RU105571U1 - ANOSCOPE - Google Patents

Abstract

 1. Anoscope formed by a retractor made in the form of a hollow body of revolution with a blind distal rounded end and an open proximal end provided with a conical extension, with the possibility of using an optical system, characterized in that it further comprises a channel for installing an ultrasonic Doppler probe, made in the form U-shaped profile and positioned on the inner wall of the hollow body of rotation along the axis of the rectifier, and the handle bonded to the outer surface of the conical expansion proximal Foot end of the retractor, the rotation of the hollow body wall at the distal end of retractor rounded perforated first and second holes spaced one another by an angle of 90 to 270 ° in a plane perpendicular to the longitudinal axis of the retractor. ! 2. Anoscope according to claim 1, characterized in that the end of the channel for installing an ultrasonic Doppler probe in the area of the distal end of the retractor is associated with a third hole in the wall of the hollow body of revolution. ! 3. Anoscope according to claim 1, characterized in that on the top of the blind distal rounded end, a pipe is installed on the inside of the retractor for positioning the working end of the needle holder.

Description

The utility model relates to the field of medical technology and can be used for intracavitary examination and treatment of diseases of the anal canal of hemorrhoidal origin.

In the prior art, an anoscope [1] is known, comprising a housing, a light guide and a tube. A cutout is made in the distal section of the tube, and an obturator is installed inside the tube. The obturator consists of an olive fixed on a rod with a handle. The front edge of the tube is made with a straight cut, and the cutout in the distal section of the tube has a U-shape. The shape of the proximal part of the tube has the form of a cone, at the outer edge of which the output end of the fiber is installed, while the fiber itself is fixed along the body.

The disadvantage of the considered analogue is the low level of functionality, limited only by the possibility of application for detecting a hemorrhoidal focus.

The closest in technical essence and the achieved result to the claimed device is an anoscope [2], formed by a retractor made in the form of a hollow body of revolution with a blind distal rounded end and an open proximal end. The retractor is equipped with a cone extension and is configured to use an optical system. This device is adopted as a prototype device.

The disadvantage of the prototype is the relatively low level of functionality of the device, limited only by the scope of intracavitary examination of the condition of the anal canal.

The task to which the creation of the claimed device is directed is to reduce the level of injuries and reduce the time when performing a complex of work on the treatment of hemorrhoids.

The technical result expected from the use of the claimed device is to expand its functionality.

The claimed technical result is achieved by the fact that the anoscope formed by a retractor made in the form of a hollow body of revolution with a blind distal rounded end and an open proximal end provided with a conical extension, with the possibility of using an optical system, further comprises a channel for installing an ultrasonic Doppler probe made in the form of P -shaped profile and positioned on the inner wall of the hollow body of rotation along the axis of the rectifier, and a handle fastened to the outer surface of the cone th extension proximal end of the retractor, the rotation of the hollow body wall at the distal end of retractor rounded perforated first and second holes spaced one another by an angle of 90 to 270 degrees in a plane perpendicular to the longitudinal axis of the retractor.

It is desirable that the end face of the channel for installing an ultrasonic Doppler probe in the area of the distal end of the retractor is mated to a third hole in the wall of the hollow body of revolution.

It is preferable that a nozzle for positioning the working end of the needle holder would be installed on top of a blind distal rounded end on the inside of the retractor

The claimed device is illustrated in graphic materials. Figure 1 shows the longitudinal profile of the cross section of the rectifier (scale 1: 1), and view "a" is on the left relative to the symmetrical longitudinal section of the handle, and view "b" is on the right relative to the symmetric longitudinal section of the handle; figure 2-a conventionally shows the mutual positioning of the first and second holes in a plane perpendicular to the longitudinal axis of the retractor, and figure 2-b presents a 3D image of a General view of the claimed device; figure 3 schematically shows the use of the claimed device in the case of using the first hole for injection; figure 4 schematically shows the use of the claimed device in the case of using an optical system to search for manifestations of hemorrhoids on the surface of the anal canal of the patient; figure 5 schematically shows the use of the claimed device in the case of using a Doppler sensor to detect hemorrhoidal nodes near the surface of the anal canal of the patient; 6 schematically shows the use of the claimed device in the case of using surgical instruments for suture ligation of the revealed hemorrhoid.

