RU2069991C1 - Method for postoperative treating pelvioperitonitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves passing thick drainage tube through cervical canal of the uterine neck stump into the vaginal atrium and the second thin tube is brought through the posterior vaginal vault. The tubes are attached to each other by means of cross member so that the proximal end of the thin tube is above the drainage tube. EFFECT: enhanced effectiveness of long-term injection of medical preparations. 2 dwg

Description

 The invention relates to medicine, in particular to gynecology, and can be used for irrigation of the small pelvis with chemotherapy in the postoperative period after supravaginal amputation of the uterus, treatment of inflammatory diseases, drainage.

 A known method of postoperative treatment of ascites of the abdominal cavity (S.N. Davydov, B.M. Khromov, V.Z.Sheyko. Atlas of gynecological operations. - L.Meditsina, 1982, S. 55-57) with supra-vaginal amputation of the uterus with appendages ovarian cancer by draining the abdominal cavity at the final stage of the operation, removing fluid as it accumulates through the drainage tube.

 However, this method has drawbacks: conducting a drainage tube through the anterior abdominal wall to the lower corner of the postoperative wound is associated with a number of inconveniences and complications, especially the outflow of fluid is difficult, since the flat parts of the abdomen are located significantly below the level of the anterior abdominal wall. The drainage tube, regardless of the material from which it is made, is a foreign body in the anterior abdominal wall and this is fraught with either the formation of a fistula, purulent canal, an inflammatory reaction in the wound canal, the phenomena of necrosis and maceration of the skin.

 There is a method of Yu.S. Sidorenko drainage of the abdominal cavity with supravaginal amputation of the uterus (ed. St. CCCR N 13224649, A 61 M 5/00, publ. Bull. N 22 from 07.23.87,), including bringing the drainage tube to the pelvic abdominal cavity, peritonization; in order to effectively drain drainage and reduce trauma during prolonged use of the drainage system, the distal end of the drainage passes through the cervical canal of the stump in advance of the vagina.

 However, this drainage tube is an effective means for displacing pus, serous fluid, ascites through it from the abdominal cavity and pelvis, but for the treatment of pelvic peritonitis, insufficient drainage is necessary; antibiotic and chemotherapy are necessary. Drainage is provided mechanically in an upright position and stable fixation by the tissues of the abdominal wall.

 The aim of the invention is the long-term postoperative irrigation of the pelvis with drugs and reliable drainage.

 This goal is achieved by passing a thick drainage tube through the cervical canal of the cervical stump in advance of the vagina, and a second thin tube through the posterior vaginal fornix, and the tubes in the abdominal cavity are fixed to each other by a jumper so that the proximal end of the thin tube is above the drainage tube.

 The invention is expressed in the aggregate of distinctive essential features: the introduction through the posterior vaginal fornix of a thin tube into the abdominal cavity for drug irrigation, fixing it with a jumper with a thick drainage tube, but above the opening of a thick drainage tube, which ensures long-term administration of drugs, drainage through a thick tube and reliable fixation of the tubes in the abdominal cavity in a certain position on the surface of the posterior fornix.

 The drug from the thin tube spreads down, irrigating the abdominal cavity, and then flows into the most flat part of the small pelvis, and then through the thick drainage tube leaves through the cervical canal. In contrast to the well-known, an independent channel is formed for conducting the necessary drugs into the abdominal cavity of antibiotics, disinfectants or chemotherapeutic drugs, and the tubes are fixed with a jumper.

 Thus, the invention is new, as it is not known, from the level of medicine in this field of treatment of postoperative complications, pelvic peritonitis.

 The invention has an inventive step, since for a specialist surgeon, an oncologist surgeon, it clearly does not follow from the level of medical technology, supravaginal amputation of the uterus.

 The invention is industrially applicable, so it can be used in healthcare for the treatment of pelvioperitonitis, after supravaginal amputation of the uterus, for ovarian cancer.

 The essence of the method is as follows. After supravaginal amputation of the uterus with appendages, Geghar expanders up to N 6 are introduced into the uterine stump from the side of the abdominal cavity, as a result of which the diameter of the canal increases to the size necessary for subsequent manipulation. Then, from top to bottom, through the lumen of the canal from the abdominal cavity into the vagina, a thick drainage tube 1 (0.5-2 cm in diameter) is passed into the cervical canal, while a second, thin tube 2, 1-2 mm in diameter, is passed through a puncture in the posterior arch from the abdominal side cavities. This tube enters the vagina through the posterior arch. Tubes from the side of the vagina are captured by clamps and then stretched until they exit the vagina. At the same time, the upper ends of the tubes from the side of the abdominal cavity in their final position lag behind the upper edge of the cervical stump at such a distance that after suturing the cervical stump, the drainage tube would be 1.5-2 cm from the suture line. Peritonization is carried out. Both tubes are fastened by a jumper 3, which lies on the upper surface of the rear arch (Fig. 1).

