Video endoscopy method for treating abscesses with puncture drains

FIELD: medicine.

SUBSTANCE: method involves puncturing pyogenic abscess cavity under ultrasonic control with draining tube left therein. Laparoscope connected to monitor unit is introduced into abscess cavity. One of introduced drains is set in upper point of the cavity and the other one in lower point. The abscess cavity is filled with ozonized solution to 2/3 of its volume and bubbled with ozone-oxygen mixture during 2-3 min changing the solution until it becomes transparent. The emptied cavity walls are treated from distance of 3-4 cm with laminar airflow heated to 38-40°C under pressure of 1-1.5 atm during 2-3 min. Next to it, the cavity walls are irradiated from distance of 2-3 cm with non-coherent red light during 2-3 min per each area.

EFFECT: improved safety conditions and healing quality.

 

The invention relates to medicine, namely to video endoscopic surgery.

The known method puncture and aspiration and drainage treatment of the abscess under ultrasound control (Afernoon, Adetimehin, Vueling, Wiesco. “Puncture and aspiration and drainage treatments in abdominal surgery”, Annals of surgery. No. 2, 1997, pp.42-47), lies in the puncture and drainage of the purulent cavity by one or more drains, depending on its volume, by washing with antiseptics.

The disadvantage of the existing method is, first, the inability to visually assess the degree of necrotic tissue damage inside the cavity, and secondly, this method allows only to evacuate the contents of the abscess, but does not allow high-quality processing of the walls of the cavity.

The technical result of the invention is to improve the quality of rehabilitation abscess cavity and safer manipulation through process visualization on the monitor screen.

The technical result is achieved in that in the cavity of the abscess under ultrasound entered 2 perforated drainage, one of which is placed at the top and one at the lower end of the cavity, and the laparoscope is 2 mm in diameter, attached to the monitor. Under the control of correction of the position of the drains. Then filling the cavity 2/3 of the amount of the ozonated physiological the practical solution concentration 1000-1500 mcg/l so, to the laparoscope and the upper drainage was out of fluid. Through the bottom drainage under the control of the image on the monitor is bubbling cavity of the ozone-oxygen mixture obtained in the ozonizer, for 2-3 minutes While the excess gas is removed by aspiration through the upper drainage. After this suspension is aspirated and the procedure is repeated to obtain a clear solution. Then the liquid is removed from the cavity and the walls of the cavity will be processed within 2-3 min in a laminar stream of air from a distance of 3-4 cm under pressure of 1-1,5 ATM, at a temperature of 38-40°also under the control of the video camera. After that, the wall cavity is affected by the emission of incoherent red light for 2-3 minutes on each phase from a distance of 2-3 cm

The method is as follows: pre-during ultrasound estimated localization of the abscess and the possibility of puncture and aspiration and drainage treatment. Then under ultrasound abscess cavity punctured two trocars through which are 2 specially perforated drainage so that one was located towards the bottom of the abscess and the other to his vault. The contents of the abscess was evacuated and its cavity is entered laparoscope with a diameter of 2 mm, is connected to the monitor. Visually estimated wall, the complexity of configuration Polo the year and the position of the drains. If necessary, the drains are shifted in the right direction. Then through the lower drainage of the abscess cavity is filled with ozonated saline solution at a concentration of 1,000-1,500 mg/l to 2/3 of its volume so that the laparoscope and the upper drainage was out of fluid. After that, the upper drain connected to the aspirator, and through the bottom under pressure of 1-1,5 ATM served ozone-oxygen mixture. Thus produce bubbling cavity within 2-3 minutes Received a suspension through the bottom drainage aspirinum and the procedure is repeated several times to obtain a clear solution. The resulting liquid is evacuated and remove both drainage. Through one of the remaining trocars wall cavity under the control of the image on the monitor handled in a laminar stream of air heated to a temperature of 38-40°C for 2-3 min from a distance of 3-4 cm under pressure of 1-1,5 ATM. Further, between the light source of the illuminator and the optical fiber is installed filter KS-10 and the cavity is treated non-coherent red light for 2-3 minutes on each irradiated area, and then is introduced into the cavity perforated for drainage outflow of fluid and the trocar with the camera removed.

Example: Patient S., 62 years old, was admitted to the Department of purulent surgery Bureau No. 1 in Voronezh with the diagnosis of liver Abscess”. The ultrasound revealed a liquid image is of the left lobe of the liver size of 8.0× 11,0 see After further examination under the ultrasound control access in the right hypochondrium produced by the puncture of the abscess two trocars with a diameter of 4 mm was Removed, 200 ml of pus with a foul smell. In the cavity entered the laparoscope with a diameter of 2 mm, is connected to the monitor. The cavity is inspected. Through the trocars under the control of the image set perforated drainage type pig-tail 10 Fr - one at the top and one at the lower end of the cavity. Through the bottom drainage optionally aspirated 50 ml of pus. Then through it introduced 200 ml of ozonated saline solution to a concentration of 1000 µg/L. the Upper drainage is connected to a suction pump with a vacuum of 1 ATM, and was fed through the bottom of the ozone-oxygen mixture from the ozone “Medozons-M” under the pressure of 1 ATM. The bubbling was continued for 3 minutes Obtained suspension is aspirated through the bottom drainage. The manipulation was repeated 5 times to obtain a clear solution. Then the drains were removed, and through one of the remaining trocars wall cavity was processed in a laminar stream of air heated to a temperature of 40°under the pressure of 1 ATM for 2 minutes from a distance of 3-4 cm After drying one of the trocars were removed. Later in the xenon illuminator between the light source and the optical fiber is placed a filter KS-10. Thus, in the abscess cavity from the tip of the laparoscope was obtained cone nekoga entogo red light, giving at a distance of 3 cm spot diameter of about 3 see the Walls of the cavity were consistently treated this light for 2 min on each parcel. Then introduced into the cavity perforated drainage type pig-tail 10 Fr, and the laparoscope and the trocar removed. Amid held antibacterial therapy and washing drainage 1% solution dioksidina the patient's condition rapidly improved. In the control ultrasound after 5 days of residual cavity around the drainage has decreased to $ 3.0×4,0 see after 5 More days the patient after fistulografii and removal of drainage was discharged home.

The proposed method of treatment allows to produce high-quality, visually controlled reorganization of the abscess cavity. The method can be used to treat abscesses of any localization in the absence of contraindications for puncture and aspiration and drainage treatment method.

The way video endoscopic puncture and aspiration and drainage treatment of abscesses, which consists in puncturing the cavity of the abscess under ultrasound leaving drainage, characterized in that the cavity of the abscess is inserted laparoscope connected to the monitor, one of the entered drains placed at the top and the other at the lower end of the cavity, then the abscess cavity is filled to 2/3 of its volume with ozonized solution and barbatiruem ozone-oxygen mixture for 2-3 min with Smena the solution, to obtain transparency, then wall drained cavity handled 2-3 min in a laminar stream of air heated to a temperature of 38-40 degrees, under pressure of 1-1,5 ATM, from a distance of 3-4 cm, and then the wall cavity is irradiated with incoherent red light for 2-3 minutes on each phase from a distance of 2-3 cm



 

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