The method of rehabilitation of the abdominal cavity with generalized peritonitis and device for its implementation

 

The invention relates to medicine, namely to surgery, and can be used for sanitation of the abdominal cavity with generalized peritonitis. Serves oxygen through tube irrigators installed in the right and left mesenteric sinus, the right and left subphrenic space, which goes through laparotomy. Served in laparostomy in the opposite direction saline. Carry out the removal of the exudate through the drain tube installed in the pelvic cavity and along the right and left side channel. Spend 24-48 hours planned revision of the abdominal cavity. Device for creating laparostomy contains protective frame in the form of a plate with a hole. The protective frame is made for sewing the contour laparotomic wound has a hole suture thread. The device contains a grid placed on the contour of the hole of the side plate and congruent to the side of the cover. The backsplash is made for loading and unloading the grid. The grid is made for cuddling cover at the bottom. At the bottom of the cap is hollow. The recess has the opportunity to interact with the tab on the side and fixation. Hole suture thread is located along a side. The invention improves afgrow, to reduce the risk of secondary infection of the abdominal cavity. 2 N. p. F.-ly, 5 Il.

The invention relates to medicine, namely to General surgery, and can be used in the treatment of generalized forms of peritonitis.

The known method of sanation of abdominal cavity in the postoperative period, developed Neidhardt et al. (1979, France), namely, that by creating laparotomy (open mid wounds of the abdomen) of the abdominal cavity remains open. Through laparostomy is a constant fraction (intermittent, not less than four times per day) lavage (washing) of the abdominal cavity. Liquid (dialysate) flowing through a tubular or malosochnye drains, pre-inserted through separate incisions in the dorsal (posterior wall of the abdominal cavity) abdomen. The direction of fluid flow is from top to bottom. Total consumption of liquid for lavage is 18-68 liters per day. [Thick P. I., Ivanyan A. N. Drainage in surgery, obstetrics and gynecology. Moscow-Smolensk, 2000. - S. 67].

The disadvantages of this method.

Such a method of treatment of peritonitis has the disadvantages of peritoneal dialysis. The peritoneum lining the entire surface of the abdominal cavity, is a biological memb the bones for lavage (washing) from the abdominal cavity washed out, in addition to microbes and pathological exudate (purulent effusion), the natural protective factors, such as fibrin, cells of the immune protection, protein fractions, electrolytes. In this regard violated not only the local immune system, but also occurs protein and electrolyte deficiency in the body that require replacement to maintain homeostasis.

Is not software (planned) revision of the abdominal cavity. Given that in the abdominal cavity during inflammation pronounced adhesive-adhesions due to deposition of fibrin, loops of intestine are glued together, forming isolated not drained cavities and pockets, where there are a pathological exudate with a large number of microbes. Subsequently, the cavity nagnaivajutsja, forming intra-abdominal abscesses. Software revision of the abdominal cavity (examination of the abdomen for surgery under General anesthesia allows you to break loose spikes and drain formed accumulation of exudate, rinse and osasivat the abdominal cavity, remove the threads of fibrin, necrotic tissue, check the patency of the drainage tubes, and, if necessary, to change them, to determine the viability and integrity of superimposed seams, activatin drains into the abdominal cavity in the coming days ogranichivayutsya (isolated) from the free abdominal cavity. Because of this drainage does not adequately take input through laparotomy (median wound of abdominal fluid. Part of the liquid remains in the abdominal cavity and subsequently becomes infected and suppurate, forming abscesses between loops of intestine.

This method of treatment of peritonitis is carried out using a device known of the invention, for applying laparotomy, which we have chosen as a prototype. The device presents an elastic ring with a transparent plastic cone, the top of which is a catheter. The device operates as follows. Along the perimeter of the laparotomic wound in the abdominal cavity is entered elastic ring plastic, transparent cone that is suspended above the bed of the patient. Through the catheter, located in the top of the cone, is the introduction of dialysate (washing liquid). [Thick P. I., Ivanyan A. N. Drainage in surgery, obstetrics and gynecology. Moscow-Smolensk, 2000. S. 67].

