RU2665459C2 - Drainage device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment and can be used to drain purulent cavities with heterogeneous contents that need regular thorough sanitation, especially relevant for the treatment of pancreatonecrosis. Drainage device consists of a drain tube located inside the irrigation tube and a liquid supply device. At the proximal end of the irrigation tube, a pressure control valve with a length of 1/4 to 1/3 of the diameter of the irrigation tube is cut, directed at an angle of at least 45 ° to the current of the liquid.

EFFECT: increase of efficiency and reduction of terms of treatment of purulent cavities with heterogeneous contents.

1 cl, 1 dwg

Description

The invention relates to medicine, in particular to surgery, and can be used for drainage of purulent cavities with heterogeneous contents, requiring regular thorough sanitation, especially relevant for the treatment of pancreatic necrosis.

A device for the tight drainage of a sanitized purulent cavity in the form of a double-lumen silicone tube (Kanshin N.N. et al. Herald of surgery, 1974, 11, pp. 25-31).

The disadvantage of this device is the inability to create a turbulent flow of the solution necessary for leaching necrotic tissue. Another disadvantage is the inability to discharge excess fluid, which leads to an increase in intracavitary pressure, and this, in turn, reduces the effectiveness of debridement or leads to the destruction of the walls of the cavity.

Closest to the claimed is a drainage device (US Pat. RF No. 2197286), consisting of a drain pipe with side openings and a narrow longitudinal channel for air, an irrigation tube passing inside the drain and having a nozzle at the working end for irrigation of the purulent cavity under pressure. The movement and positional stability of the irrigation tube is achieved by the presence of a steel core in it.

The disadvantage of the device selected as a prototype is that the antiseptic solution through the irrigation tube cannot be supplied under pressure. Spraying the solution through the nozzle does not create turbulent fluid flows that contribute to the active leaching of necrotic tissue.

Another disadvantage of the device is the holes on the drain tube, which can clog necrotic tissue.

The objective of the invention is to increase the efficiency and reduce the time of treatment of purulent cavities with heterogeneous contents.

The technical result of the task is achieved by the fact that in the drainage device, consisting of a drain tube located inside it of an irrigation tube and a fluid supply device, a pressure control valve with a length of 1/4 to 1/3 of the diameter of the irrigation tube is cut out at the proximal end of the irrigation tube, at an angle of at least 45 ° to the fluid flow.

The supply of the solution under high pressure creates turbulent fluid flows in the cavity, which contributes to better sanitation of the walls and leaching of necrotic tissue. The pressure control valve helps maintain optimal pressure, at which it is possible to maintain turbulent fluid flows inside the cavity, without the risk of stretching and damage, which is especially true for drainages installed intraoperatively, because the formation of the dense walls of the cavity and the wound channel occurs on the 7-10th day.

The optimum angle of inclination of the valve with respect to the fluid flow is at least 45 ° to the fluid flow, and the valve length is from 1/4 to 1/3 of the diameter of the irrigation tube. It is at these values that the pressure necessary to wash out the necrotic tissue from the cavity is created. If the valve is less than 1/4 of the diameter or the angle of inclination is less than 45 °, excess pressure is created inside the cavity, and necrotic tissue is moved to the walls of the cavity. With a valve size of more than 1/3 or an inclination angle of more than 45 °, the pressure in the cavity is not enough to wash out the necrotic tissues, and they circulate through the cavity, bypassing the drain pipe.

Thanks to the above structural differences, the sanitation of the cavity is improved, there is no need to replace the drainage or reoperation if it is ineffective. Therefore, improving efficiency and reducing the treatment time of purulent cavities with heterogeneous contents is achieved.

In FIG. 1 shows a General view of the inventive device, consisting of a drain pipe 1 located inside it of an irrigation tube 2, a pressure control valve 3 and a fluid supply device 4.