The list of positions:

1. Retractor.

2. Cone expansion.

3. The handle.

4. The first hole.

5. The second hole.

6. Section line.

7. The patient.

8. Arteries.

9. Hemorrhoidal node.

10. The syringe.

11. The receiver of optical information.

12. The light guide.

13. To the visualizer of optical information.

14. The source of light.

15. The power supply unit of the light source.

16. Ultrasonic Doppler probe.

17. To the device of ultrasonic dopplerography.

18. Ligature node.

19. The conditional image of the needle holder.

20. The conditional image of the clamp.

21. The plane of the cross section.

22. The separation angle of the first and second holes.

23. Branch pipe.

24. Channel.

25. The third hole.

The claimed device forms a retractor 1 (Figure 1), which has the shape of a hollow body of revolution and can be made of a transparent thermoplastic, for example polyacrylate or polycarbonate. The distal end of the retractor 1 (Figure 1) is muffled and rounded. The proximal end of said retractor 1 (Fig. 1) is open and crowned with a conical extension 2 (Fig. 1, Fig. 3-Fig. 6). With the outer surface of said conical extension 2 (FIG. 1, FIG. 3-FIG. 6), a handle 3 is fastened (FIG. 1, FIG. 3-FIG. 6). It is designed to hold the claimed anoscope, insertion - removal of it from the anal canal of the patient 7 (Fig.3-Fig.6) and rotation in the working position around the longitudinal axis of the retractor 1 (Fig.1). In addition, in the handle 3 (Figure 1) there is a round groove for installing the optical system and the illuminator. In the body of the retractor 1 (Figure 1-a), near the distal rounded end, a first hole 4 (Figure 1-a) is made, essentially rectangular in shape with rounded short sides. Typical dimensions of the sides, characterizing the dimensions of the first hole 4 (Figure 1-a) have the following meaning: length 25, 35 or 45 mm, width 5, 10 or 15 mm. The range of reduced sizes of the first hole 4 (Figure 1-a) allows you to level the known differences in the anal canal (actually the deviation in the positioning of arteries and hemorrhoidal nodes) for patients with different weight and height indicators. It should be noted that the first hole 4 (Figure 1-a) serves as a window for injection into the hemorrhoid 9 (Figure 3), in particular using a syringe 10 (Figure 3).

The second hole 5 (Fig.1-6) is spaced with respect to the first hole 4 (Fig.1-a) at an angle of 22 (Fig.2-a) from 90 to 270 degrees in a plane perpendicular to the longitudinal axis of the retractor, i.e. . the plane of its cross section 21 (Figure 2-a). The second window 5 (Fig.1-6) is used for the suture ligation procedure.

As a receiver of optical information 11 (Figure 4), a lens on a fiber or a disposable medical micro-camera (for example, a micro-camera from Medigus, Israel) can be used. As the optical fiber 12 (FIG. 4), an optical fiber, for example, a multimode MM optical cable with a core thickness of 1 × 10 ^-5 m, can be used. To receive the light, the source 14 (FIG. 4) can be an LED with a small power supply 15 (FIG. four). It is advisable for the claimed device to use an ultrasonic Doppler probe 8 MHz CW / PW connected to an ANGIODIN-procto ultrasonic analyzer as an ultrasonic Doppler device. When performing suture doping for the formation of the node 18 (Fig.6) on the affected hemorrhoidal artery 8 (Fig.6) can be used needle holder 19 (Fig.6), for example, the German brand "Dimeda" (model 24.214.26), and clamps 20 (FIG. 20), for example, VIVA Fishing Tackle 22 (China).

Example 1

Patient M., 41, was admitted with complaints of exacerbation of chronic hemorrhoids. Over the past three days, he experienced pain and mild (3-4 ml) hemorrhoidal bleeding after defecation. At the end of the third day, the pain sensations developed into painful ones (i.e., with severe pain syndrome). The body of the incoming patient 7 (Figure 3) is positioned in the knee-elbow position. The anal canal is revised by means of a digital examination of its walls and the identification of the legs of hemorrhoidal nodes (i.e., pulsating terminal branches of arteries are actually detected). According to the results of a preliminary finger examination (additionally verified by using standard visual observation tools, for example, a laparoscope) of arteries 8 (Figure 3) on the surface of the anus of the patient 7 (Figure 3), four slightly enlarged mobile internal hemorrhoidal nodes and a swollen bleeding hemorrhoid were revealed node located at 3 o’clock (on the conditional dial). Then, having previously lubricated the surface with a transparent lubricant (for example, glycerin), the claimed anoscope made of a transparent polymer is introduced into the anal canal. Using the handle 3 (FIG. 3), the retractor 1 (FIG. 3) is oriented for 3 hours so that the bleeding hemorrhoid 9 (FIG. 3) protrudes through the first hole 4 (FIG. 3). Then, by means of a syringe 10 (FIG. 3), for example, a disposable three-component KD 20 ml (manufacturer Tianjin) with a twice elongated needle, an anesthetic injection (for example, lidocaine solution) is made in the center of the first hole 4 (FIG. 3). After 3 minutes after the injection, the anoscope is removed from the anal canal of the patient's body 7 (Figure 3). Thus, a very pronounced pain syndrome in the anal canal of the patient 7 (Figure 3) is temporarily blocked. Table No. 1 presents the comparative functional characteristics of the claimed device and the prototype device, manifested by both devices in the framework of this example.