The disadvantages of this device.

- This unit laparostomy performs a narrow feature and allows you to enter into the abdominal cavity of the liquid and does not provide the option of displaying, for example, gas.

- The device is quite traumatic for dangedest (loss of elasticity, mobility of the muscles of the anterior abdominal wall, and this causes the difficulty of suturing median wounds of the abdomen. Later may be formed of postoperative hernia.

There is a method of treatment of generalized peritonitis developed Guthy et al. (1980, Germany), consisting in a continuous dorsoventrally the lavage (washing of the abdominal cavity in the direction from the rear to the front) with outflow dialysate (wash liquid) through laparotomy (not stitched median wound of the abdomen) in a bandage. The liquid is fed through tubes pre-installed on the back wall of the abdominal cavity. For washing use an electrolyte with a total flow of 40 liters per day [Thick P. I., Ivanyan A. N. Drainage in surgery, obstetrics and gynecology. Moscow-Smolensk, 2000. S. 68].

The disadvantages of this method.

- Large volumes of electrolyte introduced into the abdominal cavity, leading to disorders peculiar to the peritoneal dialysis.

- Infected soft tissues of the abdominal wall in the area of laparotomic (median) wounds. This leads to suppuration in the next.

The difficulty of patient care, as the outflow of 40 liters of dialysate occurs through not sutured laparotomic wound in a bandage: there is a need for frequent smaniotto and derived liquid.

- No software revision of the abdominal cavity.

As a prototype of the selected method upward gas-liquid flow as a way of extended sanation of abdominal cavity with generalized peritonitis [Remizov, I. C., Savchenko, Y. P., Azarian S. C., Matosian, T. D. use of the method of the upward gas-liquid flow as a variant of extended sanation of abdominal cavity with widespread purulent peritonitis // Proceedings of the third Russian scientific forum “SURGERY 2001”, Advances in modern surgery” M, “Aviastar”, 2001. - S. 269-270].

The essence of the method lies in the direction of liquid flow from the back wall of the abdominal cavity to the front with a closed abdominal cavity. After elimination of the source of peritonitis lavage and drainage of the abdominal cavity the greater omentum wrapped up and fixed with a suture to a small gland in the presence of signs of omentitis (inflammation of the greater omentum) he resected (removed). Through individual contraditory (sections-punctures) on the side walls of the stomach into the abdominal cavity is entered four perforated tube irrigators that are dorsally much farther (on the back wall of the abdominal cavity) along the right lateral channel in polnodoznuu ulcer, along the left lateral channel in the subphrenic space through a hole made in the falciform ligament of the liver. Thus, the tube-irrigators are in the main anatomical pockets of the abdominal cavity.

Perforated drain pipe installed on top of the intestinal loops along the mid laparotomic wound. The abdominal cavity layers are tightly sutured. After surgery through the tube irrigators served pulsating jet of a mixture of antiseptic solution with air, the frequency of sessions washing 4-5 times a day, while in the abdomen occur ascending turbulent flows with high mechanical-cleaning properties, and under the anterior abdominal wall creates an air bubble. Evacuation of liquid and air through the ventral located perforated drainage tube, which is located on the border of the upper level of the liquid and the gas bubble, and therefore does not separating the drainage tube. Between sessions washing remains hydropneumoperitoneum (gas and fluid in the abdominal cavity), which tube overlap. After cupping peritonitis liquid passive (gravity) merges the tubes-irrigators, to the Ziya abdominal cavity is not possible to visually assess the dynamics of the inflammatory process, sanitize and check (inspect) all anatomical pockets of the abdominal cavity, to drain the possible clusters, which in the postoperative period can nagnaivatsya. There is no possibility to verify the viability of the seams in place of a remote source of peritonitis, destroy the formed sealing, insulation installed in the abdominal cavity of the tube.