The device is used as follows, a drain tube 1 is installed in the cavity (intraoperatively or under ultrasound control). An irrigation tube 2 is installed in the drain pipe 1. A solution begins to flow through the irrigation pipe 2. The solution washes the liquid contents and necrotic tissue from the cavity due to the turbulent flow. As the cavity fills and the intracavitary pressure increases, excessively incoming fluid begins to be discharged through the pressure control valve 3, thereby maintaining a turbulent fluid flow inside the cavity. As the device 4 for supplying fluid, a Janet syringe is used.

Example 1. Patient G., 31, was admitted to St. Petersburg GBUZ Nikolaev hospital on 03.24.2016 with a diagnosis of Acute pancreatitis. Large focal pancreatic necrosis. Parapancreatic abscess. From the anamnesis it is known that he was sick for 3 days. Complaints of epigastric pain, radiating to the back. In a clinical blood test, an increase in white blood cell count to 13.3 × 10 ^ 9. In a b / x blood test, chiles. Amylase 557 U / L, Bilirubin 25.7 mmol / L, Glucose 14.3 mmol / L, Creatinine 214 mmol / L, Lipase 3162 U / L According to ultrasound: pronounced edema of the pancreas and paranephral tissue. The parapancreatic abscess that formed and revealed during SKT was drained under ultrasound monitoring on 05/04/2016 with a TMMK double-lumen tube through which it was sanitized. 04/18/2016 tube clogged with sequesters, attempts to flush are ineffective. Again, under the control of ultrasound, a new TMMK double-lumen tube was installed. The latter clogged with sequesters and ceased to function 04/22/2016.

Under ultrasound control, the claimed drainage device was installed in the area of the parapancreatic abscess, through which daily sanitation of the abscess cavity was carried out, during which sequestration abundantly clogged the previous tubes of TMMK. The patient's condition progressively improved. On the 2nd day after the drainage change, the pain significantly decreased, and the fever subsided. 05/18/16 sequestration ceased to depart. 05/23/2016 on the control ultrasound of the cavity is not detected. Drainage removed from the channel. 05/25/2016 the patient was discharged. In this clinical case, we managed to avoid repeated surgery, which would be inevitable if the drainage was ineffective.

Example 2. Patient L. 38 l. was admitted to St. Petersburg GBUZ Mykolayiv hospital on October 12, 2016 with a diagnosis of Acute pancreatitis. Subtotal pancreatic necrosis. Omentobursitis. Purulent parapancreatitis, purulent paracololar streak on the left. Reactive hydrothorax on the left. According to the severity of the condition, the patient was hospitalized in the intensive care unit of anesthesiology and intensive care. On October 17, 2016, an autopsy and drainage of the infiltrate in the left lumbar region were performed. 10/19/2016 The patient underwent autopsy, rehabilitation and drainage of the retroperitoneal space on the left. 10/27/2016 with SCT revealed a purulent leak in the left paracolar space.

Performed ultrasound-assisted drainage of this abscess of the claimed device. The patient received a daily toilet of the purulent drip cavity with antiseptic solutions. 11/25/2016 the drainage is blocked. 11/30/2012 drainage removed. In this clinical case, despite a large abscess, we managed to avoid a large, severe and traumatic operation. 12/02/2016, the patient was discharged.

The inventive device allows to improve the results of treatment of purulent cavities, especially in patients with acute pancreatitis complicated by pancreatic necrosis, because:

- promotes better sanitation of purulent cavities

- avoids surgical interventions associated with impossible adequate sanitation of purulent cavities with conventional drainage systems

- ease of manufacture and use of the drainage system makes it accessible to surgical hospitals.

The device allows to avoid traumatic surgical interventions and reduces the surgical trauma caused to patients while ensuring adequate sanitation of purulent cavities.

When using the inventive device, purulent cavities (abscesses) heal 30% faster than when using TMMK tubes, and 45% faster than when using conventional single-lumen drains.

Claims (1)

A drainage device consisting of a drain pipe located inside it of an irrigation tube and a fluid supply device, characterized in that a pressure control valve is cut at the proximal end of the irrigation tube from 1/4 to 1/3 of the diameter of the irrigation tube, directed at an angle of at least 45 ° to the fluid flow.

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