one direction, and made with the possibility of introducing the necessary volume of bile by uniform expulsion by reducing the internal elastic membrane, and the filter and bile flow rate limiter were installed sequentially in front of the gastrostomy.

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