- Intra-abdominal pressure is increased, saved hydropneumoperitoneum (gas and fluid in the abdominal cavity). When peritonitis, when there is paresis of the intestine (the lack of motility and peristalsis of the intestines and swelling of its walls, the conditions of increased intra-abdominal pressure are unfavorable. Aggravated disorders of microcirculation in the intestine, increases the load on the diaphragm, which leads to a decrease of ventilation in the lower sections. An increased risk of developing pulmonary complications.

In the case of peritonitis expressed spaece-adhesive process. Therefore, the tube-irrigators within 16-24 hours ogranichivayutsya (isolated) from the free abdominal cavity, and the ascending gas-liquid turbulent flows will seek the path of least resistance for output through the ventral (drainage installed under the anterior abdominal steketee will be removed gas and to a lesser extent the pathological exudate and rinsing liquid. This is due to the fact that the direction of flow of gas-liquid mixture goes from below upwards, against gravity.

The closest is “a Device for laparotomy” patent SU 1713562, MKI 5 AND 61 IN 17/00, BI No. 7, 1992, C. 17. Site protection the wound made in the form of cuff glove manipulator, which includes clips of the wound size, each of which is made in two vertical bars with heel and a horizontal tube with telescopic extensions.

The disadvantages of this device.

- This device can perform only the draining function and does not provide active rehabilitation.

- The device does not provide an introduction into the abdominal cavity fluid.

- The device does not allow the planned revision, as is the final and only method of drainage of the abdominal cavity.

- Design does not allow to create a hydraulic lock, ogranichivaya the abdominal cavity from the external environment.

The objective of the invention.

To create a method that improves the effectiveness of the treatment through a combination of active rehabilitation of the abdominal cavity in laparostomy by creating upward gas flow and counter him liquid stream at a pressure close to atmospheric, inside the bra is th allows you to more effectively remove the pathological exudate. To ensure more effective protection of the tissues of the anterior abdominal wall, to prevent its infection due to the structure of the device and to distinguish the abdominal cavity from the external environment, preventing the drying of the abdominal cover by creating a trap through which extends a gas and a liquid.

This object is achieved by way of sanation of abdominal cavity with generalized peritonitis, including the supply of gas through pipes to irrigators and liquid through laparotomy in the abdominal cavity in the opposite direction. Simultaneously the removal of the exudate through the drainage tube and gas from the abdominal cavity. As gas serves oxygen. Tube-irrigators installed in the right and left mesenteric sinus, the right and left subphrenic space. The gas exits through laparotomy (median wound of the abdomen), which is in the opposite direction serves fluid. Drainage of exudate and wash water are carried out by the drainage tubes installed in the pelvic cavity and along the right and left side channel. 24-48 hours carry out the planned revision of the abdominal cavity (software relaparotomy), which share the resulting loose adhesions, restore the patency of Germany, evaluate the dynamics of the inflammatory process.

Distinctive features of the proposed method are that:

as the gas fed through tubes to the irrigators that use oxygen;

- tube-irrigators installed in the right and left mesenteric sinus, the right and left subphrenic space,

gas exits through laparotomy, which is in the opposite direction serves fluid. Thanks a counter movement of gas and liquid, turbulent movement with mechanical cleansing effect,

- removal of the pathological exudate and the wash water passes through the drain tube installed in the pelvic cavity and along the right and left side channels,

- planned revision of the abdominal cavity (software relaparotomy) carried out in 24-48 hours.

The proposed method is illustrated in the drawings, is shown in Fig.1, Figs.2, Figs.3.

In Fig.1 shows the arrangement of tubes-irrigation and drainage in the abdomen.

In Fig.2 shows the arrangement of tubes-irrigation, drainage and device laparostomy.

In Fig.3 shows the movement of liquid and gas in the abdominal cavity.

To achieve the mentioned technical result preds. The protective frame is made in the form of a plate with a hole, on a path which passes the side with a ledge along the side of the protective frame is made holes suture thread on the ledge next to the stack grid which press the cover congruent to the side of the protective frame with a hole in the upper part, following the contour of the bottom of the lid has a notch having the opportunity to interact with the tab on the side and fixing holes suture thread is located along a side.

