Drainage device

 

(57) Abstract:

The invention relates to medicine, namely to surgery, and can be used in the treatment of widespread purulent peritonitis. The technical result is to have a reliable noninvasive and full isolation zone sutured skin sutures laparotomic wound of anterior abdominal wall from the abdominal cavity and possible aspiration drainage of tissues sutured laparotomic wound when suppuration. Drainage device consists of two single-channel tubes on the sides which made holes. One of the tubes connected to the external source of vacuum. Drainage device made in the form of two hollow plates. The top section of the plate in cross section has the shape of a "hill", the lower elongated along the major axis of the ellipse, the side edges of which are made monolithic. In the Central part of each section longitudinally placed on the tube. In the tube "printing" section posted an additional tube with a side opening at the proximal end. The distal ends of the additional tube and elliptical section is connected to the external source of vacuum. "Hummocky" surface plate holes order. 1 Il.

The invention relates to medicine, namely to surgery, and can be used in the treatment of widespread purulent peritonitis, especially complicated by abscess of the anterior abdominal wall.

It is known that one of the most effective and common treatment methods widespread purulent peritonitis is programmed method or step readjustments of the abdominal cavity, which consists in a series of repeated at regular intervals of relaparotomy (1).

Multiple repair of musculoaponeurotic layer laparotomic wound leads to its damage, fragmentation, and contact with the peritoneal exudate - to severe, mainly clostridiales anaerobic, purulent-necrotic process in the tissues of the anterior abdominal wall (CBE) - the abscess. However, the spread of purulent exudate from inflamed tissues CBE when the abscess into the free abdominal cavity capable of supporting peritonitis or cause its progression.

There are various drainage devices used for the treatment of wounds and cavities.

As well known suction drainage Redon (2). Known devices is

The disadvantage of this construction when restoring the anterior abdominal wall in patients with widespread purulent peritonitis is the inability to reliably prevent contamination and recontamination peritoneal cavity exudate from the tissue CBE and Vice versa due to the configuration and dimensions of the formed skin and visceral space. In addition, it is impossible to conduct adequate drainage of skin and visceral space in communication with the suction of the tissue to the side holes of the tube and the loss of its drainage function.

Also known is close to the technical nature of the proposed device for drainage of the abdominal cavity, containing intra-abdominal and vnebrachnyy tube connected with a fixing device. For exceptions to the suction bodies and the walls drained cavity to the abdominal tube with long-term aspiration clamp is made in the form of a hollow cylindrical body with elbows, stabilizer and tube. A latch mounted on vnebrachnoj tube (3).

The disadvantages of this device should include inability reliable and complete isolation laparotomic wound cavity from the abdominal cavity.

The closest in technical essence to the present invention is drory holes. The Central tube of smaller diameter is connected to the external source of vacuum. Between the tubes has a gap, which prevents the adhesion of the outer tube to subject the tissues (4).

The disadvantages of this device should be attributed to the impossibility of full evacuation of purulent exudate from the skin and visceral space and reliable prevention of contamination and recontamination abdominal exudate from the tissue CBE and Vice versa, due to the configuration and dimensions of the formed skin and visceral space.

The task of the invention is to develop a device to enable a reliable and noninvasive isolate the area sutured skin sutures laparotomic wound CBE from the abdominal cavity and to drain this area in patients with widespread purulent peritonitis.

The technical result of the present proposal is to prevent the spread of purulent exudate with festering tissue laparotomic wound PBS into the peritoneal cavity by eliminating contact tissue laparotomic wound CBE with purulent exudate from the abdomen and enabling suction drainage area sutured skin sutures laparotomic wound Pago of two single-channel tubes, on the lateral surfaces of which are made of holes. One of the tubes connected to the external source of vacuum.

Distinguishing features of the claimed device are that the drainage device is designed as a two-piece hollow plate, the upper section of which in cross section has the shape of a "hill", the lower elongated along the major axis of the ellipse, the side edges of the plates are made from monolithic continued edges. Inside the plate, in the Central part of each section, longitudinally placed on the tube, on the side surfaces of which the holes. In the tube "printing" section placed longitudinally and negerlein additional tube with a side opening at the proximal end. Additional tube with a pipe "ellipsoid" section of the plate is connected to the external source of vacuum. On the upper surface of the "ellipsoid" section of the plate with holes, staggered. Along the side surfaces of the "hummocky" part of the plate holes. The bottom surface of the drainage device is made whole.

