RU150872U1 - DEVICE FOR DRAINING PUSH CAVITIES - Google Patents

Abstract

A device for draining purulent cavities, which is a drainage of a polyvinyl chloride tube with a microirrigator, characterized in that the tube is made with 3-4 lateral holes and has an internal diameter of 1-1.5 cm, while the microirrigator is inserted into the tube by piercing its wall onto a distance of 5-10 cm from the outer end of the tube and passes inside the tube with its fixation to the tube wall with kapron thread below the second hole from its inner end.

Description

The utility model relates to medicine, namely to surgery - to devices for draining wounds and suppurating residual cavities of the liver after echinococcectomy and other organs of the abdominal cavity.

Despite significant progress in the development of purulent surgery, the problem of drainage of cavities is still relevant. Existing methods of drainage, including passive, flowing, active and even peritoneal lavage, are not adequate enough: not all the purulent cavity is drained, there are areas of accumulation of exudate, which contributes to the long course of the disease, the development of complications, multiple organ failure and sepsis.

Particularly great difficulties arise when draining the residual cavities of the liver after echinococcectomy: they often suppurate, abscesses develop, which is associated with inadequate drainage, the inability to wash off all departments due to the narrow inner diameter of the drainage tube and its frequent displacement up or to the side inside the residual cavity during respiratory movements and with a decrease in size or "reduction" of the liver after echinococcectomy or removal of the cyst.

Utility Model Analogs

A device for passive drainage with the introduction of a PVC pipe along the flank, which is located along the bottom of the wound or purulent cavity, is necessarily in its lowest part, since the drainage effect is created due to the passive outflow of exudate through the drainage by introducing a drainage tube through separate small incisions outside the main wounds, in order to avoid displacement or prolapse, the tube is fixed with a skin suture (V.K. Gostischev. Operational purulent surgery. Manual for doctors. M: Medicine, 1996. - S. 386-388).

It is known (RU, patent 2197286 C2 F A61M 27/00, 2003) a device for draining the purulent cavity consisting of an aspiration tube with side openings and a longitudinal channel for air and an irrigation tube with a nozzle at the working end and a flexible steel core inside for reciprocating movements and stabilization of the position of the nozzle.

It is known (RU Patent 2052999 A61M 27/00, 1996) a device for draining cavities and suctioning fluid from an operating field, comprising an elastic perforated tube with a rounded working end and a cannula coaxially located inside the cannula protruding outward, the distal part of the drainage is bent relative to the axis of symmetry at least 25 °, while the proximal end of the outer tube is concave inward, and the maximum diameter of the axial hole of the tube at the working end is equal to the diameter of the cannula channel.

Known provisional patent No. 1015 A61B 17/00, 2008) a device for draining the purulent cavity, made in the form of a tube, one end of which is equipped with petals formed by its dissection, bent back and fixed on the outside of the tube by a movable clamp from suture material with the release of the ends of the petals from under him.

Criticism of analogues

The disadvantages of the above technical devices should be taken:

- some devices make it difficult to drain from the lower parts of the purulent cavities, where there is no pronounced hydrodynamic pressure gradient, and accordingly the accumulation of exudate, the progression of purulent processes;

- the second device does not provide sufficient fixation of the drainage in the wound and the need to select its specific size, determined by the length of the cylindrical body between the corrugation and the restrictive cuff, respectively, the impossibility of the current adaptation of the device for drainage.

- third devices impede drainage ability during drainage of purulent cavities due to subsidence of their walls, impossibility of modeling relief for drainage of complex cavities.

- used antibacterial drugs for washing and treating purulent cavities have low antibacterial and necrolytic effects.

Prototype of the invention

As a prototype, the closest to our invention is a drainage device for draining purulent and residual cavities after echinococcectomy, provisional patent RU No. 0502, class A61B 17/00, A61M 27/00, 2002 (Uzakbaev K.A., Kononov V.S., Kochkunov D.S.). This device, consisting of a vacuum apparatus, a settling tank, drainage pipes of different diameters, entering one another and having side openings in the working part, with the internal drainage pipe mounted in openings additionally made on one of the sides of the drainage pipe with a larger diameter , forming branched tubes and the simultaneous introduction of drugs after treatment of the cavity.

The essence of the prototype lies in the drainage of cavity formations in the treatment of residual cavities after echinococcectomy, opening of soft tissue abscesses with a device consisting of a vacuum apparatus, a settling tank, drainage tubes of different diameters, entering one another and having side openings in the working part, with an internal drainage the tube is mounted in a hole that is additionally made on one of the sides of the drainage tube, which is larger in diameter, forming branched pipes and at the same time Eden Pharmaceuticals after oral treatment.

Prototype criticism

However, the following disadvantages are noted in this device:

1. The narrow inner diameter of the drainage tube and its frequent displacement upward or to the side inside the residual cavity during respiratory movements cannot provide adequate drainage.