Distinctive features of this device are that:

- additionally contains a grid,

- placed on the contour of the hole of the side plate and congruent to the side of the cover,

the backsplash is made for loading and unloading the grid, and the grid is made for cuddling cover, the lower part of which is hollow, having the opportunity to interact with the tab on the side and fixing

- hole suture thread is located along a side.

The device laparostomy isolates the tissue of the anterior abdominal wall from the free abdominal cavity. Reduced infection of the tissues of the abdominal wall pathological peritoneal exudate, which is the prevention of suppuration of the middle wounds in paleoparadoxia solutions (saline solution) and at the same time, given that the abdominal cavity remains open, freely withdraw gas (oxygen). In such conditions, when the abdominal cavity is open, intra-abdominal pressure during the active rehabilitation will be increased slightly. Due to the design it creates a layer of liquid (water trap), which dissociates the abdominal cavity from the external environment. This protection of the abdominal cavity from the external environment prevents drying of the abdominal cover, reduces the risk of secondary infection of the abdominal cavity. The device eliminates evisceration (loss) of internal organs through laparotomy.

The device illustrated by the drawings, is shown in Fig.4 and Fig.5.

In Fig.4 - the device is disassembled.

In Fig.5 - the device is fully assembled.

The method is as follows. After elimination of the source of peritonitis lavage and drainage of the abdominal cavity the greater omentum is attached to a small gland that it does not impede the outflow of peritoneal exudate in laparotomy. In the left (D) and right (C) mesenteric sinus, left () and right (A) subphrenic space are tube-irrigators. Drainage pipes are installed in the cavity of the lesser pelvis (E) and right (F) and , which are conducted by the esophagus, through the stomach and the small intestine). In laparotomic wound hub U-joints (10), carried out through all the tissues of the abdominal wall, into the protective frame (1). Between the device and laparotomic wound laid gauze (11), richly impregnated with ointment. Thus, the tissue of the abdominal wall are isolated from the abdominal cavity. In the recovery room through the tube-irrigators (A, B, C, D) starts the supply of the humidified oxygen under a pressure of 0.2 ATM, and through the hole (9) of the lid joins the physiological salt solution (NaCl 0,9%). Saline solution has the least damaging effect on the cells of the abdominal cover and to a lesser extent has the effect of peritoneal dialysis. The feed rate of the liquid and the volume of the gas are selected so as to create in the device layer of fluid, which serves as a delimiter between two media (the abdominal cavity and atmosphere), and thereby creates a hydraulic lock. The liquid is gradually disappearing from the device into the abdominal cavity, where it meets with the ascending gas stream of oxygen. The oxygen goes through the hole (9) of the device. Turbulent-liquid bubbly flows. You receive the effect of churning, which region is yset oxygenation of the tissues, reduces adhesions. The outflow of peritoneal exudate is drainages (E, F, K), and for recovery of the liquid layer through the opening (9) drip device continues to receive saline. The effect of “mini-kit” of the abdominal cavity. The volume of injected saline 3-5 liters per day. A small amount injected into the abdominal cavity saline to a lesser extent than in the dialysis causes a negative effect of leaching through the peritoneum of electrolytes and proteins. 24-48 hours is planned revision of the abdominal cavity: the design is removed, sterilized by standard methods in the solution of formic acid. The abdominal cavity is inspected, separated loose spikes, check the patency of the drainage (E, F, K) and tubes of irrigators (a, b, C) is washing and thorough drainage of the abdominal cavity. If the phenomenon of peritonitis was not stopped, the device laparoscopically wound is restored, active remediation of the abdomen continues. Gauze napkins (11) richly impregnated with ointment are changed daily. They additionally provide sealing devices protect the tissues of the abdominal wall from drying out and infected the Le which the tube-irrigators (A, B, C, D) are removed. Drainage tube (E, F, K) are left. Layers stitched together with laparotomic wound, thereby closes the abdominal cavity. If left drainages (E, F, K) in the postoperative period cease to function (it stops no exudate in the abdominal cavity), they should be removed.

