EA010844B1 - Device for aspiration method of detection and catheterization a mouth of large lymphatic basins - Google Patents

Abstract

The invention relates to medical apparatuses, in particular, to devices for detecting locations mouths of large lymphatic basins and catheterization the lumen thereof.The device is a structure as a system of three densely-elastic pipes combined therebetween. The outer system pipe serves as a guide for inserting the device into the lumen of the venous angle (guiding part), it moves upwards and downwards relative to the middle system pipe (starting part) and bringing into open or closed position its elastic balloon, and clockwise/counter clockwise rotation of the inner system pipe (searching part) permits to coincide the lumen of the device parietal canals for providing working position of the elastic balloons in the venous angle cavity.For detecting location of the lymphatic basins mouth it needs to set the device working position in the venous angle cavity by increasing the elastic balloon volume by introducing physiological salt solution into its hydraulic chamber through the lumen of the axial parietal canal and creating negative pressure (aspiration) in an aspiration cell of the elastic balloon through the lumen of the side parietal canal. Within the aspiration cell where a stable lymph sampling procedure is provided the lymphatic duct mouth is detected and catheterization of its lumen is performed through the side parietal canal.

Description

The invention relates to medical technology. The existing devices for collecting lymph are tubular structures (catheters) through which surgical drainage of the terminal thoracic duct is performed (2-7). However, the complexity of the topographic-anatomical relationship of the thoracic duct with neurovascular formations and organs located in the left supraclavicular region, as well as the variability of the shape and position of the arc of the thoracic duct and the large individual variability of the place where the end section (the mouth of the duct) enters the venous angle makes it difficult to isolate and catheterization (8-12).

Known probe (1) to collect lymph from the left venous angle with preservation of blood flow through the main veins of the neck, which contains an outer tube in the form of a tee with inflatable balloons at the ends of this tee and an inner tube connected to the edges of the hole in the wall of the outer tube.

The disadvantages of this device.

1. The invasiveness of surgical manipulation during the introduction of the probe into the lumen of the venous angle at which the walls of the veins and its endothelium are inevitably damaged, leading to thrombosis.

2. Constructive feature of the probe, which does not allow separate lymph collection (separate from venous blood).

Given that the external jugular vein falls into the venous angle in the immediate vicinity of the confluence of large lymphatic reservoirs, it can serve as a natural anatomical reference point for accurate detection of the mouth of these lymphatic reservoirs.

The purpose of the invention is the provision of a non-operational procedure to search for the mouths of large lymphatic collectors in the venous angle and catheterization of their lumen through the external jugular vein for long and separate lymph intake. This goal is achieved by using a device of special design (Fig. 1), which is made in the form of a system of three densely elastic tubes combined with each other. The outer tube of the system serves as a conductor for inserting the device into the lumen of the venous angle (the conductor part of the device is 1A) and consists of a capsule (1) and brackets (2). The middle tube of the system is the starting part of the device - 1B and consists of a stopper (3), external wall holes (5, 6), which communicate with an elastic cylinder of variable capacity (7). The limiter of the starting part of the device is marked with a digital scale from 0 to 8 (4). The inner tube of the system is used to search for the location of the mouth of the lymphatic collectors (the search part of the device is 1B) and consists of the search disk (8) and the inner wall openings (10, 11). Disk search part of the device has two indicative marks - "0" and "A" (9).

In general, the design of the system is made in such a way (Fig. 1G) that the conductor part of the device (1A) shifts up or down and brings the elastic cylinder of the starting part of the device (1B) to the open or closed position, and the search clockwise or counterclockwise rotation parts of the device (1B) allows you to combine its inner wall holes with the outer wall holes of the starting part of the device. Thus, the operating position of the starting part of the device is established by opening the elastic cylinder of variable capacity (Fig. 2), which consists of a hydraulic chamber (12) and aspiration cells (13). Aspiration cells have a cone-shaped contour and are separated from each other by thin partitions - septa (14). The hydraulic chamber is isolated from the aspiration cells and the communication with the cavity of the indicated working parts of the elastic cylinder is provided through the near-wall openings of the search and starting parts of the device. By rotating the disk (8) of the search part of the device, we combine its inner axial wall opening (11) with the outer axial wall opening (6) of the starting part of the device and saline into the hydraulic chamber of the elastic cylinder (Fig. 2A) through the axial wall channel (15). Upon further rotation of the disk of the search part of the device, the axial wall duct (15) overlaps and its inner side wall opening (10) coincides with one of the external side wall holes (5) of the device’s starting part and a message with the aspiration channel is provided through the side wall channel (16). cell elastic cylinder, in which the procedure of lymph intake and the procedure of catheterization (17) of the lumen of the detected lymphatic collector (Fig. 2B).