Comparative analysis of the proposed solutions and prototype shows that the proposed device difference is about is a rectangular two-piece plate with rounded edges. Top "printing" section of the plate is made parallel to the bottom having a shape elongated along the major axis of the ellipse with monolithic lateral edges. "Hummocky" surface plate holes are made in a checkerboard pattern. The holes in the "hummocky" part of the plate is made along the lateral surfaces.

From the comparative analysis shows that the proposed drainage device meets the criteria of the invention of "novelty."

Drainage device comprising the invention, is intended for use in health care. The implementation of its capabilities is confirmed as described in the application techniques and equipment.

The inventive device enables the achievement of a technical result, namely preventing the spread of purulent exudate with festering tissue laparotomic wound PBS into the peritoneal cavity. The developed device allows noninvasive, reliable and efficient drainage of skin and visceral space, avoid contact tissue laparotomic wound of anterior abdominal wall along its entire length with the abdominal cavity and thereby to prevent the spread of purulent exudate from the tissue lapar, is that the claimed invention meets the condition of patentability "industrial applicability".

The implementation of the upper partition plate in the form of a "hill" matches (congruent) section of postoperative wound CBE, stitched only skin sutures and provides full (the entire surface) and atraumatic tissue contact of the wound with drainage device.

The presence in the Central part of the "printing" section of the plate located longitudinally of the tube with side holes and inside it longitudinally and negerlein placed an additional tube with a side opening in the proximal part and connected to the external source of vacuum creates the possibility of evacuation pronicheva inside through the side holes "printing" section of wound by wound CBE without the "suction" of wound tissues to the holes.

The location of the holes on the upper surface of the "ellipsoid" section of the plate in a checkerboard pattern provides uniform and complete "the suction plate to the abdominal wall, and reached its isolation from the abdominal cavity.

The lower section of the drainage plate of the device is made in the form of an extended olnine side edges of the "ellipsoid" section of the monolithic plate provides the possibility of varying the size of the drainage device, depending on the specific parameters of the wound.

The implementation of the inventive drainage device of flexible biologically inert material - silicone - allows you to minimize tissue reaction of an organism to a foreign body.

In the analysis of aspirators and known devices for dewatering identified is the lack of information about the impact of the distinctive features of the proposed drainage device to achieve a technical result that allows us to consider the claimed invention meets the criterion of "inventive step".

The essence of the inventive device is illustrated by a drawing, which shows a General view of the inventive drainage device.

Drainage device made in the form of two hollow plates, the upper section 1 which in cross section has the shape of a "hill", the lower section 2 of the plate has a shape elongated along the major axis of the ellipse with continued moulded edges 3. Longitudinally in the Central part of the upper section 1 and the lower section 2 is posted tubes 4 and 5, respectively. The distal edge of the tube 4 is open. On the lateral surfaces of the tubes 4 and 5 holes all over the partition plate (not shown). Inside the tube 4 is an additional tube 6 with the only bienia. On the lateral surfaces of the "printing" section 1 longitudinal holes 8. On the upper surface of the "ellipsoid" section 2 holes 7, staggered.

The inventive device operates as follows.

The length and width of the drainage device formed in accordance with the length of laparotomic wound and topographic-anatomical situation in the abdominal cavity. To reduce the width of the plate shears during surgery, after proper fitting, cut to the desired size of the molded edge 3 ellipsoid section 2 on both sides. To reduce the plate along the length of the scissors during the operation, after proper fitting, cut to the desired size of the proximal end of the plate perpendicular to its longitudinal axis along the width, then slightly tighten the tube 6 in the proximal direction along the longitudinal axis outward perform at its proximal end side opening and return the tube 4 is flush with the end of the tube 4. The drainage device is installed in the abdominal cavity so that the longitudinal axis of the wound CBE coincided with the longitudinal axis of the plate. The upper surface of the ellipsoid section 2 of the plate is adjacent to the parietal bruche several speaking over her musculoaponeurotic layer. Below the lower angle laparotomic wound, some distance from him 3 cm, cut into 3 cm in the transverse direction of the skin with the subcutaneous fatty tissue to the aponeurosis and make the wound channel through which outward display tube 4 tube 6 and the tube 5. After installation of the drainage device laparotomic wound completely sutured only skin sutures on the "printing" section 1, and tubes 5 and 6 connected to a source of external pressure.

