RU2536787C2 - Device for small intestinal intubation in technically complex environment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to devices for the small intestinal drainage in acute abdominal surgical pathology. A device for the small intestinal intubation in the technically complex environment consists of an outer elastic tube of 12 mm in diameter, 280-300 cm long and having holes at a caudal end. A supplementary tube of 3 mm in diameter is inserted into a lumen of the outer tube along the entire length; a longitudinal rubber bag is attached to the caudal end of the supplementary tube brought out through the caudal end of the outer tube; at the end of the caudal end, there is an olive movable in relation to the outer tube. Progressive motion of the olive in the intestinal lumen is ensured by the inflation and elongation of the bag. The device is movable by fixing the olive in the intestinal lumen by the elastic contraction of the bag after de-aeration.

EFFECT: invention provides reducing injuries that might accompany the intestinal intubation manipulations in the technically complex environment.

6 dwg

Description

The invention relates to medicine, namely to devices for drainage of the small intestine in acute abdominal surgical pathology.

Despite the progress made in recent years in the instrumental and technical equipment of surgical hospitals providing emergency care, the problem of insufficient reliability, efficiency and safety of devices and techniques for small intestine drainage remains relevant. This situation is due to an increase in the number of patients with acute enteric insufficiency, in which indications for intestinal intubation reach 70% of cases.

Clinical experience indicates that attempts to intubate the intestines with existing devices (the Abbot-Miller intestinal probe and its analogs) in 10-20% fail due to the inability to conduct the probe along the physiological and pathological bends of the intestinal tube, and another 10-15% cases are associated with an undesirably high level of trauma to the intubated intestine when performing energetic traction of the probe (1, 4).

The device of the intestinal probe, the most commonly used in modern surgical practice and taken by us as a prototype, is the following. Commercially available drainages such as the Abbot-Miller probe (W. Abbot, T. Miller) made of silicone or polyvinyl chloride, a common design feature of which is the presence of a hollow relatively rigid elastic tube (10-12 mm in diameter, 280-300 cm long with perforations to remove contents intestine and stomach), rigidly fixed to the distal end of the olive tube, necessary for fixing the probe in the lumen of the intestine (2, 3). The technique for performing intestinal intubation with this device is that after passing through the nasal passage, pharynx and esophagus, the probe enters the stomach. Next, the surgeon with his right hand presses the probe to the lesser curvature of the stomach, and with his left hand, fixing the pylorus, directs the probe olive to the pyloric department and the duodenum. Then the left hand enters the subhepatic space and, repeating the duodenal bend with the palm of your hand, directs the probe into the lower horizontal part of the duodenum. Often, for unhindered passage of the probe, at this stage, a dissection of adhesions fixing the stomach and 12 duodenal ulcer, as well as mobilization of the intestine according to the Kocher method and, with a high and close to the colon location of the duodenal angle, dissection of the Treitz ligament are shown. Given the technical difficulties of conducting a probe in this area, to give greater mobility to the distal duodenum, many modern authors recommend dissecting the posterior sheet of the peritoneum at the site of its transition from the ascending part of the duodenum to the aorta (3).

After olive has passed the duodenal junction, the assistant should fix it by pressing it through the intestinal wall and continue intubation by the method of phasing the intestine onto the drainage. The technique of conducting the probe into the lower intestine is that the surgeon collects (“corrugates”) 10-15 cm of intestine in the distal part of the probe, after which it grabs the probe in the olive area with one hand and the proximal section of the intestine straightens .

This device for intubation of the intestine has significant disadvantages:

1) the design of the intestinal probe does not provide for the possibility of active translational advancement of the device inside the intestinal lumen without pulling and fixing from the outside through the intestinal wall, which greatly complicates the passage of the probe through the physiological and pathological bends of the small intestine, especially with adhesive disease of the abdominal cavity;

2) the device of the intestinal probe suggests that the translational movement of the probe is provided by rather traumatic manipulations:

the surgeon "puts" the intestine on the rigid tube of the probe (the method of collecting in the "accordion", "corrugating" the intestine). This manipulation injures the intestinal mucosa and inevitably causes more or less pronounced “crushing” mucosal injuries (1, 4).

