RU2160126C1 - Draining device - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has two single-canal tubes having openings on lateral surfaces. One tube is connected to external rarefaction source. The draining device has bisectional hollow plate. The upper section has hill-like cross-section and the lower one has cross-section like ellipse elongated along its greater axis which lateral sides are made monolith. One tube is placed in the central part of every section. An additional tube having a lateral hole on the proximal end is placed in the hill-like cross-section tube. The distal ends of the additional tube and the ellipse section tube are connected to rarefaction source. The holes are produced along the hill- shaped surface and in chessboard order in the case of the ellipse section of the plate. EFFECT: reliable isolation of zone sutured with skin sutures. 1 dwg

Description

 The invention relates to medicine, namely to surgery, and can be used in the treatment of common purulent peritonitis, especially complicated by phlegmon of the anterior abdominal wall.

 It is known that one of the most effective and common methods of treating common purulent peritonitis is the method of programmed or staged abdominal sanitation, which consists of a series of relaparotomies repeated with a specified interval (1).

 Repeated suturing of the muscle-aponeurotic layer of the laparotomy wound leads to damage, fragmentation, and contact with peritoneal exudate leads to the development of a severe, mainly non-clostridial anaerobic, purulent-necrotic process in the tissues of the anterior abdominal wall (PBS) - to phlegmon. At the same time, the spread of purulent exudate from the inflamed PBS tissues with its phlegmon into the free abdominal cavity is capable of supporting peritonitis or leading to its progression.

 There are various drainage devices used to treat purulent wounds and cavities.

 Redon suction drainage is well known (2). The known device consists of a single channel tube with side holes. The tube is connected to an external vacuum source.

 The disadvantage of this design when restoring the anterior abdominal wall in patients with widespread purulent peritonitis is the inability to reliably prevent contamination and re-contamination of the peritoneal cavity by exudate from PBS tissues and vice versa due to the configuration and size of the formed skin-visceral space. In addition, it is impossible to conduct adequate drainage of the skin-visceral space due to the suction of tissues to the lateral openings of the tube and the loss of its drainage function.

 Also known is close in technical essence to the proposed device - drainage for the abdominal cavity, containing intra-abdominal and extra-abdominal tubes connected by a retainer. To exclude the suction of organs and walls of the drained cavity to the intraperitoneal tube during prolonged aspiration, the retainer is made in the form of a hollow cylindrical body with nozzles, a stabilizer and a stopper. The latch is mounted on the extra-abdominal tube (3).

 The disadvantages of this device include the impossibility of reliable and complete isolation of the laparotomy wound from the abdominal cavity.

 The closest in technical essence to the proposed one is a drainage device consisting of two coaxially arranged single-channel tubes, on the lateral surfaces of which holes are made. A smaller central tube is connected to an external vacuum source. Between the tubes there is a gap that prevents the suction of the outer tube to the underlying tissues (4).

 The disadvantages of this device include the impossibility of a complete evacuation of purulent exudate from the skin-visceral space and the reliable prevention of contamination and re-contamination of the abdominal cavity by exudate from PBS tissue and vice versa, due to the configuration and size of the formed skin-visceral space.

 The objective of the invention is to develop a device that allows you to reliably and atraumatically isolate the area stitched with skin sutures of the laparotomy wound of PBS from the abdominal cavity and to drain this area in patients with advanced purulent peritonitis.

 The technical result of this proposal is to prevent the spread of purulent exudate from the suppurative tissue of the PBS laparotomy wound into the abdominal cavity by eliminating the contact of the tissue of the PBS laparotomy wound with purulent exudate from the peritoneal cavity and providing the possibility of aspiration drainage of the area of the sutured laparotomy wound of the PBS.

 The technical result is achieved by the design of the proposed drainage device, consisting of two single-channel tubes, on the lateral surfaces of which holes are made. One of the tubes is connected to an external vacuum source.

 Distinctive features of the claimed device are that the drainage device is made in the form of a two-section hollow plate, the upper section of which in cross section has the shape of a "hill", the lower section is an ellipse elongated along the major axis, the lateral edges of the plate are made with monolithic extended edges. Inside the plate, in the central part of each section, it is longitudinally placed along the tube, on the side surfaces of which holes are made. An additional tube with a side opening at the proximal end is placed longitudinally and leaking in the tube of the “hill-shaped” section. An additional tube with a tube of an "ellipsoidal" section of the plate is connected to an external vacuum source. On the upper surface of the "ellipsoidal" section of the plate, holes are arranged in a checkerboard pattern. Holes are made along the lateral surfaces of the "hill-shaped" part of the plate. The bottom surface of the drainage device is made integral.

 A comparative analysis of the proposed solution and the prototype shows that the proposed device differs from the known shape and functions of its constituent elements, namely: - the claimed drainage device is a rectangular two-section plate with rounded edges. The upper “hill-shaped” section of the plate is parallel to the lower one, which has the shape of an ellipse elongated along the major axis with monolithic lateral edges. On the "hill-like" surface of the plate, the holes are staggered. The holes in the "hilly" part of the plate are made along the side surfaces.

