RU2737913C1 - Biopsy instrument from tubular organs - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to a biopsy instrument from tubular organs. Biopsy instrument from tubular organs comprises a tubular body with a lateral opening. Cutting tool is installed inside the tubular housing with possibility of axial movement. Tubular housing is made of three parts, two of which are made of flexible material, and located between them cylindrical metal part with side hole per 1/3 of its perimeter and length equal to length of cutting tool. Cutting tool is installed on metal tube fixed inside distal part of cutting tool, made in form of hollow cutting cylinder with sealed distal end and skew proximal cutting part, and on the distal portion of the tube located in the cavity of the cutting tool, there is a side opening. On the metal tube there is a negative pressure generating unit.

EFFECT: use of the invention provides the safest and most effective biopsy.

1 cl, 2 dwg

Description

The proposed instrument for biopsy from tubular organs relates to medicine, namely to surgery, and can be used for biopsy inside the tubular structures of the body (intra- and extrahepatic bile ducts, urinary tract, etc.), obliterated due to any formation ...

The causes of occlusion inside the tubular structures of the body can be:

1) benign: a) lithiasis (stones in the ducts); b) postoperative strictures,

2) malignant, a) primary tumor of tubular structures (hepatic ducts, ureters, etc.) b) primary tumor of the parenchymal organ, c) primary tumors of a certain area of the body (hepatobiliary, paranephral, etc.) d) metastatic processes ...

Known tool for biopsy from tubular organs, containing an outer hollow needle with an oblique cut at the working end and an inner hollow needle with a handle, and the cutting edge of the inner hollow needle is made in the form of a spiral, on the outer surface of this needle a groove is made in which a flat springy knife is installed ... (SU No. 848016 according to class A61B 17/34, 1981)

The disadvantages of the known device are:

the complexity of its manufacture,

This instrument is a rigid structure, due to which the possibility of injury to the patient is increased by cutting off pieces of tissue.

Known device for puncture biopsy, containing a rod with a pointed distal end, coaxially placed in a tubular body (patent RU No. 2348362 2348362 according to class A61B 10/02, 2009).

The disadvantage of the known device is the limited amount of collection of biopsy material and the limitation in the localization of the biopsy area, which leads to a decrease in the diagnostic value of the method.

The closest to the claimed technical solution is a tool for biopsy from tubular organs, including a tubular side hole, installed inside it with the possibility of axial movement of the cutting tool. (see RU 93252 according to class А61В 10/00, 2009)

The disadvantages of the known tool are its rigid construction;

its use can lead to damage to nearby organs and tissues;

provokes an increase in the number of complications due to the lack of flexibility in the design of the instrument;

this tool does not allow to take material from certain places of the organ.

The technical result solved by the present invention is the creation of a biopsy instrument from tubular organs of a flexible design, which allows biopsy to be carried out in the safest and most efficient manner.

The technical result in the proposed invention is achieved by creating a tool for biopsy from tubular organs, including a tubular body with a side hole, mounted inside it with the possibility of axial movement of a cutting tool, characterized in that the tubular body is made of three parts, two of which are made of flexible material, and a cylindrical metal part located between them with a side hole at 1/3 of its perimeter and a length equal to the length of the cutting tool, and the cutting tool is mounted on a metal tube fixed inside the distal part of the cutting tool, made in the form of a hollow cutting cylinder with a sealed distal end and an obliquely located proximal cutting part, and on the distal section of the tube located in the cavity of the cutting tool, a lateral opening is made, while a block for generating negative pressure is placed on the metal tube.

The use of a flexible instrument for biopsy from tubular organs for the collection of histological material from the tubular structures of the body significantly increases the percentage of pathology verification that causes complete or partial obturation of the tubular structures in a patient, and can significantly reduce the number of complications after diagnostic manipulation.

The supply of a metal tube with a block for creating a negative pressure ensures the creation of a vacuum inside the lumen of a cylindrical metal part with a side hole, as a result of which, under the action of a vacuum, a necessary and sufficient amount of tissue of the examined organ is drawn into the cavity of the middle part of the tubular body, which increases the amount of biopsy material collection.

The flexibility of the device and the ease of its movement make it possible to take biopsy material from several zones of the structure, i.e. multiple times.

The essence of the invention is the following description and graphic material, where

FIG. 1 shows a schematic diagram of a tubular biopsy instrument;

FIG. 2 shows a fragment of the proposed tool.