Using the proposed method can significantly improve the effectiveness of rehabilitation (purification) of the abdominal cavity, thereby improving the results of treatment of peritonitis. This is achieved by creating upward gas flow and counter him liquid through laparotomy. In the abdominal cavity, turbulent motion, which has a high mechanical cleansing effect. This readjustment is carried out at laparotomy. The gas exits through the open abdominal cavity (laparoscopy), the pressure in the abdominal cavity remains elevated slightly. Such conditions for the blood supply to internal organs, are more favorable than the terms closed abdominal cavity, when intra-abdominal pressure during peritonitis due to paresis of the intestine, always increased. Arising in the abdominal cavity turbulent motion causes not only a cleansing effect, but also prevents slipcovered the sticking of the internal organs with each other. Due to this, in the abdominal cavity are formed less blind pockets and closed cavities, which accumulates the peritoneal exudate. Inserted into the abdominal cavity oxygen bactericidal effect on the microflora and oxygenates (saturates tissues with oxygen) to the tissues of the abdominal organs, improving their nutrition and blood supply. Save laparotomy (open abdomen) can significantly reduce intra-abdominal pressure. A constant supply of the liquid solution (saline solution) through laparotomy allows you to save in the abdominal cavity moist environment, preventing the drying of the abdominal integument. Drying peritoneal cover internal organs causes damage to the cells of the peritoneum, which increases adhesions in the abdominal cavity. Thanks to the continuous introduction of liquid through laparotomy and remove the drainage tubes is constant washing of the abdominal cavity (lavage) that provides separation and removal of the pathological exudate. Given that the amount of fluid in the abdominal cavity per day does not exceed 3-5 liters, there is no negative effect of peritoneal dialysis. Additionally installed drains allow you to more effectively remove the Ute soft tissue of the abdominal wall from drying and infection improve the sealing function of the device.

The proposed method can improve the efficiency of the treatment of generalized peritonitis due to a combination of active rehabilitation of the abdominal cavity in laparotomy through the creation of an ascending gas (oxygen) flow and counter him downward liquid flow (physiological solution) inside the abdominal cavity with the current software revision of the abdominal cavity. Oppositely directed gas and liquid flow causes turbulence, has a cleansing effect. Additionally installed drains allow you to more effectively remove the pathological exudate and rinse water.

Clinical example.

Patient, 65 years admitted in serious condition with the hospital of peritonitis.

History: 10 years, suffering from gastric ulcer with frequent exacerbations. Recent exacerbation of two weeks ago. Day ago there was a sudden sharp pain in the upper abdomen, which is then slightly decreased, but not passed. The pain has not disappeared, radiate along the right side of the channel, and then spread throughout the abdomen.

Objectively: a serious condition, acrocyanosis (cyanosis cognita heart rate (HR) 130 minutes Belly swollen, in the act of breathing is not involved, the noise of intestinal peristalsis is not heard, palpation moderate strain in all departments with positive peritoneal reaction. In the blood - marked leukocytosis with a shift of neutrophils to the young forms. After 3-hour preoperative preparation of the patient is taken to the operating room.

Operation: the patient is laid on the operating table in position lying on the back”. The bladder is supplied catheter to monitor urine output. In the stomach entered the probe. The patient is given endotracheal anesthesia (ATN). After treatment, the surgical field is made orgnanization laparotomy - opened the abdominal cavity. In all departments of the abdominal cavity muddy purulent-fibrinous effusion in an amount of about 2 liters, taken sowing effusion to determine the spectrum of microflora and its sensitivity to antibiotics. The drainage of the abdominal cavity by the suction apparatus. During inspection found perforating ulcer of the front wall of the pyloric stomach, which is stitched according to the method of the Oppel-gear. There is diffuse purulent-fibrinous peritonitis in the toxic phase: the loops of the intestines is not strippable deposits of fibrin. The belly is swollen, crimson, thin loop of intestines paretic. The device in RA what's cavity with furatsilina (10 liters), the drainage. The small intestine intubirovannah transnationale. Evacuated to 1 liter of stagnant content. In shallow places of the abdomen in the right side channel, left side channel and pelvis installed PVC drainage tube (E, F, K), which is removed through a separate incision on the anterior abdominal wall. The drainage tube is hermetically fixed to the skin. Tube-irrigators (A, B, C, D) is installed in the left and right mesenteric sinus and subphrenic space left and right. The greater omentum is encased with interrupted sutures to the small gland. Protective frame stitched through all layers along the contour laparotomic wound. Cover design worn on the side of the protective frame. Thus, the device tightly sewn in laparotomic wound. Between the device and the tissue laparotomic wound padded gauze cloth, richly impregnated with ointment Vishnevskogo (liniment balsamic on Vishnevskaya).

