RU2295982C1 - Combined drainage of choledochus and subhepatic space - Google Patents

Abstract

FIELD: medicine, abdominal surgery.

SUBSTANCE: the present innovation deals with draining a choledochus, an epiploic foramen and a subhepatic space. The device for draining contains a tube with foramens at its working end and is supplied with a tube of larger diameter, with foramens at its working end. The tubes are movably connected together with rings located on a second tube. The innovation provides the chance to perform simultaneous draining with a single drainage of the choledochus and the epiploic foramen and the subhepatic space that excludes traumatism and formation of adhesions.

EFFECT: higher efficiency of draining.

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Description

The invention relates to medicine, namely to abdominal surgery, and serves for drainage of the common bile duct, Vinslov hole and subhepatic space.

When performing operations on the biliary tract for drainage of the common bile duct and abdominal cavity by surgeons, drainages of various designs are used. Currently, many choledoch drainages have been developed: T-shaped drainage of Kera, A.V. Vishnevsky's drainage - the intraductal part of the tube goes in the proximal direction, Kerth drainage in the distal direction, the drainage along the Holstedu-tube is established through the cystic duct. All these methods are not always reliable due to the difficulty of firmly fixing the drainage tube, which often leads to its displacement or loss, followed by leakage of bile into the abdominal cavity.

The prototype is Vishnevsky’s drainage (N.A. Maistrenko, V.V. Stukalov “Choledocholithiasis”, St. Petersburg, 2000, 49 p., B.A. Korolev, D.L. Pikovsky “Emergency surgery of the biliary tract” . - M., 1990, 186 pp., “Hepatobiliary Surgery” edited by N.A. Maistrenko, S. Petersburg, 1999). The use of the prototype is associated with the need for additional drainage for the subhepatic space, which leads to trauma to the peritoneum and the formation of peritoneal adhesions.

The technical result is the expansion of the technical capabilities of the device, the ability to use one drainage to simultaneously drain both the common bile duct and Vinslov hole and subhepatic space.

Figure 1 and figure 2 shows a diagram of a device and method of drainage, respectively.

The device proposed for use is a drainage consisting of two silicone tubes 1 and 2 0.5 m long and 6 and 4 mm in diameter, respectively. At the working end of the tube 1 there are 3-4 holes 3 with a diameter of 2-4 mm. The tube 2 at the working end has openings 4 and freely passes through rings 5 with an inner diameter of 5 mm, which are located on the tube 1. Due to the design features of the drainage, it is possible to simultaneously drain the common bile duct, Vinslov hole and subhepatic space and separate time-lapse removal of tubes. The proposed device is a drainage consisting of two silicone tubes with a diameter of 4 and 6 mm, which in the working part have holes with a diameter of 2 and 4 mm, respectively, and are movably interconnected by rings located on the tube of a larger diameter (Fig. 1, 2).

The proposed device is used as follows: after the completion of the main stage of the operation, this drainage is carried out by the surgeon into the abdominal cavity through contraperture in the right hypochondrium. In this case, a silicone tube 2 with holes 3 is inserted into the proximal choledochus and is fixed with a catgut ligature with piercing, and a silicone tube 1 is inserted behind the hepatoduodenal ligament into the Vinslov hole. Drainage is fixed to the patient’s skin with kapron ligatures with sewing of each tube separately. In the postoperative period, tube 1 is removed for 3-5 days in the absence of detachable from the subhepatic space after dissection of the retaining ring. Tube 2 is removed 12-16 days after surgery when the cholangitis phenomena subside and signs of obstructive jaundice subside after cholangiography.

Clinical outcome

Combined drainage of the common bile duct and subhepatic space was used in 3 patients operated on for cholelithiasis complicated by jaundice and cholangitis.

Patient N., 69 years old, medical history No. 3261, was admitted with a clinic of cholelithiasis complicated by obstructive jaundice. After preoperative preparation, he was operated on for 2 days. Operation - minilaparotomy, cholecystectomy, intraoperative cholangioscopy, choledocholithotomy, drainage of the common bile duct and subhepatic space. The duration of the operation is 1 hour 20 minutes. The postoperative period was uneventful. The subhepatic drainage was removed on the 3rd day after the operation, the choledoch drainage was on the 12th day. The patient was discharged on the 16th day after the operation in satisfactory condition.

Patient M., 71 g., Medical history No. 5073. Was admitted to the hospital on 06.04.05 g as an emergency with a clinic of cholelithiasis complicated by cholangitis, 66 mmol / l bilirubinemia, the patient was operated on the same day. Operation - minilaparotomy, cholecystectomy, intraoperative cholangioscopy, choledocholithotomy, drainage of the common bile duct and subhepatic space. Postoperative course without complications. Subhepatic drainage was removed on the 4th day after the operation, the bile rate per day ranged from 300 to 150 ml per day. Drainage of the common bile duct was removed on the 10th day. The patient was discharged on the 18th day after the operation in satisfactory condition.

Patient P., 48 years old, medical history No. 5142 was admitted to the clinic on 04.25.05, with a picture of acute calculous cholecystitis complicated by cholangitis and jaundice. After preoperative preparation after 6 hours operated. Operation - laparotomy, cholecystectomy, choledocholithotomy, drainage of the common bile duct and subhepatic space. The duration of the operation is 1 hour 15 minutes. The subhepatic drainage was removed on the 5th day, and the choledoch drainage on the 14th day after the operation. The patient was discharged from the clinic on the 18th day after the operation in satisfactory condition.

Claims (1)

A drainage device comprising a tube with holes at the working end, characterized in that it is provided with a second tube of a larger diameter, the holes at the working end of which are made, while the tubes are movably connected to each other by rings located on the second tube.

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