The device works as follows: in the left or right supraclavicular region, a soft tissue is cut by a longitudinal incision 3–5 cm long that forms the superficial skin-muscular layer (skin, subcutaneous tissue, subcutaneous muscle — P1a1u8ta, and superficial fascia of the neck), and within the scapula -clavicular triangle (1pdopit otos1au1siagae) exposes the external jugular vein. The above-described device is inserted into the lumen of the external jugular vein, which is then advanced to the level of the subclavian vein (Fig. 3). The working position of the device in the lumen of the subclavian vein is established by opening the elastic cylinder of variable capacity. To do this, the elastic cylinder (7) of the starting part of the device is extended from the capsule (1) of the conductor part of the device, then the axial wall channel (15) is opened by rotating the disk (8) of the search part of the device, saline is introduced into the hydraulic chamber (12) of the elastic balloon. The lumen of the axial near-wall channel will be opened when the mark “0” on the disk of the search part of the device coincides with the mark “0” on the limiter of the start part of the device. After the introduction of saline in the hydraulic

- 1 010844 chamber of an elastic balloon; it acquires the discoid shape of a curved configuration, which corresponds to the configuration of the internal semicircle of the subclavian vein. In this case, the hydraulic chamber of an elastic balloon will face the lumen of the vein and will not impede free blood flow in the venous angle, and the aspiration cells (13) will closely adhere to the endothelium of the vein at the locations of the mouth of lymphatic collectors. To detect the location of the mouth of the lymphatic collectors in one or another aspiration cell, further rotation of the disk of the search part of the device is performed, which will open the side wall channel, the lumen of which communicates with the desired cell. The lumen of the side wall channel will be opened when the mark “A” on the disk of the search part of the device is combined with the mark either “1”, or “2”, or “3”, or “4”, or “5”, or “6”, or "7", or "8" on the limiter starting part of the device. The numbers indicate the number of the aspiration cell of the bladder, with which the side wall channel communicates. The procedure of lymph intake is performed by creating a negative pressure (artificial aspiration) in the intended aspiration cell of an elastic balloon through the lumen of the search part of the device and through the lumen of the side wall channel. Catheterization of the lymphatic duct (17) is also performed through the lumen of the search part of the device and through the lateral parietal channel in the aspiration cell, within which the mouth of the duct is detected and a stable procedure of lymph intake is provided. After the above-described manipulations are completed, saline is discharged from the hydraulic chamber of the elastic balloon through the lumen of the search part of the device, which allows reducing the volume of the elastic balloon to the initial level and removing the device from the lumen of the external jugular vein. The proposed device has a multipurpose purpose, which allows to increase the completeness and accuracy of detection of the mouth of all lymphatic collectors flowing into the venous angle, and allows simultaneously with the artificial lymph intake procedure (aspiration) to catheterize the lumen of the detected lymphatic duct without disturbing its anatomical integrity and without disturbing the blood flow vein.

Sources of information taken into account in the examination.

1. USSR author's certificate No. 797698, class 61 M 25/00, 1981.

2. USSR author's certificate No. 839502, class 61 B 17/00, 1981.

3. USSR author's certificate No. 923225, class 61 В 17/00, 1982.

4. USSR author's certificate No. 939012, class 61 M 1/03, 1982.

5. USSR author's certificate No. 992031, cl. A61B 17/00, 1983.

6. Patent of the Russian Federation KI 2062122, 1996.

7. Japanese Patent No. 1099443, cl. A61M 25/02, 1998.

8. Zhdanov D.A. Surgical anatomy of the thoracic duct and main lymphatic collectors and trunk nodes. - Gorky, 1945.

9. Lopukhin Yu.M. et al. Hemosorption. - M .: "Medicine", 1978, p. 65-128.

10. Malkosyan V.A. et al. Drainage of the thoracic lymphatic duct in surgical practice. - M .: "Medicine", 1979, p. 40-60.

11. Patient M.D. et al. The method of drainage of the thoracic lymphatic duct. - M .: "Surgery", 1977, No. 3, p. 63-67.

12. Yarema I.V. Lymphogenous treatment in surgery. - In Sat. scientific Proceedings of "Clinical Medicine", 1986, p. 38-41.

Claims (2)

CLAIM 1. A device for the aspiration method of detecting and catheterizing the mouth of large lymphatic collectors is a system of three closely aligned elastic tubes, the outer tube of which is longitudinally displaced relative to the middle tube of the system and brings its elastic balloon into open or closed position, and the circular rotation of the inner tube relative to the middle tube of the system brings into the open and closed position the wall channels of the device through which the lumen is regulated the working parts (hydraulic chamber, suction cells) of an elastic balloon. 2. The use of the device according to claim 1 for the detection and catheterization of the mouth of large lymphatic collectors is made through the lumen of the external jugular vein.