The way to stop internal bleeding in the chest wall

 

(57) Abstract:

The invention relates to surgery. Goal: develop long-term compression on the area of bleeding from the vessels of the abdominal and thoracic walls. The inventive tampon of absorbable hemostatic fabric pressed against the bleeding surface 1 - 3 of U-shaped stitches through all layers of the underlying wall. The ligature tied on the gauze pad from the skin sutures are removed in 5 to 7 days. Positive effects: prolonged compression hemostatic absorbable tissue using the U-shaped seams provides the final stop of bleeding.

The invention relates to medicine, namely to surgery, and can be used for bleeding arising from the walls of the thoracic and abdominal cavities after the mobilization of bodies with extensive commissural processes or removal of tumor entities.

The known method the final stop bleeding by electrocoagulation of blood vessels, isolated or together with the surrounding tissue. (K. I. Pikin. In kN. Guide surgery. M., 1962, T. 1 S. 691-702).

However, this method in capillary bleeding or bleeding from the arteries is not effective when crtam blood pressure, and a second bleed, including in the postoperative period.

The known method the final stop bleeding, including extensive commissural processes by ligation or flashing vessels together with part of the surrounding tissue after applying clamps (P. M. Khromov. Errors, hazards and complications in surgery. L., 1965, S. 73). However, this method is not effective when the bleeding is caused by many gaping vessels, for example, from the bed of the tumor in the apex of the pleural cavity, bone and vertebral sulcus, the anterior surface of the sacrum. Under these conditions, the imposition of clamps impossible due to the small length of blood vessels and bone tissue, which cannot be stitched together with the vessel and restricts the ability to work with clip.

The known method the final stop bleeding by tight tamponade bleeding wound surface of the dome of the pleura or other areas with the use of absorbable hemostatic tools: sponges, gauze (U. Frick, G. Frick. Hemostasis. In kN. General surgery. Ed. by C. Schmitt, B. Artiga, M. I. Cousin. Medicine, 1985, S. 118-119). The method is effective in capillary bleeding when even a slight compression within a few minutes is monady, and left tampons, including hemostatic fabric, do not provide the necessary compression, which leads to continued bleeding.

Also known for the way the final stop bleeding, for example, from the vascular plexus using special pelota, made in the form of perforated plates, which on one side has a pointed rod with variable cross section (Ed. St. N 1377056, class A 61 B 17/12, 1988). Pilot allows you to create long-lasting and sufficient for hemostasis compression of the bleeding surface placed under him hemostatic fabric, such as gauze. The compression ratio created by vcol pointed rod into the bone. The method selected as a prototype and quite effective provided in the area of bleeding bone tissue, in which you can enter the said rods. If bleeding from the vessels of the abdominal wall, the dome of the pleural cavity and other areas due to lack of bone sites for insertion of nails method is not effective, as the soft tissue does not hold the said rod-holders.

The aim of the invention is the creation of long-term compression on the area of bleeding and the coy absorbable tissue pressed against the bleeding surface 1-3 U-shaped seams, imposed through all layers of the underlying wall, and fasten the ends of the ligatures on the gauze pad from the skin. Stitches are removed after 5-7 days.

Comparative analysis of the proposed technical solution with the prototype shows that the inventive method differs from the known fact that the tampon of absorbable hemostatic fabric pressed against the bleeding surface 1-3 U-shaped stitches through all layers of the underlying wall and tied a ligature on the gauze pad from the skin sutures are removed after 5-7 days.

Thus, long-term compression of the inner surface bleeding chest wall or abdominal cavities using absorbable hemostatic fabric and the U-shaped stitches drawn through all layers of the underlying wall, allows the final stop of bleeding. The number of the U-shaped seams depends on the area of the open surface. The sutures removed after 5-7 days is sufficient time to implement the hemostatic effect.

In connection with the above, the claimed method meets the criteria of the invention of "novelty."

The features distinguishing the claimed technical solution to the prototype, not identified in other technical solutions in the study who's different."

The invention is as follows.

P R I m e R 1. Patient B s P. I. 49 years, East. bol. N 14988/Yu, entered the thoracic Department of RNII 19.12.90 g, diagnosed with cancer of the left lung. Radiographically at the root of the left lung is determined bumpy education with indistinct contours, merging with the shadow of the mediastinum, the holding in zone 1-3 segments. Bronchoscopically is determined by the tumor of upper lobe bronchus. Cytological opinion on the biopsy: usernotification adenocarcinoma. Clinical diagnosis: Central form of cancer of the left lung III Art.

