RU2226364C1 - Method for indirect access into duodenal cavity - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: one should carry out cholecystostomy, apply cholecystostomic catheter in gallbladder, withdraw this catheter outside through the puncture of abdominal wall. Preparation should be injected through cholecystostomic catheter into gallbladder and further through biliary ducts into duodenal cavity. In peculiar case, it is necessary to perform an access into the cavity of excluded duodenum. In peculiar case, an access should be conducted into the cavity of duodenal stump. This innovation enables to carry out injection of preparations in case of no direct access into intestinal cavity. EFFECT: higher efficiency of operation. 2 cl, 1 dwg, 2 ex

Description

The invention relates to medicine and can be used for patients operated on on the abdominal organs.

A known method of duodenography, including the introduction of a probe into the descending part of the duodenum with olive, filling the duodenum through the probe with a contrast medium and performing duodenography (see, for example, Yu.A. Nesterenko et al. Chronic duodenal obstruction. - M., 1990, p. .47).

The application of the known method is based on the possibility of introducing a probe into the internal cavity of the duodenum.

The closest analogue prototype is a method of relaxation duodenography (see, for example, RF patent No. 2004186 with priority of July 1, 91, IPC A 61 M 25/00), based on the use of a catheter for examining and treating a patient by administering a drug to the duodenum using a gastrointestinal tube (catheter).

This method can be used for patients operated on by the abdominal organs, however, in the absence of the possibility of direct access to the internal cavity of the duodenal stump, formed due to, for example, distal resection of the stomach, including gastrointestinal and interintestinal anastomoses, it is not applicable for administration in the stump cavity of drugs, for example, hemostatic in case of bleeding with ulcerative lesions of the internal cavity of the stump or contrast for diagnosis their procedures.

The essence of the invention lies in the fact that in the proposed method of indirect access to the cavity of the disconnected duodenum, based on the use of a catheter for administering the drug for examination and / or treatment of the patient after distal resection of the stomach, including performing gastrointestinal and intestinal anastomosis, the patient undergo cholecystostomy and a cholecystostomy catheter is placed in his gallbladder, which is brought out through a puncture of the abdominal wall, and the corresponding drug is administered Erez holetsistostomichesky catheter into the gallbladder and then through the bile ducts into the cavity of the stump of the duodenum.

This method provides the possibility of introducing into the cavity of the stump of the duodenum of the patient formed after distal resection of the stomach, including performing gastrointestinal and interintestinal anastomoses, drugs, for example, hemostatic in case of bleeding with ulcerative lesions, or contrast for diagnostic procedures, or nutrient solutions.

The drawing schematically shows a picture of the possibility of indirect access to the internal cavity of the duodenal stump.

It is indicated here: 1 - part of the stomach remaining after resection; 2 - resected (removed) part of the stomach; 3 - a stump (the disconnected part) of a duodenum; 4 - gastrointestinal anastomosis; 5 - intestinal anastomosis; 6 - postoperative sutures; 7 - affected (for example, bleeding ulcer) part of the stump; 8 - the liver; 9 - gall bladder; 10 - bile ducts; 11 - catheter; 12 - the route of entry of drugs.

The fact is that with distal gastric resection performed, for example, according to the Billroth-P method in the modification of the Hoffmeister-Finsterre and providing the creation of a gastroenteroanastomosis on a short loop and spur formation for the prevention of gastric contents reflux into the adductor loop (see, for example, the Guide to emergency surgery of abdominal organs / Under the editorship of BC Saveliev. - M .: Medicine, 1976, p. 224-226), the formation of the duodenal stump is formed, the inner cavity of which is subsequently inaccessible to the rectum examination and / or treatment, for example, using a probe (catheter) and, accordingly, the introduction of appropriate drugs into it.

However, the studies conducted by the authors showed the possibility of indirect access to the internal cavity of the duodenal stump using a cholecystostomy catheter installed in the gallbladder of the patient through the gallbladder and its ducts, connected to the duodenum and not affected during resection.