When creating a negative pressure in the cavity ellipsoid section 2 of the plate is "sucked" it to the parietal peritoneum in the area laparotomic wound through holes 7, and this is achieved isolation zone laparotomic wound cavity from the abdominal cavity. Exudate with laparotomic wound CBE through holes 8 on the side surfaces of the "printing" section 1 plate penetrates section, then through the side holes of the tube 4 enters into the tube 4, where he was evacuated tube 6 connected to the vacuum source. Given that after removal of the tubes 4 and 6 to the outside of the abdomen in the supine position of the patient, wound fluid in the tubes 4 and 6 will move under the action of gravity in the front-rear direction, the accumulation of exudate will be deleted Tr is syvania" surface "printing" section 1 of the plate to the tissues laparotomic wound, thereby improving the quality of drainage. The bottom surface of the "ellipsoid" section 2 plate made of flexible, biologically inert material (e.g. silicone), is a protector for the subject of the abdominal cavity.

Each subsequent relaparotomy drainage device is removed. After cupping purulent process in the abdominal cavity and/or the wound CBE device is permanently deleted.

The efficiency of the proposed device is confirmed by a clinical example.

Clinical example.

Sick Bazeev B. C., 35, N and b. 29665 was in the Department of surgical infection OKB N 1 23.12.98, 16.01.99, with a diagnosis of blunt abdominal trauma with rupture of the small intestine, diffuse fibrinous-purulent peritonitis. Postoperative multiple unformed small bowel fistulas.

From the anamnesis: blunt abdominal trauma - 4.01.98,

In Alarskii RSD procedures were performed:

1) laparotomy, interalia, closure of iatrogenic perforation of the small intestine;

2) relaparotomy, resection of small intestine, sanation of abdominal cavity.

After transferring the design Bureau No. 1 condition was caused by intoxication, sled">

Performed:

1) 24.12.98,: relaparotomy, entero-enterostomy "side-to-side, sanitation and drainage of the abdominal band. This operation is applied the proposed drainage design described above. Within three days spent conservative antibiotic, infusion therapy, vacuum drainage of the subcutaneous tissue.

2) 27.12.98,: relaparotomy, delete the original drainage design, sanation of abdominal cavity. On the operation intractable cellulitis of the anterior abdominal wall, docked peritonitis.

The patient underwent plastic anterior abdominal wall. In a satisfactory condition the patient was discharged from hospital 16.01.99,

Thus, the proposed device allows

reliable and noninvasive be isolated from the abdominal area sutured skin sutures laparotomic wound CBE, which prevents contamination and recontamination tissue wounds CBE as part of the abdominal cavity, and Vice versa, with the development of purulent-necrotic process in the tissues laparotomic wound CBE;

effectively drain active way (suction type drainage) laparotomic wound CBE, after closing her skin sutures;

to protect adjacent to the wound istwa contributes to the reduction and prevention of suppurative inflammation in the abdominal cavity and tissues laparotomic wound CBE, and prevention of traumatic lesions adjacent to laparotomic wound CBE internal organs of the abdominal cavity and primarily intestines.

The use of the proposed drainage devices has improved the results of treatment of patients with widespread purulent peritonitis, reduce the time of their treatment, to reduce the number of complications.

Literature

1. Kuzin, M. I. Current issues of classification and treatment of the widespread purulent peritonitis. Surgery. - 1996. - N 5. - S. 9-15.

2. Papirov S. Pyo-septic surgery. Sofia, 1977. Medicine and physical education. 502 S.

3. USSR author's certificate N 774561, M. CL.3A 61 B 27/00, 1980.

4. Bystritskii A. L. abdominal Drainage/journal of surgery. - 1998. - N 7. - S. 131-134 prototype.

Drainage device consisting of two single-channel tubes, on the lateral surfaces of which are made of holes, one of the tubes connected to the external source of vacuum, wherein the drainage device is designed as a two-piece hollow plate, the upper section of which in cross section has the shape of a "hill", the lower elongated along the major axis of the ellipse with monolithic continued KRA is asesina additional tube with a side opening at the proximal end, which tube is elliptical section is connected to the external source of vacuum on the upper surface of the elliptical section of the plate with holes in a staggered manner, and in the "printing" section of the holes are made along the side surfaces.

 

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