A method of treatment of abscesses of the abdominal cavity and retroperitoneal space
(57) Abstract:The invention relates to medicine, in particular to surgery, and can be used to treat abscesses in the abdominal cavity and retroperitoneal space. Re percutaneous puncture of ulcers. Evacuate the exudate and washed with an antiseptic solution or antibiotic. After each washing the cavity is filled with a solution of an antiseptic or antibiotic up to 80% of the volume of the evacuated fluid. 3 Il. The invention relates to medicine, namely to surgery, and can be used in the treatment of purulent diseases of the abdominal cavity and retroperitoneal space by using closed percutaneous puncture under visual control, for example, using an ultrasound scanner.There is a method of treatment of purulent diseases of the abdominal cavity and retroperitoneal space, including pathological aspiration of the contents, the introduction of medicinal substances and drainage pathological cavity under ultrasound control. Invasive intervention carried out by a needle with a diameter of 1.3 mm, length 15 cm without mandrel. Percutaneous drainage in all cases conducted one - way umbrella stiletto-catheterize narrowing, which fix it to the thickening of the stiletto. When fixing and tensioning of the catheter on the stiletto blade "baskets" will not interfere with catheter in pathological cavity. After removal of the stylet "basket" is returned to its original position due to the "memory" of the material, which prevents the loss of the catheter from the cavity. When draining the contents of the cavity is completely evacuated, and the cavity was washed with a saline solution to clean detachable. The contents of the cavity was estimated visually and sent for bacteriological examination. Complete emptying of the cavity was controlled using ultrasound. The catheter 2-3 times a day, washed with 20-30 ml of physiological solution in order to avoid clogging. If there are two drains were established constant washing the cavity with an antiseptic solution with a speed of 20 to 40 drops per minute. Condition perform invasive surgery under ultrasound control is a visualization of the needle tip during manipulation that provides orientation and security puncture. The average duration of drainage was 18 days (1).Closest to the present invention is a method of diagnosis and treatment of purulent processes in the abdominal Polo is autotrophy therapy, systemic antibacterial and symptomatic therapy. All patients manipulations were performed under the control of ultrasonography (USG) or computer studies (CT). Puncture method is applied mostly sick once. If necessary, they were re-puncture using a needle with a larger diameter. After the evacuation was conducted cavity sanation of the pathological focus, followed by the introduction of broad-spectrum antibiotics. When receiving data on the sensitivity of microflora used targeted antibiotic therapy. therapeutic effect was assessed by morphometric indices, intensity ultrasonic symptom Murphy and clinical laboratory data. Ultrasonography is the method of choice in the diagnosis of purulent destructive processes, especially in elderly and senile age. Treatment under the control of the USG or CT can reliably achieve relief of pain and to avoid the need to perform emergency surgery. The average duration of treatment was 5-28 days. Complications method: pneumothorax, location drainage, lack of drainage features (2).However, the known methods have the following creatures the cavity of a more complicated configuration, fragmentation and the formation of additional cavities, which can be detected visually and, therefore, to remain nasyrovairina. From fragmented cavities may form multiple purulent cavities, and sometimes abscess, decreasing in size, the state is not subject to puncture treatment. Long-term drainage of purulent cavities can also lead to fragmentation of the cavity and the impossibility of complete evacuation of the fluid.2. With long-term drainage of purulent cavities through adjacent organs and cavities, it may be infected.Based on the existing level of technology of treatment of purulent diseases of the abdominal cavity and retroperitoneal space, and eliminate the disadvantages of the known technology, the task was set: to increase the efficiency of treatment by managed maintain the volume and contours of the rehabilitated purulent cavity during treatment.The problem is solved as follows.Treatment of purulent diseases of the abdominal cavity and retroperitoneal space is performed by percutaneous puncture and evacuation of fluid, lavage with a solution of an antiseptic or antibiotic under visual solution antiseptic or antibiotic up to 80% of the volume of the evacuated fluid.Explain the significance of the distinctive features of the proposed method.Filling purulent cavity with an antiseptic solution or antibiotic up to 80 percent of the volume of the evacuated fluid after each washing cavity allows to maintain a controlled amount and the contours of the