RU2295333C1 - Method for administering pleurodesis in treating pneumothorax cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves draining pleural cavity to introduce specially prepared solution. Given solution contains Chlorhexidine taken in concentration no less than 0,05% and ethanol in concentration no less than 70% by volume. The introduction being done, the draining tube is blocked for at least 1 h. Then, active suction is carried out with pressure not less than 20 mm of water column.

EFFECT: safe and reliable pleural cavity obliteration.

Description

The invention relates to medicine, namely to surgery.

A known method of obliteration of the pleural cavity using pleurectomy. Pleurectomy is performed from II to VII intercostal space. The pleura is dissected along the rib with an electrocoagulation hook or scissors, peeled from the underlying tissues and removed (Endoscopic Surgery edited by B.C. Saveliev, Moscow, 2001, p. 227).

The disadvantage of this method is its invasiveness, as well as the risk of damage to the intercostal vessels.

Also known is a method of chemical pleurodesis using cytostatic - Bleomycetin. The method consists in the fact that after thoracocentesis with active aspiration of the exudate until the pleural cavity is completely drained, 45 mg of Bleomycetin in 50 ml of 0.9% NaCl solution was introduced into the pleural cavity (V. Belsky et al., I Scientific and Practical Conference “ Thoracic Oncology ”, Abstracts, p. Olginka, 2003, p. 83).

The disadvantage of this method is the high cost of bleomycetin and a low percentage of complete obliteration of the pleural cavity (46.2%).

Closest to the claimed is a method of chemical pleurodesis of talc.

After thoracocentesis with active aspiration of the exudate until the pleural cavity is completely drained, pleurodesis is performed by insufflation of 5-10 ml of sterile talc. The pleural cavity is drained by 1-2 drainages for 5-10 days until the end of the exudation (D. N. Pilkevich, Second Scientific and Practical Conference “Thoracic Oncology”, Abstracts, p. Olginka, 2004, p. 50).

The disadvantage of this method is the high risk of such a complication as empyema of the pleura, which makes this method quite dangerous for its use.

The technical result of the invention is to reduce the cost of the procedure and increase the clinical effectiveness of obliteration of the pleural cavity.

The technical result is achieved by the fact that after thoracoscopy according to the standard technique under endobronchial anesthesia, pleurodesis is performed by introducing a group of biguanides, for example chlorhexidine, at a concentration of not less than 0.05% on ethyl alcohol in a concentration of not less than 0.05% of ethyl alcohol in the pleural cavity 70% alcohol in a volume of 20-30 ml. The drainage is closed for 1-1.5 hours, then connected to active aspiration, creating a negative pressure of 20-30 mm water column. Drainage is removed 3-5 days after the termination of exudation. The alcohol solution of the antiseptic of the biguanide group, for example chlorhexidine, causes the burning effect of the visceral and parietal pleura, which leads to aseptic inflammation in the pleural cavity and subsequently reliable obliteration.

Patient E., medical history No. 307/1. Diagnosis: Recurrent spontaneous pneumothorax on the right. Operation: Video thoracoscopic ligation bull. Chemical pleurodesis January 16, 2004.

Under endobronchial anesthesia, a trocar was introduced into the right pleural cavity in the V intercostal space along the mid axillary line. During the audit revealed bulla with a diameter of 0.5-1.0 cm in the apical part of the upper lobe. Produced by their electrocoagulation. Checked aerostasis - tight. Introduced drainage into the pleural cavity in the VII intercostal space. Skin wounds are sutured. Aseptic sticker. In order to obliterate the pleural cavity, 30 ml of the claimed solution was introduced into the pleural cavity through the drainage. The drainage is closed for 1-1.5 hours, then connected to active aspiration with a vacuum of 30 mm water column.

The patient was hospitalized from 01/14/2004 to 01/30/2004. On the 3rd day, the exudation stopped, the drainage was removed. On the control R-gram of the chest organs there are signs of obliteration of the right pleural cavity. The patient was discharged for outpatient treatment in satisfactory condition.

Using the proposed method is a cost-effective, low-impact highly effective method of chemical pleurodesis in the treatment of pneumothorax and other diseases of the chest organs, which makes it the most significant for practical health care.

Bibliography.

Endoscopic surgery. / Ed. V.S.Saveliev. - M., 2001 .-- 227 p.

Belsky V.M. // Thoracic oncology: abstract. doc. I scientific - prakt. conf. - p.Olginka, 2003 .-- P.83.

Pilkevich D.N. // Thoracic oncology: abstract. doc. II scientific - prakt. conf. - p.Olginka, 2004 .-- S.50.

Claims (1)

Chemical pleurodesis method, characterized in that chlorhexidine is introduced into the pleural cavity for drainage at a concentration of not less than 0.05% on ethyl alcohol at a concentration of not less than 70 vol.%, While the drainage is closed for at least 1 hour, followed by connection to the active aspiration with a pressure of at least 20 mm water column.