2. After emptying the echinococcal cyst or removing it, after 1-3 days the size of the liver decreases, which can move the drainage inside the cavity and cannot provide adequate drainage.

3. Known drainage can also move in the cavity due to the lack of fixation with a catgut seam.

3. Connecting drainage to an active suction to aspirate the contents of an isolated residual cavity can create a vacuum in the system and thereby stimulate the opening of bile fistulas, bile flow, bleeding into the fibrous cavity after echinococcectomy, and also adversely affects cavity contraction.

Utility Model Purpose

The purpose of the utility model is to develop a device for drainage securely fixed in the wound and increasing the efficiency of its drainage.

The essence of the utility model is that the drainage contains a polyvinyl chloride tube with an internal diameter of 1-1.5 cm, with 3-4 side holes, into the lumen of which a microirrigator is introduced by puncture of the drainage wall at a distance of 5-10 cm from its outer end, passing inside the tube with fixing the micro-irrigator to the tube wall with kapron thread below the second hole from its inner end; during the operation, the tube is fixed to the bottom of the cavity and to the outer edge of the fibrous capsule by suturing the edges of the tube with a catgut suture, leaving a slight bend of the drainage in the abdominal cavity for excursion during breathing. Then hem the drainage to the skin of the anterior abdominal wall.

The device contains a polyvinyl chloride drainage tube with an inner diameter of 1-1.5 cm, with 3-4 side openings and a micro-irrigator, as illustrated in Figs. 1-4.

FIG. 1 - Diagram of a drainage device: 1 - polyvinyl chloride tube; 2 - microirrigator; 3 - a cap for a drainage tube; 4 - a cap for a microirrigator; 5 - place for fixing the microirrigator to the tube. FIG. 2. "Drainage device" with microirrigator. FIG. 3. The inner end of the "drainage device." FIG. 4. The outer end of the "drainage device."

The device is used as follows.

After cutting the skin, opening the abscess and / or residual cavity, evacuating pus and / or the contents of the cavity, cleansing from necrotic tissue and washing, the specified drainage device is installed in the cavity - a polyvinyl chloride tube with side holes and a micro-irrigator, fixed according to our proposed technique. The adequacy of the position of the drainage device in the purulent cavity is monitored during the operation, sonographically and (or) radiographically. The wound is sutured in layers. The flushing antiseptic is delivered to the destruction cavity through a microirrigator using a Janet syringe, and the outflow is delivered via a polyvinyl chloride tube. The drain pipe is connected to the suction. As the processes of aspirating the contents of the cavity through the drainage tube are introduced, the Bemetrim product we have proposed is introduced in the amount of 2/3 of the volume of the evacuated antiseptic fluid from the residual cavity. The drainage tube and microirrigator are closed for 2 hours using caps or clamps. Subsequently, they are opened and the drainage tube is connected to a conventional suction. Drainage continues until the regeneration of the tissues of the cavity.

The combined tubular drainage and microirrigator in this device provide a high drainage ability of the device, and the use of Bemetrim has a pronounced antibacterial and necrolytic effect superior to modern antibacterial and necrolytic drugs. All this contributes to the speedy evacuation of the contents of the cavity, effective granulation and healing of the residual cavity.

Distinctive features of the utility model from the prototype

The difference between the proposed device and the prototype lies in the wider inner diameter of the drainage tube 1-1.5 cm, with 3-4 side holes, into the lumen of which a microirrigator is introduced by puncture of the drainage wall at a distance of 5-10 cm from its outer end, passing inside tube with fixing microirrigator to the wall of the tube with kapron thread below the second hole from its inner end. During the operation, the drainage tube must be fixed to the bottom of the cavity by flashing one of its edges with a catgut suture. Then fix it at the outer edge of the fibrous capsule, leaving a slight bend of the drainage in the abdominal cavity for excursions during breathing. After emptying the cyst after 1-3 days, the liver decreases in size, which can also move drainage in the residual cavity. In the next drain, we hem the skin of the anterior abdominal wall.

All this provides a high drainage ability of the device, and the use of Bemetrim has a pronounced antibacterial and necrolytic effect, which contributes to the speedy evacuation of the contents of the cavity, effective granulation and healing of the residual cavity in comparison with the known technical means.

Case Study

The device proposed as a utility model was used to ensure adequate drainage of suppurative residual cavities of the liver after echinococcectomy of the liver to 12 patients at the Department of General Surgery of the Dagestan State Medical Academy, on the basis of the Department of Hepatosurgery of the Republican Clinical Hospital of the Ministry of Health of the Republic of Dagestan, the surgical department of the Veterans Hospital of the RMC of the Ministry of Health of the Republic of Dagestan, in the department Abdominal Surgery RKB MZ RD. The course of treatment averaged 15 ± 1.0 f / d.

