RU2288647C1 - Method for stabilizing intrathoracic pressure after pulmonectomy - Google Patents

Abstract

FIELD: experimental medicine, thoracic surgery.

SUBSTANCE: the present innovation deals with developing the technique on prophylaxis of complications after massive operative interferences, particularly, after pulmonectomy. Thus, at final stage of operation it is necessary to fix two tubes in pleural cavity. Then, through a special supplying tube one should introduce silicone gel "Interphall" into pleural cavity till the moment of its appearance in proximal part of a drainage tube. The innovation enables to reconstruct the volume of pleural cavity, prevent dislocation of organs in thoracic and abdominal cavities due to applying the above-mentioned silicone gel that possesses the properties to maintain the result achieved in the course of prolonged period of time.

EFFECT: higher efficiency of stabilization.

2 ex

Description

The invention relates to experimental medicine, pulmonology, in particular to thoracic surgery, and is intended to stabilize intrathoracic pressure and prevent the development of subacute and chronic pulmonary heart.

Currently, patients with pulmonary tuberculosis, malignant neoplasms, bronchiectasis, etc., often undergo surgical treatment, in particular pulmonectomy. To combat progressive respiratory failure in the experiment, auto-, homo-, xenotransplantation of the lung is used, which is accompanied by high postoperative mortality, frequent complications, a difficult reaction of rejection, and difficulties in immunosuppression.

As a prototype, the method of surgical treatment of irreversible lung lesions was chosen - pulmonectomy, after which the cavity remains on the side of the operation, it is filled with a hemoextravasate fluid, which subsequently transforms into fibrothorax over a period of 6 months to 2 years [Sergienko V.I., Petrosyan E.A., Frauchi I.V. Topographic anatomy and surgical surgery: In 2 t. / Under the total. ed. Acad. RAMS Yu.M. Lopukhina. - M .: GEOTAR-MED, 2001. - T.1. - S.770-773]. As a result, the volume of the pleural cavity may decrease by 1/3 or more, intrathoracic pressure on the side of the operation becomes much lower than on the opposite, healthy side. This contributes to the dislocation of the mediastinal organs towards the cavity, while changing the anatomical location and the relationship of the heart, main vessels, trachea, bronchi, there is a vicar emphysema of the remaining lung, which, combined with a decrease in the surface of the lungs, with a decrease in pulmonary blood flow, alveolar hypoxia, contributes to the development of subacute and chronic pulmonary heart.

The objective of the invention is the stabilization of intrathoracic pressure after pulmonectomy and the prevention of subacute and chronic pulmonary heart.

The technical result is the restoration of the volume of the pleural cavity, preventing the dislocation of the organs of the chest and abdominal cavity, blocking the release of hemoextravasate.

The technical result is achieved by the fact that a silicone gel is pumped into the pleural cavity, for example, polyacrylamide hydrophilic biogel (PAAG) / Interfall /; MZMPR registration certificate No. 95/379 of 11/23/1995; Hygienic certificate No. 19. MC. 30.939. P. 26990. 6. from 09/18/1996, Sanitary Inspection, Moscow.

At the final stage of the operation, when the wound is sutured in layers, two drainage tubes with a diameter of 6 or 8 mm are inserted and fixed, the distal end of the inlet tube is located at the bottom of the pleural cavity, and the distal end of the outlet tube, its edge, is located in the region of the upper pole of the pleural cavity. Sterile, heated to a temperature of 37 ° -38 ° C, a polyacrylamide hydrophilic biogel is pumped into the pleural cavity through a filler tube. As the pleural cavity is filled with gel, the air is removed through the outlet tube, and its appearance in the proximal part indicates the complete, total filling of the pleural cavity, while the gel, filling the pleural cavity, glues the pleural cracks of the parietal pleura, damaged vessels, thickens, thereby blocking the appearance of hemoextravazate. Monitoring the filling of the pleural cavity with gel, as well as the location of the mediastinal organs is carried out using the ultrasound method. After this, the tubes are removed, the wound is sutured tightly.

Biogel hydrophilic polyacrylamide

- is a synthetic analogue of protein structures with a polyamide structure,

- not mutagenic,

- carcinogenicity,

- allergenicity,

- long-term preserves the shape and size of the prosthetic organ, regardless of the patient's age

- not causing encapsulation and rejection reactions,

- local inflammatory reactions

- and any immune response of the body,

- there is minimal morbidity and duration of administration,

- in addition, there is the possibility of depositing drugs in the biogel, regardless of the amount of drug administered,

- not subject to destruction by infection, temperature, enzymes,

- its specific gravity is approximately equal to the specific gravity of hemoextravazate / M.P. Pinchuk, I.K. Kebuladze, A.A. Stasenko. "The state of cellular and humoral immunity after endoprosthetics of soft tissues using the Interfall biogel - Clinical Surgery, 1997, No. 9-10, p. 36-37 /.

The advantages of the method are that at the end of the operation, the volume of the pleural cavity is restored, stabilization of the intrathoracic pressure occurs, and the dislocation of the mediastinum and abdominal organs does not develop towards the operation, the secretion of hemoextrasvazate is blocked, the “prosthesis” retains its shape and effectiveness for a long time, which can be confirmed by ultrasound of the chest cavity, which in the complex prevents the development of subacute and chronic pulmonary heart.

The experiment was performed on rats in the amount of 97, 56 (experimental group) of them, after removal of the lung, a gel was introduced into the pleural cavity, and in 41 (control group) the pleural cavity was filled with hemoextravasate. In the experimental group, the postoperative period passed without any complications, the animals quickly recovered. And the recovery period in the control group was delayed. The animals of the experimental group survived to their old age and died a natural death. Animals from the control group, more than 50%, died within one year, the rest also did not live up to the age of natural aging. When opening dead animals from the experimental group, the usual arrangement of the mediastinum was noted, the gel filled the completely pleural cavity, and kept the physiological volume and shape. At the autopsy of dead animals from the control group, a shift of the mediastinum to the side of the operation was noted, the pleural cavity was reduced in volume, the dome of the diaphragm was raised, the right sections of the heart, the emphysema of the remaining lung were enlarged.

Example 1

Rat No. 20, age 1 year, after removal of the lung, a gel was introduced into the pleural cavity. The postoperative period passed without any complications, the animal quickly recovered. She survived to her old age and died a natural death. At autopsy, the usual location of the mediastinum was noted, the gel filled the pleural cavity completely, maintaining the physiological volume and shape.

Example 2

Rat No. 81, 1 year old, after removal of the lung, the pleural cavity was filled with hemoextravasate. The recovery period has dragged on. The animal was lethargic, not active. Died after 3 months. An autopsy revealed a shift in the mediastinum toward the operation, the pleural cavity was reduced in volume, the dome of the diaphragm was raised, the right heart, the emphysema of the remaining lung were enlarged.

Claims (1)

A method of stabilization of intrathoracic pressure after a pulmonectomy, consisting in the fact that through the filling tube into the pleural cavity silicone gel "Interfall" is introduced until the gel appears in the proximal part of the discharge tube.