In the postoperative period the patient is in an epidural space of the spine has a catheter for the treatment of pain and paresis of the intestine (so-called an epidural block). Further on the background of an epidural block was performed oxygen flow through the tube irrigators in the abdominal cavity, and through the round hole and between the abdominal cavity and the external environment (water seal). The oxygen before it enters the tube-irrigators passes through a saline solution for hydration. Oxygen is supplied under pressure of 0.2 ATM. The outflow of the peritoneal exudate was carried out through the drainage tube. The flow of saline 3-5 liters per day. The flow of saline solution is selected so that the device remained fluid layer, creating a hydraulic lock. Ligation was carried out on a daily basis. Changed napkins with ointment Vishnevskogo. When the ligation cover was removed and the grid was examined loops of bowel, set forth to the wound. Then cover and the mesh was put back in working condition. Peristalsis intestinal appeared on the second day, decreased clinical signs of endotoxemia. Two days (48 hours) produced the planned revision of the abdominal cavity. The device is removed from laparotomic wound. Inspected (audited) the abdominal cavity. Effusion scant serous nature, loops of intestines spachina will peristaltic, serous cover hot pink color, tarnish fibrin no. Thus, peritonitis regressed. Tube-irrigators have been removed. Left drain tube. Laparotomic wound was sutured in layers. In the postoperative period after revision of the abdominal cavity response.

Detachable drainage pipes no, they are removed. On the third day the patient is fully transferred to enteral (natural) power, independently began to leave Gaza, was the chair. On the fifth day the patient began to walk. The wound healed by first intention, the sutures were removed on the tenth day after the last operation. The patient was in the hospital after receipt 18 of bed-days. Discharged in a satisfactory condition without complications.

To obtain this result, the proposed method of treatment of peritonitis used the device (Fig.4 and Fig.5) to create laparotomy (open mid wounds of the abdomen), containing protective frame (1) in the form of a plate with a hole is made for sewing the contour laparotomic wound (median wound of the abdomen), and having a hole suture thread (5). The shape of the hole (2) place the knob (3) with the tab (4), along a side (3). The device further comprises a grid (6). On the ledge (4) side (3) stack the grid (6) which press the cover (7), congruent with the knob (3) the protective frame (1) with the hole (9) in the cover (7) in its upper part. The contour of the lower part of the cover (7) has a recess (8) interacting with the tab (4) on the rim (3) the protective frame (1) with vozmojnosty, that is oval, and is made, for example, made of polyethylene with a thickness of 5 mm In the center of the protective frame (1) has a hole (2), also oval in shape. The shape of the hole (2) holds the knob (3) height of 20 mm In the upper part of the rim (3), around its contour, there is a protrusion (4) 5×5 mm On the protective frame (1) throughout its path, along a side (3) is made of punched holes (5) with a diameter of 3 mm under the suture thread. On the protective frame (1) is placed a plastic grid (6), which closes the oval hole (2) the protective frame (1). Its thickness 3 mm Cover (7) oval shape has a side wall height of 50 mm and its perimeter corresponds to the perimeter of the oval holes (2) the protective frame (1). At the top of the lid has a circular hole (9) with a diameter of 30 mm 20 mm from the bottom edge of the side wall of the lid (7) around the perimeter there is a recess (8), congruent ledge (4) the protective frame (1). Due to their elastic interaction is commit.