 From the above comparative analysis it follows that the claimed drainage device meets the criteria of the invention of "novelty."

 The drainage device constituting the claimed invention is intended for use in healthcare. The implementation of its capabilities is confirmed by the methods and means described in the application.

 The inventive device ensures the achievement of a technical result, namely, preventing the spread of purulent exudate from suppurative tissues of the lobarotomy wound of PBS into the abdominal cavity. The developed device allows atraumatic, reliable and efficient drainage of the skin-visceral space, to exclude contact of the tissues of the laparotomy wound of the anterior abdominal wall along its entire length with the abdominal cavity and thereby prevent the spread of purulent exudate from the tissues of the PBS laparotomy wound into the abdominal cavity during their purulent-necrotic defeat.

 From the above it follows that the claimed invention meets the condition of patentability "industrial applicability".

 The implementation of the upper section of the plate in the form of a "hill" most fully corresponds (congruently) to the cross section of the postoperative PBS wound that is sutured only by skin sutures and provides complete (across the entire surface) and atraumatic contact of the tissues of the surgical wound with the drainage device.

 The presence in the central part of the "hill-shaped" section of the plate of a longitudinally located tube with side openings and inside of it a longitudinally and non-sealed additional tube with a side hole in the proximal part and connected to an external vacuum source makes it possible to evacuate the "hill-shaped" wound detachable that penetrates through the side openings from the side of the wound PBS without "suction" of the tissue of the wound to the holes.

 The location of the holes on the upper surface of the "ellipsoidal" section of the plate in a checkerboard pattern ensures uniform and complete "suction" of the plate to the abdominal wall, thereby achieving its isolation from the abdominal cavity.

 The lower section of the plate-shaped drainage device is made in the form of an ellipse elongated along the major axis, plays the role of a tread for the abdominal organs adjacent to the wound.

 The execution of the lateral edges of the "ellipsoidal" section of the plate monolithic provides the possibility of varying the dimensions of the drainage device depending on the specific parameters of the wound.

 The implementation of the inventive drainage device from an elastic biologically inert material - silicone - allows you to minimize the reaction of body tissues to a foreign body.

 In the analysis of aspirators and known devices for drainage, a lack of information about the influence of the distinctive features of the proposed drainage device to achieve a technical result was revealed, which allows us to consider the claimed invention to meet the criterion of "inventive step".

 The essence of the claimed device is illustrated by the drawing, which shows a General view of the inventive drainage device.

 The drainage device is made in the form of a two-section hollow plate, the upper section 1 of which is in the cross section in the shape of a "hill", the lower section 2 of the plate has the shape of an ellipse elongated along the major axis with extended cast edges 3. Longitudinally in the central part of the upper section 1 and the lower section 2 placed tubes 4 and 5, respectively. The distal edge of the tube 4 is open. On the lateral surfaces of the tubes 4 and 5, holes are made throughout the length of the plate sections (not shown). Inside the tube 4 is an additional tube 6 with a single side hole at the proximal end. The distal ends of the tubes 5 and 6 are connected to an external vacuum source. On the lateral surfaces of the "hill-shaped" section 1, holes 8 are longitudinally made. On the upper surface of the "ellipsoidal" section 2, holes 7 are made staggered.

 The inventive device operates as follows.

 The length and width of the drainage device is formed in accordance with the length of the laparotomy wound and the topographic and anatomical situation in the abdominal cavity. To reduce the width of the plate with scissors during the operation, after appropriate fitting, the cast edge 3 of the ellipsoid section 2 is cut to the required size on both sides. To reduce the length of the plate with scissors during the operation, after appropriate fitting, the proximal end of the plate is cut to the required value perpendicular to its longitudinal axis in width, then the tube 6 is slightly pulled out in the proximal direction along the longitudinal axis outward, a side hole is made at its proximal end and returned into the tube 4 flush with the end of the tube 4. The drainage device is installed in the abdominal cavity so that the longitudinal axis of the PBS wound coincides with the longitudinal axis of the plate. The upper surface of the ellipsoidal section 2 of the plate is adjacent to the parietal peritoneum of the PBS in the area of the laparotomy wound, and the "hill-shaped" section 1 of the plate is in contact with the edges of the laparotomy wound, slightly protruding above its muscular aponeurotic layer. Below the lower corner of the laparotomic wound, 3 cm departing from it, the skin with subcutaneous fat is cut 3 cm in the transverse direction to the aponeurosis and the wound canal is made through which the tube 4 with the tube 6 and the tube 5 are brought out. After installing the drainage device, the laparotomic the wound is completely sutured only with skin sutures above the "hill-shaped" section 1, and tubes 5 and 6 are connected to an external vacuum source.

