RU2376948C1 - Method of aero- and hemostasis in resection operations on lungs - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine and can be used in surgical practice for aero- and hemostasis in case of resection operations on lungs. Essence of method lies in lung resection and application on its surface of synthetic material from oxidised regenerated cellulose SURGICEL. 1.5-2 min after SURGICEL fixation glue GemoKompakt is applied on all its surface in even layer from syringe.

EFFECT: application of claimed invention allows to reduce term of pleural cavity drainage, method is safe as used materials are nontoxic, non-allergic are completely resolved during 14 days.

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Description

The invention relates to medicine, namely to thoracic surgery, and can be used to prevent bleeding and air leakage from an operated lung.

There are various methods of preventing bleeding and air leakage from the operated lung. All of them consist in fixing various materials to the lung resection line:

Autopleurra is the patient’s pleura. The parietal pleura is peeled off from the chest wall in the form of strips, and laid on the line of resection of the lung, then it is sutured to the lung with a stapler or a manual suture. The method has a significant drawback - after exfoliation of the parietal pleura there is abundant capillary bleeding from the chest wall, in addition, pleurectomy is a traumatic operation. The aero- and hemostatic effect is mediocre - autopleura practically does not affect aero- and hemostasis [Myasnikova MN Surgical methods in the treatment of pulmonary emphysema. // Abstract of diss. Dr. med. sciences. Moscow, 1968 - p. 16-17].

Bovine (veal) pericardium is a natural material prepared in the factory (enzyme-treated xenopericardium, structured with solutions of glutaraldehyde). Strips of material are laid on the lung and stitched to the lung with a stapler (any suitable for lung resection). This method is widely used in the USA. The use of bovine pericardium is an extremely expensive method (the price of one strip is 200 US dollars, an average of 8 strips of 1600 US dollars is spent per operation). In addition, the bovine pericardium has only partial aerostatic and hemostatic properties, it reduces the “leakage” of blood and air from the resected lung, but does not stop him. Therefore, it cannot be considered absolutely reliable and accessible material. [J.D. Cooper, G. A. Patterson, R. S. Sundaresan, E. P. Trulock, Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. J. Thorac. Cardiovasc. Surg. 1996 112: P.1319-1330].

Ecoflon is a synthetic polymer material (porous polytetrafluoroethylene) for the manufacture of vascular prostheses. The technique is similar to the bovine pericardium. Ecoflon has a weak aerostatic effect (only due to pressing the material itself to the lung tissue) and a weak hemostatic effect. In comparison with the bovine pericardium, Ecoflon is somewhat cheaper - the cost of 1 operation is approximately $ 1,000 [Bazarov D.V. Substantiation of indications and volume of resection during surgical lung reduction in patients with diffuse emphysema. // Abstract. Diss Cand. honey. sciences. Moscow, 2007 - p. 15-16].

SURGICEL is a synthetic material from oxidized regenerated cellulose. It has good hemostatic properties, does not have aerostatic properties. It can be sutured to the lung resection line or laid on the surface of an already resected lung. SURGICEL - absorbable and non-allergenic. Cost - a cheap drug, the average cost of 1 operation is 40 US dollars [Sabel M, Stummer W. Use local haemostatic Surgicel and Surgifoam // Eur Spine J. 2004; 13: P 97-101].

Tachocomb is a collagen plate covered on one side with components that promote blood coagulation. The covering layer consists of highly concentrated fibrinogen, thrombin and aprotinin. Tachocomb plates are placed on the edge of the resected lung, moistened with saline within 3-5 minutes, Tachocomb adheres to the lung tissue. Tachocomb has good hemostatic properties, but also mediocre aerostatic. A significant drawback of Tachocomb is the formation of a massive adhesive process in the pleural cavity. The cost of using 1 operation for 30-50 US dollars [Hollaus, P. The use of Tachocomb in thoracic surgery / P.Hollaus, N. Pridun // J. Cardiovasc. Surg. - 1994. - P.169-170].

