The way catheterization abdominal cavity

 

(57) Abstract:

The invention relates to medicine, Oncology, and surgery may be used to hold intraperitoneal chemotherapy. On the middle line of the abdomen an incision of the skin between the navel and belly length 5 see the dotted line in the abdominal cavity in the corners of the section. The tube is a conductor located in the puncture, enter the upper and lower horizontal branches of a U-shaped catheter. Tube Explorer is removed. The vertical portion of the catheter equipped with absorbable wound clutch of ketsurui thread. The vertical portion of the catheter fixed with sutures. The method provides the possibility of long-term catheterization of the abdominal cavity.

The invention relates to medicine, namely to the catheter for drainage of the abdominal cavity for surgical interventions, and can be used in Oncology for holding permanent intraperitoneal chemotherapy in peritoneal dialysis in surgery.

There is a method of drainage of the abdominal cavity (Eklund C. N. Surgical implantation of CAPD catheters: presentation of midline incision is lateral placement method and a review of 110 procedures. // Nephrol Dial Transplant, - 1995, - # 10. - P. 386-390), namely, that in the abdominal cavity surgically injected standard catheter, the outer end of the drainage into the environment associated with the risk of infectious complications, mechanical damage of the catheter, with the need to hide it under clothes, adverse psychological impact on the patient. The catheter can be treated for about 6 months after surgery due to subsequent septic complications, thrombosis its fibrin, mechanical damage to the catheter and abdominal organs, adhesions around the drainage that does not allow its use for long-term chemotherapy.

Known "Method of chemotherapy for ovarian cancer" (see author's certificate SU 1693742 A1 22 07,1991 ed. Sidorenko Y. S., Galatina L. Yu), according to which the massive introduction of chemotherapy performed through catheters introduced into the abdominal cavity during surgery at 11 ribs on the anterior axillary line, the proximal ends of which hang down into the abdominal cavity, and the distal ends remain on the skin of the abdomen for a long time Known method of catheterization abdominal cavity provides for the elimination of all drains into the external environment, which creates the risk of infection of the tissues of the anterior abdominal wall, mechanical damage of the catheter, causing the need to hide the catheter under clothing, limit physical activity, disadvantages the plantations of the permanent catheter in the anterior abdominal wall without laparotomy, ensuring the long-term catheterization, availability for puncture, the exception of course of the liquid infusion media in the subcutaneous tissue during manipulation.

This objective is achieved in that in the midline of the anterior abdominal wall an incision in the skin between the navel and belly length of 5 cm to subcutaneous fat in both corners cut the dotted line in the abdominal cavity of the trocar with put on him tube-conductor with a longitudinal slit width of 5 mm along the entire length, remove the stylet, the tube-conductor remaining in the puncture, enter the upper and lower horizontal branches of a U-shaped catheter having a length of 10-15 cm and a diameter of 3-4 mm, tube Explorer after the introduction of the horizontal branch in each corner of the incision extract, the vertical portion of the catheter has a length of 5 cm and a diameter of 5 mm, connects the two horizontal branches, equipped with a wound on her absorbable coupling of thin methodoloy thread, recorded seams, which is sutured incision directly under the skin, after 7-8 days after the sutures are removed catheter fixation provides naturally formed connective tissue channel, repeating U-shaped catheter.

The invention "Method of catheterization abdominal pony, using catheterization abdominal cavity. The novelty of the invention lies in the fact that in the midline of the anterior abdominal wall an incision in the skin between the navel and belly length of 5 cm to subcutaneous fat in both corners cut the dotted line in the abdominal cavity of the trocar with put on him tube-conductor with a longitudinal slit width of 5 mm along the entire length, remove the stylet, the tube-conductor remaining in the puncture, enter the upper and lower horizontal branches of a U-shaped catheter having a length of 10-15 cm and a diameter of 3-4 mm, tube Explorer after the introduction of the horizontal branch in each corner of the incision extract, the vertical portion of the catheter has a length of 5 cm and a diameter of 5 mm, connects the two horizontal branches, equipped with a wound on her absorbable coupling of thin methodoloy thread, recorded seams, which is sutured incision directly under the skin, after 7-8 days after the sutures are removed catheter fixation provides naturally formed connective tissue channel, repeating U-shaped catheter.

The invention "Method of catheterization abdominal cavity has an inventive step, as for a specialist surgeon-oncologist is not obvious from the level of medicine in the U-shaped form, implanted in the anterior abdominal wall directly under the skin. The vertical portion of the catheter has a clutch of biodegradable material, the catheter has a variable diameter, fixed skin sutures, and after the removal of sutures naturally formed a connective channel, repeating its shape. The catheter is available for percutaneous puncture, removing ascitic fluid, injection of drugs into the abdominal cavity. The Method of catheterization of the abdominal cavity (the original, not obvious, not obvious from the level of medicine in this area catheterization, not known in the available sources of information, or in CIS, neither in Russia nor abroad.