15.01.91 performed surgery: left pulmonectomy with vnutriarterialnah processing vessels. In the process of mobilizing easy top share in the area of the third segment was intimately fused with the anterior chest wall. Acute and obtuse by the upper portion is separated from the chest wall. This dense commissure of the left on the chest wall have any bleeding, which was stopped by clamping with subsequent flashing, electrocoagulation, prolonged tamponade with manual pressure. The prevalence of tumors in the area of the root of the lung has necessitated the implementation pnev the pelvis revealed: after the cessation of pressure on the bleeding site chest wall bleeding resumes. Additional flashing tissue in the area of bleeding and coagulation effect is not given. To the open surface attached swab of hemostatic sponges and gauze. Swab stitched three U-joints with piercing all layers of the chest wall and excretion of the ends of the ligatures on the skin. After the tension of the ligature and quite tightly pressed hemostatic tampon bleeding surface of the chest wall ligatures tied to the skin through a gauze pad. The bleeding stopped. Drainage of the pleural cavity. The closure of the chest wall.

In the first and second day after surgery through the drainage was allocated respectively 300,0 200,0 and ml of bloody fluid with hemoglobin 92 and 74 g/L. This corresponds to the usual degree of hemostasis. The drainage was removed. Further postoperative period without complications. Ligatures removed by conventional techniques, stitches are removed on the 5th day after the operation. Patients received postoperative chemotherapy. Discharged 22.02.91,

P R I m m e R 2. Patient A. 17. East. disease 1428 N/R, was admitted to the Department 11.05.89 diagnosed with a tumor of the posterior mediastinum to the left. After the examination diagnosed with a neuroma of the mediastinum. 21.05.89 operation: removal of the tumor with mobile. The tumor is located in the costal-vertebral sulcus at the level of the fourth and fifth thoracic vertebrae. After dissection of the parietal pleura tumor acute and obtuse selected by the circumference. Posterior-medial surface of education has been "impacted" in the area of intercostal space at the level of the heads of the ribs and the lateral surface of the vertebral bodies. After separation of the tumor from her bed appeared intensive bleeding from the vascular plexus. Attempt alloying, flashing and coagulation of bleeding vascular bed of the tumor was not successful. Tamponade compression of the hemostatic fabrics gave a short-term effect, the attenuation of the compression led to renewed bleeding. Total blood loss during the operation was 1200 ml To finally stop the bleeding in the tumor bed is laid swab of hemostatic gauze, then flashed a wide U-shaped seam at the edges with long puncture needle to the entire thickness of the chest wall and excretion of the skin ligatures on the skin in the paravertebral area. Ligature tying its ends through the gasket tightly around her hemostatic tampon to the bed of the tumor. The bleeding stopped. Drainage of the pleural cavity. The closure of the chest wall. Signs of ongoing cravate is discharged in a satisfactory condition.

The following case history shows comparison of the effectiveness of the presented method final stop bleeding using traditional methods of hemostasis, overlay clips, flashing, coagulation and tamponade.

P R I m e R 3. B-s To s And R.; 58 years, East. B. N 10283/s, enrolled in tor. the CTD. 10.09.90 was diagnosed with a tumor in the lower lobe of the right lung. On the basis of clinical, radiological and endoscopic data were diagnosed: Central cancer proximal bronchus of the right lung, fibrosis focal tuberculosis of the upper lobe of the right lung. 26.09.90, the patient underwent surgical intervention: right pulmonectomy. During the audit found that the upper portion is sealed with, intimately fused with the parietal pleura from all sides. The lower and middle lobe also sealed, but free from adhesions. At the root of the lung is palpated lumpy tumor mass size HH see Decided to perform pneumonectomy. When it tries to allocate/share from commissure have any bleeding, which stopped the imposition of clamps and tamponade. Processed and crossed the elements of the root of the lung, which remained fixed only svarte upper lobe. Blunt and astrumporta removed. During the allocation percentage was fairly significant bleeding from vascular commissure. Particular difficulties have arisen in the area of the dome of the pleural cavity, where flashing is fraught with damage to the subclavian vessels, coagulation is not very effective, and tamponade gave only a temporary effect. However, using the whole set of well-known means, managed to achieve stop the bleeding. Blood loss during surgery was 4500 ml Pleural cavity drained, chest wall sutured. After 3 h after surgery, the rate of emission of bloody fluid from the pleural cavity increased. Conducted the whole complex hemostatic therapy. The patient was not allowed to perform rethoracotomy. A breach is detected, the blood coagulation system. Despite hemostatic and substitution therapy, the bleeding continued and 29.09.90 stated biological death. Data sections confirmed posthemorrhagic anemia. This observation was the lack of surgical hemostasis, the resumption of bleeding in the postoperative period in the face of violations of the blood coagulation system.

Technical and economic efficiency of the way the final stop bleeding alosta using absorbable hemostatic fabrics of the U-shaped seams, conducted through the thickness of the wall, provides the final stop of bleeding. The method prevents necrosis, re-bleeding, application of clips. Resorption of pressure vessels funds subsequently increases the value of the method. Application of the method is effective for bleeding disorders.

The WAY to STOP INTERNAL BLEEDING IN the CHEST WALL, including the fixation of hemostatic sponges in the area of the open surface, characterized in that, to improve the reliability of hemostasis, fixation perform end-to-end through the chest wall of the U-shaped seams, the nodes are fixed in the skin on gauze pads, and remove sutures after 5 to 7 days.

 

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