RU2444274C1 - Method of determining localisation of bronchus which ventilates part of lung parenchima bearing broncho-pleural fistula - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to thoracic surgery, phthisiology and pulmonology. Localisation of bronchus, which ventilates part of lung parenchyma bearing broncho-pleural fistula, is determined. By means of air blower, connected to manometer, positive pressure of air is created only in examined lobar or segmental bronchus below installed Levin's valve. Presence or absence of broncho-pleural fistula, its exact localisation and dimensions are determined by the character of changes of manometer readings.

EFFECT: method increases accuracy of search occlusion of broncho-pleural fistulas of lobar or segmental bronchi.

6 dwg

Description

The method for determining the localization of bronchopleural fistula belongs to the field of medicine, namely to thoracic surgery, phthisiosurgery, pulmonology.

The known method [1, 2] for determining the location of the bronchopleural fistula (Fig. 1, Fig. 3, Fig. 5), which consists in alternately searching occlusion of the lobar or segmental bronchi (14) with a Levin valve (15), dressed on the end of a fibrobronchoscope (16) , and creating a constant negative pressure in the pleural cavity (5) by sucking air out of it through a drainage tube (6), the outer end of which (13) is immersed in an antiseptic solution (11) located in Bobrov’s bank (10). The second tube is at one end in the Bobrov bank above the level of the antiseptic solution, and the other end is connected to an aspirator (7), which creates negative pressure (8) in the pleural cavity (5). The presence of a fistula is manifested by the appearance of air from the drainage tube (6) of the pleural cavity (5) in the form of bubbles (12) from its end (13), immersed in an antiseptic solution (11) in Bobrov's bank (10).

The disadvantage of this method is that when aspirating air from the pleural cavity (5), the source of which can be not only bronchopleural fistulas, but also leakage of the tube (6) in the pleural cavity, past which, at the place of its passage in the chest wall, air can enter the pleural cavity when a negative pressure is created in it, as well as in the presence of residual air in the pleural cavity with total and subtotal pneumothorax. The disadvantage of this method is that the negative pressure extends to the pleural surface and the parenchyma of the entire lung. In addition, the method is applicable only in the presence of one bronchopleural fistula, and in the presence of two or more functioning fistulas (II, III), it is impossible to localize all of them due to the fact that with multiple fistulas during obstruction of one of them, air enters the pleural cavity from other fistulas ( Fig. 1, Fig. 3, Fig. 5), and the obstructed, in this case, bronchus is regarded as a bronchus through which air is not discharged into the pleural cavity through the bronchopleural fistula of the lung parenchyma carrying it, as a result of which it is made okirovanie and obstruction of the other bronchus, and when aspirated from the pleural cavity, air begins to flow through the fistula of the first bronchus, previously unlocked.

Technical result

To overcome these shortcomings, a method is proposed which consists in increasing the accuracy of determining the localization of not only single, but also, in this case, multiple bronchopleural fistulas by creating and monitoring positive pressure in the cavity of only the lobar or segmental bronchus under study using a special device for alternating search occlusion lobar or segmental bronchi.

Based on the rate of reduction of intrabronchial pressure increased with the help of the device, one can judge the size of bronchopleural fistulas. So, when the pressure in the bronchus is created below the Levin valve (15), if it does not decrease, then this indicates the absence of a bronchopleural fistula. If the pressure cannot be created, then this indicates the presence of a large bronchopleural fistula. If the pressure decreases slowly, then this indicates a smaller bronchopleural fistula.

We examine the patient’s I, II, III and IV bronchi, two of which (II and III) carry bronchopleural fistulas. The objective of the study is to determine the bronchi bearing bronchopleural fistulas. We examine each of the bronchi in turn.

When examining the bronchus I using a pre-existing method (Figure 1), it is obstructed using the Levin valve (15), dressed on a fibrobronchoscope (16). Through the bronchi II and III, air from the respiratory tract enters the pleural cavity (5), and then through the drainage of the pleural cavity (6, 13) into the Bobrov apparatus (10) with an antiseptic solution (11) in it due to negative pressure (8 ) created in Bobrov’s apparatus (10) with an aspirator connected to it (7). Passing through an antiseptic solution (11), air forms bubbles (12), which are indicators of the absence of a fistula in the bronchus I.

