Method for control of bleedings accompanying perforating wound of liver

FIELD: medicine.

SUBSTANCE: wound canal is packed with a preparation of recovered oxygenated cellulose. Thereafter in an entrance wound, the preparation is exposed to 2 cycles of cryotherapy with liquid nitrogen at a temperature of minus 196°C for 1-2 minutes until an ice crust is formed on the wound surface.

EFFECT: method provides excluding the possibility of bleeding and bile flowing from an inner surface of stab wounds, reducing a risk of recurrent bleedings, formation of liver haematomas postoperatively.

3 dwg, 2 tbl, 2 ex

 

The invention relates to medicine, namely to abdominal surgery, and can be used to stop bleeding when a through stab wounds of the liver.

At the present time to stop bleeding in injuries of the liver using suturing the tissue in various modifications.

One way of achieving hemostasis is the body wrapping compression mesh from strands of catgut [S. R. Sabirov Organ principles of hemostasis in injuries of parenchymal organs (liver, spleen and kidneys). // Author. Diss. doctor. honey. of Sciences, Moscow, 2006. - 34 p.]. The described method does not lead to hematoma formation, but in the tissues develops adhesions in the area of the implanted mesh, this method is not widely used in the clinic due to technical difficulties arising from the anatomical features of the human liver and its massiveness.

Many researchers noted a high hemostatic effect of ultrasonic (harmonic) scalpel [Biryukov Yu. V liver Injury / Y. V. Biryukov, O. V. Volkov, S. Roy // Surgery. - 1997. - No. 2. - Pp. 24-27; Sun, D. Development and application of ultrasonic surgical instruments / D. Sun, Z. Y. Zhou, Y. H. Liu // Trans. Biomed. Eng. - 1997. - Vol. 44. - Pt. 6. - P. 462-467]. The disadvantages of this device is not effective hemostasis the coagulation of vessels of over 1 mm in diameter and the high cost of this device�VA [K. V. Lapkin Feedback on the use of radiosurgical device "SURGITRON" in surgery of abdominal organs / K. V. Lapkin // Actual problems of surgical Hepatology. - M - 2000. - P. 54].

Famous drug tachocomb. It is made from the collagen of tendons of the horse, lyophilized human fibrinogen, porcine fibrin, animal Aprotinin. Components of this drug of animal origin and can cause allergic reactions to the introduction of a foreign protein. The physical properties of this drug does not allow you to apply it to the wound channels, it sticks to hands and tools, require special storage conditions (2-8°C), has no bactericidal effect and the high cost of the drug [Khorobrykh T. V. Treatment of traumatic injuries of the liver with the use of analogue fibrin glue: dis. ...candidate. honey. Sciences: 14.01.17 / T. V. Khorobrykh. - M., 1995. - 168 s.; Kram, N. B. Use of fibrin glue in hepatic trauma / H. B. Kram, Reuben B., A. W. Fleming, W. C. Shoemaker // J. Trauma. - 1988. - Vol. 28. - Pt. 8. - P. 1195-1201].

Known way to stop the bleeding with a sponge containing collagen and drug substance (Patent RF №2122867 from running from 10.12.1998). These components are evenly applied on the entire area of the wound surface. This method is chosen as a prototype. The proposed method is only applicable in capillary bleeding, and when applying the sponge to the surface of the wound occur �nutricentre hematoma, liver abscesses and ongoing bleeding, which causes the need for re-operations.

The present invention is to eliminate the possibility of bleeding and seletected from the inner surface of the stab wounds and reduce the risk of recurrent bleeding and the formation of a Central hematoma of the liver after surgery.

The technical result is simple and lies in the combined effect on the inner surface of the stab and incised wounds with liquid nitrogen at minus 196°C and stopped using the drug recovered from oxygenizing cellulose, and the effectiveness of the freezing of the drug is controlled by the appearance of ice on the wound site.

The technical result of the proposed method is achieved by tamponade of the wound surface of stab and incised wounds and cooling plugging of the drug with liquid nitrogen to minus 196°C. the Technical result is achieved in that according to the invention the wound channel tamponiruut drug recovered from oxygenizing pulp, then in the input hole of the wound channel on the drug spend 2 cycles of cryotherapy with liquid nitrogen at minus 196°C for 1-2 minutes until formation of an ice crust on the surface of the wound.

The proposed method is carried out� as follows: the wound channel tamponiruut drug recovered from oxygenizing pulp. The drug effect within 1-2 minutes with liquid nitrogen at minus 196°C. is Carried out 2 cycles of cryotherapy, and the effectiveness of the freezing of the drug is controlled by the formation of ice on the wound surface.

The described method is illustrated graphic material. Figure 1 depicts a bleeding stab wound of the liver (1). Figure 2 - plugging the wound channel from a recovered drug oxygennitrogen pulp (2). Figure 3 - the effects of liquid nitrogen on the surface with a DAB of the drug at the inlet exit wounds of the liver (3).