Table number 1 No. Type of test anoscope Name of functional characteristic Result one Claimed device The ability to inject when the device is in the anal canal of patients. Is available 2 Prototype device The ability to inject when the device is in the anal canal of patients. Not available

Example 2

Patient S., 31 years old, 14 days after the successful delivery of two twins, complained of not pronounced pain in the anal canal during bowel movements. The chair is normal. The body of the patient 7 (Figure 4) is positioned in the knee-elbow position. After that, having previously lubricated the surface with a transparent lubricant (for example, glycerin), the declared anoscope made (as in the previous example) from an optically transparent polymer is introduced into the anal canal of the patient 7 (Figure 4). Then, in the retractor 1 (Fig. 4), an optical information receiver 11 (Fig. 4) is placed, connected by a light guide 12 (Fig. 4) to an optical information visualizer 13 (Fig. 4). Separately, the light source 14 (FIG. 4) connected to the power supply 15 (FIG. 4) is also introduced there. Manipulating the position of the receiver of optical information 11 (Figure 4) and the light source 14 (Figure 4), the wall structure of the lower ampullar part of the rectum is revised. At 11 o’clock (according to the conditional dial) in the anal canal, a falling hemorrhoid is detected. After removing from the anal canal of patient 7 (Figure 4) an anoscope with an optical information receiver 11 (Figure 4) and a light source 14 (Figure 4), rectal suppositories with sea buckthorn oil were assigned to her and ligation of the revealed hemorrhoidal node was recommended. Table No. 2 presents the comparative functional characteristics of the claimed device and the prototype device, manifested by both devices in the framework of this example.

Table number 2 No. Type of test anoscope Name of functional characteristic Result one Claimed device The possibility of revising the arteries of the anal canal of patients using optics Is available 2 Prototype device The possibility of revising the arteries of the anal canal of patients using optics Is available

Example 3

Patient Yu. 26 years old, a professional athlete (specializing in weightlifting) turned about aperiodically felt after training noticeable pain in the anal canal during bowel movements. The chair is normal. The body of the incoming patient 7 (Figure 5) is positioned in the knee-elbow position. After that, after lubricating the surface with a transparent lubricant (for example, glycerin), the declared anoscope made of an optically transparent polymer is introduced into the anal canal of the patient 7 (Figure 5). Studies conducted using the optical devices described in example No. 2, did not allow to identify the causes of these pains. A decision is made on the use of ultrasound dopplerography of the anal canal of patient 7 (Figure 5). For this purpose, an ultrasound Doppler probe 16 (Figure 5) of an 8MHz PW / CW complex for the treatment of hemorrhoids "ANGIODIN-procto" / manufactured by ZAO NPF BIOSS, Russia / is inserted into channel 24 (Figure 2-b). The information taken from the ultrasonic Doppler probe 16 (Figure 5) due to the third hole 25 (Figure 2-b), which provides the contact of the transceiver element of the ultrasonic Doppler probe with the surface of the anal canal, is fed to the said ultrasonic Doppler ultrasound device 17 ( 5) and is being processed. The result of the treatment was the detection of hemorrhoids in patient Yu in the form of the presence of a hemorrhoidal artery in the zone for 7 hours (according to the conditional dial), which is deepened by 0.4 cm into the tissue structure of the anal canal.

After extracting the anoscope, patient 7 (Figure 5) is recommended conservative treatment and periodic examinations. Table No. 3 presents the comparative functional characteristics of the claimed device and the prototype device, manifested by both devices in the framework of this example.

