RU2148954C1 - Method for treating the cases of peritonitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves treating the abdominal cavity with solutions introduced into canals and bursae through microirrigator units. A microirrigator unit is introduced into the greater omentum from the bursa omentalis cavity and a cavity is formed in the greater omentum by applying blunt exfoliation of the second and the third sheet of the embryo peritoneum. The microirrigator unit is pushed into the cavity. Lymph stimulation agents are introduced through the unit. EFFECT: enhanced effectiveness in removing metabolism products and exudate fluids from the abdominal cavity. 2 dwg, 2 tbl

Description

 The invention relates to medicine, more specifically, to surgery. It can be used during surgery and in the postoperative period. The invention improves metabolic processes in the abdominal cavity and thereby the treatment of peritonitis.

 It is known that one function of the greater omentum is to improve the sliding properties of the surfaces of organs / 1 /. The literature emphasizes its exceptional ability to envelop and absorb macromolecular substances, suspensions, foreign bodies, etc., that have fallen into the abdominal cavity under various circumstances. Scientific observations have shown that in 24 hours a large omentum can absorb up to 5 ml of carcass suspension from the abdominal cavity. The latter through the lymphatic hatches penetrates into the lymphatic "lakes", where its particles are fragmented, and then evacuated through the bloodstream or deposited in the lymph nodes / 2, 3 /.

 The functions of resorption, delimitation of inflammation, fibroplastic process, etc. are studied in detail and described in D.A. Zhdanova / 4, 5 / and others.

 A known method for the prevention of insolvency of the sutures of the gastrointestinal tract with peritonitis / by A. with. 1697760 /, based on knowledge of such functions / 6 /. Its essence lies in the fact that a lock of a large omentum is hemmed along the line of sutures applied to the organs of the gastrointestinal tract. To stimulate the functions, drugs are introduced into the hemmed portion of the omentum through a catheter inserted into the organ tissue. This catheter, it becomes clear from the description of the invention, is installed in the adipose tissue of the omentum.

 This introduction of drugs into the body ensures absorption of fatty tissue, but does not stimulate the absorption function of the peritoneum. But it is precisely the peritoneal cover of the omentum that provides purification of the abdominal cavity from xenomaterials by omentopinosis.

 Prevents postoperative complications "A method for preventing postoperative complications during operations on the organs of the abdominal cavity and abdominal wall" / a. with. 724133, 7 /, in which, in order to prevent adhesions of the intestinal loops with the postoperative scar of the anterior abdominal wall, before suturing the surgical wound, the section of the anterior / first / leaf of the greater omentum is hemmed as a patch to the parietal sheet of the peritoneum at a distance of 5-6 cm from the edges of the operating room wounds.

 Based on the physiological norm - the presence of mobility of the omentum and a certain mobility of the internal organs of the abdomen, we consider this fixation to be unphysiological. This may be the reason for the inaccessibility of the omentum in the loop loops, sinuses and pockets of the abdominal cavity.

 As a prototype taken "Method for the treatment of peritonitis" / by and.with. 874035, 8 /. Its essence lies in the fact that after performing the main stages of the operation, use a special device. - The latter is represented by a bunch of micro-irrigators - at least 14 pieces enclosed at one end into a collector connected through a unified adapter to a dropper. The free ends of the microirrigators are introduced into the canals and bags of the abdominal cavity, through these microirrigators, drug mixtures are subsequently introduced, for example, 300-500 ml of furatsilin solution in 150-200 ml of 0.5% novocaine solution and 1.0-1.5 g of kanamycin and There is a distribution scheme of microirrigators: right and left hepatic, subhepatic, subphrenic, intermediate stuffing bags; right and left side pockets, ileocecal; intersigmoid sinus; vesico-rectal and recto-uterine deepening. Microirrigators are fixed with catgut in these formations. After suturing the surgical wound, solutions are injected at a rate of 5 drops per minute at the rate of 500 ml of solution during the day. The course of treatment is 3-4 days.