All of these drugs have their advantages and disadvantages, but most importantly: none of them is able to provide reliable and stable aerostasis and hemostasis.

The objective of the invention is to develop a method of reliable aero- and hemostasis after resection operations on the lungs.

The problem is achieved in that in the method of aero- and hemostasis during resection operations on the lungs, including resection of the lung and the application of synthetic material from oxidized regenerated cellulose SURGICEL to its surface, which is 1.5-2 minutes after the SURGICEL is fixed from the syringe for the entire GemoKompakt glue is applied evenly on the surface.

Absorbable hemostatic agents (from oxidized regenerated cellulose) SURGICEL are intended for use during surgery as an additional means of hemostasis for capillary, venous and minor arterial bleeding, when stopping bleeding by ligation and other traditional methods is ineffective or impossible. For use during endoscopic surgery, you can cut off a desired piece of SURGICEL material. The material is quickly and reliably fixed to the organ (vessel), providing reliable hemostasis within 120-180 seconds. SURGICEL has a proven bactericidal effect. The term of complete resorption of material in the body is 14 days.

HemoCompact is a homogeneous, viscous liquid of light brown color, ready for use. The glue is a polymer gel with long chains sewn together by covalent bonds into a single spatial network, which allows it to adsorb and retain a large amount of plasma.

Pharmacological properties: GemoKompakt glue is a one-component local hemostatic agent with a bactericidal effect. The drug accelerates the process of thrombus formation at the site of application, forms a film adhering to the damaged surface and, thus, provides hemostasis.

Main characteristics:

1) stops capillary-parenchymal and similar bleeding 30-180 seconds after application to the wound surface;

2) has a pronounced bactericidal and adhesive effect;

3) promotes wound healing and increases the integrity of the joints;

4) simplifies the process of closing wounds;

5) does not contain blood components, which eliminates the risk of contracting AIDS and other infections;

6) does not cause side effects;

7) does not require special preparation of the treated surface.

The method is as follows.

After resection of the lung and completion of the formation of the pulmonary suture, SURGICEL is laid on its surface, cut with strips of the desired size. SURGICEL overlap to completely cover the lung resection line. After 1.5-2 minutes, SURGICEL strips undergo tight adhesion to lung tissue, as evidenced by a change in their color (blacken). Work with SURGICEL is finished. Its role is a hemostatic matrix, on which GemoKompakt glue will be applied.

Then, on a fixed SURGICEL, GemoKompakt glue is squeezed out of the syringe. The glue is applied evenly over the entire length and width of SURGICEL, impregnating the latter and closing the pores in it. After the glue hardens (2-3 minutes), a dense film is formed on the surface of the line of the resected lung, which has a pronounced aerostatic effect and hemostatic effect.

Patient S. 54 years old No. 12986 operated on for pulmonary emphysema. The patient underwent right-sided thoracotomy, bullectomy. In the postoperative period, a massive discharge of air through the drainage. After 10 days, the patient developed acute postoperative empyema of the pleura against the background of broncho-pleural fistula. With increasing effects of intoxication, the patient died on day 21.

Patient R. 51 years old, and.b. No. 6217 was operated on for pulmonary emphysema. The patient underwent right-sided thoracotomy, bullectomy. There are no complications in the postoperative period. The air discharge through the drains lasted 7 hours. Drains removed on day 4. Discharged in satisfactory condition for outpatient treatment by a surgeon on the 18th day.

The advantage of the technique is the complete absence of pulmonary hemorrhage and complete aerostasis. In addition, after 14 days, both materials are completely absorbed without consequences for the body. The method also allows to reduce the drainage time of the pleural cavity to 3-4 days against 10-30 days when using other materials.

Claims (1)

The method of aero- and hemostasis during resection operations on the lungs, including resection of the lung and the application of synthetic material from oxidized regenerated cellulose SURGICEL onto its surface, characterized in that 1.5-2 minutes after fixing SURGICEL from the syringe, an even layer is applied on its entire surface with an even layer GemoKompakt glue.