RU2290212C2 - Probe for closed retrograd intubation of thin intestine - Google Patents

Abstract

FIELD: medicine; abdominal surgery.

SUBSTANCE: probe can be used fro patients which are not allowed to be subject to closed antegrade drainage. Probe can be used for decompression of thin intestine, intra-operational entero-dialysis and entero-sorption. Probe for closed retrograde intubations of thin intestine has two pipes with marks, openings and rubber cuffs disposed at 10 cm from top of probe and 2 cm lower than distal drainage opening. Top is soldered at external pipe and it has olive. Internal pipe, which closes opening of external one completely, is made for pull and open of holes. Drainage openings are absent at 1,5 m of corresponding part of thick intestine. Basic mark is made onto external pipe. Set of standard marks is made onto internal pipe.

EFFECT: prolonged decompression of thin intestine by closed method.

2 dwg

Description

The invention relates to medicine, namely to abdominal surgery, and is used for decompression of the small intestine, intraoperative enterodialysis and enterosorption.

The aim of the invention is the provision of long-term decompression of the small intestine in a closed manner and intraoperative enterodialysis for patients who are contraindicated in closed antegrade drainage.

Intubation of the small intestine is a necessary method for the modern treatment of patients with enteric insufficiency syndrome. The objectives of intubation are: decompression of the small intestine, evacuation of its toxic contents, enterosorption, intestinal dialysis, the introduction of medicinal and nutrient substrates into the intestinal lumen.

Open methods of drainage of the intestine have the following disadvantages [3]:

- nonsepticism;

- Most of them empty only the nearest bowel loops;

- danger of enterostomy insolvency;

- the need for repeated surgical treatment to close the enterostomy;

- infection of the postoperative wound.

Nasoenteric drainage of the small intestine, taking into account serially manufactured probes, is a quick, convenient procedure for the operating team, however, it is not without drawbacks that limit its use [3]:

- due to the antiperistaltic direction of drainage, full decompression of the small intestine is not always achieved;

- infection of the stomach, esophagus, upper respiratory tract by intestinal microflora;

- prolonged stay of the probe in the esophagus contributes to the deterioration of cardiac activity;

- complications of nasoenteric drainage can be nosebleeds, necrosis of the wings of the nose, rhinitis, sinusitis, mumps, sinusitis, laryngitis, bleeding from the wall of the esophagus and stomach.

When conducting closed antegrade drainage is absolutely contraindicated, and intubation of the small intestine is necessary, the use of closed retrograde intubation is indicated:

- tendency to nosebleeds;

- consolidated fractures of the nasal bones with narrowing of the nasal passages

(these situations do not exclude the use of oral-intestinal drainage of the small intestine, but according to our clinic, finding the probe in the oropharynx is extremely unpleasant for the patient, which leads to unauthorized intestinal extubation in the early postoperative period);

- ulcerative esophagitis;

- cicatricial strictures of the esophagus;

- varicose veins of the esophagus and cardiac section of the stomach;

- ulcerative gastroduodenitis;

- pyloric stenosis;

- pronounced adhesion process of the upper floor of the abdominal cavity;

- coronary and respiratory pathology.

The probe device is illustrated in FIG. 1 (distal part) and FIG. 2 (proximal part).

The probe consists of two polyvinyl chloride tubes (3, 4) inserted one into the other. The outer diameter of one tube is as close as possible to the inner diameter of the other. At the outer PVC pipe (4), the apex is sealed and goes into the guide stalk with olive at the end (5).

The probe features are:

- the absence of 1.5 m drainage holes corresponding to the colon (B) (which prevents obstruction of the lumen of the endotracheal tube with solid fecal masses);

- the presence of rubber cuffs (2): that hour below the proximal drainage hole (to control the correct standing of the drainage) and 10 cm from the tip of the probe (for ease of carrying out);

- the presence of the main mark on the outer tube (7) and a series of standard marks on the inner (6) through 8.7 cm for the convenience of the enterodialysis procedure;

- the inner polyvinyl chloride tube (3), which increases the stiffness of the probe and prevents clogging of the intubator with solid feces during passage through the colon, facilitates the entry of the dialysis solution into the desired sections of the small intestine.

