RU168960U1 - DEVICE FOR ABDOMINAL DRAINAGE FOR PERITONITIS TREATMENT - Google Patents

Abstract

The invention relates to medicine, namely to surgery. The device made of perforated plastic film is a hollow cylinder with a cone-shaped extension at the outer end. The expanding base of the cylinder has a bottom of a rectangular perforated plate and a flexible stiffener at the edges to expand the base of the device in the abdominal cavity and increase the drainage area. Drainage of the abdominal cavity with peritonitis is provided by the possibility of placing and changing adsorbent tampons in the cavity of the device. The device allows to improve the results of treatment of peritonitis due to delimitation of the edge of the laparotomy wound, laparostomy, isolation of the intestine from the external environment and replaceable adsorbent tampons. 2 ill.

Description

The utility model relates to medicine and can be used in the treatment of patients with peritonitis.

The objective of the utility model is to increase the effectiveness of the treatment of peritonitis using this device by creating an outflow for inflammatory exudate, and the possibility of carrying out rehabilitation measures. The device is a hollow cylinder made of polyethylene film with a cone-shaped extension at the outer end; the expanding base of the device has a bottom of a rectangular perforated plate and a flexible stiffener at the edges to expand the base of the device in the abdominal cavity and increase the drainage area.

Spilled purulent peritonitis is one of the most formidable complications of emergency surgical pathology. Various treatment options for peritonitis have been proposed, however, they are not without various drawbacks, often quite traumatic and not sufficiently radical. Unsatisfactory results of treatment of peritonitis cause an increased interest of surgeons in laparostomy.

A known method of programmatic laparotomy. The essence of this method is to conduct repeated laparotomies after 24-48 hours, during which the abdominal cavity is revised and sanitized (exudate removal, separation of friable adhesions, elimination of forming intra-abdominal abscesses, washing of the abdominal cavity with antiseptics. Tsybyrne K.A., Angelich G.A. , N. Luka, First Moscow International Congress of Surgeons, Moscow 1995. - p. 45-46). The disadvantages of this method are:

1. The difficulty in determining the time interval for the rehabilitation leads to the progression of the process.

2. Injury from repeated fixation of the edges of the abdominal wall.

3. High complexity and high cost.

A method of laparostomy is also known.

The essence of this method is to leave the laparotomy wound not sutured. Gauze napkins, perforated plastic film, polymer mesh, etc. are placed on top of the abdominal organs. Thus, the abdominal cavity is drained through the laparotomy wound, which is sutured after the relief of the inflammatory process (Anisimov A.Yu., Chuprin V.G., Yaradaykin V.V. First Moscow International Congress of Surgeons. Moscow, 1995. - pp. 48-49 )

The disadvantages of this method are:

1. This method of laparostomy does not protect the tissues of the abdominal wall from secondary infection.

2. The abdominal cavity is drained only on a limited area of the laparotomy wound area, the anterior abdominal wall sticks together with the abdominal organs.

3. The method does not exclude the possibility of forming intra-abdominal abscesses.

A known method of laparostomy for the treatment of peritonitis, in which, in order to prevent eventuation, drainage tubes are installed in the wound and the abdominal wall is strengthened with steel strings (Makokha N.S. Open method for the treatment of diffuse purulent peritonitis // Surgery. - 1984. N 9. P. 124- 126.).

The disadvantages of this method are:

1. Inadequate protection of the tissues of the abdominal wall from secondary infection.

2. Traumatic and multiple fixation of the edges of the abdominal wall using strings during rehabilitation operations.

There is also a method of treating peritonitis, RF patent No. 2147444, class. A61M 1/28, A61M 27/00, the essence of which is the resection of the greater omentum and dissection of the round and sickle-shaped ligaments of the liver, drainage and installation of irrigators in the abdominal cavity. A mixture of an antiseptic solution with air is supplied through a pulsating jet through irrigators and they are actively aspirated.

The disadvantages of this method are:

1. The invasiveness of the operation.

2. High complexity, high cost (the need for additional equipment of irrigators and devices to maintain pneumoperitoneum).