 When a negative pressure is created in the cavity of the ellipsoid section 2 of the plate, it is "sucked" to the parietal peritoneum in the area of the laparotomy wound through openings 7, thereby isolating the area of the laparotomy wound from the abdominal cavity. The exudate from the PBS laparotomy wound through the openings 8 on the lateral surfaces of the "hill-shaped" section 1 of the plate penetrates into the section, then through the lateral openings of the tube 4 enters the tube 4, from where it is evacuated by a tube 6 connected to the vacuum source. Given that after the tubes 4 and 6 are brought out of the abdominal cavity, when the patient is lying down, the wound fluid in the tubes 4 and 6 will move under the influence of gravity in the anteroposterior direction, the accumulated exudate will be removed by the tube 6 through its end and side openings . The lack of sealing in the cavity of the tube 4 prevents the "suction" of the surface of the "hill-shaped" section 1 of the plate to the tissues of the laparotomy wound, thereby improving the quality of drainage. The lower surface of the "ellipsoidal" section 2 of the plate, made of an elastic, biologically inert material (for example, silicone), is a protector for the underlying abdominal organs.

 At each subsequent relaparotomy, the drainage device is removed. After stopping the purulent process in the abdominal cavity and / or PBS wound, the device is permanently removed.

 The performance of the proposed device is confirmed by a clinical example.

 Clinical example.

 Patient Bazheev B.V., 35 years old, N and. 29665 was in the surgical infection department of OKB No. 1 from 12/23/98 to 01/16/99 with a diagnosis of blunt trauma of the abdomen with a rupture of the small intestine, spilled fibrinous-purulent peritonitis. Postoperative multiple unformed small intestinal fistulas.

 From the anamnesis: blunt trauma to the abdomen - 4.01.98 g.

In the Alar Central District Hospital the following operations were performed:
1) laparotomy, enterolysis, suturing of iatrogenic perforation of the small intestine;
2) relaparotomy, resection of the small intestine, rehabilitation of the abdominal cavity.

 After transfer to OKB No. 1, the patient’s serious condition is due to intoxication, due to progressive peritonitis, phlegmon of the anterior abdominal wall and multiple organ failure.

Operations performed:
1) 12.24.98: relaparotomy, side-to-side entero-enterostomy, rehabilitation and drainage of the abdominal band. In this operation, the proposed drainage structure described above is applied. For three days, conservative antibacterial, infusion therapy, vacuum drainage of subcutaneous tissue was performed.

 2) 12/27/98: relaparotomy, removal of the original drainage structure, rehabilitation of the abdominal cavity. On operation - stopping phlegmon of the anterior abdominal wall, arrested peritonitis.

 The patient underwent plastic surgery of the anterior abdominal wall. In satisfactory condition, the patient was discharged from the department 01/16/99

Thus, the proposed device allows
- reliably and atraumatically isolate from the abdominal cavity the area of the PBS laparotomy wound that was sutured with skin sutures, which prevents contamination and re-contamination of the tissue of the PBS wound both from the side of the abdominal cavity and vice versa, with the development of a purulent-necrotic process in the tissues of the laparotomy wound of PBS;
- effectively drain the active method (aspiration type of drainage) laparotomy wound of PBS, after closing it with skin sutures;
- protect the abdominal organs adjacent to the wound from mechanical damage.

 The use of the proposed drainage device helps to stop and prevent purulent inflammation in the abdominal cavity and tissues of the laparotomy wound of PBS, as well as the prevention of traumatic injuries of the internal organs of the abdominal cavity and especially the intestine adjacent to the laparotomy wound of PBS.

 Using the proposed drainage device allowed to improve the results of treatment of patients with widespread purulent peritonitis, reduce the time of treatment, reduce the number of complications.

Literature
1. Kuzin M. I. Actual issues of classification and treatment of common purulent peritonitis. Surgery. - 1996. - N 5. - S. 9-15.

 2. Popkirov S. Purulent-septic surgery. Sofia, 1977. Medicine and physical education. 502 s

3. Copyright certificate of the USSR N 774561, M. Kl. ³ A 61 B 27/00, 1980.

 4. Bystritsky A. L. Drainage of the abdominal cavity / Bulletin of surgery. - 1998. - N 7. - S. 131-134 - prototype.

Claims (1)

 A drainage device consisting of two single-channel tubes with openings made on the lateral surfaces, one of the tubes is connected to an external vacuum source, characterized in that the drainage device is made in the form of a two-section hollow plate, the upper section of which in cross section has the shape of a "hill", lower — elongated along the major axis of the ellipse with monolithic extended edges, in the central part of each section is longitudinally placed along the tube, and an additional tube is placed in the tube of the “hill-shaped” section a barrel with a side hole at the proximal end, which is connected to an external vacuum source with an ellipsoidal tube, holes are staggered on the upper surface of the ellipsoid section of the plate, and holes are made along the side surfaces in the “hill-shaped” section.