RU2292922C2 - All-purpose combined surgical drainage - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has narrow tube and wide TMMK tube telescopically insertable one into the other. When introduced into the wide TMMK tube, the narrow tube is sealed by means of tube clamp manufactured as tightly enveloping ring fitted on the narrow tube. The narrow tube is removable from the wide TMMK tube lumen. The wide tube has internal perforated holes spaced over surface area corresponding to cavity to be drained and 1-2 external perforated holes for receiving air inflow. The holes are produced 1-1.5 cm below the introduced tube clamp on the wide TMMK tube canal. The wide TMMK tube canal wall is to be cut at the level of the external hole when removing the narrow tube with clamp from the wide TMMK tube canal. Another embodiment of drainage is thought to have longitudinal through canals or wavy shape or other technical solution allowing atmospheric air inflow through the tube clamp. It becomes unnecessary to make external hole in the wide TMMK tube canal wall below the clamp edge and to eliminate the hole.

EFFECT: reduced risk of traumatic complications.

3 cl, 5 dwg

Description

The invention relates to medicine, more specifically to surgery, and can be used in patients with surgical pathology for the treatment of purulent diseases and complications of soft tissues, musculoskeletal system, abdominal and chest cavities, i.e. in general surgery, traumatology, gynecology, urology, cardiac surgery and a number of other areas.

The purpose of the proposed drainage is the possibility of evacuating the exudate from the cavity (purulent foci) drained both in the form of non-suction action, like the classic non-suction Chaffin drain (aspiration "in the air"), and suction, that is, by creating in the drained cavity constant dilution. The proposed drainage allows you to apply these two mutually exclusive options without replacing one type of drainage with another, which is always traumatic, unsafe for the patient and not always possible to perform.

Foreign companies produce drainages supplied to the CIS countries, consisting of a wide perforated tube and a narrower whole tube placed in its lumen, ending in an end hole. In the literature, such tubes are called Babcock non-absorbable drainage, although much earlier this design was proposed by Chaffin (Chaffin R. 1034, 1942, 1948) (figure 1). Aspiration is connected to the inner tube (2). In this case, a vacuum is created in the space between the walls of one and the other tube, and suction from the environment is carried out through small multiple lateral openings of the outer tube (4, 5). The sucked-in liquid and air rush to the end hole with the inner tube (3) and are removed through it into the collection jar.

The domestic industry also produces an non-absorbable silicone drainage tube such as Chaffin’s drainage, modernized by N.N. Kanshin (1999). (figure 2)

The Chaffin-Kanshin monolithic tube is divided by a longitudinal partition (0) into two identical channels. A wide hole in the partition (3) located at the end of the tube creates a message between the two channels. In addition, one of the channels (1) has several side openings of relatively small sizes (4, 5). Aspiration is connected to a channel that does not have lateral perforations (2). Exudate and atmospheric air are sucked into a channel having side openings (1), and move along it to the end of the tube, where through openings in the partition (3) they flow into the second channel (2) and the collector is evacuated.

To the channel sucking in atmospheric air, a drip infusion of the washing liquid is usually connected.

These tubes are advisable to use for drainage of the abdominal cavity with peritonitis, abscesses of the abdominal cavity, insufficiently sealed cavities, as well as cavities sealed at the time of surgery, not able to be sealed in the postoperative period.

If non-absorbable drains are used for non-tight or insufficiently tight cavities, then the TMMK tube (medical multi-channel organosilicon tube) developed by us (used by the domestic industry) is used to drain tight cavities and perform closed aspiration-flushing treatment.

This is also a two-channel version of the drainage tube (figure 3), only one of the channels - evacuation (1) - occupies the main part of the lumen of the tube. Another channel - a microchannel - with a diameter of only about 1-1.5 mm passes inside the segmented thickening of one of the walls of the tube (2). In the process, through the venous catheter installed in the narrow channel of the drainage tube, any washing solution is supplied from the dropper, which, having reached the opposite end (3), is immediately sucked into the wide evacuation canal, liquefying thick purulent masses and preventing clogging of this channel. Due to the rarefaction in the collection can created by suction, pus from the cavity through the perforations (4) in the wall of the wide drainage channel together with the washing liquid enter the collection can.

