RU2605645C1 - Method of ultrasonic ballonography and device for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to surgery and is intended for ballonography. Group of inventions is presented by method and device. Probe is introduced patient on empty stomach into stomach with inflatable balloon at working end. Probe is connected with T-like three-way tap by means of Luer-lock connector with three Luer-lock connectors, in one of which Janet syringe is fixed. Balloon is inflated by introduction of water with volume of 50 ml via Janet syringe. Drawing of balloon is performed under control of ultrasonic examination of stomach. At transition of balloon into thorax hiatal hernia is diagnosed.

EFFECT: group of inventions enables determining dimensions of true expansion of oesophageal opening in real time without exposure to ionizing radiation and use of radiopaque contrast agents, as well as provides possibility of multiple examination in short period of time, procedure can be performed as in designated ultrasonic examination cabinets, as at patient's bed due to use of Luer-lock connector and inflation of balloon by introduction of water.

2 cl, 1 dwg, 1 ex

Description

The group of inventions relates to medicine, namely to surgery, and is intended to determine the diameter of the esophageal opening of the diaphragm and the choice of tactics for managing patients.

With hernias of the esophageal opening of the diaphragm, there are several methods of surgical treatment, and when choosing what is necessary, an important aspect is the degree of expansion of the esophagus.

The prototype of the method of ultrasonic balloonography is a method of traction X-ray balloonography [Copyright certificate No. 1739864, 1992], which consists in the introduction into the stomach of a probe equipped with a radiopaque olive and an inflatable balloon at the end. When the olive reaches the stomach with a Janet syringe, 50 ml of liquid contrast medium is introduced into the can, which allows you to clearly limit the contours of the swollen can from the gas bubble of the stomach. A clamp is applied to the end of the probe and the inflated balloon is pulled out under the control of a dynamometer with a force of 1 kg. With a hernia, when the esophagus is widened, a 50 ml can freely passes through the chest, dragging the bottom of the stomach contoured by barium.

The main disadvantages of this method are the presence of ionizing radiation and the use of contrast agents. This limits the use of this method in dynamic follow-up and postoperative monitoring. At the stage of diagnosis, as well as in the pre- and postoperative periods, the need arises for repeated x-ray balloons, which increases the radiation dose. In addition, the static image, insufficient visualization of the x-ray image, as well as the impossibility of carrying out this method at the patient’s bed or on the operating table due to the danger of radiation to others and medical personnel are disadvantages of the method. In addition, not all medical institutions have portable x-ray machines.

The objective of the invention is the development of safe and mobile diagnostics of the expansion of the esophageal opening of the diaphragm.

The technical result when using the invention is the conduct of research in real time, the possibility of multiple studies in a short period of time, the procedure is performed both in specially designated ultrasound rooms and at the patient’s bed, radiation reduction.

The proposed method of ultrasonic balloonography is as follows. An empty stomach probe is inserted into the stomach with a probe 90 cm long, 6 mm in diameter, which is made of soft transparent siliconized polyvinyl chloride and is equipped with a balloon at the working end. The inflated balloon is made of latex 15 mm long, with the help of a luer-lock connector connected to a 3-way 2 × 2 cm T-shaped faucet having three luer-lock connectors, in one of which a Janet syringe is fixed. After inflating the can, with the help of a three-way T-shaped tap, the return flow of water into the syringe is terminated. Under the control of an ultrasound examination of the stomach, the can is pulled using a dynamometer with a force of 1 kg. Normally, the size of the esophageal opening is 2-3 cm, which impedes the advancement of the probe, however, with the expansion of the esophageal opening of the diaphragm, the free passage of the inflated balloon into the chest is determined. When the can is transferred to the chest, a hernia of the esophageal opening of the diaphragm is diagnosed.

Thus, the proposed method of ultrasonic ballonography has several advantages over traction X-ray ballonography, namely: the absence of negative effects of ionizing radiation, the absence of the need for using radiopaque substances, the study in real time, the possibility of repeatedly carrying out this technique in a short period of time, performing the procedure as in specially designated ultrasound rooms, and at the patient's bedside.

