Way abdominal lavage in peritonitis
The invention relates to medicine, namely to surgery, and may be applicable for abdominal lavage in peritonitis. Enter drains through the upper floors of the abdominal cavity. Enter the trocar with a screw head through the incision to the left of the anus under the control of a finger inserted into the rectum. Pierce tissue, muscle-podnikatel anus and pelvic peritoneum. Removing the head of the trocar. Injected into the cavity of the trocar perforated silicone drainage cylinder on the outer contour of the distal end. Remove the trocar through the crotch. Inflate the syringe cylinder for fixing drainage to the peritoneum of the pelvis. Hem drainage from the crotch to the edge of the skin wound. Provide drainage. The method provides efficient drainage with peritonitis due to good sanitation pelvis.
The present invention relates to medicine, in particular to surgery, and can be used for drainage of the abdominal cavity in the peritonitis through the crotch.
In the complex of measures for the treatment of peritonitis plays a big role peritoneal lavage.
When now the accepted method programmed abdominal lavage drenyov is the only up separately drained iliac regions. Women sometimes drain the pelvis using colostomy, but it often leads to severe infection of the vagina. Male pelvis or no drain, or (very rarely) try to empty the lower abdomen through the rectum, which dramatically complicates the patient's condition (Saveliev B. C. et al. Programmable peritoneal lavage in the treatment of common forms of peritonitis. Annals of surgery. 1996, No. 2, S. 25-29).
The disadvantage is the relatively low clinical efficacy due to poor sanitation pelvis, where under the action of gravity accumulates the greatest number of pathological substrate in peritonitis.
Object of the invention is a method that improves the efficiency of treatment of peritonitis.
This problem is solved by the method lies in the fact that after the introduction of the drainages in the upper floors of the abdominal cavity through the incision to the left of the anus under the control of a finger inserted into the rectum, introducing a trocar with a screw head, pierce subcutaneous tissue, muscle-podnikatel anus and pelvic peritoneum, removing the head of the trocar, into the cavity of the trocar impose perforated silicone drainage from ballonists drainage to the peritoneum of the pelvis, from the perineum drainage is stitched to the edge of the skin wound and drain.
Additional washing of the proposed method allows you to more fully implement the drainage of the abdominal cavity, than in the traditional way.
The following example illustrates the method. Patient 64 years enrolled 08.08.2001 was in serious condition with complaints of pain in the anus and lower abdomen, weakness, chills. Sick considers himself 6 days. A history of gastrectomy 30 years ago. When entering high fever - 39,3°C, pulse 116 min, AD - 110/60 mm RT.article Abdomen slightly painful on palpation, more in the lower sections. Symptoms of peritoneal irritation are unclear. Urination is not broken. When viewed from the crotch area is determined by painful infiltrate, starting at the root of the scrotum and extending upward on either side of the anus. Apparent fluctuations in surface infiltration not.
Per rectum: the sphincter gaping, side walls of the rectum are sealed and painful. With a gentle pressure on the rear wall of the anal canal of the extended and deep posterior anal crypts pus. Diagnosed with acute bilateral (u) rear paraproctitis. Absaa above levator. Made economical necrectomy, wounds thoroughly rinsed, drained and loosely plugged with a water-soluble ointment (levsin). Started therapy with broad-spectrum antibiotics (Tienam, metronidazole, oxan), infusion therapy. The patient's condition did not improve, increased abdominal pain, and the next day appeared obvious signs of peritonitis. Performed diagnostic laparoscopy, peritonitis confirmed, but the source is not revealed. At laparotomy in the neck of the bladder, left parietal peritoneum defined area of the dirty-gray color - space breakthrough pus from pelvirectal abscess. The abdominal cavity is washed, put two drainage in the epigastric region. Drainages in the epigastric region established the conventional method. For rehabilitation of the lower abdomen through the incision to the left of the anus introduced a special trocar with a screw with a pointed head. Punctured subcutaneous tissue, muscle-podnikatel anus, pelvic peritoneum. Head unscrewed, and in the cavity of the trocar introduced perforated silicone drainage. The trocar was removed through the crotch and syringe inflated balloon on the outer contour of the distal end of the probe. This balloon captures drainage ky tube placed into the container. Imposed a two-salmostoma. The patient's condition slowly improved. Abdominal lavage was adequately. The upper drainages removed after 5, and the bottom of the pelvic cavity after 6 days. Fester the wound of the abdominal cavity with AVANTASIA the small intestine, which required re-intervention. The patient's condition has improved, salmostoma closed, the patient was discharged after 56 days.
In this way made the drainage of the abdominal cavity in 20 patients with spilled peritonitis, which led to their recovery.
This method of drainage of the abdominal cavity improves the efficiency of treatment of patients with widespread peritonitis.
Way abdominal lavage in peritonitis, including drainage through the drainage tube, is inserted through the upper floors of the abdominal cavity, characterized in that through the incision to the left of the anus under the control of a finger inserted into the rectum, introducing a trocar with a screw head, pierce the tissue, the muscle-podnikatel anus and pelvic peritoneum, removing the head of the trocar, into the cavity of the trocar impose perforated silicone drainage cylinder on the outer contour of the distal end of the trocar is extracted through the perineum, the syringe blowing enrout.
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