RU2338560C2 - Device for long selective controlled collapse of lung - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: device for long selective controlled collapse of a lung contains the tubular case with the internal channel. The cylinder fanned by air is tightly fixed near the extremity of the channel. The additional channel is executed in the tubular case. The additional channel is located in the tubular case and tightly separated from its internal channel. The aperture is executed in a wall of the tubular case. The aperture connects the cylinder cavity to the additional channel which is deduced on an external wall of the tubular case and is bridged to the valve through the demountable adapter. Through apertures for air and exsudate excision are executed outside of the fanned cylinder in a wall of the tubular case. Necessary degree (volume) of a selective and controlled collapse of the lung damaged with tuberculosis, with achievement of the dosed out prelum (fall) of a cavern, including fibrous and creations of conditions for its cicatrisation and the termination bacterioexcretion is provided; conditions for the prevention of the most frequent and dangerous pleuropulmonary complications (bleedings, curtailed hemothorax, spontaneous amotio of a lung up to a diaphragm, an insufficient and uncontrollable collapse of a lung and a cavern) are framed; the proof sterile extrapleural cavity, suitable for further it seal by the modern preparations entering into the general metabolism (collagen and analogues) and not demanding the further excision by performance of repeated operation is formed.

EFFECT: increase of efficiency and decrease of risk of complications.

4 cl

Description

The invention relates to the field of medical equipment, namely to thoracic surgery and phthisiology, and is intended for the surgical treatment of destructive and progressive forms of tuberculosis by performing extrapleural pneumolysis.

There are various methods and means of surgical treatment of pulmonary tuberculosis (USSR copyright certificate No. 936897, RF patent No. 2218106, RF patent No. 2280413).

The closest analogue of the invention is a device (thoracointerter) for insertion into the chest cavity during extrapleural pneumolysis in patients with tuberculosis (Auersbach K., Brandt HJ // Gleichzeitige Sausdrainage und Thorakeuryse usw. Zur Beherrschung der Pneumolysennachblutung und des Pleuraierysserg. No. 3. - S.39-43), as well as after performing pneumonectomy in patients with tumors, tuberculosis and other lung diseases (Gabler A. // 15 Jahre Errahrungen mit dem Thorakeurynter bei Pneumonektomie. Prax. Pneumol. - 1977. - No. 28 - S.1045-1052).

The device has an inflatable balloon, "blindly" connected to a tube (catheter), through which air is pumped into the balloon. An inflated balloon fills the free space in the chest cavity (extrapleural cavity with pneumolysis or pleural cavity after pneumonectomy). Thoracorinter fixes the ipsi and contralateral lung, mediastinal organs in the most optimal position, contributes to a more rapid termination of the exudation process, and to some extent prevents the likelihood of early postoperative bleeding, coagulated hemothorax and associated pleural empyema.

However, the closest analogue has the following significant disadvantages:

- the thoracrinter performs only the role of an obturator (blocker) of the free air intrathoracic cavity;

- does not contribute to the maximum complete removal of air, postoperative exudate, its local delay and organization with the formation of powerful fibrous mooring in the chest cavity;

- excludes selective controlled compression (collapse) of the lung section (segment, lobe or more) of the lung affected by the destructive tuberculosis process due to the presence in the expleural cavity of two different physical media - air and fluid (hemorrhagic exudate) located above the zone of destruction of lung tissue, also containing air, blood, anatomical structures in constant motion (breathing and transmission pulsation of the heart, aorta).

The objective of the invention is to provide a device for performing surgery of extrapleural pneumolysis in patients with pulmonary tuberculosis, allowing:

- to receive the possibility of a metered and controlled (controlled) collapse of the affected lung department both on the operating table and in the postoperative period;

- to create the effect of controlled collapse of the lung, the formation of the required volume of artificially created extrapleural cavity, as well as the simultaneous evacuation of postoperative exudate and residual air;

- create conditions to reduce the volume and period of exudation and to some extent prevent postoperative bleeding, as well as the formation of postoperative hemothorax;

- to prevent spontaneous self-detachment of the pleura under the weight of the accumulated exudate in the early postoperative period with the development of an unjustifiably large amount of lung collapse;

- to form a persistent extrapleural cavity suitable for its subsequent filling with filling material in order to achieve a long-term effect of collapse therapy.

The invention consists in supplying the device with an inflatable balloon with an additional inner tube (catheter) hermetically connected to it for pumping air and inflating the balloon. The balloon inflated by air is hermetically fixed near the end of the inner channel of the tubular body, in which an additional channel (additional inner tube) is located, located inside the tubular body and hermetically separated from the inner channel of the tubular body. A hole is also made in the wall of the tubular body, which communicates the cylinder cavity with an additional channel brought to the outer wall of the tubular body and is connected to the valve through a detachable adapter, and through holes for removing air and exudate are made in the wall of the tubular body.

A detachable adapter is installed at the end of the inner channel of the tubular body, providing connection to means for continuous aspiration of air and exudate in the early postoperative period.

The valve is equipped with a cannula for a syringe, with the help of which the required volume of air is pumped into the cylinder. The device in the form of a balloon is connected to a tube (drainage) through which air and hemorrhagic exudate are evacuated from the extrapleural cavity, achieving selective metered and controlled collapse of the indicated lung volume under the control of radiation methods and clinical observations.

