RU2145241C1 - Device for treating immature fistulas - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: device has three-layered combined tampon which external layer is made from insulation material and the internal layer is made from biologically active material and draining tube inserted into it having bulb-shaped thickening at the end and two antirarefaction tubes of lesser diameter running in parallel to the draining tubes and ending in bulb-shaped thickening members. Air jets are delivered through them to fistula zone. The jets flow direction is opposite to that of rarefaction vector created with vacuum suction pump changing Δpp value at this area and preventing from tissue sticking to the main drain in the fistula zone and to the internal tampon surface. EFFECT: enhanced effectiveness of wound or fistula drainage; localized fistula exudate; excluded traumatic lesion of tissues adjacent to tampon. 2 dwg

Description

 The invention relates to medicine, namely to surgery, and can be used to treat unformed gastrointestinal and pancreatobiliary fistulas.

 A device for treating unformed intestinal fistulas is proposed as an analogue (B.A. Vitsyn and VV Atamatov. Treatment of patients with unformed intestinal fistulas. Surgery, 1984, No. 7, pp. 129-133).

 The disadvantages of this device are: the lack of drainage and adsorption qualities, the impossibility of localization, collection and accounting of the number of fistulous discharge, trauma to both the fistula and its carrying organ, leakage of fistulous contents to the skin and its maceration.

 As an analogue, a device for the treatment of unformed intestinal fistulas is proposed (V.F. Sharapov, EP Krivoshchekov. Obstruction and local dialysis for unformed intestinal fistulas. Clinical Surgery, 1985, No. 2, p. 52).

 The disadvantages of this device are: the technical complexity of its design, the lack of adsorption properties, the impossibility of complete localization and collection of fistulous discharge at the place of its formation, trauma to both the fistula itself and the organ carrying it.

 The closest in technical essence to the proposed device is a device used in the method of treatment of unformed fistulas V. A. Soloviev (V. A. Soloviev. Method for the treatment of unformed fistulas. Copyright certificate N 1251912).

There are common features of this device with the claimed device, which are expressed in the following:
a) the device is used in surgery for the treatment of unformed fistulas;
b) the device provides for the use of polymeric material in its plugging part;
c) the device includes the introduction of drainage into the plugging part;
g) the device provides for the connection of drainage to a vacuum suction with a degree of vacuum of 0.1-0.5 kg / cm and active aspiration of the fistulous discharge;
d) the device allows the collection of fistulous discharge and its full quantitative accounting.

 However, the known device does not exclude the phenomenon of suction of tissues of the fistula and the organ carrying it, which contributes not only to their trauma, but also to a pronounced violation of the drainage function.

 The objective of the invention is the development of a device for the treatment of unformed fistulas, providing localization and quantification of the fistulous discharge, collecting and removing it by the vacuum method, eliminating trauma to the organ carrying the fistula, and the fistula itself.

The solution of this problem allows you to create favorable conditions for the localization and quantification of fistulous discharge, collecting and removing it by the vacuum method, to exclude trauma to the organ that carries the fistula, and the fistula itself, which is achieved by using a three-layer combined tampon, represented by an external insulating, medium - polymer and internal - biologically active (fibrin sponge, placenta, etc.) layers. A drainage has been introduced into the tampon, which at the end leading to the fistula is flask-like expanded and has no lateral perforations within the boundaries of the implant. For drainage along the entire length in parallel planes, two anti-corrosion tubes of smaller diameter are fixed, ending in its bulb-shaped expansion. Through them, air jets enter the fistula zone, oppositely directed to the vacuum discharge vector created by vacuum suction, which changes the amount of vacuum p in this area and excludes tissue suction in the fistula zone to the drainage and the inner surface of the tampon. In this case, the pressure p is determined by the well-known formula:
p = W ² / (K ² • S ² ),
where W is the volume of pumped air;
K is the coefficient of form;
S is the area of active passage sections.

 The proposed device design is shown in FIG. 1 and 2. Figure 1 shows a General view of the device, figure 2 is a cross section of the device.

 Legend: 1 - the insulating layer of the tampon, 2 - the polymer layer of the tampon, 3 - the biologically active layer of the tampon, 4 - drainage, 5 - bulb-shaped expansion of the drainage, 6 - anti-discharge tubes, 7 - the end of the drainage connected to the vacuum suction.

 The device has the form of a three-layer combined tampon. The outer layer of which is made of insulating material 1, the middle one is made of polymer 2, and the inner one is biologically active 3. Drain 4 has a tampon with a bulb-shaped extension at the end 5 and two anti-discharge tubes fixed to it 6. The opposite end of the drainage, which is outside the tampon, is connected to vacuum suction 7.

 Example N 1. Patient P., 35 years old., N IB 829, was hospitalized in the 2nd surgical department of the Northern city clinical hospital in Kirov 06/03/92

 From the anamnesis it was established that on 03.05.92 he was admitted to the department hospital of the Gorky Railway in Kirov with a diagnosis of blunt abdominal trauma with a rupture of the duodenum, pancreas, spleen, mesentery of the jejunum with necrosis of the intestine and colon without it necrosis, shock III degree. On the same day, an operation was performed: laparotomy, splenectomy, suturing of a gap in the duodenum, pancreas, large mesentery, resection of the jejunum with the formation of gastroenteroanastomosis side to side along the Roux, debridement and drainage of the abdominal cavity.

 In the postoperative period, on the 5th day after the operation, duodenal and multiple colonic fistulas opened.