 Jumper 3, relying on the rear arch, reliably fixes both tubes, preventing them from moving down. Two channels are formed: one wide thick tube 1, for draining the contents from the pelvis to the outside, and another narrow thin tube 2 specifically for pumping medicinal solutions into the pelvic cavity. When removing the tubes, the thick tube 1 is pulled down, leaving the small pelvis, pulls up the jumper 3, which is cut off, the thin tube 2, thus freed from the jumper, is also removed from the vagina at the back arch (Fig. 2).

 An example of a specific application of the proposed method. Patient C., 35 years old, medical history N 5345 was admitted to the gynecological department of the Institute with a diagnosis of ovarian cancer, Art. 3, cl. group IIa. A gynecological examination revealed: the cervix in the mirrors is clean. In place of the uterus and appendages, a tumor conglomerate, the upper border reaching the middle between the navel and the xiphoid process. After supravaginal amputation of the uterus with appendages from the side of the abdominal cavity, Geghar expanders up to N 8 were introduced into the uterine canal, as a result of which the diameter of the canal increases to the size necessary for subsequent manipulation. Then, from top to bottom, through the lumen of the canal from the abdominal cavity into the vagina, a thick drainage tube was passed into the cervical canal simultaneously with the second thin tube, through a puncture in the posterior arch from the side of the abdominal cavity. This thin tube extends into the vagina also behind the vaginal part of the uterus directly under the posterior arch from the side of the abdominal cavity. The tubes from the side of the vagina were gripped with clamps and then extended until they exit the vagina. At the same time, the upper ends of the tubes from the side of the abdominal cavity in their final position lag behind the upper edge of the cervical stump at such a distance that after suturing the cervical stump, the drainage tube would be 1.5-2 cm from the suture line. Peritonization is carried out. The tubes are fastened with a jumper so that the thin tube for drug administration is located above the thick drainage tube. The jumper is located on the back of the cervical stump and posterior Douglas. The jumper thus reliably fixes the different height of the tubes and their position in the small pelvis, not allowing the two tubes to move down. 2 channels are formed, one wide thick drainage tube for draining contents from the pelvis to the outside, and another narrow thin tube specifically for pumping medicinal solutions into the pelvic cavity.

 The patient underwent long-term postoperative abdominal chemotherapy, chemotherapy was administered through a thin tube for 25 days: cyclophosphamide, 5-fluorouracil; sprawling tissues, detritus, descended into the flat part of the abdomen, and a thick drainage tube all this time served to remove detritus, sprawling tumor masses. After treatment on day 28 was removed pipes. With a slight pull, a thick tube was removed from the cervical canal until a jumper appeared. The jumper was cut with scissors, after which both tubes were easily pulled out.

 The proposed method was a clinical trial in 15 patients with a diagnosis of ovarian cancer. It was found that a thin tube is convenient for the introduction and distribution of drugs in the abdominal cavity, since its end is located above the end of a thick drainage tube, and a reliable stable position of this thin tube is provided by a jumper that holds it in this position and fixes two tubes on the back surface the arch. Irrigation of the pelvis with drugs in the postoperative period with antibiotics, chemotherapy, accompanied by the removal of detritus, sprawling tumor masses, provided reliable drainage.

 Postoperative treatment of patients was satisfactory, without complications.

 The technical result of the method lies in the fact that reliable fixation of the tubes due to the jumper, the formation of separate channels for drugs and drainage allows for irrigation with drugs, long-term reliable drainage, excluding inflammatory reactions around the tubes, ensures a satisfactory condition of patients in the postoperative period.

Claims (1)

 A method for postoperative treatment of pelvioperitonitis, including installation of a drainage tube in the abdominal cavity after supravaginal amputation of the uterus, removal of its external end through the cervical canal of the stump on the threshold of the vagina, removal of the drainage tube, characterized in that a second tube is placed above the first tube for irrigation with drug solutions, which is placed above the upper surface of the posterior fornix is connected by a jumper with the first, the outer end of the second tube is brought out on the threshold of the vagina through its posterior arch, and when removed With drainage, the first tube is pulled downward until a bridge appears from the cavity of the small pelvis, which both tubes cross and remove.

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