A known method of treating peritonitis, in which after laparotomy, sanitation of the source of inflammation and sanitation of the abdominal cavity, the wound of the abdominal wall is delimited by a perforated cellophane film. To protect soft tissues from contact with exudate and intestinal event, a “shock absorber” is sewn up, consisting of 3-7 stitched perforated tubes. In addition, the isolation of the opened internal organs is carried out by applying sterile foam rubber under the edges of the surgical wound (Komarov N.V., Bushuev V.V., Maslagin A.S. Method of laparostomy in the treatment of peritonitis // Clinical Surgery. - 1995. N 4. S. 42 - prototype).

The disadvantages of this method are:

1. Inadequate protection of the tissues of the abdominal wall from secondary infection due to the adherence of the perforated film to the edges of the laparotomy wound.

2. The lack of outflow of inflammatory exudate from the cavity formed by a perforated cellophane film.

Also known is a method of treating peritonitis, RF patent No. 21644088, class. A61B 17/00.

A method of treating peritonitis by performing a laparostomy, including delimiting the wound of the abdominal wall, introducing stitched drainage tubes, isolating the open internal organs, characterized in that a drainage-foam system is additionally introduced into the lower corner of the wound and continuous 24-hour irrigation with antiseptics and constant round-the-clock active aspiration of the contents of the abdominal cavities.

The disadvantages of this method are:

1. Inadequate protection of the tissues of the abdominal wall from secondary infection due to the lack of protection against inflammatory exudate.

2. The introduction of an antiseptic through the drainage does not wash all intra-abdominal formations, since in connection with the adhesive processes, the fluid flows along the "line of least resistance, so the presence of a drainage-foam system in the lower corner is not always effective.

Therefore, the objective of the utility model is to improve the results of treatment of peritonitis and, as a result, reduce fatal outcomes.

The problem is solved by performing a laparostomy, including the delimitation of the abdominal wall wounds, isolation of the revealed internal organs, the creation of an outflow for inflammatory exudate and the possibility of carrying out rehabilitation measures using this device.

The device is a hollow cylinder made of polyethylene film with a cone-shaped extension at the outer end, the expanding base of the device has a bottom made of a perforated rectangular plate 1, along the edge of which there is a flexible stiffener to better straighten it in the abdominal cavity and increase the drainage area 2. Into the device cavity 3, swabs adsorbing inflammatory exudate can be placed. Installed in the abdominal cavity 4, this device delimits the edges of the laparotomy wound, isolates the intestinal loops from the external environment and replaceable tampons. The outer edge is fixed, for example, with a band-aid to the skin or self-fixed along its perimeter, leaving the abdominal cavity open in the form of a laparostomy. The method allows for programmed sanitation of the abdominal cavity in the postoperative period.

The presented utility model is illustrated by drawings, where in FIG. 1 and FIG. 2: 1 - perforated bottom (base), 2 - stiffeners, 3 - cavity of the device for installing adsorbent tampons, 4 - abdominal cavity.

The device is used as follows.

In the postoperative period after installing the device in the abdominal cavity, sanitation is carried out by replacing adsorbent tampons as they are soaked. General anesthesia is not required. Planned staged abdominal sanitation is carried out before the subsidence of peritonitis. During the final rehabilitation, the device is removed. In the absence of a defect in the abdominal wall, the latter is sutured; in the case of a defect, treatment is carried out that promotes secondary healing of the wound.

The advantages of this method over others

1. The abdominal cavity is drained not only in the area limited by the area of the laparotomy wound.

2. Provides protection of the abdominal organs from the external environment and does not lead to an increase in intra-abdominal pressure.

3. The contact of the inflammatory exudate with the abdominal wall is limited and the risk of infection of the edges of the laparotomy wound is reduced.

4. The ability to change tampons without general anesthesia as they are soaked.

5. Due to the stiffening ribs, the base remains in a straightened state and becomes less mobile.

Claims (1)

A device for draining the abdominal cavity with peritonitis, made of perforated plastic film with the possibility of placing and changing adsorbent tampons, characterized in that the device is a hollow cylinder of plastic film with a cone-shaped extension at the outer end, the expanding base of the device has a bottom from a rectangular perforated plate and a flexible stiffening rib at the edges to straighten the base of the device in the abdominal cavity and increase the drainage area.

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