RU2467710C1 - Method for reimplantation of spleen tissues - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery and may be applied for reimplantation of spleen tissues. A parietal peritoneum is blunt layered through a window of a spleen pedicle in the lateral direction, and a retroperitoneum is formed to implant therein fragments of spleen tissue within a spleen bed. Holes for inflammatory exudate outflow are formed of spleen tissue on the parietal peritoneum above the fragments. A drain tube for external exudate outflow and a microirrigator for introduction of antibacterial preparation through a hole formed along a midaxillary line below a costal arch to the left are inserted in the spleen bed.

EFFECT: method enables reducing intraoperative injuries, reducing a risk of pyoinflammatory complications.

1 ex, 1 dwg

Description

The invention relates to medicine, namely to abdominal surgery, and can be used in forced splenectomies for autologous transplantation of spleen tissue.

From the practice of medicine, various methods of heterotopic autosplenotransplantation are known, differing in the methods of processing the organ after removal, the formation of implants and the location in the patient's body.

A known method of splenectomy after injury, including replantation of spleen tissue. The removed spleen is placed in sterile saline, then fragments of 20 × 20 × 5 mm are formed, which are sutured into a large omentum, after which the wound is sutured (see Millikans JS, Moore EE, Moore LE, Stevens RE Alternatives to splenectomy in adult after trauma Repair partial resection and reimplantation of splenic tissue // Am. J. Surg. - 1982. - Vol. 145, No. 4, P.711-716).

A known method for autologous transplantation of spleen tissue, including placing fragments in the formed pocket of the greater omentum (see as.with. No. 1648390, B.I. No. 18, 1991), during surgery, a drainage is installed in the pocket of the omentum, after which in the postoperative During the period, fragments of the otperfused spleen are washed, washed from dead non-viable cells.

The reasons that impede the achievement of the technical result indicated below when using known methods with interperitoneal placement of splenic tissue implants include a high risk of complications, and therefore the impossibility of their use, in terms of the formation of intra-abdominal abscesses during autosplenograft in conditions of massive post-traumatic infection of the abdominal cavity and purulent inflammatory intra-abdominal processes (pancreatic necrosis, peritonitis).

A known method for autologous transplantation of spleen tissue is that the pocket of a large omentum with an autograft is moved to the left subphrenic space and fixed to the dome of the diaphragm (see AS No. 1551354, B.I. No. 11, 1990).

The reasons that impede the achievement of the technical result indicated below when using the known method include insufficient drainage of the reimplantation area, the likelihood of the formation of an intra-abdominal abscess during autotransplantation of spleen tissue removed under conditions of purulent-inflammatory intra-abdominal process, as well as with massive infection and in the case of necrotic changes in the pulp .

Known methods are applicable for fresh injuries of the spleen outside contamination (infection) with the contents of the colon and for "clean" abdominal operations.

The closest technical solution in relation to the proposed set of essential features is a method for autotransplantation of splenic tissue, including splenectomy, after which the spleen is perfused with hyperosmolar saline with the addition of calcium antioxidants and antagonists in a high single dose (see RF patent No. 2112429, publ. 10.06. 1998). Then, implants are formed in the form of anatomical sub-segments of the organ, which are placed through an additional transrectal incision on the transverse fascia in the projection of the lower third of the rectus abdominis muscle. In the postoperative period, antioxidant and antibacterial drugs are administered.

The reasons that impede the achievement of the technical result indicated below when using the known method adopted as a prototype include an additional traumatic transrectal incision, insufficient drainage of the reimplantation area, the likelihood of an abscess of the anterior abdominal wall during autologous transplantation of spleen tissue removed under conditions of a purulent-inflammatory intra-abdominal process, as well as with massive infection and in the case of necrotic changes in the pulp.

The objective of the invention is to provide a method for reimplantation of spleen tissue, providing a technical result, consisting in the fact that the method improves the efficiency of transplantation of autospleen tissue in patients with a highly infected abdominal cavity or with a purulent-inflammatory process in it, to eliminate additional incisions of the anterior abdominal wall and the formation of an abscess anterior abdominal wall during autologous transplantation of spleen tissue.

The indicated technical result in the method of reimplantation of spleen tissue is achieved by splenectomy, washing of the removed spleen in sterile physiological saline, the formation of fragments from spleen tissue and their decapsulation, and the subsequent administration of antibacterial drugs in the early postoperative period.