The described probe consists of two polyvinyl chloride tubes (3, 4) 270 cm long with an inner diameter of 8 and 5 mm. The outer diameter of one of the tubes is as close as possible to the inner diameter of the other. The inner tube (3) completely fulfills the lumen of the outer (4), increases the stiffness of the intubator, and prevents obstruction of the outer tube with solid feces during passage through the colon. The tip of the probe is an oval organic plexiglass (5) olive, mounted on a 4 cm stalk from a polyvinyl chloride tube with a diameter of 5 mm. Part of the probe (figure 2), corresponding to the colon (1.5m), does not have drainage holes, so the probe does not become clogged with dense colon contents in the postoperative period. The part of the probe (Fig. 1) corresponding to the small intestine of 1 m with drainage holes (1) D = 0.7 cm located after 8 cm. For the convenience of carrying out the probe 10 cm from its tip, a rubber sleeve (2) facilitates the capture of the probe. 2 cm below the distal drainage hole, the sleeve (2), which is easily palpable through the intestinal wall, which, when the intubator is in good condition, is closely adjacent to the ileocecal valve, which corresponds to finding all drainage holes in the small intestine (retrograde reflux of the large intestine microflora from the colon through a probe is not possible).

The probe is used as follows.

Most of the solution introduced during enterodialysis enters the small intestine through the first drainage hole from the end of the inner tube. To carry out high-quality sanitation of the lumen of the small intestine on the proximal part (Fig. 2) of the inner tube (3), 10 standard marks (6) with an interval of 8.7 cm, on the outer tube (4) the main mark (7), which determines the level of enterodialysis. After installing the probe, the inner tube is tightened until the main (7) and 1st standard marks are compared, in this position only the distal drainage hole is open. Enterodialysis is performed through the inner tube (3) with a Janet syringe. The inner tube is pulled up to 1 standard interval. The procedure is repeated until the 10th standard mark and the inner tube (3) is removed.

Intraoperative anus diversion prevents the accumulation of gases in the colon.

The use of our proposed probe is absolutely indicated for strangulated intestinal obstruction. The “toxic factor” formed in the strangulated loop must be removed; its entry into the outlet section of the intestine significantly worsens the patient's condition. The probe is brought to a strangulated loop, strangulation is eliminated, the contents of the affected loop are aspirated, enterodialysis of the affected part of the small intestine is carried out, followed by the introduction of broad-spectrum antibiotics and ozonized saline into it. Further activities are carried out in accordance with the specific clinical situation.

Relative contraindications to the use of the probe for transrectal drainage of the small intestine:

- hemorrhoids with a tendency to bleeding;

- inflammatory processes and neoplasms of the colon.

Application of the proposed probe:

1. Provides long-term decompression of the small intestine and intraoperative enterodialysis in a closed manner to patients who are contraindicated in closed antegrade drainage.

2. It is absolutely indicated for strangulated intestinal obstruction, since it allows you to evacuate the “toxic factor” that has formed in the affected loop that hour after eliminating strangulation and perform decompression, enterodialysis, enteric therapy to the targeted area of the small intestine, which is achieved by pulling the inner tube of the intubator introduced into the affected segment of the intestine, by an amount equal to the length of the affected area, while the open drainage holes of the probe are only in the affected part of the thin ki shki.

Thus, the use of the proposed probe provides long-term decompression of the small intestine in a closed manner and intraoperative enterodialysis for patients who are contraindicated in closed antegrade drainage.

Literature:

1. RU 2223697 C1.

2. Lyubenko L.A. et al. Prolonged intestinal decompression in acute peritonitis and intestinal obstruction // Clinical Surgery. - 1987. - No. 4. - p. 30-32.

3. Nechaev E.A., Kurygin A.A., Kanevich M.D. Drainage of the small intestine with peritonitis and intestinal obstruction. - St. Petersburg, 1993.

Claims (1)

A probe for closed retrograde intubation of the small intestine, containing two tubes with marks, holes and rubber cuffs located 10 cm from the tip of the probe and 2 cm below the distal drainage hole, while the tip of the outer tube is sealed and has an olive, and the inner tube, completely fulfilling the external clearance, made with the possibility of pulling up to open the holes, and for 1.5 m corresponding to the colon, there are no drainage holes, while the main mark is made on the outer tube, and on the inside - a series of standard marks.

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