RU118537U1 - DEVICE FOR TREATMENT OF COMPLICATED COLOSLOSTS - Google Patents

Abstract

A device for the treatment of complicated colostomy, which consists in the fact that it has a frame, separated by 6.5-10 cm from each other, two concentric rigid rings with diameters of 7-8 ÷ 9-10 cm, connected by several posts, between which there are clamps- retainers of the edges of the stoma intestine, and the retainers are fixed on the proximally distant ring on rigid suspensions, and the edges of the opposite ring of the base are covalent.

Description

The proposed utility model relates to medicine, namely to abdominal surgery and colorectal cancer surgery, in particular, to the treatment of colostomy complications.

According to WHO data, from 20 to 65% of abdominal coloproctologic operations are completed with bowel stomatology. So, according to the Ministry of Health of the Russian Federation in 1991, up to 1.5-1.6 thousand patients are staged per 1 million population (EG Grigoryev, Surgery for a colostomy patient. Novosibirsk: Nauka, 2001. P.67). The first place among postoperative complications today continues to occupy a purulent surgical infection (6-67%). The number of purulent-inflammatory complications in the formation of an artificial anus is from 1.6 to 45%, suppurative processes of the pelvic cavity from 6 to 20%, with colonic anastomoses insolvency from 4 to 20%, peritonitis from 40 to 80% (Zakharchenko A.A., Shtoppel A.E. City Center of Coloproctology. - Krasnoyarsk, 2006). The imposition of low colorectal anastomoses is always accompanied by great technical difficulties, which in some cases leads to inconsistency of the sutures, the development of peritonitis, accompanied by high mortality up to 45-92.8% (Karimov Sh.I. et al., 1998; Isaev GB , 2002; Wang A., 2000). Complications in the field of terminal colostomy are found in 6.6-74% of patients, in the early postoperative period - 5.2-37%, and in the more remote periods of observation, complications range from 4.3 to 90.9% (Vorobev G. I., Tsar'kov P.V., 2001). Various methods of treatment are used to combat these complications. All methods of treatment differ in both certain advantages and significant disadvantages. But it is not always possible to completely localize the source of peritonitis from the side of the stomized intestine and paracolostomy wound, using various methods and devices for treating peritonitis, not without significant drawbacks, since they do not eliminate the possibility of necrosis of the removed intestine, the occurrence of paracolostomy abscesses, retraction of the colostomy, and small intestine event in colostomy, the danger of suppuration of the wound of the abdominal wall, do not provide an effective outflow of contents from the abdominal cavity, do not prevent the formation of interintestinal x abscesses. All this emphasizes the relevance of further improving methods for treating colostomy complications and methods for eliminating them.

A known device used to prevent peritonitis in case of insolvency of the sutures of the end colostomy. It contains an apparatus with a vinyl sleeve, inserted rods with connecting rings / I.I. Taranov, R.Sh. Tenchurin. "A method for preventing peritonitis in case of inconsistency of sutures of the end colostomy." Patent: RU 2163468, 02.02.1999. Date of publication: February 27, 2001 /.

This device is used to prevent peritonitis in case of inconsistency of sutures of the end colostomy. Along the perimeter of the end colostomy, the wound and the skin around it are treated with antiseptics. An intestinal suture is applied to the edges of the colostomy. A polyvinyl chloride sleeve is put on the stapler. A rod with connecting rings is introduced through the bobbin of the apparatus. The proximal ring is inserted into the lumen of the terminal colostomy. Tighten the purse string suture. With the help of the apparatus, the rings are brought together and stitched together with clips. Sew the end of the sleeve with the edge of the end colostomy. The apparatus is removed from the sleeve. The method allows to prevent the eruption of sutures around the end colostomy. This device has the following disadvantages:

1. It does not allow to isolate the abdominal cavity and abdominal wall from the pathological focus when the stoma departs into the depth of the wound (abdominal cavity) with the further development of local peritonitis.

2. Insecurely fixes the intestine to the sleeve, which inevitably leads to the failure of the "anastomosis" and secondary infection of the paracolostomy wound.

3. When the terminal colostomy has departed, it is not possible with this device to safely fix the colostomy with the used PVC sleeve without capturing adjacent organs.

For the closest analogue, a device for applying an end colostomy is taken. It contains a housing formed of a cylindrical part made in the form of a solid rod with a conical working end rounded at the top and a conically-shaped hollow part, between which an annular groove is made to allow ligatures to be fixed, while a recess is located on the surface of the cylindrical part along its entire circumference and in the wall of the cone-shaped part there are at least four through holes for ligatures uniformly spaced around its circumference in the immediate vicinity of the ring th slot /E.P.Rudin, A.S.Mironov. "Device for applying an end colostomy." Application of the Russian Federation for a patent: 2001106953/14, 16.03.2001 /.