To realize this possibility of indirect access, cholecystostomy is performed, for example, by a laparoscopic method (see, for example, Guidelines for emergency surgery of abdominal organs / Ed. BC Savelyev. - M .: Medicine, 1976, p.255), through a puncture of the bottom of the gall a silicone catheter with a diameter of 0.4-0.6 cm is introduced into the bladder, which is fixed to the bladder with catgut threads, and around the catheter two purse string sutures are made of non-absorbable material, which then fixes the bladder to the peritoneum. The cholecystostomy catheter is brought out through an additional puncture (not shown) of the abdominal wall at the site closest to the bottom of the bladder.

The preparations usually administered in the form of aqueous solutions are delivered to the catheter using a dropper (not shown).

The invention is confirmed by examples.

Example No. 1. Patient F., 26 years old. He entered the Department of Neurosurgery for a medulla oblongata tumor on 07.20.98. After the examination, operated on 07/27/98 - performed subtotal removal of the tumor.

In the postoperative period, on the 4th day, the patient revealed a perforated duodenal ulcer (no ulcerative history), for which distal resection was performed. On the 7th day after the resection, the patient showed signs of bleeding from the disconnected duodenal loop.

Conducted standard hemostatic and antiulcer therapy is ineffective.

Due to the severity of the condition, repeated abdominal surgery is unbearable for patients.

A cholecystostomy was performed by a laparoscopic method, a cholecystotomy catheter was inserted, through which epsilon-amicaproic acid was injected into an aqueous solution using a dropper (not shown) (see, for example, MD Mashkovsky. Medicines. - M .: Medicine, 1972) 2000 ml per day.

After 2-3 hours, the intensity of blood flow from the stump of the duodenum significantly decreased, however, bleeding recurrences were observed over the next few days. On the 6th day, the amount of epsilon-amikaproic acid administered was reduced to 1000 ml. On the 13th day persistent hemostasis was noted, there was no recurrence of bleeding.

Starting from the 10th day after the operation, the patient was given enteral nutrition with a balanced nutritional mixture of Peptamen through a cholecystoma, 60 drops per minute, first in an amount of 500.0 ml per day, and then up to 1000-15000 ml fractionally in 50.0-100, 0 ml

There were no complications during treatment.

Discharged in satisfactory condition.

After discharge, he was regularly examined. Peptic ulcer in remission.

Example No. 2. Patient S., 30 years old. He entered the hospital on 08/29/2001 after a penetrating bullet wound of the abdominal cavity with damage to the pancreas, crushing of the output section of the stomach, small and large intestines.

Laparotomy, revision of the abdominal organs, resection of the outlet of the stomach according to Billroth-P with gastroentero- and enteroenteroanastomoses, suturing wounds of the pancreas, small and large intestines, cholecystostomy, transversostomy, pancreatic marsupialization were performed as an emergency.

The postoperative period proceeded accordingly to the severity of the wound and the volume of surgery.

On the 7th day after the operation, in order to exclude the failure of the duodenal stump, an X-ray examination was performed, for which 80.0 ml of omnipack contrast medium was administered through a cholecystostomy (respectively, through a cholecystostomy catheter) (see, for example, the Vidal Handbook. Medications in Russia. - 1996, p. B-488 - 9). In this study, filling of the biliary tract and duodenal stump with a contrast agent was noted. No sagging of contrast medium beyond the stump.

Starting from the 8th day after the operation, the patient was given enteral nutrition with a balanced nutrient mixture Nutren 1.0 in the amount of 1000.0 ml per day in fractions of 50.0-100.0 ml through a cholecystoma.

Discharged in satisfactory condition.

Claims (3)

1. The method of indirect access to the cavity of the duodenum, including the use of a catheter to administer the drug during the examination of the patient and / or its treatment, characterized in that they perform cholecystostomy, install a cholecystostomy catheter in the gallbladder, which is brought out through a puncture of the abdominal wall, administer through a cholecystostomy catheter into the gallbladder and then through the bile ducts into the duodenal cavity. 2. The method according to claim 1, characterized in that they access the cavity of the disconnected duodenum. 3. The method according to PP.1 and 2, characterized in that they provide access to the cavity of the stump of the duodenum.

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