Table number 3 No. Type of test anoscope Name of functional characteristic Result one Claimed device The possibility of conducting a study of the condition of the anal canal of patients using ultrasound Doppler ultrasound. Is available 2 Prototype device The possibility of conducting a study of the condition of the anal canal of patients by means of ultrasonic Doppler ultrasound imaging. Not available

Example 4

Patient K., 61 years old, was admitted with chronic (second stage) hemorrhoidal disease and indications for suture ligation of the terminal branches of the superior rectal artery, responsible for the formation of a prolapsed hemorrhoidal node, positioned for 3 hours (according to the conditional dial). For two days, the preparation of patient 7 (Fig. 6) / in particular, in the morning and evening, used cleansing enemas with V = 1 liter each /. Immediately prior to surgery, the perineal skin of patient 7 (Fig. 6) was treated with a 0.7% alcohol solution of chlorhexidine, and then turunda was inserted into its anus, which was previously wetted with 5% trimecaine on glycerol. Also, before the introduction of the claimed device into the anal canal of patient 7 (Fig. 6), a parasacral blockade was performed with 1% Marcaini solution at points at 6, 3, and 9 hours (according to the conditional dial).

Then started the operation for suture ligation of the terminal branches of the upper rectal artery of patient 7 (Figure 6). The hemorrhoidal region to be ligated by corresponding rotation of the anoscope due to the handle 3 (Fig. 6) is positioned so that the hemorrhoid is displaced into the second hole 5 (Fig. 6). Then, using an atraumatic thread (for example, Vicryl 2-0), a node 18 is formed (Fig. 6), for example, a Raeder node. When forming the said node 18 (Fig.6) use a long needle holder 19 (Fig.6) with a curved needle, which is inserted with a narrow nose into the pipe 23 (Fig.6). In the process of flashing, a set of holders 20 is also used (Fig. 6), including those designed to hold the formed filament assembly 18 (Fig. 6) during the formation of the latter, and surgical scissors (not shown) are also used to remove excess vicryl filament from the finished assembly . 18 (Fig.6). The relative position of the first 4 (Figure 3) and second 5 (Figure 6) holes in the plane of the cross section 21 (Figure 2-a) in the range of 90 to 270 angular degrees 22 (Figure 2-a) allows "instantly "To produce suture doping of more than one hemorrhoidal node, which from a formal point of view can be considered as the appearance of additional functionality (see Shelygin Yu.A. et al." Treatment of hemorrhoids with suture ligation of hemorrhoidal arteries with dopplerometry "," Topical issues of coloproctology ", 5 All-Russian Conference with Int native participation Abstracts, Rostov-on-Don, 2001, pages 83-84) of the claimed device. Table No. 4 presents the comparative functional characteristics of the claimed device and the prototype device, manifested by both devices in the framework of this example.

Table number 4 No. Type of test anoscope Name of functional characteristic Result one Claimed device The possibility of suture ligation of the terminal branches of the superior rectal artery. Is available 2 Prototype device The possibility of suture ligation of the terminal branches of the superior rectal artery. Not available

As follows from the above four examples of the use of the proposed anoscope, the technical result declared in the framework of this utility model is achieved by using the anoscope in accordance with its intended purpose (i.e., it becomes possible to expand its functionality compared to the prototype device).

In connection with the use of known materials and widely available technologies for their industrial processing in the design of the claimed device, it seems reasonable to conclude that the proposed device meets the patentability criterion of the utility model "industrial applicability".

INFORMATION SOURCES

1. Utility model of the Russian Federation No. 55265, IPC: А61В 1/31, publ. 08/10/2006

2. Utility model of the Russian Federation No. 38567, IPC: А61В 1/31, publ. July 10, 2004 (prototype).

Claims (3)

1. Anoscope formed by a retractor made in the form of a hollow body of revolution with a blind distal rounded end and an open proximal end provided with a conical extension, with the possibility of using an optical system, characterized in that it further comprises a channel for installing an ultrasonic Doppler probe, made in the form U-shaped profile and positioned on the inner wall of the hollow body of rotation along the axis of the rectifier, and the handle bonded to the outer surface of the conical expansion proximal Foot end of the retractor, the rotation of the hollow body wall at the distal end of retractor rounded perforated first and second holes spaced one another by an angle of 90 to 270 ° in a plane perpendicular to the longitudinal axis of the retractor. 2. Anoscope according to claim 1, characterized in that the end of the channel for installing an ultrasonic Doppler probe in the area of the distal end of the retractor is associated with a third hole in the wall of the hollow body of revolution. 3. Anoscope according to claim 1, characterized in that on the top of the blind distal rounded end, a pipe is installed on the inside of the retractor for positioning the working end of the needle holder.