RU2272584C1 - Method for draining a cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves layer-by-layer infiltrating tissue above cavity with Novocain, making test cavity puncture with needle and skin incision, introducing trocar and draining the cavity with Foley catheter. The needle is left in the cavity as guide member for introducing the trocar. When taking cavity content, the needle is removed after having removed stiletto. The Foley catheter is introduced into the cavity through nonseparable metal bush sleeve. The trocar bush sleeve is removed from the cavity and taken away from the catheter. The bush sleeve is withdrawn through lateral slit being as long as the bush sleeve and 1/2 diameter in width.

EFFECT: high accuracy in introducing trocar; reduced risk of traumatic complications; enhanced effectiveness in draining cavities having rigid walls.

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Description

The invention relates to medicine, namely to surgery.

The drainage of the cavity consists in the introduction of a tube through the wall into it.

A known method of drainage of the cavity, proposed by the authors as an analogue (Operative surgery. / Ed. I. Littmann. - Budapest, Publishing House of the Academy of Sciences of Hungary, 1982. - P.77-78).

At the target point, layer-by-layer tissue infiltration is performed over the cavity with a 0.25% novocaine solution. At this point, a test puncture of the cavity is made with a needle. Upon receipt of the contents of the cavity (air, liquid, pus ...), the needle is removed. A skin incision is made 1 cm long at the site of the previous puncture with a needle, a trocar consisting of a sleeve and a pointed stylet with a handle is inserted through this incision (Operative Surgery and Topographic Anatomy. / Ed. V.V. Kovanov, - 2nd ed. - M .: Medicine. - 1985. - S.195-201). After removal of the trocar stylet, a drainage tube made of tubular rubber 40 cm long and with a diameter corresponding to the diameter of the trocar is inserted into the pleural cavity through the sleeve. At the working end of the tube there are three side holes with a diameter of 3 mm, located at a distance of 3 cm from each other. The sleeve of the trocar is removed from the wall of the cavity, while the working end of the drainage tube remains in the cavity, and its outer end is inside the sleeve of the trocar located outside the human body. The sleeve is removed from the drainage tube “like a boot from a foot”. The drainage tube is fixed with a thread. The thread is stitched through the skin in the area of the skin incision, a knot is tied to form a bridle, the drainage tube is fixed by knotting.

Some of the disadvantages of this method are:

- it is possible to introduce an excess fragment of the drainage tube into the cavity, which affects the quality of the drainage,

- with prolonged drainage, eruption of the fixing skin thread and loss of the drainage tube is possible,

- since the drainage tube does not have a locking mechanism, it is possible to leak fluid from the cavity (or air with the development of subcutaneous emphysema), as well as air leakage into the cavity,

- the impossibility of installing such drainage tubes, the outer ends of which have thickenings — means for fixing them on the patient’s body or branching according to the “Faley baloon catheter” type.

A known method of drainage of the cavity, proposed by the authors as a prototype (Kadoyama C., Ishikawa A., Shiba M. et al. A new sterilization technique with ball-tube thoracostomy for thoracic empyema. // Jpn J Thorac Cardiovasc Surg. - 2003. - Sep, No. 51 (9) .- P.413-419).

At the target point, layer-by-layer tissue infiltration is performed over the cavity with a 0.25% novocaine solution. At this point, a test puncture of the cavity is made with a needle. Upon receipt of the contents of the cavity (air, liquid, pus ...), the needle is removed. A skin incision is made 1 cm long at the site of the previous puncture with a needle, a trocar is introduced through this incision, consisting of a pointed stylet with a handle and a disposable plastic sleeve on the stylet, which is collapsible, has a groove-latch along the longitudinal axis and can be divided into two half-sleeves ( U.S. Patent 4,888,000, CL 604-064, publ. 1989). After removing the trocar stylet, a Faley baloon catheter is inserted into the cavity through a plastic sleeve and the fluid is pumped through the lateral branch of the catheter into the balloon at the working end of the catheter, which ensures fixation of the catheter in the cavity and sealing of the drainage wound channel. The trocar sleeve is removed from the cavity wall, while the working end of the drainage tube remains fixed in the cavity, and its outer end is inside the plastic sleeve located outside the human body. The sleeve is divided along the longitudinal axis and removed from the Faley baloon catheter.

