RU2386405C2 - Gas jet spleen resection technique - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. The patient undergoes the differentiated dissection of spleen tissues with a jet of CO₂ gas supplied at an angle 45° to the spleen surface under pressure 1.2 MPa through a nozzle of diametre 0.5 mm at gas temperature 12.4-14.4°C at a distance 1-3 mm between the nozzle and the tissue. Blood vessels of maintained integrity are separated and ligatured.

EFFECT: technique provides separated blood vessels of maintained integrity to be ligatured, prevents parenchymatous bleedings.

Description

The invention relates to medicine and can be used in surgical practice.

Recently, to achieve hemostasis during operations on parenchymal organs, various surgical devices (electric knife, plasma and laser scalpels) have been used. When stopping bleeding with their use, a large area of necrosis and destruction of the spleen parenchyma is observed. Rejection of the necrotic scab leads to repeated bleeding [Skobelkin O.K. Lasers in surgery. M., 1988.].

Also known is an ultrasonic destructor-aspirator, which allows you to isolate large vascular formations. It does not provide a reliable stop of bleeding from the parenchyma of the spleen [Atduev V.A. Clinical and morphological aspects of liver resection. Dis. Cand. honey. Sciences, 1997].

Known methods of adhesive application, hemostasis using collagen and fibrin nets, which during operations on the spleen are possible only in combination with suturing. Efficiency is achieved only on a sufficiently dry surface of the parenchyma, frequent teething leads to the resumption of bleeding [Abakumov MM, Vladimirova ES, Ermolaev NV, Kudryavtsev SN, Smolyar AN The choice of hemostasis method for damage to the spleen. Surgery, 1998; 2: 31-34, Kubyshkin V.A., Tsvirkun V.V., Vukolov A.V. Organ-saving operations for benign spleen formations. Surgery, 1999; 6: 38-42., Lokhvitsky S.V., Afendulov S.A. Damage to the spleen during surgery. Surgery, 1990; 12: 121, Brekhov E.I., Kudryavtsev B.P., Klepikov S.V., Ryabtsev V.Yu. et al. Coagulation of gunshot wounds of the liver and spleen by a plasma flow of argon in an experiment. Surgery, 1990; 9: 59-61].

Known liquid-jet cutting devices (water-jet dissector Helix Hydro-Jet Andreas Pein Medizintechnik together with ERBE, Germany; needleless injector for differentiated dissection of tissues of parenchymal organs (Developed in 1993 by Bulynin V.I. and coauthors. Russia)). Their disadvantages: fluid infiltration into the surrounding tissue and the need for aspiration of the fluid forming the cutting stream from the abdominal cavity, which increases the time of the operation.

To eliminate the shortcomings of the mentioned apparatuses, in Omsk LLC NTK “Cryogenic Technique” created a gas-jet unit UDRPO-45 with a distributed capillary-type choke (utility model patent No. 30259). There is no experience of use when performing operations on the spleen.

The objective of the invention is to develop a method of gas jet resection of the spleen.

The problem is solved in the experiment by the fact that in the method of gas-jet resection of the spleen, differentiated dissection and cooling of tissues by a gaseous CO ₂ stream under a pressure of 1.2 MPa is performed through a nozzle with a diameter of 0.5 mm at a temperature of 12.4-14.4 ° C for t ° C (at a distance of 1-3 mm from the nozzle to the fabric). A gas jet is supplied at an angle of 45 degrees to the surface of the spleen, which ensures the release of blood vessels ⌀ 0.1 mm or more while maintaining their integrity for subsequent ligation. The temperature of the jet causes a spasm of the capillaries and small vessels, which prevents parenchymal bleeding. The tissue of the spleen is dissected in layers in 2-3 passes throughout the entire thickness of the organ. The experimental selection of the required pressure, temperature and direction of the jet was carried out by trial and error.

The installation consists of a compressed gas cylinder (CO _2), a reducer, a valve regulating the gas supply, the executive body with replaceable tips and flexible pneumatic line connecting gearbox and actuator. The principle of operation of a gas-jet scalpel is as follows: from a cylinder, gas flows through a pressure reducer with an outlet pressure of 1.2 MPa through an air line to the actuator. The optimum nozzle diameter of 0.5 mm was selected experimentally. t ° C of a gas jet at a distance from the tip to the fabric from 1 to 3 mm is from 12.4 to 14.4 ° C. This allows the dissection of spleen tissue bloodless.

Using a gas jet, a scalpel is removed along a 1–1.5 cm wide resection nozzle — the spleen parenchyma is “blown out” over the entire thickness of the organ. In this case, the isolated intact blood vessels are ligated or subjected to electrocoagulation.

The positive effect is the absence of parenchymal bleeding and a decrease in intraoperative blood loss. The method of gas-jet resection of the spleen allows you to eliminate the listed disadvantages of other surgical devices when performing surgical interventions on the spleen.

Claims (1)

The method of gas-jet resection of the spleen, characterized in that they produce differentiated dissection of the spleen tissue with a gaseous CO ₂ stream, applied at an angle of 45 ° to the surface of the spleen, under a pressure of 1.2 MPa through a nozzle with a diameter of 0.5 mm at a gas temperature of 12.4-14, 4 ° C at a distance of 1-3 mm from the nozzle to the tissue, blood vessels are secreted while maintaining their integrity and then are ligated.