Method for treating residual cavity following marsupialisation and open echinococcectomy

FIELD: medicine.

SUBSTANCE: two-duct drain tube is intraoperatively inserted into a residual cavity. The tube is delivered onto an anterior abdominal wall. The cyst cavity is irrigated with 0.05% chlorhexidine every day from the second postoperative day that is followed by administering the preparation of 10% povidone iodine with the drain tube pinched for 3-5 minutes. The procedure is performed until the cyst cavity is eliminated completely.

EFFECT: method provides the reliable treatment of the residual cyst cavity following marsupialisation and open echinococcectomy, as well as prevents the postoperative complications by achieving the aseptic inflammation of the inner surface of the fibrous capsule surface followed by the cyst cavity obliteration.

2 dwg, 2 ex

 

The invention relates to the field of medicine, namely to surgical treatment of echinococcosis of the liver, and can be used to close the residual cavities after marsupialization and open echinococcectomy.

From the practice of medicine known methods of treatment of the residual cavity: gauze plugging, closure inside the cavity of the node, Z-shaped multi-row stitches (Agaev R. M. Surgical treatment of echinococcosis of the liver and its complications. Surgery 2001; 2: 32-36).

The disadvantages of the known methods are:

slow filling of the residual cavity;

- bleeding;

- geleitete;

- the pathological accumulation of fluid with a possible abscess;

- the duration of stay of a patient in a hospital bed;

- long disability and possible disability;

- education in the late postoperative period cysts that require repeated surgical intervention;

- the possibility of formation of postoperative hernia in the area of stitch fibrous capsule to the anterior abdominal wall.

The closest analogue prototype is a method of treatment of the residual cavity: plugging the cavity of the cyst, formed by suturing the edges of the fibrous capsule to the wound of the anterior abdominal wall (marsupializatsiya), ointment swab and/or thick drainage� tube (Sergiev V. P., Legonikov Y. A., O. G. Poletayev, Topolska N. And. Cystic echinococcosis (one-part) clinic, diagnosis, treatment prevention. Information-methodical textbook, Moscow 2008; page 21).

The invention is directed to improving the reliability of the treatment of the residual cavity after marsupialization and open echinococcectomy and prevention of postoperative complications.

Said technical result is achieved in that during the operation in the remaining cavity set dual drainage tube, which is drawn on the anterior abdominal wall, and then in the postoperative period on the second day daily lavage of the cavity of the cyst with a solution of chlorhexidine 0,05% with the subsequent introduction of the drug povidone-iodine 10% and a clamped drain tube for 3-5 minutes, and the procedure can be performed to eradicate the cyst cavity.

Introduction to residual cavity after marsupialization and open echinococcectomy two channel drainage tube according to the principle of irrigation and aspiration of chlorhexidine 0.05% and with the subsequent introduction of the solution povidone-iodine 10%, and clamping the drainage tube with the exposition 3-5 minutes, causes aseptic inflammation of the internal surface of the fibrous capsule, which subsequently promotes the formation of connective tissue, through which there is obliteration �sufficient cavity.

The present invention is tested on 6 patients in CB No. 2 FSI WAMC FMBA of Russia Astrakhan during the 2012-2013

Below are the results of testing.

Example 1. Patient A., born in 1967, was hospitalized in the surgical Department of the clinical hospital 2 FSI WAMC FMBA of Russia with 08.11.12 with a diagnosis Ehinokkosis liver. From the anamnesis: the patient considers himself since 2004, when I first came pain in the right hypochondrium. During the examination the ultrasound revealed a cyst of the liver. Ctot 17.10.12 - CT data for solitary cyst liquid 7-8 segments of the right lobe of the liver, size 8,04,04,0 cm, parasitic etiology. 09.11.12 operated planned, executed echinococcectomy with marsupializatsiya, during the operation in the remaining cavity was installed two-channel drain pipe, which is derived on the anterior abdominal wall, and then in the postoperative period on the second day were made daily lavage of the cavity of the cyst with a solution of chlorhexidine 0,05% with the subsequent introduction of the drug povidone-iodine 10% and the compression of the drainage tube for 3 minutes, the procedure was performed until complete elimination of the cavity of the cyst. During dynamic ULTRASOUND study on day 4 after surgery (see Fig. 1) the cavity size to 4,02,0 cm, on the 7th day after the operation (see Fig. 2) under dynamic ULTRASOUND study of the cavity of the cyst in place of standing drainpipe neopredelennoi. At 12 months after surgery, recurrence of the disease is not checked.

Example 2. Patient R., born in 1959, was hospitalized in the surgical Department of the clinical hospital 2 FSI WAMC FMBA of Russia with 04.04.13 with a diagnosis Ehinokkosis liver. From the anamnesis: considers himself sick since 2009 when I first began to disturb pains in the right hypochondrium. The survey CTOBP from 25.03.13 - CT data for parasitic cyst 7 segment liver size 7,03,52,4 see 08.04.13 operated planned, executed echinococcectomy with marsupializatsiya: during the operation in the remaining cavity was installed two-channel drain pipe, which is derived on the anterior abdominal wall, and then in the postoperative period on the second day were made daily lavage of the cyst cavity with chlorhexidine 0.05% and the introduction of the drug povidone-iodine 10% with a clamped drain tube for 5 minutes, the procedure was performed until complete elimination of the cavity of the cyst. On the 8th day after the operation under dynamic ULTRASOUND study of the cavity of the cyst in place of standing drain pipe was not determined. 6 months after surgery, recurrence of the disease is not checked.

The proposed method achieved:

- improving the reliability of the treatment of the residual cavity after marsupialization and open echinococcectomy;

- the most rapidly filling the residual cavity �soedinitelnoj cloth;

- the prevention of postoperative complications;

the exception, of bleeding and geleitete;

- exclusion of pathological accumulation of fluid in the cavity of the cyst;

- exclusion of long-term disability;

- prevent the formation of secondary cysts in the area of operation;

- prevent the formation of postoperative hernia in place, stitch the fibrous capsule to the anterior abdominal wall.

Method of treatment of the residual cavity after marsupialization and open echinococcectomy by plugging the cavity of the cyst, formed by suturing the edges of the fibrous capsule to the wound of abdominal wall with drainage tube, characterized in that during the operation in the remaining cavity set dual drainage tube, which is drawn on the anterior abdominal wall, and then in the postoperative period on the second day daily lavage of the cavity of the cyst with a solution of chlorhexidine 0,05% with the subsequent introduction of the drug povidone-iodine 10% and a clamped drain tube for 3-5 minutes, and the procedure can be performed to eradicate the cyst cavity.



 

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1 ex

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14 cl, 3 dwg, 4 tbl, 13 ex

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