 In this way, after surgery, drugs are introduced into the stuffing bag through microirrigators, but this does not stimulate the omentum, like an organ.

The prototype has the following disadvantages:
1. The visceral sheet of the peritoneum of the greater omentum is exposed to drugs, which for the most part are hypo- or hyperosmolar, have an irritating and even damaging effect. This is one of the conditions of adhesion formation, but the effect of stimulation of the greater omentum is not achieved.

 2. Injected drugs after administration through the collector, naturally, “spread” over the entire surface of the peritoneum, and its area is many times larger than the area of the greater omentum, ie the selectivity of the effect on the omentum, as an organ, decreases.

 3. The many microirrigators introduced (14 pcs.) Increase the possibility of mechanical and chemical damage to the peritoneal mesothelial layer many times over. The sorption function of the omentum is synchronous with the absorption function of the entire peritoneum, but there is no selective effect on the omentum.

 Our own experience in the treatment of similar patients, in the complex treatment of which special attention was paid to the functions of the greater omentum, allowed us to conclude that the immediate and long-term result of treatment improves the selective effect on this organ, at the same time eliminating mechanical, chemical injury to its visceral surface. Based on this, we have developed and proposed for practice a new method of treating peritonitis by stimulating the omentum.

 One of the unsolved problems is to improve the treatment of patients with peritonitis by improving the removal of metabolic products and exudate fluids from the abdominal cavity / fibrin, pus, microorganismic suspensions / due to the strengthening of the functions intended for this organism, strengthening the function of absorption of macromolecular substances from the abdominal cavity, t .e. self-cleaning of the abdominal cavity from effusion, pus, fibrin, etc.

 The essence of the proposed method is that the microirrigator is introduced from the cavity of the stuffing bag into a large omentum, for which it is previously stupidly stratified within the embryonic peritoneum located between its second and third leaves, stuffing box stimulators are introduced into the formed cavity. The method is illustrated by schematic drawings.

 In FIG. 1 shows a sagittal section of the abdominal cavity through the greater omentum, indicating the progress of the microirrigator from the abdominal wall through the omental sac to the newly formed cavity of the greater omentum. The topographic and anatomical position of the microirrigator in the abdominal cavity has the following digital indexation: 1. Transverse colon. 2. The stomach. 3. Gastrointestinal ligament. 4. The cavity of the stuffing bag. 5. Aperture. 6. The pancreas. 7. Mesocolon. 8. The lower recess. 9. 2nd leaf. 10. 3rd leaf of a large omentum. 11. Large oil seal. 12. Artificial cavity. 13. The microirrigator. In FIG. 2 shows the abdominal cavity in the frontal plane. On the diagram microirrigator / 13 /. In the diagram, the microirrigator / 13 / is inserted through the gastro-colon ligament 3 into the cavity of the omental bursa 4 behind the transverse colon / the bar designation of the course of the microirrigator /, then into the newly recanalized between 2 and 3 leaves of the embryonic peritoneum of the greater omentum 11.

 The inventive method is as follows: after laparotomy, elimination of the cause of peritonitis and sanitation of the abdominal cavity, the transverse colon 1 and stomach 2 are found. In the avascular part of the gastro-colon ligament 3, they perforate bluntly and penetrate into the cavity of the lesser omentum 4, bounded by the posterior wall of the stomach 2 , diaphragm 5, the dorsal part of the parietal peritoneum covering the pancreas 6 and the mesocolon 7. In this cavity, the lower recess 8 is determined. A hole between the second 9 and t with 10 leaves of the greater omentum 11, stratify them bluntly, form an artificial cavity 12, up to about 100 ml in volume, into which the microirrigator 13 is placed. Intraorgan stimulation of the greater omentum is carried out through the microirrigator by introducing into the newly formed cavity any solutions of choice - lymphostimulants. In solutions using known lymph-stimulating substances in known concentrations and dosages / 7 /.