The non-suction and suction drains listed by us function quite well, respectively, with or without air access. However, the drainage of the suction action, that is, effective under conditions of use in an airtight cavity, will be ineffective, and sometimes simply dangerous for the patient in conditions of depressurization of the cavity, for example, during the development of the communication of the cavity of the drained intraperitoneal abscess with the hollow organ of the gastrointestinal tract; when the seams diverge hermetically sutured wounds and much more.

No less frequent are the reverse situations requiring the replacement of non-suction drainage with suction, such as, for example, very slow obliteration of the purulent cavity with the disappearance of the threat of development of the internal intestinal fistula, etc.

In these situations, it becomes necessary to replace one version of the drainage with another with the function of suction to non-suction. However, as a result of a change in the patient’s clinical situation during the treatment process, which occurs very often in medical practice, unfortunately, replacing one drainage with another is usually very traumatic, unsafe for the patient, and not always feasible, and therefore it is sometimes necessary to resort to repeated surgical intervention.

Thus, the domestic and foreign drainages known to date, including each of the above, perform their inherent function, but are not able, if necessary, to switch to another operating principle, i.e. from non-suction to suction and vice versa. Such a need is very common in surgery. For example, in the absence or very slow obliteration of the cavity, it is necessary to switch from non-suction drainage to suction drainage for maximum approximation of the cavity walls. On the contrary, if during the drainage of the intra-abdominal abscess by the suction drainage (such as TMMK) there are signs of intestinal contents, the drainage should be urgently replaced by non-suction. However, as we noted earlier, replacing one drainage with another is traumatic, unsafe for the patient and not always feasible, and therefore often have to resort to repeated surgical intervention.

Thus, the need arose for creating universal drainage, which could, depending on changes in the clinical situation by means of simple structural changes made by the surgeon, change the principle of the drainage from suction to non-suction and vice versa, without changing its location.

The objective of the present invention is to provide a universal surgical combined drainage for more effective treatment by changing its functions (suction or non-suction) depending on the clinical situation, as a result of elementary actions (manipulations) of the medical staff, completely safe and atraumatic for the patient. That is, we are talking about creating such a drainage, the functions of which can be changed depending on the changing situation, in no way changing the location of the drainage installed in the cavity.

Similar drains in world medical practice were not made before our proposal.

An analysis of the scientific and technical literature also confirmed their absence.

The aim of the present invention is to reduce injuries during treatment, such as, for example, drainage, dressings, etc., reduce the number of complications by more quickly changing the drainage function, excluding interventions, including surgical ones, when replacing it, reducing the duration of treatment in general and inpatient in particular, mortality reduction.

The problem is solved in that in the presented drainage (see Fig. 1) of the Chaffin type (tube in the tube - Fig. 4), the narrower solid tube (1) is installed tightly in the wider perforated tube of TMMK (2) due to the "clamp" , which is a tight-fitting ring worn on a narrow tube in order to prevent its displacement relatively wide, and which, thanks to it, is removable (8). The TMMK tube of the desired diameter must first be fully prepared for operation as described in the analogue and presented in Fig. 3, i.e. internal perforation holes (4) are applied along the length of the corresponding drained cavity, a partition is cut between two channels of 8-10 mm at the end placed in the cavity (6), and a “tongue” is formed from the segmental thickening of the tube along with the microchannel located in it on the opposite outer the end of the tube (7), but at the same time (!) 1-1.5 cm lower from the “clamp” edge, previously introduced into the wide channel of the TMMK tube, on the part of the wide TMMK tube located outside the patient, 1-2 external perforations are applied (5) dl I receive atmospheric air with a working suction. In this prepared condition, the drainage works well on the principle of “suction in the air stream”, i.e. as non-absorbable drainage, moreover, with an additional opportunity to apply flushing fluid or medications, including and antibacterial, through the “tongue” microchannel (7) of the TMMK wide tube and / or through the suction channel through the external perforation hole (5) directly into the purulent foci (drained cavity).