 Upon admission to the Northern City Clinical Hospital, the patient's condition is severe, adynamic. The skin and sclera with an icteric shade, tissue turgor is reduced. Pulse 96 beats. in minutes, blood pressure 130/80 mm RT. Art. In the lungs, harsh breathing. The abdomen is soft, painless, intestinal motility is heard. In the lower corner of the postoperative wound there is a defect of 6x3x2 cm, through which bile and intestinal secretions with fecal odor are secreted, the skin is macerated.

 For preoperative preparation, a foam-rubber vacuum swab was placed in the wound, and intensive infusion-transfusion therapy was started. After 24-hour preparation, the patient's condition improved, leakage of the contents of the fistula was not observed in addition to the tampon, the phenomena of maceration of the skin were stopped. The total amount of discharge obtained by active aspiration was 900 ml.

 06/04/92, a second operation was performed: relaparotomy, resection of the transverse colon with the formation of two terminal transversostomy, resection of the retroperitoneal part of the duodenum with fistula, duodenojunoanastomosis according to Robinson with enteroenteroanastomosis, cholecystostomy, drainage of the peritoneum.

 The postoperative period was difficult. For 6 days was on mechanical ventilation. Intensive antibacterial, detoxification and immunotherapy, correction of hydroionic and protein disorders were carried out. By resolution of intestinal paresis, from 4 to 10 days artificial enteral probe nutrition was carried out with a transition from 11 days to oral ingestion. Drainages were removed on the 10-12th day, cholecystostomy - on the 14th day. Wound healing by secondary intention. Recovery with an extract for outpatient treatment for 21 days after surgery. Colostomy function well.

 Example No. 2. Patient P., 68 years old., N IB 1361, entered 05.12.90 at 17.30 with suspected acute mesenteric thrombosis. In the process of treatment and diagnostic measures, the patient developed a clinic of peritonitis.

 12/06/90, at 9.30 taken for surgery. On examination: purulent effusion in the abdominal cavity in an amount of up to 400 ml, extensive necrosis of the small intestine, mesenteric vessels pulsation is not determined. Diagnosed with thrombosis of the superior mesenteric artery with necrosis of the small intestine, diffuse purulent-fibrinous peritonitis. The case is recognized as radically inoperable. The operation is completed by rehabilitation and drainage of the abdominal cavity.

 In the postoperative period, the clinic of peritonitis persisted, but the general condition of the patient did not worsen, and therefore he was re-taken for surgery on 08/08/90 to revise the abdominal organs and resolve the possibility of resection of the small intestine.

 On the operation: the small intestine is up to 1.8 meters from the Treyts ligament of normal color with single strands of fibrin, further the intestine with signs of non-viability for up to 3.5 meters, the area of the ileum up to 30 cm from the ileocecal angle is viable, there is necrosis of the right half of the omentum.

 Performed subtotal resection of the small intestine with an end-to-end anastomosis, omentum resection, debridement and drainage of the abdominal cavity.

 The postoperative period was difficult. Eventation occurred on the 7th day, on the 11th - inconsistency of the sutures of the enteroenteroanastomosis.

 On examination: in the region of the middle third of the postoperative wound, a cavity 12x4x4 cm containing intestinal discharge, at the bottom of it there are loops of the small intestine with fibrin. Diagnosed with insufficiency of sutures of the intestinal anastomosis in the area of 0.5 cm long. A foam-rubber vacuum swab was placed in the wound.

 On the 1st day, 1000 ml of intestinal contents were evacuated. Aspiration is adequate, there is no leakage outside the swab. Over the next 7 days, the amount of discharge gradually decreased to 500 ml, the tampon functions well. Aspiration continued. On the 8th day, 250 ml was evacuated. Three weeks after the start of aspiration, the patient's condition improved significantly, the number of evacuated intestinal discharge does not exceed 200 ml per day. The wound cleansed, filled with juicy granulations.

 01/17/91, in order to reduce the wound cavity and localize the process, the patient underwent surgery: plastic surgery of the abdominal wall wounds with local tissues to the fistula. A smaller drainage-foam rubber vacuum swab of smaller sizes was placed in the wound, aspiration continued. Over the next 3 days, the amount of discharge decreased to 100 ml. The patient's condition became satisfactory, the motor regime was expanded.

 Aspiration was carried out for another 7 days, the amount of discharge from the fistula decreased to 40-50 ml, and then completely stopped. The tampon is removed, the fistula is completely closed. 02/08/91, after complete healing of the wound by secondary intention, the patient was discharged in satisfactory condition home.

 This device was tested in a clinic in 15 patients with unformed fistulas and showed good results.

 The device has a fairly simple design, has advantages over known devices and can be recommended in surgical practice.

Claims (1)

A device for the treatment of unformed fistulas, including a plugging part of a polymer material and a drainage embedded in it, connected to a vacuum suction with a vacuum level of 0.1 - 0.5 kg / cm ² , characterized in that its polymer plugging part is placed between the insulating and biologically active materials, as a result of which the tampon acquires a combined three-layer character, and the drainage introduced into it at the end leading to the fistula is flask-like expanded and has no lateral perforations within the boundaries of the implant d, two anti-discharge tubes of a smaller diameter ending in its bulbous expansion are fixed to drainage throughout parallel planes, air jets flow in opposite directions to the fistula zone, directed oppositely to the vacuum suction suction vector, which changes the suction pressure Δp and excludes suction tissues in the area of the fistula to the drainage and the inner surface of the tampon.

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