 The significance of the distinguishing features lies in the fact that for the first time it is proposed to use the natural physiological ability of the omentum to absorb macromolecular / pus, fibrin, necrotic tissue, etc. / substances from the free abdominal cavity, which is a necessary mechanism for the treatment of any peritonitis, including conditions after ulcer perforation, foreign bodies of the abdominal cavity, effusion, fibrin, treatment products artificially introduced into the abdominal cavity.

 The entrance to the omentum as an integral organ is not known. It was established that between 2 and 3 leaves, without tearing the last, one should enter precisely in the area of adhesion of two leaves of the peritoneum from the stomach and two other leaves from the transverse colon. In this place they are connected most loosely and are easily stratified during the operation. It is the entrance to the gland from the side of the stuffing bag that ensures the accuracy of penetration into the gland. Other ways to enter the cavity of the greater omentum blindly lead to perforation of 1 and 2 leaves with penetration into the fat layer itself, which does not give the desired effect, enhancing the absorption function of the peritoneum itself.

 From the course of embryology, it is known that a large omentum develops from the dorsal mesentery of the stomach / dorsal mesogastrium /, as the stomach turns, moving to the left and spreading in the caudal direction. When meeting with the mesentery of the transverse colon, the omentum fuses with it and deviates ventrally, lying on the loops of the small intestine. Its anlage is formed even before the start of the dorsal mesogastrium, which increases to the left, so the stomach, having made a turn, is lying ventrally from the stuffing box. In the future, the growth of the stuffing bag occurs in the caudal direction - it is located between the plates of the greater omentum / 1 /.

 These plates / leaflets /, as found in practice, are not always spliced. Often, 2 and 3 leaves are interconnected only by loose connective tissue fibers, which allows you to install a microirrigator between them. In the future, control is carried out visually from the side of the surface of the organ: usually the microirrigator shines through the sheets. Carry out chromoindication, determine the anatomical capacity of the formed cavity. To do this, use any dyes that are allowed for introduction into tissues and lymph vessels, for example, Evans blue, indigo carmine, etc. The second end of the microirrigator / central / is brought out through the upper corner of the wound or through a separate puncture of the abdominal wall. Then it is connected to the infusion system.

 An essential feature is the first identified layer of the omentum between the leaves of the peritoneum. In fact, they were free and not fused, and in an adult, in most cases they stick together. Therefore, this is not just a peritoneum, but an “intraorgan embryonic peritoneum” having a genetic property of absorption through peritoneal stomatomas. It is with them that the lymphocapillary begins. The visceral peritoneum of the greater omentum diverges in the adhesion area, exposes the lymphozero (synonym for lymphocyte) and provides an absorption effect / cytopinosis / of lymphocytes and an absorbing substance with the age of lymphocytes into the lymphatic channel of the omentum. That is, omentopinosis is intensified / omentum absorption of substance from the abdominal cavity /. By stimulating the lymph flow with lymphostimulants in these leaves, we have established the enhancing ability of the external peritoneal sheets to be sorbed by mesothelium. The response of the organ is synchronous and is controlled by single vegetative ganglia. In contrast to the name of the outer leaves, which are the visceral peritoneum, the inner ones are called embryonic, as in fact the remaining vestigial of embryogenesis.

 After entering from the stuffing box, between the 2 and 3 layers of the embryonic peritoneum, the entrance is of a minimum size, but sufficient for the introduction of a microirrigator. It is practically established that this is easily done with the fingers of a surgeon, special tools are not needed. However, an artificial cavity with a capacity of up to 100 ml of liquid is produced in the interior of the gland. We found that, by hydraulic preparation, the liquid itself can subsequently exfoliate the layers of the embryonic peritoneum. Any stratification of it in excess does not give any complications. It is between the 2 and 3 layers of the embryonic peritoneum that there are no arterial and venous vessels, i.e., there are no conditions for intraorgan hematomas, abscesses, and ischemia. It was revealed that the fluid introduced into the artificial cavity of the greater omentum causes a gravitational effect, i.e., the weight of the omentum increases, which contributes to its lowering and penetration into the more flat peritoneal fissures in the abdominal cavity, which is one of the important functional effects.