The device in laparotomic wound is as follows. The whole structure is sterilized by standard methods in the solution of formic acid. Protective frame (1) is filed in the office laparotomic wound nodal P-stitching through all layers of the abdominal wall for the fast isolation of dissected tissues of the abdominal wall from the abdominal cavity. In addition, the horizontal portion of the protective frame (1) is also included in the abdominal cavity and additional isolates from her abdominal wall tissue. On the protective frame (1) fit the grid (6), then put the cover (7), which is tightly fixed to the protective frame (1) through congruent communication between the protrusion (4) of the rim (3) the protective frame (1) and the recess (8) of the lid (7). Between the dissected tissues of the abdominal wall and the design fit wipes, ointment, which mechanically protects the soft tissue and further ensures the integrity of the abdominal cavity. Wipes periodically change 1 time per day during bandaging. At the next revision of the device is completely removed. If peritonitis is not stopped, the device is again restored, creating an airtight laparostomy. When mild peritonitis, after removal of the device at the next revision, the median wound was sutured in layers. The abdominal cavity is closed.

The device operates as follows. In the postoperative period through a round hole (9) of the lid (7) is fed drip saline. With the introduction of saline into the design creates a fluid layer that separates the abdominal cavity from the external environment and slum. Gas (oxygen), which is fed through tubes-irrigators, goes through a round hole (9) of the lid (7). Saline, gravity, gradually disappearing into the abdominal cavity. Washes her organs and is removed via drain tubes. Therefore, the fluid layer in the structure is constantly restored by drip insertion through a circular hole (9) of the lid (7). Thus, a continuous lavage of the abdominal cavity.

The device enables the creation of a sealed laparotomy, which allows you to open the abdominal cavity to enter a sterile liquid (saline solution) to meet the rising gas stream. When the gas passes freely through the layer of fluid in the device (water trap) and goes through a round hole (9) of the lid (7), without creating a high intra-abdominal pressure. The device allows you to isolate tissue of the anterior abdominal wall from the free abdominal cavity, which reduces their infection and renders prophylactic action suppuration of the middle wounds after suturing. Thanks to the device that creates Hermeticism between the dissected tissues of the abdominal wall and abdominal cavity during introduction through her physiological solution, creates a layer of liquid (gidravlicheskiy least traumatic to separate environments unlike synthetic materials (gauze, various types of nets, films) used in other laparostomy to protect predlagash to laparotomic wound intestinal loops of the small intestine from drying and secondary infection throughout the abdomen. The device eliminates eventration (prolapse of internal organs). The device allows you to visually control the dynamics of the inflammatory process, as the ligation cover (7) and the grid (6) can be removed from the protective frame (1) and to examine certain to laparotomic wound loops of bowel and to evaluate their morphological changes. Then again put the grid (6) on the protective frame (1) and replace the cover (7), bringing the device to a working state.

The proposed device and method is used in practice in the treatment of generalized forms of peritonitis in the emergency surgical Department of the City clinical hospital №1, Novokuznetsk.

Claims

1. The method of rehabilitation of the abdominal cavity in the generalized peritonitis, including the flow of gas through the tube irrigators and fluid in the abdominal cavity, drainage of exudate and gas, characterized in that the gas serves oxygen through tube-implemented irrigation is, which goes through laparotomy which is in the opposite direction serves saline drainage of exudate passes through the drain tube installed in the pelvic cavity and along the right and left side channels, 24-48 hours carry out the planned revision of the abdominal cavity.

2. Device for creating laparostomy containing protective frame in the form of a plate with a hole is made for sewing the contour laparotomic wound and having a hole suture thread, characterized in that it further comprises a grid placed on the contour of the hole of the side plate and congruent to the side of the lid and the rim is made for loading and unloading the grid, and the grid is made for cuddling cover, the lower part of which is hollow, having the opportunity to interact with the tab on the side and fixing holes suture thread is located along a side.



 

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FIELD: medicine.

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

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