The peculiarity is that through the window of the spleen vascular pedicle, the parietal peritoneum is bluntly peeled off in the lateral direction and a retroperitoneal space is formed into which fragments of spleen tissue are implanted in the area of the spleen bed, then openings for the outflow of inflammatory exudate are formed on the parietal peritoneum over fragments of spleen tissue, at the same time, a drainage tube is installed in the bed of the spleen, providing an external outflow of exudate, and a microirrigator for the introduction of antibacterial drugs through Verstov formed on srednepodmyshechnoy line below the costal arch on the left, followed by their removal on days 5-6 postoperatively.

The invention is illustrated in the drawing.

The method is as follows.

Perform splenectomy. The removed spleen is placed in a sterile saline solution and washed until a blood-unpainted solution appears. After that, fragments 1 are formed from the tissue of the spleen and they are decapsulated.

Through the window 2 of the vascular pedicle of the spleen, the parietal peritoneum 3 is bluntly peeled off in the lateral (lateral) direction so that a retroperitoneal space is formed. Prepared fragments 1 from spleen tissue are implanted into the formed retroperitoneal space in the area of the spleen bed. On the parietal peritoneum 3 above the fragments 1 of the spleen tissue, holes 4 are formed for the outflow of inflammatory exudate. A drainage tube is installed in the spleen bed for an external outflow of exudate and a microirrigator for administering antibacterial drugs through an opening formed along the mid-axillary line, below the costal arch on the left.

In the postoperative period, antibacterial drugs are introduced into the formed bed of the reimplanted spleen for 3 days using a microirrigator. The microirrigator and drainage tube are removed 5-6 days after surgery.

Clinical example.

Patient M., 43 years old, was admitted to the 6th surgical department of the Municipal Clinical Hospital UGKBSMP Ulyanovsk 04/23/2010 with a diagnosis of Closed abdominal injury. Hemoperitoneum. 04/23/2010, the patient was urgently operated. Performed mid-laparotomy. Intraoperatively revealed a rupture of the spleen 8.0 cm long, 3.0 cm deep, intraperitoneal bleeding. Splenectomy was performed due to the failure of organ-preserving procedures (suturing the gap).

Autograft protocol for splenic tissue. After removal, the spleen was lowered into 400 ml of physiological saline, washed, three fragments of 20 × 20 × 5 mm in size were formed and decapsulated. Through the window of the spleen vascular pedicle, the parietal peritoneum stupidly exfoliated in the lateral, left (lateral) direction and formed a retroperitoneal space of 8.0 × 8.0 cm. Fragments of spleen tissue were implanted into the formed retroperitoneal space in the area of the spleen bed. On the parietal peritoneum, holes with a diameter of 3.0 mm were formed over fragments of spleen tissue for the outflow of inflammatory exudate. A drainage tube with a diameter of 1.0 cm was installed in the spleen bed for an external outflow of exudate and a microirrigator with a diameter of 0.3 cm was used to inject antibacterial drugs through an opening formed along the mid-axillary line below the costal arch on the left. In the postoperative period, antibacterial drugs were injected into the formed bed of the reimplanted spleen for 3 days using a microirrigator. The microirrigator and drainage tube were removed 5 days after surgery.

In the postoperative period, hyperthermia persisted at subfebrile numbers in the afternoon. Antibacterial, anti-inflammatory treatment and correction of rheological disorders were carried out.

Discharged in satisfactory condition on the 10th day after the operation. Indicators of hemostasis and immunograms returned to normal on the 28th day of the postoperative period.

Examined after 3 months - healthy, no complaints.

Thus, the proposed method allows to compensate for the function of the removed spleen by performing reimplantation of splenic tissue in patients undergoing splenectomy due to trauma or with purulent intra-abdominal processes.

Claims (1)

A method for reimplantation of spleen tissue, including splenectomy, washing the removed spleen in sterile physiological saline, the formation of fragments from spleen tissue and their decapsulation, and the subsequent administration of antibacterial drugs in the early postoperative period, characterized in that the parietal peritoneum is bluntly peeled off in the lateral direction and form a retroperitoneal space into which fragments from spleen tissue are implanted in the area of the spleen bed, then on the bet openings for the outflow of inflammatory exudate are formed over the peritoneal peritoneum over fragments of spleen tissue, while a drainage tube is installed in the spleen bed providing an external outflow of exudate, and a microirrigator for introducing antibacterial drugs through the hole formed along the mid-axillary line, below the costal arch on the left, followed by their removal 5-6 days after surgery.

Images