Device for the treatment of immature fistulas

 

(57) Abstract:

The invention relates to medicine, namely to surgery, and can be used for the treatment of immature gastrointestinal and pancreatobiliary fistula. The device comprises a three-layer composite pad, the outer layer of which is provided with insulating material, the average polymer, inner - biologically active and embedded drainage with flask-shaped extension on the end and two antiIsraeli tubes of smaller diameter, running parallel to the drain and resulting in a flask-shaped extension of the latter. Through them to the area of the fistula receives a jet of air, oppositely directed to the direction of suction created by the vacuum suction, which changes the magnitude of the discharging p on this site and eliminates the adhesion of the tissues in the area of the fistula to the main drainage and the inner surface of the tampon. The technical result of the invention is to provide opportunities to adequately drain the wound or cavity with fistula, to localize the products selection of the fistula at the place of their formation, to avoid traumas to the swab, tissue, organ, carrying the fistula, the fistula. 2 Il.

The invention relates and pancreatobiliary fistula.

In as similar a device for the treatment of immature intestinal fistula (B. A. Vizin and centuries Atamanov. Treatment of patients with immature intestinal fistula. Surgery, 1984, No. 7, S. 129-133).

The disadvantages of this device are: lack of drainage and adsorption qualities, the impossibility of containment, collection and accounting of the number of fistulous discharge, trauma to the fistula, and carrying his body leakage fistulous content on the skin and maceration.

In as similar a device for the treatment of immature intestinal fistula (C. F. Sharapov, E. P. Krivosheev. Obturation and local dialysis when immature fistula of intestine. Clinical surgery, 1985, No. 2, S. 52).

The disadvantages of this device are: the technical complexity of its design, the absence of adsorption properties, the inability to fully contain and collect fistulous discharge of his or her education, trauma to the fistula, and carrying his body.

The closest to the technical nature of the present device is a device used in the method of treatment of immature fistulas Century A. Soloviev (C. A. Soloviev. How licenseto with the claimed device, which are expressed in the following:

a) the device used in surgery for the treatment of immature fistulas;

b) the device provides for the use of polymer material in plugging his part;

C) the device includes the implementation of drainage plugging in part;

g) the device provides for the drainage connection to a vacuum suction with a degree of vacuum of 0.1-0.5 kg/cm and active aspiration fistulous discharge;

d) the device allows for the collection fistulous detachable and fully quantified.

However, the known device does not eliminate the phenomenon of suction of the tissue of the fistula and body, his bearing, which helps not only trauma, but also a pronounced disturbance of the drainage function.

The task of the invention to develop a device for the treatment of immature fistulas, providing localization and quantitative consideration of fistulous discharge, collection and destruction of its vacuum, with the exception of traumatic body fistula, the fistula.

The solution of this problem allows to create favorable conditions for the localization and quantitative accounting fistulous discharge, collection and removal is of three-layer combo tampon presents an outer insulation, the average polymer and the inner - biologically - active (febrina sponge, placenta and other) layers. In the tampon embedded drainage, which in the end led to suishu, colbourne expanded the borders of the implementation has no lateral perforations. The drainage throughout in parallel planes fixed two anteretrestigewa tube of smaller diameter, ending in his flask-shaped extension. Through them to the area of the fistula coming from the air stream, oppositely directed to the direction of suction created by the vacuum suction, which changes the magnitude of the discharging p on this site and eliminates the adhesion of the tissues in the area of the fistula to the drainage and the inner surface of the tampon. Thus, the exhaustion value R is determined by the known formula:

p=W2/(K2S2)

where W is the volume of pumped air;

K - coefficient of the form;

S - the area of active flow sections.

The proposed design of the device shown in Fig. 1 and 2. In Fig.1 shows a General view of the device of Fig.2 is a cross section of the device.

Legend: 1 - insulating layer of the tampon 2 polymer layer of the tampon, 3 - biologic drainage, connected to the vacuum suction.

The device has the form of a three-layer combo tampon. The outer layer of which is made of insulating material 1, the average of the polymer 2, the interior of the biologically-active 3. In the tampon embedded drainage 4 with flask-shaped extension at the end of 5 and two fixed thereto antiIsraeli tubes 6. The opposite end of the drainage outside of the tampon, is connected to the vacuum suction 7.

Example No. 1. Patient P., aged 35., N I. B. 829, hospitalized in the 2nd surgical Department of the Northern city clinical hospital, Kirov 03.06.92,

From the anamnesis it is established that 03.05.92, he entered the Department of the hospital of the Gorky railway, Kirov with a diagnosis of blunt abdominal trauma with rupture of the duodenum, the body of the pancreas, spleen, bryzek jejunum with necrosis of part of intestine and large intestine without necrosis, shock III degree. On the same day performed surgery: laparotomy, splenectomy, suturing gap duodenum, pancreas, mesentery of the colon, resection of the jejunum with the formation of a gastrojejunostomy side-to-side on Ru, sanitation and drainage of the abdominal cavity.

In the postoperative period is the attack in the Northern city clinical hospital of the patient's condition is severe, dinamiche. The skin and sclera with a yellowish shade, reduced tissue turgor. Pulse 96 beats per minute, BP 130/80 mm RT. Art. In the lungs breathing hard. The abdomen is soft, painless bowel movements are heard. In the lower corner of the surgical wound has a defect HH cm, which is released through the bile and intestinal detachable with fecal odor, skin maseribane.

In order preoperative wound delivered drain-foam vacuum pad, started intensive infusion-transfusion therapy. After a 24-hour preparation of the patient's condition has improved, leakage of the contents of the fistula in addition to the swab is not checked, the phenomenon of maceration cropped. The total number of discharge obtained by active aspiration, amounted to 900 ml.

04.06.92, re-operation: relaparotomy, resection of the transverse colon with the formation of both ends of transversales, resection of the retroperitoneal portion of the duodenum with fistula, duodenojejunostomy by Robinson with enteroanastomosis, cholecystostomy, drainage of the abdominal cavity.

The postoperative course was hard. During the 6 day was on a ventilator. Conducted intensive antibacterial, desi is from 4 to 10 days was conducted artificial enteral tube feeding with the transition from the 11th day to the oral ingestion of food. The drains are removed after 10-12 days, cholecystostomy - 14 days. Wound healing by secondary intention. Recovery from discharge to outpatient treatment at 21 days after surgery. Colostomy function well.

Example No. 2. Patient P., 68., N I. B. 1361, received 05.12.90, at 17.30 with suspected acute mesenteric thrombosis. During medical diagnostic procedures, the patient developed clinical signs of peritonitis.

06.12.90, 9.30 taken for the operation. Examination: abdominal purulent effusion in the amount of 400 ml, extensive necrosis of the small intestine, the pulsation of the mesenteric vessels is not defined. Diagnosed with thrombosis of the superior mesenteric artery with necrosis of the small intestine, diffuse purulent-fibrinous peritonitis. Case recognized as radically inoperable. Complete sanitation and drainage of the abdominal cavity.

Postoperative clinic peritonitis remained, but the General condition of the patient deteriorated, and therefore he 08.12.90 was again taken to surgery for revision of the abdominal cavity and the decision of a question on the possibility of resection of the small intestine.

Operations: the small intestine up to 1.8 meters from the ligament of Tratta regular color with single strands of fibrin, further chiccago angle viable, there is necrosis of the right half of the gland.

Performed Subtotal resection of the small intestine with anastomosis " end to end ", resection of omentum, sanitation and drainage of the abdominal cavity.

The postoperative course was hard. On day 7 occurred eventrate, on the 11th failure of the joints enteroanastomosis.

Examination: in the area of the middle third postoperative wound cavity HH cm, containing intestinal discharge, at the bottom are loops of small intestine with fibrin. Diagnosed failure of seams inter-intestinal anastomosis on the site 0.5 cm in length. In the wound delivered drain - foam vacuum pad.

In the 1st day evacuated 1000 ml of intestinal contents. Aspiration adequate leaking outside swab no. In the next 7 days the amount of seep gradually decreased to 500 ml swab works well. Aspiration continue. On the 8th day evacuated 250 ml. three weeks from the beginning of the aspiration, the patient's condition improved significantly, the number of evacuees intestinal discharge does not exceed 200 ml per day. The wound was cleansed, ran juicy granulations.

17.01.91, in order to reduce the wound cavity and locano put new drain-foam vacuum pad smaller aspiration continue. Over the next 3 days quantity detachable decreased to 100 ml of the patient's Condition was satisfactory, extended motor mode.

Aspiration was performed within 7 days, the amount of discharge from the fistula decreased to 40-50 ml, and then stopped altogether. The tampon is removed, the fistula is completely closed. 08.02.91, after complete wound healing by second intention the patient was discharged in satisfactory condition home.

This device has been tested in the clinic in 15 patients with immature fistula and showed good results.

The device has a fairly simple design, has the following advantages over known devices and can be recommended in surgical practice.

Device for the treatment of immature fistulas, including plugging of polymeric material and embedded in her drain connected to the vacuum suction with a degree of vacuum of 0.1 - 0.5 kg/cm2, characterized in that the polymer plugging portion is placed between the insulation and biologically active materials, resulting in a tampon gets combined three-layered character, and introduced orationi holes, the drainage throughout in parallel planes fixed two antiIsraeli tube of smaller diameter, ending in his flask-shaped extension, through them, to the area of the fistula coming from the air stream, oppositely directed to the direction of suction created by the vacuum suction, which changes the magnitude of the discharging p and eliminates the adhesion of the tissues in the area of the fistula to the drainage and the inner surface of the tampon.

 

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