To change the drainage function from non-suction to suction, 3-4 minutes is enough. To do this, it is enough to remove the inner tube (1) with a clamp (8) and excise the wall of a wide lumen of the TMMK tube to the level of the external hole (s) (5) without affecting the segmented thickening of the tube wall with the microchannel passing there. After connecting the microchannel with a dropper, and a wide channel with a collection bank, the drainage is ready for operation (Figs. 4, 5).

With another, even simpler solution to the problem, you can fix a narrow tube inside a wider (TMMK) wave-shaped collar or with the presence of through channels in it, or other variants of its design that contribute to the suction of atmospheric air through this collar. At the same time, there is no need to form external holes in a wide tube, and to change the drainage function, it is enough to remove a narrow tube with a collar or to introduce it into the lumen of a wide TMMK tube.

Drainage works as follows. After introducing it into the purulent cavity, we connect the microchannel in the “tongue” zone - with a dropper filled with a wash solution (9). A narrow inner tube (1) is connected to the suction through a collection can (Fig. 4). In this case, a vacuum is created in the space between the walls of one and the other tube. The air sucked in through the external holes (5) and through the multiple internal side openings of the external tube (4) rush to the end hole (3) of the inner, narrower tube (1) and are removed through it into the collection jar.

If necessary, go to the suction version of the drainage (Fig. 5), remove the inner narrow tube (1), dissect a part of the walls of the wide tube with the outer perforation hole (5), the adapter and the usual single-lumen, reconnect the wide drainage channel to the collection can, and microchannel - with a dropper (figure 5).

With the opposite effect, that is, if it is necessary to switch from a suction to a non-suction drainage function, it is enough to introduce a narrower inner tube with a clamp “clamp” into the wide lumen of the tube, apply 1-2 external perforations on the outside of the wall of the wide channel of the tube located outside the patient . In case of an air (aero) conducted clamp construction, any sequence of changing the suction and non-suction functions of the drainage is ensured by removing or installing a narrow tube with a clamp relative to the clearance of a wide outer tube of the TMMK type.

Information sources

1. Chaffin R.C. Surgical Drainage. Amer. J. Suig., 1934, v.24, p. 100-104.

2. Chaffin R.C. Surgical suction drainage and crrigation tube. Patent June 16, 1942, No. 2, p. 286, 462.

3. Kanshin N.N. Closed aspiration-washing treatment of suppurative processes. M., 1993.

4. Kanshin N.N. Unformed intestinal fistulas and purulent peritonitis. M., 1999.

Claims (3)

1. The universal combined suction-non-suction drainage, consisting of a narrow tube and a wide tube of type TMMK, inserted into each other, and the narrow tube is made with the possibility of tight installation in a wide tube of type TMMK due to the clamp, which is a tight-fitting ring worn on a narrow tube , and with the possibility of removing a tube of type TMMK from a wide lumen, while a wide tube of a type TMMK has internal perforations deposited along the length of the corresponding drainable cavity, and 1-2 external perforation holes for suction of atmospheric air, which are created at a distance of 1-1.5 cm below the input edge of the clamp on a wide channel of a TMMK type tube, while the wall of a wide channel of a TMMK type tube is made with the possibility of excision to the level of the outer holes when removing a narrow tube with a clamp from a wide channel of a TMMK type tube. 2. Drainage according to claim 1, the sequence of changing the suction and non-suction functions of which is possible in any sequence. 3. The universal combined suction-non-suction drainage, consisting of a narrow tube and a wide tube of type TMMK, inserted into each other, and the narrow tube is made with the possibility of installation in a wide tube of type TMMK due to the clamp, which is a tight-fitting ring worn on a narrow tube, and with the possibility of removing a tube of type TMMK from a wide lumen, while a wide tube of a type TMMK has perforations deposited along the length of the corresponding drained cavity, and the clamp has t longitudinal through channels, or a wavy shape, or another version of its design, contributing to the flow of atmospheric air through the clamp.

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