RU175103U1 - DEVICE FOR DRAINING OF ABDOMINAL CAVITY IN TREATMENT OF SPILLED PERITONITIS - Google Patents

Abstract

Application to medicine, to medicine and can be used in the treatment of patients with peritonitis. Technical result: the development of a device for improving the results of treatment of peritonitis, and, as a result, reduction of deaths. Installed in the abdominal cavity, this device delimits the edges of the laparotomy wound, isolates the intestinal loops from the external environment, replaceable tampons, and drains the sloping places of the abdominal cavity. The outer edge is fixed, for example, with a band-aid to the skin or self-fixed around its perimeter, leaving the abdominal cavity open in the form of a laparostomy, 4 drainage tubes located in diametrically opposite corners of the base of the device, one end of which is led out through additional side cuts on either side of the midline in the region hypochondria and inguinal areas and are fixed by separate sutures, perforated sections of drainage tubes are installed in sloping places along the right lateral canal and pelvis on the right, the mesentery root of the small intestine, along the left lateral canal into the subphrenic space, through which the abdominal exudate is additionally removed. The essence of the utility model. Treatment of peritonitis using a drainage device, which is a chamber of a polymer film with a funnel-shaped extension at the outer end; the expanding base of the device has a bottom from a rectangular perforated plate with a flexible stiffener along the edge to straighten the base of the device in the abdominal cavity, to increase the drainage area, with the presence of radiopaque and ultrasonic marks on the stiffening ribs of the base, which allow you to control the position of the device in the abdominal cavity and 4 drainage tubes located in diametrically opposite corners of the base of the device, one end of which is brought out, through additional, side cuts, on both sides of the midline of the abdomen, in the hypochondrium and inguinal regions, and are fixed by separate sutures, perforated sections of the drainage tubes are installed in flat places along the right lateral canal and pelvis on the right, mesentery root of the small intestine, along the left lateral canal in subphrenic space, through which abdominal exudate is removed additionally, and mobility of the structure itself is created. The device allows for programmed sanitation of the abdominal cavity in postoperative period.

Description

DEVICE FOR ABDOMINAL DRAINAGE DURING TREATMENT OF SPILLED PERITONITIS

The utility model relates to medicine, surgery. It can be used in the treatment of patients with diffuse peritonitis.

The objective of the utility model is to increase the effectiveness of the treatment of peritonitis using this device by draining the abdominal cavity and creating a full outflow for inflammatory exudate, as well as the possibility of carrying out rehabilitation measures. The device comprises a polymer film chamber with a funnel-shaped extension at the outer end; the expanding base of the device has a bottom from a rectangular perforated plate with a flexible stiffener along the edge to straighten the base of the device in the abdominal cavity, to increase the drainage area, with the presence of radiopaque and ultrasonic marks on the stiffener of the base, which allow you to control the position of the device in the abdominal cavity and 4 drainage tubes located in diametrically opposite corners of the base of the device, one end of which is brought out through additional sides cuts, on both sides of the midline of the abdomen, in the hypochondrium and inguinal regions, and are fixed by separate sutures, perforated sections of the drainage tubes are installed in flat places along the right lateral canal and pelvis on the right, mesentery root of the small intestine, along the left lateral canal in subphrenic space, through which the abdominal exudate is removed additionally, and the mobility of the structure itself is limited.

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 treating spilled purulent peritonitis is RF patent RU 2113864 C1, in which the abdominal cavity is drained and perfused using a device that contains two separate lobes of an elastic perforated hydrophobic film with fan-shaped soldered drainage tubes with electrodes. The upper lobe contains the sealed ends of the tubes. The upper lobe is placed on the intestines. The lower lobe with open working ends is placed under the intestine. The output tubes are collected in separate tubes of a larger diameter and brought out. Dialysis solutions are introduced through the upper tube. The contents of the abdominal cavity are removed through the lower tube. With intestinal paresis, electrocoagulation is performed.

The disadvantages of this method are:

1. High labor intensity, high cost (the need for additional equipment of irrigators and devices)

2. 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. An open method for treating diffuse purulent peritonitis // Surgery. - 1984. N9. 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

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.