The device is fixed by ligatures to a cone-shaped expanded hollow part, between which an annular groove is made. A recess is located on the surface of the cylindrical part along its entire circumference, and there are four through holes in the wall of the conically shaped part for conducting ligatures uniformly spaced around its circumference in the immediate vicinity of the annular groove. The technical result consists in the possibility of eliminating early paracolostomy complications: bowel retraction in the abdominal cavity, paracolostomy abscesses, phlegmon of the anterior abdominal wall and retroperitoneal space, paracolostomy event of abdominal organs into the colostomy, and late complications: the development of paracolostomy hernias, fistula, stricture , evagination.

This device has the following disadvantages:

1. There is no possibility of imposing an end colostomy in suppurative processes (in complicated processes).

2. This device is not intended to treat complications of colostomy with the further development of local peritonitis.

3. During dressings it is impossible to exercise visual control over the course of treatment.

The objectives of this proposal are:

1. To prevent the development of local peritonitis due to the delimitation of a festering paracolostomy wound and stoma intestine from the organs of the abdominal cavity.

2. Eliminate the possibility of developing necrosis of the excreted intestine.

3. To create conditions for the reconstruction of the colostomy without relaparotomy and without imposing a discharge proximal colostomy.

4. To provide the possibility of strong fixation of the stoma colon to the paracolostomy wound in the regeneration phase.

5. Provide visual monitoring of the state of nearby organs and tissues through a paracolostomy wound during dressings, and when forming abscesses - emptying them.

6. To ensure the prostate structure, low cost, ease of sterilization and the possibility of use in any medical institution.

The tasks are achieved in that the device for treating complications from the side of the colostomy, which consists in the fact that it has a frame, 6.5-10 cm distant from each other, two concentric rigid rings with diameters of 7-8-9-10 cm, connected several racks, between which are clamps-clamps of the edges of the ostomy intestine, and the clamps are mounted on a proximal removed ring on stiff suspensions, and the edges of the opposite ring of the base are worn.

The technical result of this device allows by fixing clamps to the edges of the wall of the stoma intestine at 4 points to suspend the stoma colon over the paracolostomy wound to prevent the development of local peritonitis by delimiting the suppurative paracolostomy wound and the stoma intestine from the abdominal organs. Eliminates the possibility of development of necrosis of the edges of the stoma intestine by laying on the clamp-retainer at the working end. During dressings, it is possible to visually monitor the condition of nearby organs and tissues through a paracolostomy wound, and when abscesses are formed, emptying them. This ensures the possibility of strong fixation of the stoma intestine in the regeneration phase, without relaparotomy and without the application of an unloading proximal colostomy.

The device was tested for 14 patients in the purulent ward of the KRASNODAR REGIONAL CLINICAL HOSPITAL No. 1 (KKB) named after Professor Ochapovsky S.V. and showed good results, as well as in Federal State Institution "Russian Center for Functional Surgical Gastroenterology of Roszdrav" for 3 patients and showed good results.

All patients succeeded in eliminating local peritonitis in a short time (6-10 days), avoiding the development of diffuse peritonitis and preventing suppuration of the paracolostomy wound and ostomy intestine, which contributed to the strong fixation of the stoma colon to the paracolostomy wound in the regeneration phase without relaparotomy and application of an unloading colostomy. The hospital stay of patients was reduced by an average of 2 weeks.

For a better understanding, the device is schematically shown in figure 1., a General view of the device in operation, in figure 2. - front and top views, where 1 is the stomatal gut, 2 is the double-lumen drainage, 3 is the intestinal contents, 4 is the paracolostomy wound, 5 is the two concentric rigid rings, 6 is the stand, 7 is the clamp is the retainer, 8 is the proximal removed ring, 9 - stiff pendants; 10 - zauovlenny base of the ring.