 Examples of specific performance.

 1. B. B., 46 years old / history of N 32 132 dd. 02.16.88 / was admitted for treatment with a clinic of acute bowel obstruction. The patient was operated on two years ago for a penetrating wound to the abdomen with damage to the loops of the small intestine. An attempt at conservative therapy at present has been unsuccessful and, after preoperative preparation, the patient has been operated on. Under endotracheal anesthesia, a median laparotomy was performed. Extensive adhesion process. Using a microsurgical instrument, with certain technical difficulties, loops of the small intestine and large omentum were released from the joints, a commissure was crossed, which caused acute obstruction of the small intestine at a distance of 40 - 45 cm from the ileocecal angle.

 Given the macroscopic changes in the abdominal organs, such as the hemorrhagic nature of the exudate in an amount of up to 250 ml, overstretched loops of the small intestine, many spotted subserous hemorrhages, etc., we decided to perform a complex of therapeutic measures, including our technique. The abdominal cavity was thoroughly washed with a copious amount of isotonic sodium chloride solution, nasointestinal intubation was performed - 800 ml of stagnant intestinal contents were removed. Then the border of the greater omentum, transverse colon was determined. A hole was made in the gastrocolic ligament. From the cavity of the stuffing bag, the lower recess is determined by the index finger of the left hand. Then, through the recess, a passage is formed into the cavity of the greater omentum between 2 and 3 leaves, a cavity of 7 x 7 x 8 cm is formed. The distal end of the microirrigator is installed in it. The central end is brought out through the upper corner of the wound of the operating room. In order to determine the integrity of the formed cavity, a quarter percent solution of novocaine stained with methylene blue was introduced into it. In this case, a perforation hole was detected at its bottom. Obviously, it formed during the separation of the greater omentum from the surgical scar of the anterior abdominal wall. The hole is sutured. The surgical wound is also sutured. In the postoperative period, infusion therapy was carried out, prolonged epidural anesthesia. Anti-inflammatory drugs, lymphostimulants and antibiotics / kanamycin, chymotrypsin, novocaine, hydrocortisone, trental, nicotinic acid, etc. / were administered twice daily for 7 days at appropriate dosages and dilutions. On the 3rd day we noted relief of peritonitis, positive dynamics of the disease. Complications from the therapy and the disease itself were not observed. The patient was discharged 12 days after surgery. Examined after 6 months. The patient does not complain.

 2. B-th M., 43 years old / history of B-ni N 1100 dated 3.04.89 / was operated on urgently with a diagnosis of acute appendicitis complicated by diffuse peritonitis. Under endotracheal anesthesia, a median laparotomy was performed. In the abdominal cavity up to 200 ml of turbid effusion. Inflammation is predominantly in the right iliac region. There are signs of a disorder of blood microcirculation, lymph in the intestinal wall, mesentery. The appendix is 9 x 1.5 cm deep dark purple in tension. Performed an appendectomy. The abdominal cavity is washed with isotonic sodium chloride solution. Gastrointestinal ligament opened. We entered the stuffing bag and stupidly made an entrance between 2 and 3 sheets of a large omentum, formed a cavity of 6 x 6.5 cm. A micro-irrigator was installed in it. The latter shines through the wall of the organ. The large omentum is shifted by hand to the right iliac region. The proximal end of the microirrigator is brought out. The wound is sutured. In the postoperative period, intra-mental infusion of drugs was performed 2 times a day: a quarter percent solution of novocaine - 100 ml, 1 million units. oxacillin, 2.5 units heparin, trental, etc. Treatment for 8 days. No complications after surgery were observed. Examined and examined by the patient after 8 months for complications. The latter were not found.

