The way external drainage of bile ducts during laparoscopic surgery

 

(57) Abstract:

The invention relates to medicine, surgery can be used for external drainage of the bile via laparoscopic surgery. Remove the gallbladder. Enter the drain tube in the common bile duct. Put the drain tube on the bed of the gallbladder. Sutured edge of the box over the drainage pipe. Seams are imposed so that the drainage tube was covered by no less than 4/5 of the length of the bed. Remove the drain tube to the anterior abdominal wall. The method allows to ensure the prevention of biliary peritonitis. 2 Il.

The invention relates to surgery. Known methods of external drainage of the biliary tract, which can serve as the method described in the book Bohuslav Niederle "Surgery of the biliary tract" (Prague, medical publishing house "Avicenum", 1982), and includes removal of the gallbladder, the introduction of a drainage tube in the common bile duct and bring her to the anterior abdominal wall through the free abdominal cavity.

The disadvantage of this method is that after removal of the drainage tube into the anterior abdominal wall around the tube is not always adhesions are formed, and therefore, after removal of the tube mausima with the abdominal cavity with the potential entrance of bile and development of biliary peritonitis.

It is known that the starting point for the development of adhesions in the abdominal cavity is damage to the abdominal integument. Laparoscopic surgery is a minimally invasive surgery, in which peritoneal damage cover is minimal. This suggests that the removal of drainage of the bile duct through the free abdominal cavity during laparoscopic operations can be risky.

The aim of our invention is to provide a method of external drainage of bile ducts during laparoscopic surgery.

The technical result of the invention consists in that the location of the drainage tube, in which around it guaranteed formed adhesions, and after removal of the tube remains the channel which is connected with the entrance of the common bile duct and extending to the anterior abdominal wall, and then self-closing.

The essence of the invention (Fig. 1) is that in the way, including the removal of the gall bladder, the introduction of the drainage tube 3 in the common bile duct 4 and bring it to the anterior abdominal wall, in contrast to the nearest analogue, before removal of the drainage tube is placed on a bed remote gall bladder 2 [which PR is kladivo thus, to the drain pipe was closed edges of the bed of the bubble, i.e. the end located inside the channel of the liver tissue (Fig. 2).

The causal link listed techniques with the technical result consists in the fact that when carrying out the drainage tube through the bed of the gallbladder and it is guaranteed to form a channel, and the drain pipe is isolated from the free abdominal cavity.

The stitches on the couch is so stitched was not less than 4/5 of the length of the bed. As a result of researches it is established that the conditions indicated suturing (for example, the stitches so that the drain pipe is immersed in the bed of the bubble is less than 4/5 of its length), leads to the formation of the channel, which in one way or another can communicate with the free abdominal cavity.

The method is as follows: after removal of the gallbladder during laparoscopic surgery drainage tube is introduced into the common bile duct. Then the tube is placed on the bed of the gallbladder and output through a puncture of the anterior abdominal wall. The edge of the bed is sutured over the drainage tube, wrapping the joints so the discoveries, when the need for external drainage of the bile duct ends (3-4 weeks), the drainage tube is removed, and in its place remains the channel, which is self-closing.

Clinical example:

Sick Ya 37 years, and. b. 16339, acted in chronic calculous cholecystitis, which hurts for many years. During examination of the gallbladder revealed a large number of concretions. Given the availability of easy isterichnost sclera and the increased level of bilirubin in the plasma up to 36 mmol/l, the patient performed a retrograde cholangiography, which supraduodenal Department of choledochus, extended up to 2 cm, was determined by two calculus size 13 and 15 mm Below the localization of stones choledoch had a funnel shape, Sivas down, and over the distal 3-4 cm in diameter was 6-8 mm, which made it impossible to remove concretions transpapillary duodenoscopes way. The operation completed 09.07.93, under General anesthesia. The laparoscope and the mice were injected via the standard point. Available adhesions around the gallbladder separated by electrorocket. Selected and double-clipped cystic duct and artery. The artery is crossed, created a "window" for the neck as the second thread, the left strand is derived through in vitro subcritically trocar, right saracena clip that secures the neck of the gallbladder. Choledoch opened micronozzle in the longitudinal direction for 15 mm Choledocholithiasis hole corresponded concrements and we have not experienced difficulties in their search. Stones removed with tongs and placed in a latex bag. Through a 10-mm trocar into the abdominal cavity fully submerged T-shaped drainage and using clamps entered in the choledoch. Choledocholithiasis hole is sutured to the atraumatic drainage absorbable thread. Intraoperative cholangiography confirmed the absence of concretions in choledocho and free reset contrast in the 12-duodenum. Suture-holders removed, crossed the cystic duct, the gallbladder is separated from bed by electrorocket placed in the same container and removed from the abdominal cavity through paraumbilical puncture. The discharge end of the T-shaped drainage laid on the bed of the gallbladder, the edges of the bed overlaid with 5 stitches, after tying the drainage was completely covered hepatic tissue, the free end of the drainage removed from the abdominal cavity through the mid-clavicle piercing, fixed skin suture. In obstructive prana removed on the 3rd day; T-shaped drainage removed 4 weeks after completing fistulography. There was a small (about 5 ml) leakage of bile from the channel output, which stopped the next day. The patient was discharged home in good condition. Examined in 4 months, 1 and 2 years after operation condition is satisfactory, no complaints. Control abdominal sonography pathology has not revealed.

The way external drainage of bile ducts during laparoscopic surgery, including removal of the gallbladder, the introduction of a drainage tube in the common bile duct and bring her to the anterior abdominal wall, characterized in that, before the removal of the drainage tube is placed on the bed of the gallbladder and is sutured to the edge of the box over the drainage tube, and the seams are imposed so that the drain pipe was covered by no less than 4/5 of the length of the bed.

 

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