(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 isThe 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.
SUBSTANCE: method involves conducting bougie through the liver. Flexible tube is attached to its end and set in bile ducts. Flexible radio-opaque conductor is introduced through the flexible tube. The tube is removed. Draining tube is introduced along the conductor from porta hepatis to its diaphragmatic surface into the ducts to be drained.
EFFECT: reduced risk of traumatic complications.
SUBSTANCE: method involves puncturing pyogenic abscess cavity under ultrasonic control with draining tube left therein. Laparoscope connected to monitor unit is introduced into abscess cavity. One of introduced drains is set in upper point of the cavity and the other one in lower point. The abscess cavity is filled with ozonized solution to 2/3 of its volume and bubbled with ozone-oxygen mixture during 2-3 min changing the solution until it becomes transparent. The emptied cavity walls are treated from distance of 3-4 cm with laminar airflow heated to 38-40°C under pressure of 1-1.5 atm during 2-3 min. Next to it, the cavity walls are irradiated from distance of 2-3 cm with non-coherent red light during 2-3 min per each area.
EFFECT: improved safety conditions and healing quality.
FIELD: medical engineering.
SUBSTANCE: device has suction tube having lateral openings and irrigation tube. The irrigation tube is connected to jet-action atomizer. The atomizer is hollow collapsible cylinder with holes. Ultrasonic radiator having conductor to ultrasonic frequency oscillator is available in the cylinder. The radiator and conductor enable one to introduce ultrasonic oscillations into antiseptic solution.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves puncturing pyogenic cavity with trocar having blunt obturator via skin incision made outside of abscess boundary having length equal to arthroscope diameter. Then, arthroscope is introduced and the cavity is filled with physiologic saline. Pyogenic cavity revision is carried out under arthroscope control, irrigation cannula is set, constant water medium is created. Arthroscopic mill on shaver handle is introduced via another skin incision. Non-viable tissues are removed with stage-by-stage hemostasis using endocoagulator. The cavity is healed. Perforated draining tube is set under arthroscope control. Tube ends are brought out through pierces outside of the cavity and sutured to skin. Active suction of wound exudates is carried out using closed vacuum drain system in postoperative period. The drainage is removed when cleaning the wound from wound microflora and single sutures are placed.
EFFECT: enhanced effectiveness of treatment.
FIELD: medicine, abdominal surgery.
SUBSTANCE: the present innovation deals with treating patients in case of destructive forms of pancreatitis. One should lance a gastro-colic ligament, mobilize splenic and hepatic angles of large intestine, tighten a middle colic artery, descend mesenteric root cross-sectionally against a colon, dissect parietal peritoneum along the upper and lower edges of pancreas to withdraw it into abdominal cavity, remove necrotized tissues. Then one should apply a rubber balloon with drainage tubes along its upper and lower edges into omental cavity: one balloon's end should be withdrawn through median wound, another one - through contra-aperture being 5 cm below a costal arch along median axillary line. The method suggested enables to form adequate access to patient's pancreas.
EFFECT: higher efficiency of drainage.
6 dwg, 1 ex
FIELD: medical engineering.
SUBSTANCE: device has liquid-permeable porous lining that is to be placed on or in a wound, flexible plastic film having a set of holes distributed over its surface, liquid-impermeable film napkin and connection means. The porous lining has foamed polymer material having interconnecting cells. The plastic film makes contact with porous lining surface and is between wound surface and the lining when used. The film napkin is placed above the porous lining and is sticky along its perimeter to provide sealing in skin area surrounding the wound. The connection means passes through the film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. Another embodiment has removable wound bandage usable in particular for treating large wounds requiring draining fluids. It has the first porous lining, the second porous lining, elastomer envelope, film napkin and tubular connection means. The first liquid-permeable porous lining contacts the wound and has foamed lining having foamed material based on polymer built of interconnecting cells and isolated transverse holes. The elastomer envelope has the first and the second sheets of elastomer film soldered along their periphery and enveloping said foamed lining. Each of the first and the second elastomer film sheets has spaced-apart holes. The holes in the second sheet are justified with said spaced-apart holes in the first sheet. The second liquid-permeable porous lining is to be placed under the first porous lining. It has foamed polymer material having interconnecting cells. The liquid-impermeable film napkin is placed above the second porous lining. The first porous lining is placed above the wound. The film napkin is sticky along its perimeter to glue the napkin to skin area surrounding the wound. The tubular connection means passes through said film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. The third embodiment has the first elastomer film sheet having spaced-apart holes deviated from spaced-apart holes in the foamed lining. The second elastomer film sheet has spaced-apart holes adjusted to the spaced-apart holes in the foamed lining.
EFFECT: simplified usage; accelerated wound healing.
15 cl, 3 dwg
FIELD: medicine, surgery.
SUBSTANCE: one should perform decompression of Wirsung's duct with the help of silicone instrument or catheter in case of pancreatogastrostomy in the course of pancreatoduodenal resection. Moreover, the above-mentioned instruments should be fixed in anastomosis with one of the sutures in internal row, their free ends should be loosely located in the stomach and tightened to caprone ligature to be then withdrawn through patient's nose. In 7-10 d either silicone instrument or catheter should be removed due to pulling by caprone ligature. The innovation enables to decrease the risk in the failure of pancreatogastroanastomoses and post-operational pancreatitis.
EFFECT: higher efficiency of draining.
FIELD: medicine, surgery.
SUBSTANCE: at the end of the main stage of operation conducted one should perform paravertebral Novocain blockade by puncturing the sheath of m.erector trunci, the drainage should be introduced towards lateral edge of m.ilipsoas through paracentesis of lumbar area being about 1-2 cm above ilium's ala at the line made via the end of the 12th rib vertically up to ilium's ala. Retroperitoneal space should be, also, drained. The innovation enables to prevent purulent-septic complications and decrease the pain.
EFFECT: higher efficiency.
1 dwg, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: uterine cavity should be drained in the course of operation, moreover, irrigator's distal end should be withdrawn through operation wound at anterior abdominal wall, and 2 h after the end of operation uterine cavity should be washed through irrigator with 400 ml of cooled 0.06%-sodium hypochlorite solution at perfusion rate being 200 ml/h, 6 times every 12 h up to 3-4 d; after each perfusion one should introduce 1 g kanamycin directly into uterine cavity, moreover, in case of availability of bacterioid and/or anaerobic flora in uterine cavity according to the results obtained due to pre-operational antibioticogram one should add 100 ml 3%-hydrogen peroxide solution into perfusion solution. The present innovation enables to efficiently sanitize uterine cavity due to intrauterine injection of antibiotics by taking into account antibioticogram performed at all stages of operative treatment.
EFFECT: higher efficiency of prophylaxis.
1 cl, 2 ex
FIELD: medical engineering.
SUBSTANCE: device has lateral holes and is manufactured from absorbable material like polydioxanon. The holes are diametrically arranged in two rows along the whole tube length in chessboard order in the first embodiment of the invention. The absorbable material of polydioxanon is manufactured as threads arranged as reticular mesh grid structure of 12-20 u/cm in building tube walls.
EFFECT: eliminated occurrence of pyo-inflammatory complications.
2 cl, 2 dwg