When examining bronchus I using the proposed method (Figure 2), it is obstructed using the Levin valve (15), dressed on a fibrobronchoscope (16), to the instrument channel (17) of which is connected a device consisting of an air blower (3), representing a pear from a tonometer, and a manometer (1). When air is injected from the device (1, 2, 3) through the instrument channel (17), it penetrates into the bronchus under study (14), causing an increase in pressure in it due to the lack of discharge, which can be controlled by the pressure gauge (1). An increase in pressure in the bronchial system I below the Levin valve (15) indicates the absence of a bronchopleural fistula on it through which air would be discharged.

When examining bronchus II using a pre-existing method (Figure 3), the bronchus I is unlocked and the bronchus II is obturated with a Levine valve (15), dressed on a fibrobronchoscope (16). The discharge of air from the respiratory tract into the pleural cavity through the fistula of bronchus II stops, but continues through the fistula of bronchus III, causing it to enter the pleural cavity (5) and drain the pleural cavity (6, 9, 13) into the Bobrov apparatus (10) with a solution antiseptic (11) in it, causing the formation of air bubbles in the antiseptic solution (12), which is a false indicator of the tightness of the studied bronchus II.

When examining the bronchus II using the proposed method (Figure 4), the bronchus I is unlocked and the bronchus II is obstructed using the Levin valve (15), dressed on a fibrobronchoscope (16), to the instrument channel (17) of which the proposed device is connected (1, 2 , 3). When air is injected from the device (1, 2, 3) through the instrument channel (17) of the fibrobronchoscope (16) it penetrates into the bronchus under study (14), without causing an increase in pressure due to the presence of air discharge through the fistula of bronchus II, which is determined by indications pressure gauge (1). The absence of an increase in pressure in the bronchus II system indicates the presence of a bronchopleural fistula in it.

When examining bronchus III using a pre-existing method (Figure 5), the bronchus II is unlocked and the bronchus III is obturated with a Levine valve (15), dressed on a fibrobronchoscope (16). The discharge of air from the respiratory tract into the pleural cavity (5) through the fistula of bronchus III stops, but resumes through the fistula of bronchus II, causing it to enter the pleural cavity (5), and through the drainage of the pleural cavity (6, 9, 13) into Bobrov’s apparatus ( 10) with an antiseptic solution (11) in it, causing the formation of air bubbles (12) in the antiseptic solution (11), which is a false indicator of the tightness (absence of fistula) of the bronchus III under study.

When examining the bronchus III using the proposed method (Fig.6), the bronchus II is unlocked and the bronchus III is obstructed using the Levin valve (15), dressed on a fibrobronchoscope (16), to the instrument channel (17) of which the proposed device is connected (1, 2 , 3). When air is injected from the device (1, 2, 3) through the instrument channel (17) of the fibrobronchoscope (16), it penetrates into the bronchus under study (14), without causing an increase in pressure due to the presence of air discharge through the fistula of bronchus III, which is determined by indications pressure gauge (1). The absence of an increase in pressure in the bronchus III system indicates the presence of a bronchopleural fistula in it.

When examining bronchus IV using a pre-existing method, the situation will be repeated, similar to the situation when examining bronchus I (Figure 1). When examining the bronchus IV using the proposed method, the situation will be repeated, similar to the situation when examining the bronchus I (Figure 2).

Arrows (4) in the figures show the movement of air inside the apparatus (2), the bronchial tree, the studied bronchi (14), the pleural cavity (5), the drainage tube of the pleural cavity (6, 9), the tube going to the aspirator (7).

References

1. Levin A.V., Samuilenkov A.M., Zimonin P.E. Contrapulsive bronchial block in the treatment of pulmonary tuberculosis. // Materials of the VII Russian congress of TB doctors. Endoscopic and endosurgical methods of examination and treatment for tuberculosis. June 3-5, 2003, Moscow.

2. Levin A.V., Tseymakh E.A., Zimonin P.E. The use of valvular bronchial block in case of complicated pulmonary tuberculosis. A manual for doctors, second edition, supplemented. Medlung, Barnaul, 2008 .-- 24 p.

Claims (1)

A method for determining the location of a bronchopleural fistula with a fibrobronchoscope with a Levin valve, characterized in that using an air blower connected to a pressure gauge, positive air pressure is created only in the test lobar or segmental bronchus below the installed Levin valve, the absence or presence of a bronchopleural fistula is determined by the nature of the pressure gauge , its exact localization and size.

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