RU2296521C1 - Method for active parametrial draining after hysterectomy at isthmus-type disposition of myomatous node - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: on removing isthmus myomatous nodes it is necessary to introduce a drainage tube supplied with foramens at its active end into parametrium. Moreover, this drainage tube should be introduced through additional incision in lateral abdominal area and in peritoneum before the round ligament. The tube should be fixed due to applying a purse-string suture onto cervical or vaginal stump, and its external end should be connected with a vacuum-aspirator. The innovation enables to accelerate reparative processes in surgical wound, decrease the risk of inflammatory complications in post-surgical period.

EFFECT: higher efficiency of draining.

2 dwg, 2 ex

Description

The invention relates to medicine, in particular to gynecology.

The prototype of the invention is a method for draining parametria with purulent-necrotic parametritis with preserved uterus after evacuation of pus and necrotic tissue. A silicone tube, d = 8 mm, with the corresponding cavity by the number of perforations, which is supplied to the parametrium, is isolated from the abdominal cavity by peritonization of the parameter with separate catgut sutures and extraperitonally removed through contraperturation on the anterior abdominal wall from the corresponding side (Surgery Drainage) as drainage. , obstetrics and gynecology / P.I. Tolstoy, A.N. Ivanyan. Moscow-Smolensk, 2000, p. 174, 179). This technique does not properly ensure the removal of exudate, since the drainage is passive and quickly clogs.

The problem solved by the invention is the timely removal of extravasate and serous exudate from the parameters after enucleation of the isthmus nodes of the fibroids and subsequent hysterectomy, which is one of the methods for the prevention of suppuration of the postoperative wound.

The technical result is an acceleration of reparative processes in the postoperative wound, a decrease in the risk of inflammatory complications in the postoperative period, a reduction in rehabilitation time.

This technical result is achieved due to the fact that after removal of the isthmus nodes of myoma and hysterectomy, a drainage tube with holes at the working end is inserted into the parametrium through an additional incision in the lateral abdomen and in the peritoneum before the round ligament, the tube is fixed by applying a purse string suture to the neck stump or vagina, and its external end is connected to an aspirator in the form of an "accordion", which creates negative pressure and actively aspirates the pathological fluid.

The proposed method is as follows: After the main stages of the operation are performed - enucleation of the isthmus of the myoma and removal of the uterus, a polyvinyl chloride tube 2 in diameter 1.0 cm with a perforated free end is inserted into the formed parametric cavity 1 through an additional incision in the lateral region of the abdomen and installed in the parametry through an additional incision 0.3-0.5 cm long in the peritoneum before the round ligament 3. Then peritonization of the stump of the cervix or vagina is performed with peritoneal leaves with a "purse string" suture, when tightened, the drainage tube is mechanically fixed in the cavity. The outer end of the drainage, removed from the abdominal cavity, is strengthened with one suture to the skin of the abdomen and connected to a vacuum aspirator 4 in the form of an “accordion”. As the exudate accumulates in the aspirator tank, the negative pressure in it is removed, so 2-3 times a day the container is disconnected from the drainage, freed from the contents, brought into working condition and reconnected to the system. The duration of the drainage is from 1 to 3 days. As a result of the drainage tube being introduced into the parametrium through an additional incision in the region of the circular ligament, the drainage itself passes through the parietal peritoneum and not through the intestinal loops, which is important for the prevention of adhesions, before it reaches the anterior abdominal wall.

Figure 1 shows the course of drainage into the parametric cavity.

In Fig.2 - the pelvic region after surgery, the introduction of drainage and peritonization with a purse string suture.

This technique was applied in 50 patients with a specific gynecological pathology. The results consist in accelerating the healing processes of the postoperative wound due to more active adhesion of the walls of the parametric cavities, which reduces the time of the inflammatory phase of the wound process and the overall healing time of a clean postoperative wound.

The proposed method is illustrated by examples.

Patient X., 50 years old, medical history No. 1265, was admitted for planned surgical treatment in the gynecological department with a diagnosis of uterine fibroids, isthmus node on the right. Indications for the operation were: the size of the myomatous node and impaired function of neighboring organs.

An operation revealed an isthmus node located in the right parametrium, measuring 7x7x6 cm. After a hysterectomy, an extensive cavity formed in the right parametry and there were signs of slight but diffuse capillary bleeding of its walls. In parametria, drainage was introduced according to the method described above. About 700 ml of serous-hemorrhagic exudate is aspirated on the first day, about 300 ml on the second day, 100 ml on the third, and the drainage system is removed. The postoperative period proceeded without a pronounced temperature reaction, leukocytosis and pain. On the 7th day, she was examined by ultrasound and bimanally: no infiltration and hematomas in the area of the right parametrium were detected.

Patient K., 55 years old, medical history No. 313, was admitted to the gynecological department as planned for recurrence of fibroids after supravaginal amputation 3 years before. Diagnosis at admission: Cervical stump myoma. The operation revealed a myoma of the stump, measuring 4x3x3.5 cm, leaving in the right parametrium. After removal of the stump of the neck with the node, drainage was set in the right parametric region according to the method described above. On the first day, 200 ml of extravasate is aspirated, on the second - 100 ml and the drainage is removed. The postoperative period was uneventful. During vaginal examination and ultrasound on the 7th day after surgery, hematomas and infiltrates were not detected in the parametria.

On these examples, we can conclude about a milder course of the early postoperative period in women with this pathology.

The proposed method of drainage during traumatic gynecological abdominal operations for isthmus nodes of uterine fibroids helps to reduce the risk of complications such as postoperative parametritis and pelvic infiltrates, which accelerates the rehabilitation period of patients.

Claims (1)

The method of closed maintenance of the parametric cavity after removal of the isthmus of the myoma by introducing a drainage tube with holes on the working end into the parametrium, characterized in that it is introduced through an additional incision in the lateral region of the abdomen and in the peritoneum before the round ligament, the tube is fixed by applying a purse string suture on the stump of the neck or vagina, and its outer end is connected to a vacuum aspirator.

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