 3. B-th T., 26 years old / history of N-2200 dated 6.05.90 / was operated on for penetrating stab-cut wounds to the abdomen, internal bleeding 1.5 hours after injury. At the border of the mesogastric and epigastric regions there is a stab wound 1.5 x 0.2 cm in size. The patient has anemia, hypovolemia, pneumoperitoneum. Under endotracheal anesthesia, a median laparotomy was performed. In the abdominal cavity up to 600 ml of dark blood with clots. Bleeding from a damaged vein of the mesentery. Hemostasis. During the audit of the abdominal organs, 7 additional wounds were found on the small intestine in its different departments and of different sizes. The wounds are sutured. Performed primary surgical treatment of the wounds of the anterior abdominal wall. The abdominal cavity is washed away from the spilled intestinal contents and blood. By the nature of the injuries, the severity of the surgical intervention, we came to the conclusion that there is a high probability of occurrence of a subsequent adhesive disease. Therefore, the developed technique of omenostimulation was applied to the patient. Through the window formed in the gastro-colon ligament, the lower recess between the upper wall of the colon and the front two leaves of the greater omentum is determined by finger examination. Through tunneling, the entrance to the cavity of the greater omentum was made, a cavity of 12 x 10 cm was formed in it and a micro-irrigator was installed, and its central end was brought out through the upper corner of the surgical wound. Bleeding was not observed, the sutures on the wall of the intestine are tight. The surgical wound is sutured. After surgery, on the background of rehabilitation therapy twice a day for the first 8 days, intra-mental infusion of drugs was performed / novocaine, trypsin, hydrocortisone, trental, nicotinic acid, etc. /. After each administration of drugs, the patient felt a feeling of fullness in the abdomen and a decrease in pain intensity. We did not observe any complications from the application of the method. After 10 days, the patient was transferred to outpatient treatment. It was observed for about two years. We did not observe any complications.

 When comparing the prototype with the claimed method, common signs were revealed: they relate to the treatment of peritonitis, include such moments of surgical technique as sanitation of the abdominal cavity, its suturing, the introduction of solutions into the abdominal cavity through microirrigators. Compared with other analogues, this coincides in the main feature - the treatment of peritonitis by debridement / removal of effusion, foreign bodies and other xenobiological substances / abdominal cavity. This is especially true for thick pus, formed fibrin, foreign materials with perforated stomach ulcers or injuries of a hollow organ. This allows us to consider this analogue as a prototype.

 However, there are distinguishing features. According to the claimed method, the stimulation of the greater omentum is carried out selectively, i.e. the effect is directed to the tissue of the omentum, and not to the entire surface of the peritoneal cover.

 If, according to the prototype, the microirrigator is installed in the cavity of the small omentum, located dorsal to the omentum itself, then according to the claimed method, the microirrigator is introduced into the large omentum, as an independent organ that carries out sanitation of the abdominal cavity, which increases the selectivity of drug exposure to this organ, its stimulation is created for the first time.

 If, according to the prototype, the microirrigator was introduced into the cavity of the stuffing bag, i.e., into the space between the posterior wall of the stomach, the mesentery of the colon and the posterior parietal sheet of the peritoneum, which was the final drainage site, then according to the claimed method, the stuffing bag is used only as an entrance to the stuffing box itself . It is such an entrance that creates the accuracy of penetration between the embryonic leaves of the peritoneum of the omentum. That is, the place of drainage, irrigation is fundamentally different. It provides lymphostimulation, omentopinosis. This method contributes to a more effective cleaning of the abdominal cavity in the postoperative period.

 Repeated laparotomy, undertaken by a patient previously operated on the prototype and at different times after the first operation, allowed to ascertain the adhesion process of various lengths. In patients operated using the developed method, clinically adhesive disease was not detected for two to three years / 15 observations /.

 In contrast to the prototype, drugs are distributed between the entire duplicate of the primary / embryonic / peritoneum, i.e. there is a clear increase in the deposit function, and the absorbed medication stimulates the functions of the organ for a greater extent.

 A new layer / 2 and 3 leaves of the embryonic peritoneum was revealed in the omentum / stimulation of which enhances the lymph flow in the organ and, accordingly, the sorption ability / activation / of the entire omentum, which is its physiological function and biological purpose.