cavity of the abscess during treatment, and the ability to effectively re-punctures and visualization of the pathological focus, as well as to eliminate fragmentation purulent cavity and the formation of multiple abscesses (see Fig.1).In addition, the cavity filling a medical solution allows to displace air from the rigid cavity, which makes it difficult ultrasonic diagnosis. Rigid cavity, usually formed in parenchymatous organs, and during the evacuation of fluid from a cavity in it for air circulation. A long exposure of antiseptic filled in, straightened cavity well sanitizes the entire cavity of the abscess. Treatment of multiple punctures with the creation and maintaining of a controlled volume and contours of the abscess by filling it with an antiseptic solution can be called managed and controlled.Conducted patent research in subclass a 61 M diseases of the abdominal cavity and retroperitoneal space, did not reveal the identical technologies offer. Thus, the proposed method is new.The relationship and interaction of the essential techniques of the proposed method of treatment ensure the achievement of a new medical results in solving the task, namely, to increase the efficiency of treatment by managed maintain the volume and contours of the rehabilitated purulent cavity during treatment.The proposed method of treatment of purulent diseases of the abdominal cavity and retroperitoneal space can be widely applied in medical practice, as it can be used repeatedly. Necessary equipment, for example, ultrasonic scanners, and the presence of needle sensor, method of treatment is minimally invasive and does not require large expenditures. The proposed method of treatment used successfully in the treatment of abscesses parenchymatous organs: liver, spleen, pancreas, kidneys, prostate gland. Effective in the treatment neorganic abscesses: subphrenic, subhepatic, stuffing bags, the inter-intestinal and purulent paranephritis. Successfully applied in the treatment of empyema of the gallbladder, purulent inflammation of the fallopian trust, as, for example, brand drains make up a significant proportion of total costs in the treatment of these patients.The essence of the proposed method of treatment of purulent diseases of the abdominal cavity and retroperitoneal space is the following.Spend CCS diagnostics to determine the area of the pathological focus, its settings and secure access to the hearth. Invasive surgery is performed, for example, on the device "Aloka" SSD-650 using a linear gauge needle UST-5037P-3.5 MHz with built-in puncture sector, needle "Chiba" 18G. If there are indications to the treatment method of percutaneous puncture define safe access purulent hearth, perform local anesthesia in the range of 0.25-0.5% solution of novocaine. Then enter the puncture needle into the abscess cavity under visual control, for example, by means of the ultrasonic scanner. Produce the highest possible aspiration of purulent cavity from the portion to direct the material for bacteriological examination and determination of the sensitivity of microflora to antibiotics and antiseptical. Thoroughly washed purulent cavity with an antiseptic solution to light, close to prozrachnosti. Aspiration and lavage of the cavity is performed under constant visual control that allows you to avoid injury to nearby organs and tissues and to carry out a more complete evacuation of purulent fluid from the cavity. Then fill cleansed from pus cavity with an antiseptic solution up to 80 percent of the initially established its volume without creating tension in the cavity, so as not to cause the leakage of injectate through the puncture needle. Pull the needle puncture. Re-treatment is carried out through the day depending on clinical and other symptoms. After receiving the results of bacteriological tests and the detection sensitivity of microflora to specific antibiotics or antiseptical repeated puncture under visual control on the above technologies according to the sensitivity of microflora. The trajectory of the puncture may change in the treatment process, change the volume and contours of the purulent cavity, it is important to comply with the highest security. Again delete the contents of a purulent cavity, carefully washed, determine its volume and fill the remaining cavity corresponding to the sensitivity of microflora solution unusualimage observations for example, under the control of the CCS for patients establish the periodicity of subsequent percutaneous punctures (in the first 7 days frequency of punctures usually more often, in subsequent intervals on average 4-5 days, in some cases 7-8 days). Together with antibiotic therapy to patients. Criteria for termination of treatment approach is to obtain bacteriologi punctate, significant reduction in the volume of purulent cavity on the background of clinical improvement.The essence of the proposed method is illustrated by clinical examples.Example 1. Patient M., 51. Diagnosis at admission: Infiltration of the abdominal cavity? Tumor of the