The way postoperative laparoscopic sanation of abdominal cavity in diffuse purulent peritonitis

 

(57) Abstract:

The invention relates to medicine, namely to endosurgery, and can be used in the treatment of spilled purulent peritonitis. Exercise pneumoperitoneum. Enter through the abdominal wall of a laparoscopic cannula. Advanced through the abdominal wall injected four cannula. Two cannula set diametrically in the iliac regions, and two similarly podrebarac. The cannula is fixed ligatures. Ligatures are conducted through the heel support, the thickness of the anterior abdominal wall and the flange of the clamping cylinder and output. Carry out the lifting of the anterior abdominal wall by means of ligatures. Conduct overview laparoscopy and subsequent laparoscopic correction of the condition of the abdominal cavity. Possible lifting of the anterior abdominal wall ligatures all tubes simultaneously or sequentially. The method provides a comprehensive adequate laparoscopic sanation of abdominal cavity. 2 C.p. f-crystals, 2 Il.

The invention relates to medicine, namely to endosurgery, and can be used in the diagnosis and treatment of inflammatory diseases of organs of abdominal cavity, mainly in the treatment of spilled purulent cutting the abdominal cavity to the point of Tracing paper to the left of the navel device for sanation of abdominal cavity, the imposition of the pneumoperitoneum, the inspection and subsequent washing of the abdominal cavity after a certain period of time. (Ed. mon. USSR N 1544442, IPC A 61 M 27/00, publ. 1990).

The disadvantage of this method is that there is only one channel for the implementation of rehabilitation measures, the inability prepositional inspection of the abdominal cavity, making timely diagnosis of emerging intra-abdominal complications, and no possibility of correction of the position of the drains in any part of the abdominal cavity and the need to create a busy peritoneum in terms of respiratory failure.

Closest to the present invention is a method of postoperative laparoscopic sanation of abdominal cavity in diffuse purulent peritonitis, including the imposition of pneumoperitoneum, the introduction through the abdominal wall laparoscopic cannula, the review of laparoscopy and subsequent laparoscopic correction of the condition of the abdominal cavity (the Manual for doctors. Software laparoscopic sanation of abdominal cavity in the complex therapy of diffuse purulent peritonitis. Ed. MONICA, M., 1998, pp. 9-11).

The disadvantage of this method are the need for how to install, it is impossible to make a full laparoscopic correction of emerging complication from the abdominal cavity through the cannula.

The problem posed by the authors, is to eliminate these drawbacks by providing selective refurbishment of various departments of the abdominal cavity with accumulation of purulent exudate, and selective masking standing drainage in any specific period of time and laparoscopic correction of complications arising from the abdominal cavity in the early stages.

For this purpose, the method of laparoscopic sanation of abdominal cavity in diffuse purulent peritonitis, including the imposition of pneumoperitoneum, the introduction through the abdominal wall laparoscopic cannula, the review of laparoscopy and subsequent laparoscopic correction of the condition of the abdominal cavity, the proposed advanced through the abdominal wall to enter at least four drainage cannula, and two cannula set diametrically in the iliac regions, two similarly - podrebarac, one cannula in the paraumbilical region, with the distal ends of the cannula to lock the suture on the anterior abdominal wall with the conclusion of Latur.

In addition, the proposed lifting of the anterior abdominal wall to make ligatures all tubes simultaneously or sequentially.

What in the abdominal region set in this way, at least five of the cannula, allows you to completely eliminate the subjective factor when making tactical decisions in treatment, provides the full exercise of adequate laparoscopic sanation of abdominal cavity, significantly reduces adhesive processes in the abdominal cavity, resulting in prolonged hospital standing drains. The method allows for dynamic morphological and microbiological diagnosis stage of the inflammatory process.

In Fig. 1 shows a diagram of the installation of the needle on the anterior abdominal wall, Fig. 2 - scheme of fixing the cannula to the anterior abdominal wall.

The method is as follows.

At diagnosis of peritonitis produce laparotomy, eliminate the source of peritonitis, produce putting the intubation. Surgical intervention to complete vivarium in podrebarac and iliac regions on opposite sides of at least four drainage tubes 1 and paraumbilical area - Lau anterior abdominal wall 5, then through the flange of the clamping cylinder 6. Ligatures 3 fasten the flange of the clamping cylinder 6, leaving long ends of the threads of 10-15 cm for subsequent lifting.