Some of the disadvantages of this method are:

- the plastic collapsible sleeve of the trocar has a small mechanical strength, which is permissible when draining soft-walled cavities (for example, the bladder) and makes it extremely difficult to manipulate the walls of the cavities with rigid walls (for example, the chest wall with fibrotic thickened pleura in case of chronic pleural empyema),

- since the needle after the test puncture of the cavity is removed, the introduction of the trocar is partially blind, without a guide axis.

The authors propose the following method of drainage of the cavity.

At the target point, layer-by-layer tissue infiltration is performed over the cavity with a 0.25% novocaine solution. At this point, a test puncture of the cavity is made with a needle. Upon receipt of the contents of the cavity (air, liquid, pus ...) the needle is left in the cavity. A skin incision is made 1 cm long at the location of the needle, a modified trocar is introduced through this incision.

The trocar proposed by the authors (Fig. 1) consists of a sleeve (1) and a pointed stylet (2) with a handle (3). The sleeve of the trocar (figure 2) has a side slot (4) along the entire length of the sleeve with a width of 1/2 the diameter of the sleeve. It is possible to use a trocar of any size depending on the situation, however, the width of the slot on the sleeve is always half the diameter of the sleeve.

The needle inserted during the test puncture of the cavity is left as a guide in the cavity wall, which increases the accuracy of trocar insertion and reduces the risk of damage to organs near the drainage zone. After removal of the trocar stylet, upon receipt of the contents of the cavity, the needle is removed, a Faley baloon catheter is inserted through the sleeve into the cavity and fluid is pumped through the lateral branch of the catheter into the balloon at the working end of the catheter, which ensures the fixation of the catheter in the cavity and the drainage wound canal is sealed. The sleeve of the trocar is removed from the wall of the cavity, while the working end of the drainage tube remains fixed in the cavity, and its outer end is inside the sleeve located outside the human body. The sleeve is removed from the Faley catheter through a side slot on the sleeve.

The advantages of this method are:

- the use of a needle inserted during test puncture of the cavity as a guide increases the accuracy of the introduction of the trocar,

- the risk of damage to organs near the drainage zone is reduced, especially when draining limited small cavities,

- the metal non-separable sleeve of the trocar has great mechanical strength, which allows it to be used when draining not only soft-walled cavities, but cavities with rigid walls, for example, a pleural cavity with a fibrotic thickened pleura in case of chronic pleural empyema.

Clinical example. Patient C., medical history N 168 (tuberculosis sanatorium "Chernogubovo"). The operation of the drainage of the right pleural cavity due to empyema of the pleura with bronchial fistula.

The position of the patient sitting on a stool with his back arched back, resting his chest on the pillows that are laid on the table in front of the patient. At the point indicated by fluoroscopy, a layer-by-layer infiltration of the tissues of the chest wall is made with a 0.25% solution of novocaine. In this place, a test puncture of the pleural cavity is made along the upper edge of the rib with a needle; a thick greenish odorless pus is obtained. The needle is left in the pleural cavity, a skin incision is made 1 cm long at the location of the needle, through this incision, a trocar is introduced along the upper edge of the rib, consisting of a pointed stylet with a handle and a sleeve, which had a side slot along the entire length of the sleeve 1/2 width in diameter sleeves. After removing the trocar stylet, a Faley catheter is inserted through the sleeve into the pleural cavity, and the balloon at the working end of the catheter is inflated with physiological saline. The sleeve is removed from the chest cavity, while the working end of the Foley catheter remains in the pleural cavity, and its outer end is inside the sleeve located outside the human body. The sleeve is removed from the drainage tube through a side slot.

Thanks to the use of this method of drainage in a particular patient, it was possible to increase the accuracy of introducing the trocar along the guiding needle inserted during the test puncture of the pleural cavity, reduce the risk of damage to organs near the drainage zone (diaphragm, heart), and introduce a Faley catheter through a fibrotized thickened pleura.

The method can be used to drain the cavity of any location.

Claims (1)

A method for draining a cavity, including layer-by-layer tissue infiltration above the novocaine cavity, a test puncture of the cavity with a needle, a skin incision, the introduction of a trocar and drainage of the cavity with a Foley catheter, characterized in that the needle after the trial puncture is left in the cavity as a guide for introducing the trocar after removing the stylet when the contents of the cavity are obtained, the needle is removed, the Foley catheter is inserted into the cavity through a non-separable metal sleeve, the trocar sleeve is removed from the cavity and removed from the catheter, and the sleeve is removed through a lateral slot formed along the entire length of the sleeve width 1/2 the diameter of the sleeve.

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