 We found that the cavity of the greater omentum / on cadaveric material / holds up to 1000 ml of liquid. It has been clinically established that up to 100-300 ml can be injected into a cavity without tissue damage. The gland is heavier by the size of the injected fluid, and it shifts 1–7 cm more caudally, where it itself carries out the sanitizing function.

 If, according to the prototype, the sanitizing function of many microirrigators ends by the 3rd - 4th postoperative day, then according to the claimed method, the effect on the omentum can be extended for the entire period of treatment of the patient in the hospital / 8-16 days /, without fear of the damaging effect of the microirrigator on the peritoneum.

 According to the claimed method, the possibility of the influence of lymphostimulants, called in this case, omentostimulants, is achieved.

 The application of our proposed method was preceded by a study of the anatomy / 16 studies / and the functions of the omentum / 20 studies / in an acute experience on cats. It became known that the area of the omentum is sufficient to cover the surface of the loops of the small intestine in front. Regardless of the shape of the omentum, its lowermost edge reaches the bottom of the unfilled bladder. There is a cavity in the greater omentum closed along its edges. The most convenient and easy access to the organ cavity through the lower recess of the stuffing box. In most cases, the cavity of the greater omentum does not communicate freely with the rest of the abdominal cavity. With slow filling of the organ through the introduced microirrigator, it is able to accommodate up to one liter of solution. As the cavity of the greater omentum is filled, it becomes heavier and spontaneously begins to shift to the lower parts of the abdominal cavity. Displacement begins after the introduction of 100 - 300 ml of solution. In experimental cats, 2 to 5 minutes after the intramental injection of the drug mixture, usually diffuse weeping of the surface of the organ and draining from it with extremely rare drops of liquid, similar in appearance and appearance to lymph, is observed.

 At the same time, in two groups of animals (100 animals each), we studied the cellular composition of smear impressions from the serous membrane of the small intestine. The first prints were made after laparotomy / intravenous anesthesia - calipsol 2 mg / kg /, the second - 24 hours after intraperitoneal administration of 20 ml of isotonic sodium chloride solution. The solution was injected using a microirrigator installed in the first group of animals into one of the mesenteric sinuses, and in the second into the cavity of the greater omentum according to the developed technique. After laparotomy, animals were used for another purpose. The prints were stained according to Romanovsky-Giemsa. Counted the number of mesotheliocytes, fibroblasts, leukocytes in one field of view. Per 100 cells, the percentage ratio of neutrophils, lymphocytes, monocytes was determined. The method of variation statistics compared the number of cellular elements in groups of animals / table. 1/.

 According to the data obtained, the difference in the increase in the number of cellular elements became visible 24 hours after the infusion of saline intra-mentally. So, a marked increase in the number of fibroblasts by a factor of two compared with the group of animals to which the fluid was administered intraperitoneally. The number of neutrophils increased in the same proportion. At the same time, a shift towards the predominance of lymphocytes and monocytes was noted.

 Thus, in the experiment it was shown that the introduction of sodium chloride into the greater omentum increases secretory function to a greater extent than in one of the mesenteric sinuses.

 This conclusion is confirmed by clinical observations.

 In two groups of patients (20 people each) operated on for acute adhesive intestinal obstruction with serous peritonitis, who, after the main stage of the operation, had a microirrigator intraperitoneally installed for anti-adhesive therapy in the postoperative period, we determined the total protein, total lipids, cholesterol, using standardized methods phospholipids, triglycerin on the 2nd, 6th, 12th day after the operation in the washing fluid of the abdominal cavity. At these times, before the next administration of the drug mixture, an isotonic sodium chloride solution (300 ml) was poured into the microirrigator. After lightly shaking the anterior abdominal wall, after about 8 to 10 minutes, we sucked out 10 ml of solution to perform biochemical studies. Additionally, the washing liquid obtained on the 6th day in this way, we examined the strength of the surface tension. The difference in the intraperitoneal therapy of the two groups of patients was that in one group of patients we installed the microirrigator in the mesenteric sinus / intraperitoneally /, and in the other - into the cavity of the greater omentum according to the developed technique / intramental /. The research results are presented in table. 2.