abdominal cavity? Admission: pain in the left iliac region and there is palpable painful infiltrate sizes 10x15, seePatients received an ultrasound scan and revealed an infiltrate in the left iliac region, which is viewed fallopian tube in the form of convoluted tubular education by € 13.4 x 2.2 cm from the left corner of the uterus to the left iliac region, the end part of which is located in the immediate vicinity of the anterior abdominal wall (see Fig.2). Made of medical-diagnostic tool for the linear probe UST-5037P-3.5 MHz with built-in puncture sector, needle "Chiba" 18G. When the first puncture received 35 cm3pus with a foul-smelling odor (bacteriologically of aspirate the selected intestinal flora). The cavity of the fallopian tube thoroughly rinsed with antiseptic until a clear solution and filled up to 25 cm3(70% of the volume of the evacuated pus) 1% solution Dioksidina. The patient's condition has improved, the pain was gone. The size of infiltration for 3 days decreased by 1/3. With repeated percutaneous puncture under visual control, after 3 days was evacuated to 20 cm3purulent fluid, the cavity washed furatsilinom and filled with a solution of the antibiotic on the identified sensitivity - Gentamicin in the amount of 80 mg (75% of the volume of the evacuated pus). General antibiotic therapy was carried out in the first week of hospital stay. When the third puncture in 7 days on the technology described above, obtained bacterially punctate in the amount of 10 cm3the cavity is washed with antiseptic and put into the cavity 5 cm3(50% of the volume of the evacuated exudate) solution of the antibiotic. The patient was discharged in good condition after 18 days after receipt. Viewed through the month: the abdomen is soft, painless, infiltration is not palpated, when the CCS and the 7 years. Diagnosis: cirrhosis of the liver. Complaints about General weakness, weight loss over the last month on 10 kg, lack of appetite, pain in the right hypochondrium, periodic fever.Ultrasonography (CCS) revealed an abscess of the liver up to 170 cm3in the projection of the fifth, sixth and seventh segments of the liver (see Fig.3).The first percutaneous puncture under the control of an ultrasonic scanner, Internet access and projection 7 and 8 intercostal space, closer to the costal arch, received 140 cm3stinking thick pus with detritus (bacteriological examination revealed intestinal flora). The cavity thoroughly washed and sanitized furatsilinom filled 90 cm30.3% of dioksidin (64% of the volume of the evacuated pus). Concurrently assigned antibacterial and infusion therapy. Clinical improvement occurred immediately after the first puncture. Normalized temperature, appetite. Sick intensified.The second percutaneous puncture is performed under visual control through the day received 100 cm3liquid pus odourless (repeated bacteriological study - flora is not defined). Purulent cavity newly sanitized, carefully washed and filled with 70 cm3the Oh. Received up to 70 cm3liquid pus mixed with detritus. Purulent cavity rinsed, sanitized, and filled with 40 cm30.5% of dioksidin (70% of the volume of the evacuated pus). Canceled General antibiotic therapy. The patient's condition is satisfactory. Fourth puncture performed after 6 days on the above diagram, obtained 60 cmCit takes a cavity filled at 75% of the volume of exudate 0.5% dioksidin. Clinically significant improvement of the patient, no complaints, active, putting on weight. Completed fifth puncture received 40 cm3liquid pus. After rehabilitation cavity lavage with saline solution and fill 75% of the volume of the evacuated exudate 0.5% dioksidin. When monitoring ultrasound in the projection of the sixth and seventh segments of the liver include abdominal liquid education capacity 19 cm3in the form of cysts. The patient's condition is satisfactory, no complaints, weight gain was 5 kg, was discharged for outpatient treatment.Thus, the proposed method of treatment of purulent diseases of the abdominal cavity and retroperitoneal space allows, in comparison with other known technologies to support the Oia repeated punctures and visualization of the pathological focus, and also to eliminate the fragmentation of a purulent cavity and the formation of multiple abscesses, which are difficult to sanitize.Sources of information
1. Briskin B. C. et al.. Therapeutic intervention under control of the ultrasonic studies in diseases of the abdominal / Surgery them. N. And. Pirogov, mediasphere, 1996, N6, c. 17-21.2. Grigoriev E. G. , Kogan A. S. Surgery of severe purulent processes // Nauka, Novosibirsk, 2000, c. 133-157. A method of treatment of abscesses of the abdominal cavity and retroperitoneal space by repeated percutaneous punctures, evacuation of fluid, lavage with a solution of an antiseptic or antibiotic under visual control, characterized in that after each washing cavity filled with a solution of an antiseptic or antibiotic up to 80% of the volume of the evacuated fluid.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg