RU2157195C2 - Method for producing superficial wound hemostasis in parenchymatous organs - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves injecting 3% solution of sodium tetradecyl sulfate into the tissues surrounding the wound defect. EFFECT: accelerated and reliable hemorrhage arrest.

Description

 The invention relates to medicine, more specifically to surgery, and can be used to stop bleeding from superficial wounds of parenchymal organs.

 A known method of stopping bleeding from superficial wounds of parenchymal organs, such as the liver, by electrocoagulation (Andrianov N.G., Experimental justification and clinical application of thermocoagulation to stop parenchymal bleeding during liver operations: Diss. Cand. Medical Sciences. - M., 1974 ) The implementation of this method of hemostasis is accompanied by thermal necrosis of the tissue, and when the electrode is removed from the source of bleeding, the scab may break off and bleeding may resume.

 To avoid thermal tissue necrosis, a method for stopping bleeding with fibrin glue has been proposed (Gisauri B.C., Movchun A.A., Gauthier S.V. et al. Surgery journal 1989, N 4, pp. 89-93). But with this method, certain conditions are necessary: a “dry” wound, for which the feeding vessel or parenchyma is squeezed with a soft pulp, which in turn lengthens the operation time, causes organ ischemia, and does not allow using this method for hemostasis during laparoscopic surgery.

 The objective of the invention is to achieve fast, reliable hemostasis with superficial wounds of parenchymal organs, regardless of the method of surgical intervention, an increase in the number of organ-preserving operations.

 The problem is solved in that hemostasis of the superficial wounds of the parenchymal organs is carried out by injection of the drug with a 3% solution of sodium tetradecyl sulfate by chipping off the tissue surrounding the wound defect.

 It is known to use in medicine a 3% solution of tetradecyl sulfate for sclerotherapy for bleeding from varicose veins of the esophagus (Express-Information Journal "Surgery", issue 1-3, Moscow, 1992, 25-28).

 The essence of the method is as follows. In patients with bleeding from superficial wounds of the parenchymal organs, the tissues surrounding the defect are infiltrated by injecting a 3% solution of sodium tetradecyl sulfate until the bleeding stops completely. The drug is administered up to 20 ml per injection. It is used for hemostasis in an isolated form, as well as in combination with other methods, in order to achieve faster and more reliable hemostasis, for example, with wound closure, in case of continued bleeding from a sutured wound. This method of hemostasis can be used for "open" (laparotomy) and "closed" (video laparoscopic surgery) surgical interventions on parenchymal organs.

 A series of experiments on rats showed that the application of the drug 3% sodium tetradecyl sulfate is ineffective, hemostasis does not occur. When injected using 0.5%, 1% and 2% sodium tetradecyl sulfate solutions, hemostasis occurs slowly and not in all cases. The introduction of a 3% solution of sodium tetradecyl sulfate leads to a stop of bleeding, while the area of necrosis is small around. The use of a 4% solution and a higher concentration causes significant necrosis of the parenchyma. The drug infiltrates the tissues surrounding the defect to a depth of 5 mm. With the introduction of the drug to a depth of less than 5 mm, the outflow of the drug into the wound occurs, as a result of which the hemostatic effect slows down. If the drug is administered deeper than 5 mm, then to achieve hemostasis, it is necessary to increase its dosage, which, in turn, can increase the zone of necrosis and cause a toxic effect.

 The volume of administration of the drug should not exceed 20 ml per injection (permissible single dose for pharmacopeia).

 Clinical example N 1. Patient G., 50 years old, was admitted 3 days after the onset of the disease with a diagnosis of acute calculous cholecystitis. The patient underwent conservative therapy, inflammation in the gallbladder subsided. In a delayed order, after 2 weeks she underwent surgery - cholecystectomy. The removal of the gallbladder was carried out from its neck with separate ligation of the cystic duct and cystic artery. The dull and sharp path of the gallbladder is removed. On the liver from the gallbladder bed, bleeding at 3 points was noted. Infiltration was performed by injection of a 3% sodium parenchyma tetradecyl sulfate sodium solution around each source of bleeding to a depth of 5 mm in a volume of up to 0.7 ml, while a decrease in bleeding activity was noted up to a stop for 5-7 minutes. They refused electrocoagulation and suturing of the gallbladder bed. The subhepatic space was drained by drainage, the wound of the abdominal wall was sutured. After the operation on the 1st day, the patient's condition corresponded to the volume of intervention; no drainage was noted. On the 2nd day, an ultrasound scan of the abdominal cavity was performed, while no free fluid was found in the latter, a narrow hypoechoic zone of 6 mm was doped under the liver, and a section of increased echogenicity of the liver parenchyma 15x15 mm with a narrow hypoechoic zone around was doped under the liver . The patient's condition improved. On the 3rd day, safety drainage was removed from the abdominal cavity. On the 5th day, an abdominal ultrasound was repeated, in which positive dynamics was noted: a decrease in the hypoechoic zone under the liver and a decrease in the hyperechoic density section to 10x10 mm. On the 11th day the patient was removed skin sutures, and on the 12th day after the operation they were discharged home in satisfactory condition.

 Clinical example No. 2. Patient N., 23 years old, was admitted 3 hours after a household injury with a diagnosis of combined trauma, closed fracture of the wing of the iliac and pubic bones on the left, closed fracture of the bones of the middle third of the right forearm, closed trauma of the abdomen, rupture of the spleen, concussion brain, bruised wound of the frontal region, traumatic shock of the II degree. Upon admission, the patient noted pain in the left half of the abdomen, she underwent an ultrasound scan, in which a heterogeneous echostructure was revealed in the area of the irregular shape of the spleen 40x30 mm, around the spleen there was a hypoechoic zone, indicating its rupture. The patient was operated on. During the operation, 300 ml of fresh blood was found in the abdominal cavity; during the audit, a gap of 30x5 mm, up to 10 mm deep, with bleeding was found on the visceral surface of the spleen. One Z-shaped suture with a vikril thread was applied to the wound, while the intensity of bleeding decreased, but new sources of bleeding appeared from the injection sites of the needle, as well as from one section of 10x3 mm of the erupted tissue. Infiltration was performed by injection of 3 ml of a 3% solution of sodium tetradecyl sulfate of the spleen tissue, 5 mm from the edge of the defect. Additionally, the injection sites and the erupted area, respectively, 0.5 ml were infiltrated with the drug. A total of 5.5 ml of the solution was injected, while a decrease in bleeding activity was noted until it stopped within 7-10 minutes. Additional methods of hemostasis were abandoned. The abdominal cavity was drained, the left subphrenic space and the pelvic cavity were drained, the wound of the abdominal wall was sutured. After the operation, on the 1st day, the patient's condition corresponded to the severity of the injury and the volume of intervention, a total of 15 ml of hemorrhagic discharge was allocated from the abdominal cavity through the drainage. A day after the operation, an abdominal ultrasound was performed, and it was revealed that the contours of the spleen were smooth, the echostructure was homogeneous, and the vascular pattern was preserved. On the same day, we performed a computed tomography of the abdominal cavity, in which it was noted that the spleen was of a normal form, in its central parts, a zone of reduced (up to 3-6 units) density with fuzzy even contours, measuring 9.8x2.1 mm, was determined. After amplification by contrast, its accumulation in this zone was not revealed. The patient's condition improved. On the 2nd day there was no discharge through the drains, on the 3rd day the drains were removed. After 3 days, the ultrasound was repeated, in which it was noted that the spleen echostructure was homogeneous, and the spleen vessels dopplerography showed preserved blood flow in the organ. The patient was gradually recovering. After 5 days with dynamic ultrasound, it was noted that the echostructure of the spleen is homogeneous, the vascular pattern is not changed. On the 7th day, the day after the operation, a radioisotope scintigraphy of the spleen was performed with the Technitium-99m preparation. A sufficient accumulation of the radiopharmaceutical in it was revealed on the scintigram, its distribution was uneven with a decrease in its accumulation in its central part, without drug extravasation beyond the spleen contours. The patient on the 11th day removed the stitches from the skin. On the 12th day, the patient was transferred to the trauma unit for aftercare of a skeletal injury in a satisfactory condition.

 Thus, the use of the proposed method of hemostasis of superficial wounds of parenchymal organs will allow you to achieve fast, reliable hemostasis, regardless of the method of surgery ("open" - laparotomy or "closed" - video laparoscopic surgery), increase the number of organ-preserving operations.

Claims (1)

 The method of hemostasis of superficial wounds of parenchymal organs, including the introduction of the drug into the wound, characterized in that the drug is used as a 3% solution of sodium tetradecyl sulfate, which is injected, chipping tissue surrounding the wound defect.