 It was established: as patients recover, the level of total protein, lipids and their fractions in the abdominal lavage decreases. However, in patients who we administered intramedically, a higher level of total lipids and their ingredients / P <0.05 / remained in the wash liquid than in patients with the intraperitoneal route of administration of drugs. A lower surface tension force of the washing liquid / 64 ± 6 versus 76 ± 8 dyne / cm / was also found.

 We applied the intramental infusion method according to the developed method according to the indications in 44 patients / 1988-1995 / operated on an emergency basis with various forms of diffuse peritonitis. These patients have been observed for several years. We did not observe any complications from the application of the technique. And in the near postoperative period, almost all patients found clinical signs that indicate the effectiveness of the method. Usually, after the intra-mental administration of drugs following a short-term sensation of heaviness, the patient notes a decrease in the intensity of abdominal pain and intestinal motility. The temperature stops already at 2 - 3 days from the start of treatment. We did not observe paresis of the gastrointestinal tract, traditional in such situations - independent stool was noted on 3-4 days. Healing of the surgical wound took place without suppuration, normalization of white blood counts occurred on the 4th - 5th day, if there were no complications. In this group of patients, we did not observe fatal cases; the average treatment period was 12-15 days.

 Such treatment indices significantly distinguished this group of patients from those treated by traditional methods.

List of references
1. Greater omentum: anatomy, physiology, pathology, surgery - a historical essay. Edited by D. Liebermann-Mefert, H. White. Translated from English by B.A.Shilova. - M .: Medicine, 1989 .-- S. 1 - 335.

 2. Ignatiev G. K. On the issue of microcirculation in the small omentum and in the wide ligament of the uterus // In the book: Yubilein. conf. - Stavropol, 1961 .-- S. 60 - 61.

 3. Borisov A.V. Lymphatic capillaries and vessels of milk stains of human omentum // Archive of Anatomy, Histology and Embryology. - 1963. - T. 44. - Vol. 3 .-- S. 115 - 120.

 4. Zhdanov D.A. Greater seal // BME. - 1984. - T. 22. - S. 456 - 458.

 5. Zhdanov D.A. On the participation of the omentum blood and lymph vessels and the resorption of true colloidal solutions and suspensions from the abdominal cavity // Materials on the anatomy of lymphatic vessels and nodes. - Gorky, 1942 .-- S. 31 - 36.

 6. A.S. USSR N 1697760. A method for the prevention of inconsistency of sutures of the gastrointestinal tract / Auth. I.Yu. Polyansky, B.O. Milkov and O.I. Polyansky on request 46272442/14 of 10.25.88 MKI A 61 B 17/00, A 61 M 19/00. Publ. BI 1991. - N 46.

7. A. p. USSR N 724133. A method for preventing postoperative complications during operations on the abdominal wall and organs of the abdominal cavity / K.D. Toskin, V.V. Zherebovsky. According to the application N 26075007 / 28-13. Announced 04.25.78 MKI ² A 61 B 17/00. Publ. 1980. BI N 12.

 8. A.S. USSR N 874035. A method for the treatment of peritonitis / Auth. G.I. Dudenko and G. D. Petrenko on the application N 284793 / 28-13. Declared 05.12.79. MKI A 61 B 17/00. Publ. 1981. BI 39.

Claims (1)

 A method of treating peritonitis by sanitizing the abdominal cavity with its suturing and introducing solutions into the channels and bags of the peritoneum through microirrigators, characterized in that the microirrigators are introduced from the cavity of the omental bursa into a large omentum, for which the cavity is formed in the latter by bluntly stratifying 2 and 3 sheets of embryonic peritoneum, where the microirrigator is promoted and lymphostimulants are introduced through it.

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