A method of treatment of peritonitis

 

(57) Abstract:

The invention relates to medicine, in particular to surgery, and can be used in the treatment of acute surgical diseases of abdominal cavity. Resetinput greater omentum. Cut the round and falciform ligament of the liver. In sloping areas of the abdomen establish irrigators along the right side of the channel and pelvis to the right, the root of the mesentery of the small intestine, along the left side of the channel in the subphrenic space. Served on irrigators pulsating jet of antiseptics in mixtures with air. Aspiritual content through the median drainage. The median drainage feature along the anterior abdominal wall on top of the intestinal loops. After the intervention creates a gas bubble between the abdominal cavity and the abdominal wall. For drainage use sodium hypochlorite solution. Washing is carried out every 5-6 hours Method can improve therapeutic effect of the treatment of peritonitis. 2 C.p. f-crystals, 2 Il.

The present invention relates to medicine and can be used in surgery in the treatment of acute surgical diseases of the abdominal cavity.

Acute widespread purulent peritonitis is one who replaced attention due to insufficient efficiency of antibacterial therapy, high mortality, a significant cost of treatment of peritonitis. Proposed to use different ways to treat peritonitis, however, they are not without disadvantages, often quite traumatic and insufficiently radical. One of the most important and problematic components of the complex treatment of peritonitis is the question of adequate surgical correction, and more specifically the issue of adequate intra - and postoperative rehabilitation of the abdominal cavity. All other components of therapy, as in General in purulent surgery, are important, but more effective in the treatment of this disease, and therefore the urgency of solving the issue of postoperative correction is of the greatest interest to improve therapeutic effect.

There is a method of re-laparotomy (programmed a relaparotomy).

The essence of this method lies in the re-laparotomy after 24-48 h, which make the removal of the exudate, separation of loose adhesions, the elimination of the emerging intra-abdominal abscesses, abdominal lavage antiseptics. Cyberne K. A., Angelich, A., Luke, N. A. The first Moscow international Congress of surgeons. Moscow 1995. - S. 45th cavity leads to the progression of the process.

2. The invasiveness of the method.

3. The high complexity and high cost.

There is also known a method of the "open abdomen" (laparostomy, peritoneoscopy).

The method consists in the abandonment of laparotomic wound after surgery unembroidered. On top of the abdominal cavity stack gauze wipes, perforated plastic film, plastic mesh, etc., Thus, the abdominal cavity drain through laparotomic wound, which is sutured after inflammation (Anisimov A. Y., Chuprin Century, Fradicin centuries of the First Moscow international Congress of surgeons. Moscow, 1995. - S. 48-49).

The disadvantages of this method:

1. The peritoneal cavity is drained by only a limited area of the open wound area, is the adhesion of the anterior abdominal wall with the abdominal cavity, which leads to the formation of adhesions.

2. The method does not exclude the accession of exogenous nosocomial infections.

3. The method does not exclude the possibility of the formation of intra-abdominal abscesses.

4. Some authors believe that the method promotes the formation of intestinal fistula.

For the prototype we made ed. St. USSR N 1601810, class A 61 M 7/00 "the Way prophylactic lavage of the abdominal cavity in the risk zones. To this end, the suturing of the abdominal cavity in the end of the operation through a separate puncture the abdominal wall into the abdominal cavity injected 3 drainage. The first of them feature in the subphrenic area to the right, the second in the subphrenic area on the left, the third in dupacova space. For implementing the method using dual drainage from medical PVC, while the inner tube connected to a source of constant negative pressure mode of 0.2-0.4 kgf/cm2. Aspiration begin immediately after installation of the drainage in the abdomen. Washing continued for 6-9 days prior to the termination of contamination of the abdominal cavity Escherichia coli.

The method has the following disadvantages:

1. When the delimitation in the processes of adhesion) drainage tubes expose through them is not an adequate amount of fluid that can cause delay and strenuous hydropericardium.

2. In connection with adhesive processes in the abdominal cavity does not wash with antiseptic of all intra-abdominal formations, the fluid is on the "line of least resistance".