In the postoperative period after 6 to 12 hours in the intensive care unit there is a necessity for the inspection of the abdominal cavity. Using previously left ligatures perform sequential or simultaneous lifting of the anterior abdominal wall with subsequent laparoscopic examination installed through the cannula using a flexible fiberoptic endoscope. Depending on the received visual picture or perform reorganization of the identified clusters effusion, or the installation of drainage, produce microbiological diagnosis stage and extent of inflammatory changes in the abdominal cavity. Install needle in specified areas of the abdomen allows you to get a visual verification of all departments of the abdominal cavity, which, in turn, allows you to fully and adequately perform remediation activities. After 12 hours or more in situations of substantial accumulation of purulent exudate perform a complete laparoscopic reorganization in operating conditions. Pneumoperitoneum is carried out at reduced pressure in brunocoppolani and microbiological criteria healing sessions rehabilitation cease, the cannula is easily removed after cutting ligatures. Skin defects within 2 to 3 days to heal by second intention.

Example.

Patient P. , 52, (ist. bol. N 2700, 1999). He admitted with a diagnosis of ligature abscess postoperative scar of the anterior abdominal wall. One month prior to admission operated on for perforated ulcer. It was performed by suturing the perforation 12 duodenal ulcer, the imposition of a gastrojejunostomy with Brown sostem about stenosis 12-pertnoy intestine. On the third day from the time of admission the patient developed clinical picture of peritonitis. When the survey was revealed free gas under the diaphragm, the patient urgently operated on the operation revealed a perforating ulcer of the gastrojejunostomy. Performed by suturing the perforation, sanation of abdominal cavity, shivanie needle by the given method. Abdominal drainage the drainage carried out through all of the drainage cannula. After 11 hours after surgery in the intensive care unit after numbing omnomnom 1.0 ml intramuscularly through a laparoscopic cannula review laparoscopy using fiberoptic optics, thus there is an accumulation of turbid serous effusion in the right lateral channel and the cavity: after giving anesthesia was carried out by lifting the laparoscopic cannula, through it introduced the laparoscope. Drains were removed through a drainage cannula after the facelift introduced manipulators. Performed the sampling swab for microbiological testing, biopsies of peritoneal exudate removed using a suction apparatus. The abdominal cavity is washed with an aqueous solution of chlorhexidine, drained. Through the drainage cannula under the control of the laparoscope re-installed drainage from the lateral channels and the pelvis. After another 12 hours after detection of re-accumulation of exudate in the abdominal cavity above manipulations were repeated.

After another 12 hours diagnosed the lack of accumulation of peritoneal exudate and other pathological changes of the organs of the abdominal cavity, which was the indication for termination of further bailouts. Next, after cutting ligatures drainage and laparoscopic cannulas were removed. Wound channels healed by second intention on the 3rd day. On day 7 after the operation the patient was discharged in satisfactory condition.

The proposed method allows to reduce the time of stay of the patient in the hospital, excludes re-laparotomy if necessary, repeated readjustments of the abdominal cavity. Reduced risk of complications, vision purulent peritonitis, including the imposition of pneumoperitoneum, the introduction through the abdominal wall laparoscopic cannula, the review of laparoscopy and subsequent laparoscopic correction of the condition of the abdominal cavity, characterized in that it further through the abdominal wall is administered at least four of the cannula, and the two of them set diametrically in the iliac regions, two similarly in podrebarac, while the cannula is fixed ligatures holding the ligature through the heel support, the thickness of the anterior abdominal wall and the flange of the clamping cylinder and the output out, and sanitation of the abdominal cavity is carried out after the lifting of the anterior abdominal wall by means of ligatures.

2. The method according to p. 1, characterized in that the lifting of the anterior abdominal wall is performed by ligatures of all tubes at the same time.

3. The method according to p. 1, characterized in that the lifting of the anterior abdominal wall is performed by ligatures of all tubes in series.

 

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FIELD: medicine, pulmonology.

SUBSTANCE: one should perform lovage in three stages:during the 1st stage one should carry out lovage of tracheoalveolar tree for 3-4 min with 60-80 ml 0.08%-sodium hypochlorite solution, at the 2nd stage one should introduce 5-7 ml 10%-fluimucyl solution into tracheobronchial tree for 4-6 min, and at the 3d stage one should perform lovage of tracheobronchial tree for 3-4 min with 60-80 ml 0.11%-sodium hypochlorite solution. The present innovation favors secreta release of decreased viscosity into large bronchi that simplifies its evacuation and this, in its turn, simplifies the access of antiphlogistic and antibacterial preparations towards tracheobronchial tree's mucosa that leads to interrupting inflammatory process in more shortened terms.

EFFECT: more prolonged period of remission.

2 ex

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