The decompression method of the duodenal stump and nasoduodenal probe for its implementation

 

The invention relates to medicine, namely to surgery, and can be used in the treatment of patients who are gastric resection or gastrectomy. Nasoduodenal probe is made in the form of a tube and the second tube. One tube is put into another. The outer tube has a diameter of 5-6 mm proximal and distal groups of 4-5 holes in each, spaced from each other at a distance of 20 cm Inner tube with a diameter of 2-4 mm has at the end of 4-5 holes. Tube made PVC. How decompression stump duodenum includes an introduction nasoduodenal probe and aspirate the contents of the intestine. Nasoduodenal probe is positioned so that the distal group of holes of the outer tube was located in the lumen of the lower horizontal part of the duodenum and proximal group of holes in the stomach. Create inner tube nasoduodenal probe discharge at 0.15-0.30 kg/cm2. Realize the aspiration of the duodenum continuously during the first 2-4 days of the postoperative period. The technical result is fully adequate decompression of the stump of the duodenum. 2 AD. and 1 C. p. F. used in the treatment of patients, which is gastric resection or gastrectomy.

There is a way decompression stump of the duodenum, in which intraoperative it introduces nasoduodenal probe consisting of a single tube (godlewsky A. I., MITYC I. I. Prevention of insolvency of the seams of the duodenal stump after gastric resection// journal of surgery, 1989, No. 9, S. 34-37).

However, with this method it is possible the development of insolvency seams stump of the duodenum due to the fact that the usual nasoduodenal probe cannot provide adequate evacuation of the contents of the intestine as in “passive” and “active” aspiration. In the first case due to the limited capabilities of this method (for “passive” evacuation should be sufficiently high intraluminal pressure in the duodenum, where the seams of the stump of the body will experience a significant pressure that would cause a violation of the healing process and the likelihood of insolvency of the seams), the second because of the possible suction probe to the wall of the intestine.

The technical result is fully adequate decompression of the duodenal stump.

The essence consists in the following. Nasoduodenal with a diameter of 5-6 mm has proximal and distal groups of 4-5 holes in each, spaced from each other at a distance of 20 cm Inner tube with a diameter of 2-4 mm has at the end of 4-5 holes. Tube made PVC.

In the method of decompression of the stump of the duodenum, including the introduction nasoduodenal probe and aspirate the contents of the intestine, the probe is positioned so that the distal group of holes of the outer tube was located in the lumen of the lower horizontal part of the duodenum and proximal group of holes in the stomach. Create inner tube nasoduodenal probe discharge at 0.15-0.30 kg/cm2and realize the aspiration of the duodenum continuously during the first 2-4 days of the postoperative period.

In Fig.1 shows nasoduodenal probe, consisting of two PVC pipes: 1 outer diameter of 5-6 mm and 2 internal diameter of 2-4 mm, inserted one into the other. The outer tube 1 has a proximal group of 4-5 holes 3 and the distal group 5 4-5 4 holes. Proximal and distal group of holes 3 and 4 of the outer tube 1 is located at a distance of 20 cm from each other. The inner tube 2 is located in the outer tube 1 and at its end has 4-5 holes 5.

The way assests the capacity probe. Distal group of holes 4 outer tube 1 feature (Fig.2) in the lumen of the lower horizontal part of the duodenum and proximal her band hole 3 in the stomach (resection). Decompression of the duodenum provide continuous aspiration of its contents through the creation of the internal tube 2 inserted into the outer tube 1, nasoduodenal probe vacuum in the 0.15-0.30 kg/cm2during the first 2-4 days of the postoperative period.

Design nasoduodenal probe ensures the reliability of the method. A constant flow of air from the external environment, passing between the inner wall 2 and outer tubes 1, does not permit last in contact with the mucosa of the duodenum and stomach to stick to it. Quantitative control over the volume of the evacuated discharge allows to determine the optimal timing of active aspiration of the residual limb of the duodenum. Generally, reducing the number of detachable 2 - 3-day postoperative period coincided with the recovery of the peristaltic activity of the intestine.

In cases of gastrectomy sensing carried out by the proposed method with listig.3).

Testing method performed in 44 patients with peptic ulcer disease or gastric cancer or duodenal ulcer, which was performed resection of the stomach Billroth-II (33) or gastrectomy (11).

Patients which underwent gastric resection, intraoperative nasoduodenal probe was installed so that the distal group of holes of the outer tube was located in the lumen of the lower horizontal part of the duodenum, and its proximal group of holes in the stomach. In observations with gastrectomy intubation was performed under the same scheme, with the proximal group of holes of the outer electrode was set at the level of a loop of jejunum. In the early postoperative period (2-4 days) is decompressed duodenum continuous aspiration of its contents through the creation of the internal tube nasoduodenal probe vacuum in the 0.15-0.30 kg/cm2in the first 2-4 days of the postoperative period.

When the analysis of the direct results of patients who underwent gastric resection or gastrectomy, a high efficiency in the way. In all cases there was a positive result. Insolvency joints, infiltration of tissues and abscesses in ablaye discharged from the hospital with recovery.

In the control group, consisting of 26 patients, duodenal stump drained by the traditional method. It turned out that in 4 cases there was a failure of the seams stump duodenum, causing peritonitis and death of two patients.

Example. Patient N. (1948, No. 956) was admitted to the hospital for ulcer duodenal ulcer, complicated subcompensated stenosis of the output section of the stomach. From the anamnesis: sick peptic ulcer disease for 16 years. When endoscopic and radiographic studies revealed a chronic ulcer in the posterior wall of the duodenal bulb with a diameter of 1.8 cm, scar-ulcer deformation of the body, subcompensated stenosis. After preoperative preparation under General anesthesia the patient underwent laparotomy, resection of 2/3 of the stomach Billroth-II in the modification of the Comptroller of Finsterer. Duodenum drained by the proposed method. In the early postoperative period there were no complications. When active aspiration of duodenal contents were determined within 2 days. By this time, the intestinal motility recovered. After 11 days after the operation the patient was discharged in udovletvoridelnye implemented, allows you to create optimal conditions for decompression stump of the duodenum, which is one of the most important conditions for the prevention of insolvency of its seams.

Claims

1. Nasoduodenal probe, made in the form of a tube, characterized in that it contains a second tube, one tube is put into another, with the outer tube has a diameter of 5-6 mm proximal and distal groups of 4-5 holes in each, spaced from each other at a distance of 20 cm and an inner tube diameter of 2-4 mm has at the end of 4-5 holes.

2. The probe p. 1, wherein the tube is made PVC.

3. The decompression method of the stump of the duodenum, including the introduction nasoduodenal probe and the aspiration of the colon, characterized in that the probe p. 1 install so that the distal group of holes of the outer tube nasoduodenal probe was located in the lumen of the lower horizontal part of the duodenum and proximal group of holes in the stomach, creating inner tube nasoduodenal probe discharge at 0.15-0.30 kg/cm2and realize the aspiration of the duodenum is not the Sabbath.

 

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