Also known is 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 and a pulsating jet is fed through irrigators and 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)

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.

There is also known a method of treating peritonitis, RF patent No. 2164088 class. A61B 17/00 A method for treating peritonitis by performing a laparostomy, including delimiting the wound of the abdominal wall, introducing stitched drainage tubes, isolating open internal organs, characterized in that a drainage-foam system is additionally introduced into the lower corner of the wound and they are constantly irrigated with antiseptics and a round-the-clock round-the-clock irrigation active aspiration of the contents of the abdominal cavity.

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 goes along the "line of least resistance, therefore, the presence in the lower corner of the drainage foam system is not always effective

There is also known a method of treating peritonitis using the device for drainage of the abdominal cavity of the Russian Federation patent No. 168960 (prototype), carried out by laparostomy, including delimiting the wound of the abdominal wall, isolation of open internal organs, creating an outflow for inflammatory exudate and the possibility of rehabilitation.

The disadvantages of this method are:

1. The mobility of the structure in the abdominal cavity

2. The lack of the possibility of additional drainage of the sloping places of the abdominal cavity, which does not exclude the possibility of the formation of intra-abdominal abscesses.

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 polymer film chamber for receiving adsorbent tampons, with a funnel-shaped expansion at the outer end and an expanding base; the base has a bottom from a rectangular perforated plate 1, with a flexible stiffener around the perimeter, characterized in that the stiffener has radiopaque and ultrasonic marks 5, which allow you to control the position of the device in the abdominal cavity. The device also contains 4 drainage tubes located in diametrically opposite corners of the base 4, one end of which is brought out through additional side sections on both sides of the midline of the abdomen in the hypochondrium and inguinal areas, and are fixed with separate sutures, perforated sections of the drainage tubes are installed along the right lateral canal and the pelvis on the right, the mesentery root of the small intestine, along the left lateral canal into the subphrenic space, through which additional removal occurs exudate of the abdominal cavity, and a limitation of the mobility of the structure itself is created.

Tampons adsorbing inflammatory exudate can be placed in the chamber of the device 3. Installed in the abdominal cavity, 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. X-ray contrast and ultrasonic marks along the perimeter of the stiffening rib allow you to control the position of the device in the abdominal cavity, and drainage tubes installed with perforated ends in the sloping places of the abdominal cavity and removed through separate punctures on the abdominal wall and fixed with nodal sutures create additional fixation of this device in the abdominal cavity cavities. 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 - stiffener, 3 - device chamber for installing absorbent tampons, 4 - drainage tubes, 5 - radiopaque and ultrasound marks. The device is used as follows.

In the postoperative period after installing the device in the abdominal cavity and removing 4 drainage tubes located in diametrically opposite corners of the base of the device, one end of which is brought out through additional lateral incisions on both sides of the midline of the abdomen in the hypochondria and inguinal regions and are fixed with separate sutures, perforated areas drainage tubes are installed along the right lateral canal and the pelvis on the right, the mesentery root of the small intestine, along the left lateral canal in the subphrenic space and conduct remediation by replacing absorbent tampons, as impregnation. Carrying out x-ray or ultrasound examinations as necessary to monitor the position of the device. 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 advantage of this method over others are

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

2. Drainage tubes located in diametrically opposite corners of the base of the device are installed along the right lateral canal, the pelvic cavity, along the left lateral canal, the mesentery root of the small intestine, thereby additionally draining the sloping places of the abdominal cavity.

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

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

5. Due to the stiffener and fixed drainage tubes, the base remains in a straightened state and the mobility of the structure is limited.

6. The presence of radiopaque and ultrasound marks on the stiffener of the base allows you to control the position of the device in the abdominal cavity.

Claims (1)

A device for draining the abdominal cavity with spilled peritonitis, comprising a polymer film chamber for receiving adsorbent tampons with a funnel-shaped expansion at the outer end and an expanding base; the base has a bottom from a rectangular perforated plate with a flexible stiffener around the perimeter, characterized in that the stiffener has radiopaque and ultrasonic marks; the device also contains 4 drainage tubes located in diametrically opposite corners of the base.

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