This device was used in the treatment of 12 patients, of which 3 patients with recurrent echinococcosis of the liver, 4 patients with suppuration echinococcosis of the liver, 2 patients with suppuration of the residual cavity, 3 patients with primary hydatitic liver echinococcosis. In all cases, a positive result has been achieved.

Example: Patient K., 47 years old, was admitted with complaints of pain in the right hypochondrium, high body temperature, chills, weakness. From the anamnesis it was found that the patient was operated on 2.5 months ago for a suppuration of an echinococcal cyst of the right lobe of the liver. An open echinococcectomy was performed. Upon admission according to ultrasound in 7-8 segments of the liver there is a residual cavity with a liquid component. Diagnosed with an abscess of the right lobe of the liver. After preparation, an operation was performed - laparotomy, during which a residual cavity was revealed after echinococcectomy with suppuration. The abscess is sanitized, the cavity is drained by a "drainage device" with a tube diameter of 1.2 cm, with 3 side holes with an original micro-irrigator. The residual cavity is pre-washed with an antiseptic solution through a microirrigator. Then, using the microirrigator, the Bemetrim agent was injected daily into the cavity according to the technique we proposed. The postoperative period was uneventful. On the 4th day after the start of the course of treatment, body temperature returned to normal and appetite improved. On the 8th day, an ultrasound scan was performed, in the right lobe in the projection of 7-8 segments, a hypoechoic mass was measured with dimensions of 2.0 × 1.5 cm, with uneven fuzzy contours, a drainage tube in the cavity of the formation. On drainage for 9 days there is no discharge. A washout from the residual cavity was sent for bacteriological examination - bacterial growth was not inoculated. Under the control of the endoscope, a biopsy was taken from the wall of the fibrous capsule for histological examination. The drainage tube is removed on the 9th day. The patient in satisfactory condition was discharged home for 14 days.

Thus, as shown by the treatment by drainage of the residual cavity after echinococcectomy with suppuration using the "drainage device" according to our proposed method, it led to a quick and complete cure.

Features of the invention, distinctive from the prototype

1) a "drainage device" with an inner tube diameter of 1-1.5 cm, with 3-4 lateral holes and a microirrigator introduced into the lumen of the tube of the original design to ensure adequate drainage;

2) during the operation, the drainage tube must be fixed to the bottom of the cavity and to the outer edge of the fibrous capsule by flashing one of its edges with a catgut suture, leaving a slight bend of the drainage in the abdominal cavity for excursion during breathing to prevent it from moving up or to the side inside the residual cavity;

3) the use of a "drainage device" connected to an active suction to aspirate the contents of the sealed residual cavity can create a vacuum in the system and thereby stimulate the opening of bile fistulas, bile ducts, the development of cholangitis, bleeding into the fibrous cavity, and also adversely affects the reduction of the cavity;

4) the use of Bemetrim for washing and treating a suppurative residual cavity after echinococcectomy has a pronounced antibacterial and non-political effect.

The positive effect of the application of the invention

The proposed "drainage device" with the Bemetrim tool, unlike other known at the present time, allows to improve the treatment results of patients with a festering residual cavity after echinococcectomy. The results obtained from the use of this "drainage device" allow to speed up 1.5-2 times the purification of the residual cavity from the purulent-necrotic process; provide rapid elimination of pathogenic microflora due to the bactericidal action of the drug; to activate the wound healing processes by stimulating the regeneration of multi-acting agents. Reducing the duration of treatment of patients, the simplicity and low cost of the "drainage device" favorably affects the economic effect, which allows to improve the quality of treatment for this category of patients.

The "drainage device" according to the invention was used in 12 patients, according to our proposed methodology led to a quick and complete cure.

The design makes it possible to drain the residual cavity with the least trauma, which accelerates tissue regeneration, reduces the entry of hospital infection into the wound or cavity and shortens the treatment time. The device makes it possible with the least traumatism for tissues to effect on the deep sections of the residual cavity and to evacuate its contents from the bottom of the cavity. For excursions while breathing it is sutured to the skin of the anterior abdominal wall. The device was used in the abdominal surgery department of the Republican Clinical Hospital of the Ministry of Health of the Republic of Dagestan, in the hepatosurgery department of the Clinical Hospital of the MH of the Republic of Dagestan, in the surgical department of the Veterans Hospital of the RMC MH of the Republic of Dagestan for 12 patients without complications. Control examination after 1.5-2 months. gave a good result.

Claims (1)

A device for draining purulent cavities, which is a drainage of a polyvinyl chloride tube with a microirrigator, characterized in that the tube is made with 3-4 lateral holes and has an internal diameter of 1-1.5 cm, while the microirrigator is inserted into the tube by piercing its wall onto a distance of 5-10 cm from the outer end of the tube and passes inside the tube with its fixation to the tube wall with a kapron thread below the second hole from its inner end.

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