The method of drainage of lymphocele

 

(57) Abstract:

The invention relates to medicine and can be used in the development of lymphocele in patients after allotransplantation cadaveric kidneys. Under the ultrasound control the dotted line in the cavity lymphocele from Antero-lateral abdominal wall. Injected dye. Message cavity lymphocele and peritoneum carry out puncture the establishment in the cavity lymphocele under the control of the laparoscope trocar-catheter with shape memory. The distal end of the catheter is fixed in the cavity lymphocele. The proximal cross at a distance of 3-4 cm from the cavity and remove. The method can reduce the volume of surgical intervention and to reduce the number of complications.

The invention relates to medicine and can be used mainly in the development of lymphocele in patients after allotransplantation cadaveric kidneys.

There is a method of external drainage of lymphocele (Filipsen P. J. Clinic, diagnostics and treatment of surgical complications in patients on hemodialysis and after kidney transplantation. Dessert. for obtaining the academic Art. Doc. the honey. Sciences. M. , 1990, S. 291-292), including transcutane external drainage of the cavity according to Seldinger.

Nedostatkov, long-term treatment of lymphatic cysts, a great loss of lymph, i.e. protein.

There is also known a method of drainage of lymphocele, including ultrasonic positioning lymphocele, laparoscopic creation of a communication between the cavity lymphocele and peritoneum (see Shumakov Century. And. Transplantation. Leadership., M.: Medicine, 1995, S. 200).

The disadvantage of this method is the complexity of the visualization lymphocele side of the abdominal cavity, the probability of closing the window lymphocele and abdominal cavity loops of intestine or omentum, infringement in the generated window loops of intestine, the risk of bleeding when the window is created, the probability of infection for an open surgery.

The problem posed by the authors, is to eliminate these drawbacks by reducing the risk of infection when transcutane internal drainage, reduction of the volume of the cavity of the intervention; reduce the duration of the postoperative period.

For this method of drainage of lymphocele, including ultrasonic positioning lymphocele, laparoscopic creation of a communication between the cavity lymphocele and peritoneum, proposed under the control of ultrasound to puncturevine the e and peritoneum to make trocar-catheter with shape memory, which is under the control of the laparoscope puncture and aspiration set in the cavity lymphocele; however, the distal end of the catheter locking cavity lymphocele, and proximal to cross at a distance of 3 - 4 cm from the cavity and remove.

That under ultrasound injected dye, allows better visualization of lymphocele side of the abdominal cavity, which makes it possible, without damaging large vessels, to adequately drain the cavity lymphocele. Installation of drainage shape memory side of the abdomen laparoscopic helps reduce the risk and extent of surgical intervention and to exclude the possibility of re-education lymphocele.

The method is as follows.

On the day of surgery under ultrasound produce fine-needle puncture lymphocele for introduction into its cavity 5-10 ml of 1% solution of methylene blue for intraoperative visualization education.

The operation is performed under General combined endotracheal anesthesia. After processing operating margins impose pneumoperitoneum. On the middle line above or below the navel through desyatikilometrovy incision introduce the trocar with the laparoscope. Produce an overview laparoscopy, clarifies di the new left in the middle of the abdomen lies lateral to the rectus abdominis muscle at the level of the navel, the second in the right iliac region srednechrochnoy line.

When right-sided localization location trocars change accordingly.

Cavity lymphocele, usually well visualized by radiographic methylene blue. When insufficient visualization produce puncture lymphocele through one of the trocars. Internal drainage of lymphocele is carried out by puncture of the establishment in the cavity of education 3 - 5 mm plastic tube of shape memory at the end of the drainage in the form of a quatrefoil. For additional fixing may podszywania drainage endosome behind the parietal peritoneum. Excess drainage cut, into the free abdominal cavity leave the end of the drainage length is not more than 4-5 see that the location of drainage control for the activity of fluids to drain from the cavity lymphocele. Oosevelt the abdominal cavity. External drainage of the abdominal cavity, as a rule, is not required. The abdomen is sutured tightly. In the postoperative period, the quality of internal drainage is controlled by the ultrasound bed of the graft and the size of the lymphatic cysts.

Example.

Patient G. , 1961 R. (East. bol. N 7652, 1998), and entered with dia is and transplant.

After laboratory diagnosis verification lymphocele under ultrasound was performed percutaneous puncture lymphocele. In the cavity lymphocele introduced in 5.0 ml of Indigo Carmine to render education from the free abdominal cavity. Under the control of the laparoscope was used to puncture lymphocele stiletto-catheter shape memory side of the abdominal cavity. The stylet was removed, the catheter independently revealed in the cavity lymphocele in the form of baskets, crossed at a distance of 4 cm from the parietal peritoneum, the distal end removed. Thus, it was implemented internal laparoscopically drainage of lymphocele "lost" drainage with shape memory. Intra-abdominal part of the catheter was fixed a ligature to the parietal peritoneum. The operation was completed by removal of the laparoscope, the suturing of the abdominal cavity. The patient was observed within one month after surgery, recurrence lymph cysts did not arise. The patient was discharged for outpatient monitoring.

The proposed method allows to reduce the volume of surgical intervention and to reduce the number of possible complications during surgery and in the early postoperative period.

Way generaie communication between the cavity lymphocele and peritoneum, characterized in that it further under the ultrasound control the dotted line in the cavity lymphocele-side front-side wall of the abdomen and injected the dye, and the message cavity lymphocele and peritoneum exercise trocar-catheter with shape memory, which is under the control of the laparoscope puncture and aspiration set in the cavity lymphocele, while the distal end of the catheter is fixed in the cavity lymphocele, and proximal cross at a distance of 3-4 cm from the cavity and remove.

 

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