3. The method can contribute to the insolvency of intestinal anastomoses, and also cause Ronnie peritonitis.

Tasks:

- elimination of inadequate exposee quantity of fluid and consequently the emergence of a busy hydropericardium;

- removing the possibility of the formation of intra-abdominal abscesses and adhesions;

- eliminating the risk of insolvency of anastomoses and disorders of protein metabolism;

- reduction in bed days at 25-30%.

The essence of the method is that irrigators when sanitizing the abdominal cavity installed in the area of the right and left side channels of the pelvis, subphrenic space, along the root of the mesentery of the small intestine and serves pulsating jet of antiseptics in a mixture with air, mainly sodium hypochlorite solution, through the median drainage along the anterior abdominal wall on top of the intestinal loops and after surgical intervention creates a gas bubble between the abdominal cavity and the abdominal wall. Washing is carried out every 5-6 hours to complete relief of the inflammatory process.

The method is as follows.

After the elimination of the source of peritonitis exudate removal and fibrinous layers lavage of the abdominal cavity unprintable image create a single subphrenic space and exclude the involvement of the omentum in saicooperation (in the formation of separated cavities).

Then through contraditory into the abdominal cavity injected 4 perforated irrigator and install them along the right side of the channel to the pelvis (1) Fig. 1 along the left side of the channel in the subphrenic space (2), along the root of the mesentery of the small intestine, above and below (3, 4).

Through contraportada impose thick perforated drainage pipe and stack it along the mid laparotomic wound (5).

Through irrigators served pulsating jet of a mixture of antiseptic solution with air, forming an air bubble between the anterior abdominal wall and the abdominal organs (6). Fig. 2.

Through the median drainage (5) actively aspiration with a weak vacuum. The procedure is repeated after 5-6 h to obtain (every time) visually clean washing solution, in the intervals between sessions maintain pneumoperitoneum. After each procedure the residual leaching solution is released through the irrigators 1, 2, 3, 4. As the leaching solution is proposed to use a solution of sodium hypochlorite.

This method was tested on a flow corpses of laboratory animals, and then applied in the clinic for 23 patients with widespread purulent parity gangrenous-perforating appendicitis, diffuse fibrinous-purulent peritonitis". Operation Laparotomy, appendectomy, abdominal drainage".

With this purpose, resection of omentum and dissection of the round and falciform ligament of the liver, that is, a unified subphrenic space, excluding the involvement of the omentum in saicooperation. Through contraportada in the abdominal cavity was entered irrigators: along the right side of the channel to the pelvis, along the left side of the channel in the subphrenic space, along the root of the mesentery of the small intestine, above and below her. Then through contraportada entered the drain pipe and laid along the middle laparotomic wound.

Through irrigators submitted in the form of a pulsating jet of the sodium hypochlorite solution with air. Between the anterior abdominal wall and the abdominal organs of the created air bubble. Aspiration was continued through the median drainage, repeating the procedure for 5-6 hours Washing was stopped when receiving the pure liquid. Between the cleaning procedures supported pneumoperitoneum, and residual leaching solution produced through irrigators.

Sanitation of the abdominal cavity was performed within two days. Then kanapienyte when you use reduces the incidence of fatal cases by 25-30%. Reduces the possibility of complications such as residual abscesses of the abdominal cavity and the progression of peritonitis. This method often allows to refuse from such a time-consuming and care for the patient method as programming relaparotomy and reduce the associated material costs, and reduce the overall duration of the washing cycle, compared with the prototype 3-4 times. (6-9 up to 2 days).

1. A method of treatment of peritonitis, including the drainage of the abdominal cavity, characterized in that after resection of the greater omentum and dissection of the round and falciform ligament of the liver in sloping areas of the abdomen to drain the abdominal cavity set irrigators along the right side of the channel and pelvis to the right, the root of the mesentery of the small intestine, along the left side of the channel in the subphrenic space and serves them pulsating jet of antiseptic mixed with air, and suction is performed via median drainage, located along the anterior abdominal wall on top of the intestinal loops and after surgery between the abdominal cavity and the abdominal wall, stitched tightly, create a gas bubble.

2. The method according to p. 1, characterized in that the Dre is carried out every 5 - 6 h, to the relief of the inflammatory process.

 

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