Patent RU-2430701-C2 (RU)
Inventor: KOCHENOV VLADIMIR IVANOVICH
IPC: A61B18/02
Filed: 2009-04-10
Granted: 2011-10-10
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to cryosurgery and can be applied for cryosurgical management of various cysts. Substance of the technique consists in the fact that cysts 2 mm in diameter with the contents translucent through skin or mucosa require cryocompression destruction by multiple freezing and thawing with covering a folded pathological tissue to be frozen from the outside by cryoaccumulators passively cooled in liquid nitrogen. At the stage of spontaneous thawing through a frozen tissue, a pointed cryoinstrument cooled in liquid nitrogen is used to perforate a cyst cavity to evacuated by cryocompression thawing and greater approaching of the cryoaccumulators than that one observed during previous freezing. The cysts up to 4 mm in diameter with the contents translucent through skin require cryodestruction by freezing combined with adhesion of a cryoapplicator actively supplied with liquid nitrogen until observing a freezing zone going beyond a projection of a cyst diameter by 2 mm all around that is followed by spontaneous thawing. Between the freezing procedures at the stage of thawing, a cyst is opened by dissection of the frozen tissues, evacuated laterally after compression thawing; the cavity is washed by antiseptics, that is followed by cryoinflation; cryodesctruction is completed by cryocompression freezing with covering and pressing the cyst walls together. If observing the cysts with the opaque contents being more than 4 mm in diameter, a lesion is frozen at large with a freezing zone going beyond a projection on a skin or mucosa surface by applications combined with adhesion of an active applicator, or by pulse-type cryoirrigation on a projection of the cyst centre and before complete thawing, ice-coated tissue is cut in the projection centre by a heated scalpel, or the frozen tissue is dissected by focused carbon laser emission or a radio wave scalpel penetrating inside the cyst. After thawing, the cyst contents is pressed out or removed by a surgical spoon. In the presence of inflammation and suppuration, the cyst cavity is washed by antiseptics. Then a heated rounded cryoapplicator fitting the size of the cyst cavity is inserted therein, and if the cavity is greater than the applicator, a soft ferromagnetic ointment or heat-conducting gel substance is introduced into the cyst cavity to insert the applicator therein, and a ring-shaped permanent magnet is arranged to surround a projection of cyst. It is followed by adhesion freezing to extent the freezing zone 1-2 mm beyond a capsule limits all around. After complete thawing, the capsule is re-frozen. Provided the cyst cavity exceeds the sizes of the applicator, it is moved with pressing to different cyst walls followed by re-freezing so that each segment of the cyst capsule is frozen at least twice with surrounding soft tissues at an ensured cryodestructive effect. The cysts having a thin capsule which does not show any tendency to be smoothed out, while the rounded cyst is not reshaped after being pressed from the outside, the surgery is completed at this stage; anti-inflammatory drugs are introduced in the cyst cavity to be coated with a compression band; formation of dry cryonecrosis is followed by active mechanical removal of a cryonecrotised area otherwise evaporated by the carbon laser emission, the radio wave scalpel that required another cryoexposure in a projection of remote tissue by cryoirrigation or by adhesion applications. If observing a dense cyst capsule which enables the cyst to get smoothed out after being pressed due to its elasticity, after internal cryodestruction, a heated cryoapplicator with a heated axially movable insulating element put on a cannula is inserted inside the evacuated smoothed out cyst through an incision with a tip delivered therefrom; the cryoapplicator is pressed to the capsule within a cyst bottom, then cooled, and immediately after observing adhesion accompanied by continuous cooling, the cryoapplicator and the protective element are actively removed from the cyst cavity with holding surrounding soft tissues, breaking the capsule off and turning it as a stocking, antiseptics are introduced in the incision coated by the compression band. 
     EFFECT: use of said invention allows higher efficacy of cryosurgical management of cysts, observing a differentiated approach to cryogenic management of cysts with considering volume, depth and cyst capsule density, and reducing injury rate. 
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