The device is used as follows. A double-lumen drainage (2) is introduced into the lumen of the ostomy intestine (1) to aspirate the intestinal contents (3) by electric suction pumps. After aspiration of the intestinal contents (3) from the lumen of the stoma gut (1), the double-lumen drainage (2) is removed. Processing of the surgical field is carried out according to the generally accepted technique. Removal of skin sutures from the colostomy and surgical treatment of the parastomal wound (4) and ostomy colon (1) are performed according to the generally accepted technique. Complicated ostomy colon (1) is excreted up to 7 cm above the paracolostomy wound (4). Then take the device in the form of a frame 6.5-10 cm removed from each other two concentric rigid rings (5) with diameters of 7-8-9-10 cm, connected by several uprights (6), between which clamps are located (7) ) for the edges of the ostomized intestine (1), and the clamps-clamps (7) are fixed on the proximal removed ring (8) on the rigid pendants (9), and the edges of the opposite base ring are wired (10) previously. The device is installed by a stoned concentric ring (10) along the outer perimeter of the projection of a paracolostomy wound (4) with fixation to the skin with 4 sutures. Then, the ostomy intestine (1) is fixed to the device by fixing the clamps-clamps (7) to the edges of the wall of the ostomy intestine (1) at 4 points, so that the intestine is suspended above the paracolostomy wound (4), to delimit the festering paracolostomy wound (4) and ostomy intestine (1) from the abdominal organs and exclude the development of local peritonitis. The working ends of the clamps-clamps (7), which are adjacent to the edges of the ostomy intestine (1), are protected by a rubberized gasket to protect the edges of the ostomy intestine (1), which in turn eliminates the possibility of necrosis of the edges of the stoma intestine (1). The space between the paracolostomy wound (4) and the stoma gut (1) is loosely laid with gauze napkins with an antiseptic to partially isolate the abdominal cavity from the pathological focus, which in turn reduces the risk of suppuration of the stoma gut (1) and paracolostomy wound (4), and the progression of peritonitis . A tampon with a levomekol ointment is placed in the lumen of the ostomy colon (1). Along the perimeter, over the paracolostomy area where the device is installed, they cover with a 4-layer sterile gauze sheet treated with an antiseptic, changing during dressings to combat exogenous factors. Dressings with a gauze napkin with an antiseptic between the paracolostomy wound (4) and the stoma gut (1) are carried out 2 times a day until the inflammatory processes subside. During dressings through a paracolostomy wound (4) in the first days of treatment, it is possible to visually check the condition of the abdominal organs and to empty them when abscesses are formed. After the purulent processes disappear in the area of the paracolostomy wound (4) and the ostomy (1), a bandage with levomekol is applied once a day. The dressing with levomekol is introduced into the lumen of the stomatized intestine (1) once a day. At the same time, adequate antibacterial and infusion therapy is prescribed. During dressings, every 3 days, the place of fixation of the clamps-fixators (7) in the wall of the stoma intestine (1) is changed. A double-lumen drainage (2) is introduced into the lumen of the ostomy intestine (1) to aspirate the intestinal contents (3) by electric suction at the treatment stages, if necessary. After firmly fixing the ostomy colon (1) to the paracolostomy wound (4) in the regeneration phase, the device is removed. Excesses of the ostomy colon (1), which is located above the paracolostomy wound (4), are excised with the reconstruction of the colostomy by the developed technique by stitching the submucosal layer of the stoma intestine with the skin of the paracolostomy wound itself.

When using this device, it is possible to eliminate local peritonitis in a short time, to avoid the development of diffuse peritonitis and to prevent suppuration of the paracolostomy wound (4) and ostomy (1), which contributes to the strong fixation of the stoma intestine (1) to the paracolostomy wound (4) in the regeneration phase without relaparotomy and the imposition of an unloading colostomy. Eliminated the possibility of the development of necrosis of the edges of the stoma intestine (1). The duration of the patient’s stay in the hospital was reduced by 40%.

Example. Patient I., 65 years old, was admitted to the coloproctology department of KKB with a diagnosis of colon diverticulosis complicated by perforation and necrosis of the intestinal wall.

The patient is prepared for surgical treatment. The course of surgical treatment: resection of the sigmoid colon according to Hartmann, excretion of a single-barrel colostomy. Sanitation of the abdominal cavity, the introduction of double-lumen drainage into the lateral canals of the abdomen and into the small pelvis.