The instrument for biopsy from tubular organs contains a tubular body made of three parts, two 1 and 2 of which are made of flexible material and a cylindrical metal part 3 located between them with a side hole 4 by 1/3 of its perimeter and a length equal to the length of the cutting tool.

The cutting tool is installed inside the tubular body with the possibility of axial movement.

The cutting tool is mounted on a metal tube 5, fixed inside the distal part 6 of the cutting tool, made in the form of a hollow cutting cylinder 7 with a sealed distal end and an oblique proximal cutting part 8, and on the distal section of the tube 5 located in the cavity of the cylinder 7 there is a side opening 9, while at the proximal end of the metal tube 5 is placed a unit 10 for creating negative pressure, for example, in the form of a syringe.

The work of the proposed instrument for biopsy from tubular organs is carried out on the example of a biopsy from the fusion area of the lobar bile ducts in Klatskin's tumor.

After the elimination of obstructive jaundice with the help of transhepatic drainage of the bile ducts, the external-internal bile drainage on the conductor is replaced with a tubular instrument body with a bougie-filler located inside its lumen (not shown in the devil).

The latter closes the side opening 4 of the central part of the tubular body from the inside, preventing tissue from entering it during the replacement of instruments.

The lateral opening 4 of the central part 3 of the tubular body is positioned in the area of the intended sampling of the biopsy material.

A cutting tool fixed on a metal tube 5 is introduced into the lumen of the tubular body, and the hollow cutting cylinder 7 should take a position distal to the opening 4 of the central part 3 of the tubular body.

Next, negative pressure is created in the lumen of the cutting knife through the negative pressure generating unit 10 located on the proximal part of the metal tube 5.

The entire structure is displaced inward by 2-3 mm with a translational movement to make an incision of the biopsy tissues with an obliquely located proximal cutting part 8 of the lateral opening 4 of the central part 3 of the tubular body.

Then the cutting cylinder is progressively moved outward by pulling the proximal end of the metal tube 5 and removed from the tubular body outward.

For better extraction of the obtained biopsy material from the lumen of the cutting cylinder 7, its lumen is flushed with saline through the unit 10 for creating negative pressure.

Example:

Patient A., 65 years old, 02/05/2020, was subjected to bilateral (separately through the right and left lobar bile ducts) transhepatic drainage of the bile ducts.

Moreover, an external “picktail” drainage 9F was installed in the left lobar bile duct. And in the right lobar bile duct externally internal bile drainage 9F is introduced, the tip of which is installed in the common bile duct distal to the occlusion of the area of confluence of the lobar bile ducts.

After the elimination of jaundice on February 19, 2020, the right, external-internal bile drainage along the conductor was replaced by a tubular body with a bougie-filler located inside its lumen.

The lateral opening 4 of the central part 3 of the tubular body is positioned in the area of the intended sampling of the biopsy material. The filler bougie and guide are removed.

A cutting cylinder is inserted along the lumen of the tubular body. It is entirely positioned distal to the side opening 4 of the central part 3 of the tubular body.

With the help of the block 10 for creating negative pressure, located on the proximal part of the thin metal tube, a vacuum is created in the lumen of the cutting cylinder 7.

The entire structure is shifted inward by 2-3 mm in a translational motion to make an incision of the biopsy tissues with the proximal sharp edge of the window of the central part of the tubular body.

The cutting cylinder is pulled out of the lumen of the tubular body by translational movement towards itself. A column of tissues was obtained, sufficient not only for histological examination, but also for performing immunohistochemical studies.

A flexible conductor with a bougie-filler is introduced into the lumen of the tubular body. On the guidewire, the biopsy instrument was replaced with an external internal bile drainage.

Claims (1)

A tool for biopsy from tubular organs, including a tubular body with a side hole, a cutting tool installed inside it with the possibility of axial movement, characterized in that the tubular body is made of three parts, two of which are made of flexible material, and a cylindrical metal part located between them with a side hole at 1/3 of its perimeter and a length equal to the length of the cutting tool, and the cutting tool is mounted on a metal tube fixed inside the distal part of the cutting tool, made in the form of a hollow cutting cylinder with a sealed distal end and obliquely located proximal cutting part, and a lateral opening is made on the distal part of the tube located in the cavity of the cutting tool, while a block for generating negative pressure is placed on the metal tube.

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