Method of hemostasis surface wounds parenchymatous organs

 

(57) Abstract:

The invention relates to medicine, namely to surgery, and can be used for hemostasis surface wounds parenchymatous organs. 3% solution of sodium tetradecyl sulfate cut away the surrounding wound tissue defect. The method allows a fast and reliable stop the bleeding. This increases the number of organ-sparing surgery.

The invention relates to medicine, more specifically to surgery, and can be used to stop bleeding from superficial wounds parenchymatous organs.

A known method of stopping bleeding from superficial wounds parenchymatous organs such as the liver, by electrocoagulation (N. Andrianov.G., Experimental study and clinical application of thermocoagulation to stop parenchymal bleeding during operations on the liver: Diss. Kida. the honey. Sciences. - M., 1974). The implementation of this method of hemostasis is accompanied by thermal necrosis of tissue, and when removing the electrode from the source of bleeding can be broken scab and renewed bleeding.

To avoid thermal necrosis of tissue, the method stops Cavotec is the property requires certain conditions: dry wound, why compress the supply vessel or parenchyma soft pulp, which in turn lengthens the time of surgery, causing ischemia of the organ, it is not possible to use this method for hemostasis during laparoscopic surgery.

The objective of the invention is to achieve fast, reliable hemostasis in surface wounds parenchymatous organs, regardless of the method of surgical intervention, increasing the number of organ-sparing surgery.

The problem is solved in that the hemostasis surface wounds parenchymatous organs carry out the injection of 3% solution of sodium tetradecyl sulfate by injections of tissue surrounding the wound defect.

Known medical use 3% solution of tetradecyl sulfate for sclerotherapy for bleeding from esophageal varices (journal Express information "Surgery", issue 1-3, Moscow, 1992, 25-28).

The method consists in the following. In patients with bleeding from superficial wounds parenchymatous organs perform infiltration of the tissues surrounding the defect by injection of 3% solution of sodium tetradecyl sulfate to stop the bleeding. The drug is administered up to 20 ml per inheirent faster and reliable hemostasis, for example, suturing wounds, if continued bleeding of sutured wounds. This method of hemostasis can be used in open (laparotomy) and "closed" (video-assisted laparascopic surgery) surgical interventions on parenchymatous organs.

A series of experiments on rats it was shown that the application of the drug 3% solution of sodium tetradecyl sulfate is ineffective hemostasis does not occur. For injectable use of 0.5%, 1% and 2% solutions of sodium tetradecyl sulfate hemostasis occurs slowly and not in all cases. The introduction of a 3% solution of sodium tetradecyl sulfate causes it to stop bleeding, and the area of necrosis around the small. The application of a 4% solution of higher concentration causes significant necrosis of the parenchyma. Drug infiltrate the tissue surrounding the defect to a depth of 5 mm With the drug at a depth of less than 5 mm occurs after the medicine into the wound, resulting in a slowing of the hemostatic effect. If you enter a drug deeper than 5 mm, to achieve hemostasis is necessary to increase the drug dose, which, in turn, can increase the area of necrosis and cause toxic effect.

The volume of ven is the second example No. 1. Patient, 50 years, received in 3 days from onset of illness with a diagnosis of acute calculous cholecystitis. The patient held conservative therapy, inflammation in the gall bladder subsided. In a delayed manner after 2 weeks she performed surgery - cholecystectomy. Removal of the gallbladder made from his neck with separate ligation of the cystic duct and cystic artery. Blunt and sharp by gall bladder removed. The liver of the gallbladder bed is marked bleeding in 3 points. Performed infiltration injection of 3% solution of sodium tetradecyl sulfate of the liver parenchyma around each source of bleeding at a depth of 5 mm up to 0.7 ml, noted a reduction in the activity of bleeding until the stop within 5-7 minutes. From electrocautery and the suturing of the gallbladder bed refused. Was trenirovki subhepatic space drainage, the wound of abdominal wall, left the house taking. After the operation in the 1st day the patient's condition corresponded to the amount of interference, the drainage discharge were noted. On day 2 performed ultrasonography (USG) of the abdomen, with free fluid in the latter is not found under the liver was Legerova narrow hypoechoic zone 6 mm, in the area of the bed sustoyanie the patient was improved. On the 3rd day he removed the safety drainage from the abdominal cavity. On the 5th day repeated abdominal ultrasound, which marked a positive trend: decreasing hypoechoic area under the liver and reduction of area hyperechoic density up to 10x10 mm Patient on the 11th day took skin seams, and on the 12th day after surgery, she was discharged in a satisfactory condition.

Clinical example # 2. Patient N., 23 years old, went through 3 hours after the household injuries with a diagnosis of concomitant injury, closed fracture of the iliac wing and the pubic bones to the left, closed fracture of the middle third of the right forearm, closed abdominal trauma, rupture of the spleen, brain concussion, bruised wound of the forehead, traumatic shock of the II degree. When entering the victim noted pain in the left abdomen, she performed an ultrasound, which revealed a heterogeneous echostructure in the field gate spleen irregular shape 40x30 mm, around the spleen - hypoechoic zone, which indicated it to break. The patient was operated on. During surgery found 300 ml of fresh blood in the abdominal cavity, when the revisions found in the visceral surface of the spleen rupture 30x5 mm, depth up to 10 mm with bleeding. The wound left od the Nike bleeding from places Ukolov needle, and one part of 10x3 mm prometaphase tissue. Performed infiltration injection of 3 ml of 3% solution of sodium tetradecyl sulfate tissue spleen, departing 5 mm from the edge of the defect. Additionally, the drug was unfilterable designated Ukolov and portassist plot, respectively, 0.5 ml. of All introduced to 5.5 ml, noted a reduction in the activity of bleeding until it stops for 7-10 minutes From the additional methods of hemostasis refused. The abdominal cavity was drained, was trenirovki left subphrenic space and the cavity of the pelvis, left the house taking the wound of the abdominal wall. After the operation in the 1st day the patient's condition corresponded to the severity of the injury and the amount of interference, the drainage from the abdominal cavity has allocated a total of 15 ml of hemorrhagic discharge. A day after the surgeries were performed abdominal ultrasound, has revealed that the contours of the spleen smooth, echostructure homogeneous, vascular drawing is saved. On the same day held a CT scan of the abdomen, which noted that the spleen is of the usual form, in its Central sections is determined by the area of low (3-6 units) density with fuzzy smooth contours, size 9,8x2,1 mm After amplification by contrast did not reveal the drains removed. After 3 days of repeated ultrasound, which noted that the echostructure of the spleen uniform, and Doppler blood vessels of the spleen showed preserved blood flow in the body. The patient gradually recovered. After 5 days under dynamic ultrasound noted that the echostructure of the spleen homogeneous, vascular pattern is not changed. On the 7th day postoperative day produced radioisotope scintigraphy spleen preparation of Tehnici-99m. On the Scintigram revealed sufficient accumulation of the radiopharmaceutical in it, the distribution was uneven with reducing its accumulation in the Central part thereof, without extravasation of the drug beyond the contours of the spleen. The patient on the 11th day the stitches were removed from the skin. On the 12th day the patient was transferred to the casualty Department to continue treatment of skeletal injuries in a satisfactory condition.

Thus, the use of the proposed method of hemostasis surface wounds parenchymatous organs will allow you to achieve fast, reliable hemostasis, regardless of the method of surgical intervention (open - laparotomy or "closed" - video-assisted laparascopic surgery), to increase the number of organ-sparing surgery.

Method of hemostasis surface wounds parenchyma is th solution of sodium tetradecyl sulfate, who administered the injection, alkalima tissue surrounding the wound defect.

 

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