The invention "Method of catheterization abdominal cavity is industrially applicable and can be used in health care, in medical institutions of all kinds, in particular gynecology, Oncology, cancer research institutes and oncologic dispensaries.

"The way catheterization abdominal cavity is performed as follows. First it should be noted that the human body anatomy is viewed in vertical position, respectively, which orients the position of the catheter in perkei between the navel and belly length of 5 cm to subcutaneous fat, in both corners cut the dotted line in the abdominal cavity of the trocar with put on him tube-conductor with a longitudinal slit width of 5 mm along the entire length, remove the stylet, the tube-conductor remaining in the puncture, enter the upper and lower horizontal branches of a U-shaped catheter having a length of 10-15 cm and a diameter of 3-4 mm, tube Explorer after the introduction of the horizontal branch in each corner of the section is extracted, the vertical portion of the catheter has a length of 5 cm and a diameter of 5 mm, connects the two horizontal branches, equipped with a wound on her absorbable coupling of thin methodoloy thread fixed joints. Closure of skin incision and preliminary fixation of the catheter under the skin is carried out by using the following line of stitches: WCOL needles produce to the left, some distance of 1 cm from the edges of the incision, the needle is performed under the vertical part of the catheter, put right at 1 cm from the edge, over again right directly at the edge of the skin incision, performed over the catheter and put the left on the edge of the skin incision, stitches impose with intervala 1-1,5 cm over the entire vertical part of the catheter. Therefore, the number of seams, covering the catheter is fixed directly under the skin. After 7-8 days after the sutures are removed catheter fixation provides natures is operating, and connective tissue sheath, formed on the place of the wound on the vertical portion of the catheter methodoloy clutch, prevents leakage of fluids from places prior to injection.

Thus, intraperitoneally catheter variable diameter with coupling made of absorbable material on the vertical part implanted in the anterior abdominal wall directly under the skin, easily accessible to puncture and drug administration, excretion of ascitic fluid. In the absence of conditions for puncture of the abdominal cavity, namely at high risk of damage to the intestines and other abdominal organs, the U-shaped catheter set similarly, when a simple or minilaparotomy, without puncture tissue of the abdominal wall, with the length of the horizontal branch is chosen by the doctor depending on the space in the abdominal cavity, where it is required to bring the ends of the catheter.

An example of a specific implementation of the Method of catheterization abdominal cavity".

Patient M 67 years old, was admitted to the surgical Department of the Rostov city Oncology hospital with a diagnosis of ovarian cancer Art. 3 CL gr. 2, ascites, conditions after supracervical amputation of the uterus with appendages, resection b is in the gynecological ward of a city hospital, where during operation established extensive dissemination of the tumor in the peritoneum, the chemotherapy, the patient was not conducted. After consultation of the oncologist, it was decided to drain the abdominal cavity with the purpose of intraperitoneal chemotherapy.

The purpose catheterization abdominal cavity in the midline between the umbilicus and the bosom made the skin incision with a length of 5 cm to subcutaneous fat in both corners of the wounds produced punctures the entire thickness of the tissue prior to entry into the abdominal cavity, lost about 2 litres of ascitic fluid, then the tube with a longitudinal slit entered the horizontal branch of the T-shaped catheter, the vertical part of which is sewn directly under the skin. Sutures were removed on day 7. The catheter was a U-shaped tube, the vertical part of which has a diameter of 5 mm, length 5 cm, provided with a clutch from a wound on her catgut 0, the two horizontal branches with a diameter of 2-3 mm is introduced into the abdominal cavity to a depth of 5 cm After removal of the stitches the patient within 3 months was conducted intraperitoneal chemotherapy by percutaneous puncture of an implanted catheter.

Technical and economic efficiency "Method catheterization abdominal cavity" is that it allows catheterizing the tion, a long intraperitoneally chemotherapy and removal of ascitic fluid, eliminates the occurrence of an administered drug in the subcutaneous tissue. The method allows to obtain reliable long-term access to the abdominal cavity for therapeutic manipulation in the outpatient setting. Reliable fixation of the catheter is provided with seams, and after their removal connective tissue cavity formed around the catheter and repeating its shape. Small diameter horizontal branches of the catheter excludes the fibrin thrombosis during his stay in the abdominal cavity.

The way catheterization abdominal cavity, including the implantation of the catheter, its fixation, protection from leaks from places prior to injection, characterized in that the midline of the anterior abdominal wall an incision in the skin between the navel and belly length of 5 cm to subcutaneous fat in both corners cut the dotted line in the abdominal cavity of the trocar with put on him tube-conductor with a longitudinal slit width of 5 mm along the entire length, remove the stylet, the tube-conductor remaining in the puncture, enter the upper and lower horizontal branches of a U-shaped catheter, having a length of 10-15 cm and a diameter of 3-4 mm, tera has a length of 5 cm and a diameter of 5 mm, connects two horizontal branches, equipped with a wound on her absorbable coupling of the thin ketsurui thread, recorded seams.

 

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