Examples of the practical use of

Example 1

An experimental study on dogs. The day before surgery, the animal number 3 stopped feeding is not restricted to the consumption of water. For the purpose of relieving tension, aggression and to reduce salivation, 30 minutes before the start of anesthesia premedication was administered (intramuscularly introduced diphenhydramine 1%, droperidol 0.25% and rometer 2% and subcutaneous platifillina tartrate 0.2%) and dosing per 1 kg of body weight. After sedation was carried out by fractional anesthesia is the introduction of a 5% solution of thiopental sodium at a dose of 7 mg/kg intravenously at the rate of animal weight. The weight of the animal was 9 kg. In the period between the fractional anesthesia the animal shaved off the hair on the anterior abdominal wall. Dogs� in the supine position was fixed to the operating table. The operation field was treated with a solution of itaperuna and alcohol. Further laparotomy was performed. The operation field was overlaid with sterile towels. In the center of the left medial lobe of the liver with a sharp scalpel was applied through stab wound 2 cm and with diastasis of the wound edges of 0.3-0.4 cm From the wound surface was observed constant bleeding. In the wound channel was introduced captured with tweezers separate layers restored oxygennitrogen cellulose, the bleeding stopped after 45 seconds. After tamponade of the wound channel drug recovered from oxygenizing cellulose on the drug worked for 2 minutes in liquid nitrogen at minus 196°C. was Performed twice cryosurgery. The efficiency of a freezing of the drug is controlled by the formation of ice on the wound surface. After thawing bleeding from the wound was observed. Following the audit the abdominal cavity was sutured in layers. The animal was removed from the experiment for 14 days. At the time of observation of clinical signs of re-bleeding is not noted. At the autopsy of the animal revealed unexpressed adhesions at the wound of the liver, signs of hemorrhage were not observed.

Example 2

An experimental study on dogs. The day before surgery animal No. 8 removed the food, but have limited� in the receiving water. 30 minutes before the start of anesthesia prescribed premedication (intramuscularly introduced diphenhydramine 1%, droperidol 0.25% and rometer 2% and subcutaneous platifillina tartrate 0.2%) and dosing per 1 kg of body weight. The dog's weight is 12 kg. Anesthesia was carried out by fractional introduction of a 5% solution of thiopental sodium at a dose of 10 mg/kg intravenously. After sedation and the period between the introduction of fractional anesthesia it's not your fault the animal. Lying on the back of the animal was fixed to the operating table. Treated surgical field with an antiseptic, performed a laparotomy. The area of application of the wound was covered with sterile Drapes. Further modeling was performed through stab-incised wounds of the liver. In the center of the left medial lobe of the liver with a sharp scalpel was applied through stab wound 2 cm and with diastasis of the wound edges of 0.3-0.4 cm From the wound surface was observed constant bleeding. The wound channel tamponirovanie individual layers restored oxygennitrogen cellulose, hemostasis observed in 55 seconds. After tamponade of the wound channel drug recovered from oxygenizing cellulose on the drug worked for 2 minutes in liquid nitrogen at minus 196°C. was Performed twice cryosurgery. The efficiency of a freezing of the drug is controlled by the formation of ice on the wound surface. �after thawing bleeding from the wound was absent. Following the audit the abdominal cavity of the latter was sutured in layers. Animal No. 8 was removed from the experiment on day 7. During observation of the dog were not observed signs of re-bleeding and peritonitis. At autopsy of a corpse of an animal in the wounds of the liver was visualized unexpressed adhesions, bleeding is not noted.

These examples illustrate the possibility of applying the proposed method to stop bleeding at through stab wounds of the liver.

Experimental study was conducted on 21 animal. As experimental animals, we have selected mongrel dogs of both sexes weighing from 6 to 25 kg. the Experiment was performed at the animal clinic at the Federal state institution "Russian scientific center "Restorative traumatology and orthopedics named after academician G. A. Ilizarov of Russia, the city of Barrow. Description of possible complications during experiments on laboratory animals are presented in table 1. Table 2 provides the timing stop bleeding after applying the proposed method and the prototype 5 examples of experimental studies.

The proposed method allows to reduce the number and frequency of occurrence of postoperative complications, save the budget by reducing the time of hospitalization and lack of cost �and repeated surgical intervention. The simplicity and effectiveness of the proposed method in the experimental model allows to test this method on people.

Table 1
Possible complications when using the proposed method
ComplicationThe complication rate in % (n=21)
Ruptures of the liver parenchyma during the plugging of the wound channel0±4,3
Re-bleeding4,8±4,7
Peritonitis0±4,3
Adhesions9,5±6,4
Mortality0±4,3

Example 1
Table 2
The timing of bleeding when using the proposed method and the prototype (in seconds)
Time stop bleeding, sec (prototype)Time stop bleeding, sec (proposed method)
86±2145±12
Example 275±1555±7
Example 3180±3265±8
Example 456±748±11
Example 5180±3255±7
M±MA total of 115.4±2153,6±9

The way to stop bleeding through the wounds of the liver characterized in that the wound channel tamponiruut drug recovered from oxygenizing pulp, then in the input hole of the wound channel on the drug spend 2 cycles of cryotherapy with liquid nitrogen at minus 196°C for 1-2 minutes until formation of an ice crust on the wound surface.



 

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