The prototype of the device for ultrasonic balloonography is a device for traction x-ray balloonography [Copyright certificate No. 1739864, 1992], containing a probe inserted into the stomach, equipped with a radiopaque olive and an inflatable balloon at the end. When the olive reaches the stomach with a Janet syringe, 50 ml of liquid contrast medium is introduced into the can, which allows you to clearly limit the contours of the swollen can from the gas bubble of the stomach. A clamp is applied to the end of the probe and the inflated balloon is pulled out under the control of a dynamometer with a force of 1 kg. With a hernia, when the esophagus is widened, a 50 ml can freely passes through the chest, dragging the bottom of the stomach contoured by barium.

The main disadvantages are the use of relatively rough and large in diameter gastric tubes, insufficiently tight connection of the working end of the tube and the balloon to be inflated, as well as weak contact between the balloon and the Janet syringe.

The objective of the invention is the development of safe and mobile diagnostics of the expansion of the esophageal opening of the diaphragm.

The technical result when using the invention is to increase safety and reduce pain when introducing a probe during the study, conducting the study in real time, the possibility of multiple studies in a short period of time, performing the procedure both in specially designated ultrasound rooms and at the patient’s bed.

The invention is illustrated by the figure, which shows a General view of the proposed device Assembly.

The proposed device for conducting ultrasonic balloonography contains a probe 1 with a length of 90 cm, which is made of soft transparent silicone-coated polyvinyl chloride, 6 mm in diameter, equipped with an inflatable balloon 2 made of latex, 15 mm long at the working end, the probe is connected using a Luer lock 3 connector with a three-way T-shaped faucet 4, 2 × 2 cm in size, with three Luer lock connectors, one of which contains a 50 ml polytropylene Jane 5 syringe for inflating the can with water (figure).

The proposed method of ultrasonic balloonography and a device for its implementation were used in a clinic in 17 patients with a hiatal hernia. No complications associated with the use of the method have been identified.

Clinical example. Patient D., 42 years old, was re-admitted with complaints of constant painful heartburn, belching, difficulty swallowing, severe epigastric pain, especially intensifying after eating and in a horizontal position.

Fibroesophagogastroscopy was prevented by severe gagging of the patient. A chest x-ray was performed, the data of which did not allow to accurately judge the pathology of the cardia due to the vagueness of the contours of the diaphragm. Due to the risk of patient exposure, instead of X-ray ballonography, ultrasound balloonography was undertaken according to the developed technique. A patient in a position of sitting through the mouth into the stomach probe is introduced. When the balloon probe reaches the stomach, 50 ml of water is injected with a Janet syringe, thereby inflating the balloon inside the stomach. Pulling the inflated balloon to the cardiac section of the stomach, under the control of ultrasound, visualize the balloon on the monitor. Next, we determine the dimensions at which the balloon passes through the esophageal opening of the diaphragm, which correspond to its expansion. The expansion of the esophageal opening of the diaphragm to 5 cm was diagnosed. The patient underwent the procedure well, without any undesirable side effects. Based on the obtained data, a planned operation was performed for a hiatal hernia. The Nissen fundoplication was carried out. In the early postoperative period, complications were not observed, the course was smooth, without features. The patient was discharged on the 8th day in satisfactory condition. Examined after 3 months - no complaints, working in the specialty, with the control of ultrasound balloonography, the size of the esophageal opening of the diaphragm is within normal limits.

Claims (2)

1. The method of balloonography, including the introduction into the stomach cavity of a probe with an inflatable balloon at the working end of the probe, inflating the balloon by introducing a 50 ml liquid with a Janet syringe, stretching the swollen balloon and, when the balloon is transferred to the chest, diagnosing a hernia of the esophageal opening of the diaphragm, characterized in that the probe using the luer-lock connector is connected to a three-way T-shaped faucet having three luer-lock connectors, in one of which a Janet syringe is fixed, water is introduced as a liquid, and an extract The spray can is carried out under ultrasonic control. 2. Ballonography device comprising a probe with a balloon to be inflated at the working end, a Janet syringe, characterized in that the probe is connected to a three-way T-shaped faucet with a Luer lock connector having three Luer Lock connectors, one of which is fixed Syringe Janet.

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