Device (protector) for preventing, stopping and controlling hemorrhages in performing laparotomic operations

FIELD: medical engineering.

SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.

EFFECT: reliability in stopping hemorrhages and retaining patient mobility.

2 dwg

 

The invention relates to medicine, namely to prevent, stop and control diffuse bleeding during the removal of the gallbladder, removal of the hernia, removal of cysts and tumors, removal of the Appendix and other operations, which resulted in the observed diffuse bleeding tissue sections.

As an example of application of the device (protector), described the prevention and control of bleeding at the same time from two wounds from the bed of the gallbladder and liver from the stump of the cystic artery and geleistete from the stump of the cystic duct, as the most complex tasks. In order to learn about these complications and stop the bleeding, geleisteten, surgeons usually put one drainage in the subhepatic space. However, when the allocation of blood and bile drainage in large numbers, surgeons wondering where bleeding or from the gallbladder bed, or from the stump of the cystic artery. This situation stems from the fact that the foci of hemorrhage is not separated by a reliable barrier. Accurate diagnosis location (source) bleeding is the first problem. More importantly, for the fate of the patient as early as possible to know the surgeon source (location) of geleistete or from the stump of the cystic duct or the gallbladder bed. Abundant geleisteten is from the bile ducts of the bed bile pusy who I am. Accurate diagnosis location (source) geleistete is the second problem. The third issue is how to prevent and stop diffuse bleeding, geleisteten from the liver, gallbladder bed. To prevent and stop diffuse bleeding and geleistete from the liver into the region of the gallbladder bed, surgeons during laparoscopic surgery carefully treated the wound of the liver in the region of the gallbladder bed:

- coagulated special ball electrode is common in the Russian way, but it is not very reliable;

- coagulated plasma scalpel or a laser beam, it is dangerous for the patient and the surgeon's way and very expensive, there are reports of regeneration of the liver tissue in cancer after such treatment;

- coagulated ultrasonic electrode, it is an expensive way and a bad influence on the regeneration of liver tissue;

is applied to the wound of the liver "hemostatic collagen sponge and leave it in the abdominal cavity, but not all of the sponge absorbed and often suppurate, complicating the operation, and sometimes requires re-operation. But most importantly it is in most cases not stop diffuse bleeding from the wounds of the liver;

- plugging gauze napkins bleeding surface of the liver.

The way is good, but have to wait long, and surgeons in a hurry, not uderjivayut time early clean cloth, put the drain and wait for the day until the bleeding stops. The principle of modern surgery "one day Surgery" is not implemented.

The objective of the invention is to eliminate all three of the above problems, the use of the device (protector) prevent, stop, and control diffuse bleeding during laparoscopic operations. Device (protector) is: from the thread, which is placed in parallel (Figure 1), (Position 1) or circular rows and fixed between a collagen gel, or consists of a segment of knitting fabric that is easy to "dismiss" when you pull the thread. The canvas is combined with the inner surface of the film (Pos.2) collagen gel, which prevents full "blooming" of the canvas. Film your area overlaps a few inches around the perimeter size of the canvas and has a hole (Pos.4)equal to the drainage channel. On the outer surface of the film attached dual drain (3), in which one channel is short, the other long. Short drainage channel in the distal connect with a hole in the film (Pos.4) and form a hermetic fistula. Long drainage channel in the distal beyond the limit of the film by a few centimeters (Pos.5). The proximal end of the channel drain has the same length of the channels. Proximal the s ' end of the drainage carried out by the tool through the side surface of the abdominal wall to separate the connection of the two channels to the vacuum receiver (Pos.6). The thread from the cloth is conducted from the inner surface of the film, through a tight fistula in a short channel drainage, bring the thread out and fix on the wall of the short channel (Pos.7).

The operation of the device (protector). After removal of the gall bladder or other laparoscopic procedures to prevent, stop and control bleeding install the device (protector). To this end, the surgeon takes from the sterile packaging device (protector), roll the film with a cloth to drain, as a cigar, and enters into the abdominal cavity through the trocar. In the abdominal cavity, under the control of laparoscopy, the device is placed proximal end to the side surface of the abdominal wall. With a scalpel, make an incision in the side surface of the abdominal wall, puncture introducing forceps, grasp them under control laparoscopy proximal end of the drainage and take him out. The collapsed film and the painting unfold. To do this, the surgeon takes the proximal end of the dual drainage and rotate it around the axis, find the edge of the film, under the control of laparoscopy takes his clip and rotating arm drainage, deploys film and canvas, the canvas covers the wound surface of the liver. Under the control of laparoscopy, the surgeon tool spreads the film to a healthy surface of the liver around the perimeter, the film sticks to the surface the displacement of the liver, the entire wound surface and cloth, covered with foil, turn into a closed cavity. All closed cavity under film drained through a short channel. Distal drainage channel (5)extending beyond the area of the film, by instrument under the control of laparoscopy, set in the wound, where the stump of the artery and duct. To enhance the hemostatic effects of the canvas, a short tube connected to the vacuum tank (Pos.6), its suction effect presses the cloth to the wound surface. To increase the hemostatic effects and pain from the wound, tissue moistened hemostatic solution and painkillers prior to introduction into the abdominal cavity.

Device (protector) hermetically separates and divides two potential sites of bleeding and geleistete - region of the gallbladder bed and the area of the residual limb artery and duct. Separate drainage of these places, a dual drainage allows the surgeon to know the exact location of the bleeding and geleistete. The world's many years of experience in the use of drainages showed their great value, but the experience of their application requires timely removal, the sooner the better, so as not developing an infection. Clinical experience stop diffuse bleeding tamponade, after removal of tampons requires control bleeding, h what about the exercise by monitoring drainage. So removing device (protector) divided by us into three phases:

Stage I - relieve pressure on plugging the canvas, to do this disconnect the vacuum from the short channel drainage and watching the drainage. If bleeding drainage is not, carry out phase II.

Stage II - remove plugging the canvas. For this release the thread, fixed in the wall of the short channel drainage (Pos.7), and pull the thread completely take up the whole canvas, carrying out the role of the tampon. For the convenience winder thread, it is fixed on the axis of a small electric motor that runs on batteries. After removal of the plugging of the canvas, watching the drainage. If no blood, carry out phase III.

Phase III drainage removed. To easily and safely remove the device (protector), the surgeon rotates the arm drainage along the axis of the rolled film on the drain, and then remove the drainage of film. Device (protector) has a different size, shape and number of drains depending on the size and shape of the wound surface. Figure 2 - position of the device (protector) on the liver.

Device (protector) to prevent, stop and control bleeding during laparoscopic operations containing bound in cloth, thread, fabric, whereby plugging the wound and remove the thrust of the thread, is connected with the internal surface is Yu film collagen gel, the film covers the area of the canvas and has a hole equal to the dual channel drain, which is attached to the outer surface of the film and in which a single channel is longer than the other, with the distal end of the short channel is connected with a hole in the film, and the distal end of a long gated channel beyond its proximal end can be connected to the vacuum receiver and the thread from complete conducted from the inner surface in a short channel and secured to the outer wall of the short channel.



 

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