The technical result achieved by using the invention is a consequence of solving the above problems and, in addition, is as follows:

- the necessary degree (volume) of selective and controlled collapse of the lung affected by tuberculosis is ensured, with the metered compression (decay) of the cavity being achieved, incl. fibrous, and creating conditions for its scarring and termination of bacterial excretion;

- conditions are created to prevent the most frequent and dangerous pleuropulmonary complications (bleeding, coagulated hemothorax, spontaneous lung detachment up to the diaphragm, insufficient and uncontrolled collapse of the lung and cavity);

- a stable sterile extrapleural cavity is formed, suitable for its further filling with modern drugs that are part of the general metabolism (collagen and analogues) and do not require their further removal by performing a second operation.

The achievement of the technical result is due to the implementation of the casing and the additional channel according to the “tube in tube” scheme, which allows you to create two independent channels, one of which is designed to fill the inflatable balloon with air, and the other due to the presence of drainage holes in the wall of the housing outside the cylinder — for drainage postoperative exudate and residual air. An additional channel for removing postoperative exudate and residual air is removed from the tubular body as a thin flexible tube, which, when the valve is disconnected, can abut against the body from the outside and not prevent the device from entering through a separate puncture of the intercostal space outside the thoracotomy into the extrapleural cavity. The dimensions of the inflatable balloon to be installed are easily adjustable, which ensures selective metered and controlled collapse of the indicated lung volume during the control carried out by radiation methods, as well as clinical observations.

The invention is illustrated in the drawing, which shows a cross section of a device.

A device for long-term selective controlled collapse of the lung consists of a tubular body 1, which is a hollow tube of silicone rubber with an outer diameter of 6.0 to 10.0 mm with an internal (main) channel having two outlet openings 7A and 7B at the ends. A balloon 5 with a maximum volume of 0.5-0.6 l is hermetically fixed on the tubular body 1 near the opening 7A.

To fill the cylinder 5 in the tubular body 1, a hole 4 is made, opening in the cavity of the cylinder 5 and communicating the cavity with an additional channel 2. Channel 2 is located inside the tubular body 1 and is hermetically separated from it. Channel 2 is brought out through the wall of the tubular housing 1 near the opening 7B of the housing 1 and through a detachable adapter 9 is connected to a one-way valve 8, equipped with a cannula for a syringe, with which the required volume of air is pumped into the cylinder 5.

Outside the volume of the inflated balloon 5 in the wall of the tubular body 1 there are several (2-3 on each side) through additional holes 6 for removing air and exudate. In the hole 7B, a detachable adapter 10 is installed, which provides connection of the device to means for continuous aspiration of air and exudate in the early postoperative period.

The operation of the device is as follows.

Under general anesthesia with artificial ventilation of the lungs and intubation of the trachea (or main bronchi), using lateral or posterior intercostal thoracotomy with limited (3-5 cm) subperiostal resection of segments of 1-2 ribs, parietal bone pleura is exposed in the projection of thoracotomy and the affected part (lobe, segment) of the lung. Extrapleural and / or extrafascial lung excretion is performed with thorough hemostasis, including using BATS technology. After completion of the visual and palpation revision of the collapsed lung and the formed extrapleural cavity, the adequacy of its volume is assessed. Then, through a separate puncture of the intercostal space, outside the thoracotomy, 1 or 2 are injected into the extrapleural cavity (depending on the volume of the cavity, its configuration, localization, shape and size of the cavity and the surrounding area), a device (s) for selective controlled lung collapse in pulmonary tuberculosis and through the adapter is connected to the valve 8. The cylinder (or, if necessary, the cylinders) 5 under the control of vision is inflated with air introduced by a syringe through valve 8 and channel 2 until the free air spaces are completely eliminated extrapleural in a cavity and complete contact between the cylinder wall (cylinder) 5 with pleural sheets. At the same time, the balloon (s) 5 is modeled until it (they) has achieved congruence of its (their) shape with the shape of the extrapleural cavity.

The tubular body 1 is fixed with separate sutures on the skin and the hole 7B is connected to the active aspiration system to remove air and exudate. The valve 8 is constantly closed and ensures the tightness of the cylinder 5.

The surgical wound is sutured in layers tightly. Perform round-the-clock continuous evacuation of exudate through openings 6, the inner opening of the tubular body 1 and opening 7B, as well as clinical and beam monitoring of the installed devices and the adequacy of the collapse of the affected tuberculous lung.

Claims (3)

1. A device for long-term selective controlled collapse of the lung, containing a tubular body with an internal channel, near one end of which a balloon inflated by air is sealed, while an additional channel is made in the tubular body located inside the tubular body and hermetically separated from its internal channel in the wall a hole is made in the tubular body, communicating the cylinder cavity with an additional channel brought to the outer wall of the tubular body and through a detachable adapter with union of a valve, wherein the outside of an inflatable balloon in the wall of the tubular body is provided with through holes for air removal and exudate. 2. The device according to claim 1, characterized in that a detachable adapter is installed at the end of the inner channel of the tubular body, providing connection to means for continuous aspiration of air and exudate in the early postoperative period. 3. The device according to claim 1, characterized in that the valve is equipped with a cannula for a syringe, with which the required volume of air is pumped into the balloon.