On the 4th day after the operation in connection with developing parastomal inflammation and local peritonitis, it was decided to reconstruct the colostomy using this device. The patient was taken to the operating room. After the patient was injected into anesthesia, a double-lumen drainage was introduced into the lumen of the stomatal intestine and the intestinal contents of the electric suction were aspirated, and then, after aspiration, the double-lumen drainage was removed. Processing the surgical field with iodopyrone according to the generally accepted method. Removal of skin sutures from a colostomy, wound edges diluted, fetid liquid pus was released and anaerobic non-clostridial phlegmon of the anterior abdominal wall in the colostomy area was diagnosed. Colostomy and paracolostomy areas are treated and washed with antiseptics. Surgical treatment of a parastomal wound and ostomy colon according to the generally accepted technique. The stoma intestine is 7 cm out, at the same time our device for obese patients is taken, in the form of a frame - two concentric rigid rings 10 cm removed from each other with a smaller diameter of 8 cm, and with a large diameter of 10 cm connected by several racks, between which there are clamps - fixatives for the edges of the ostomy. Clips - clamps are mounted on a proximal remote ring with a smaller diameter (8 cm) on stiff suspensions, and the edges of the opposite ring of a larger diameter (10 cm) are the base. The base of the device is pre-coiled with a tube from an intravenous infusion system. The device is installed by a stoned concentric ring of a larger diameter, along the outer perimeter of the projection of the colostomy, fixing the device with 4 sutures to the skin. The fixation of the stoma bowel to the device by fixing the clamps-clamps to the edges of the wall of the stoma bowel at 4 points, that is, the effect of suspending the stoma bowel over a paracolostomy wound is created. The working end of the clamps-clamps, which are adjacent to the edges of the ostomy intestine, are protected by a gasket - “rubberized”, to protect the edges of the stoma intestine, which in turn creates a beneficial effect without trauma to the edges of the ostomy intestine. Additionally, a paracolostomy wound and ostomy are treated with an antiseptic. Then gauze wipes with an antiseptic are loosely placed between the paracolostomy wound and the stoma intestine to partially isolate the abdominal cavity from the pathological focus, which in turn reduces the risk of suppuration of the stoma intestine and paracolostomy wound, and the progression of peritonitis. A tampon with a levomekol ointment is placed in the lumen of the ostomy intestine. Around the perimeter over the paracolostomy area where the device is installed, cover with a 4-layer sterile gauze sheet treated with an antiseptic to combat exogenous factors.

On the 9th day, the patient's condition corresponded to the severity of the operation. Dressing: the paracolostomy area is treated with an antiseptic, then a gauze napkin with an antiseptic is placed between the paracolostomy wound and the ostomy, this procedure is carried out 2 times a day until the purulent processes disappear. After the purulent processes disappear on the paracolostomy wound and ostomy, the dressing is applied with levomecol once a day. A bandage with levomecol is introduced into the lumen of the ostomy intestine once a day until the colostomy is reconstructed. Sanitation of the abdominal cavity according to the generally accepted method through double-lumen drainage installed in the first operation in the lateral canals of the abdomen and in the small pelvis. During dressings, every 3 days, the place of fixation of the clamps-fixators in the wall of the stoma is changed.

On the 14th day, intestinal contents appeared in the lumen of the stoma intestine, the device was isolated with gauze napkins. To prevent seeding of wound surfaces, double-lumen drainage is introduced, connected in advance to an electric suction pump, and intestinal contents are aspirated. Then the paracolostomy area is treated with antiseptics. An aseptic dressing is applied to the wound. An adequate antibacterial and infusion therapy was carried out, which led to a positive trend, the patient's condition improved.

On day 17, it was possible to completely eliminate the signs of local peritonitis. Normalized body temperature, peritoneal signs disappeared, the patient became more active, appetite

On the 18th day after the stoma gut is firmly fixed to the paracolostomy wound in the regeneration phase, the device is removed, the excess of the stoma gut, which is located above the paracolostomy wound, is excised with the reconstruction of the colostomy by the developed technique by stitching the submucosal layer of the stoma gut with the skin of the paracolostomy wound.

On the 25th day, the sutures from the colostomy were removed according to the generally accepted method. On the 26th day the patient was discharged in good condition, under the supervision of a surgeon with recommendations at the place of residence.

The effect of this device lies in its simplicity of design, cheapness, ease of sterilization and the possibility of use in any medical institution. When using this device, it is possible to eliminate local peritonitis in a short time to avoid the development of diffuse peritonitis and to prevent suppuration of the paracolostomy wound and stoma colon, which contributed to the strong fixation of the stoma colon to the paracolostomy wound in the regeneration phase without relaparotomy and the application of an unloading colostomy. Eliminated the possibility of the development of necrosis of the edges of the stoma intestine.

Claims (1)

A device for the treatment of complicated colostomy, which consists in the fact that it has a frame, 6.5-10 cm distant from each other, two concentric rigid rings with diameters of 7-8 ÷ 9-10 cm, connected by several racks, between which there are clamps fixators of the edges of the ostomy intestine, and the fixators are fixed to the proximal removed ring on stiff suspensions, and the edges of the opposite base ring are zaowal.