The purpose of the invention is to reduce the morbidity of manipulations with the intestine during intubation in technically difficult conditions.

This goal is achieved by the fact that the proposed device has design features that allow translational movement in the intestine without traction, pulling up and corrugating the intestine by the surgeon.

Figure 1 shows a design diagram of the distal section of the proposed device, where 1 is the outer tube, 2 is the inner tube (duct), 3 is a rubber bottle, 4 is olive. Figure 2 shows a diagram of the translational movement of the device in the lumen of the intestine, where A - balloon deflated, B - balloon inflated, B - balloon again deflated, pulled up. In Fig.3 - the device in the lumen of the intestine, the balloon is deflated, in Fig.4 - the device in the lumen of the intestine, the balloon is inflated, the olive has moved forward by 6-7 cm; figure 5 - the balloon is inflated, the olive is fixed in a new position; figure 6 - the balloon again deflated with a fixed olive, the device "pulled" forward along the intestine.

The device consists of an external elastic tube with a diameter of 12 mm, a length of 280-300 cm with holes at the caudal end and includes a device for active non-traumatic advancement in the lumen of the intestine: an additional tube with a diameter of 3 mm is introduced into the lumen of the external tube along the entire length, to the caudal end which, brought out through the caudal end of the outer tube, is attached a rubber balloon of longitudinal shape, at the end of which there is a dense olive movable relative to the outer tube (Fig. 1). In the deflated state, the balloon has a size of 1 × 5 cm, and in the inflated state, its diameter and length increase to 2 and 12 cm, respectively (Fig. 2). The translational movement of olive in the lumen of the intestine is due to inflating and increasing the length of the balloon, and after advancing the terminal part of the balloon and fixing it by holding the olive - due to the elastic contraction of the balloon after removing air from it (Figs. 3-6).

The proposed device in the gut is as follows. At the beginning of intubation (when the device is inserted into the esophagus and stomach), the terminal balloon is deflated, the device is delivered transnasally to the stomach and is passed through the sphincter of the stomach of the stomach in the traditional way. When the caudal part of the device enters the lumen of the duodenum through the cannula of the device’s additional tube, the balloon is inflated, thereby increasing its length by 6-7 cm, which ensures the forward movement of the olive inside the intestine without the additional help of a surgeon (Figs. 3, 4). After moving the olive in the lumen of the intestine, it is fixed by grasping with fingers (Fig. 5) through the wall of the intestine, and the air from the lumen of the balloon is removed. Moreover, due to the elastic properties of rubber, the length of the balloon is again reduced to its original size, and, in conditions of olive fixed in the gut, the balloon and the whole device are pulled into a new position (Fig.6).

The technical result is achieved by the fact that the design of the device involves the promotion of olive (movable relative to the outer tube) in the lumen of the intestine due to inflating of the elastic rubber balloon, and the removal of air from the balloon leads to a decrease in its size and, with fixed olive, pulling the device without traumatic manipulation of the intestinal the wall.

The proposed device was tested in the anatomical theater on 3 cadavers. In all cases, intestinal intubation was successful.

INFORMATION SOURCES

1. Andryushchenko V.P. Prolonged decompression of the small intestine in the surgical treatment of OKN // Andryushchenko V.P., Zhovniruk A.Ya. // Abstracts of the 5th Congress of Surgeons of Central Asia and Kazakhstan. - Part 1. - Tashkent. - 1991 .-- S. 129-131.

2. Nechaev E.A. Drainage of the small intestine with peritonitis and intestinal obstruction // Nechaev EA, Kurygin AA, Kanevich MD // St. Petersburg. - 1993. - P.238.

3. Sapozhnikov A.Yu. Intestinal decompression (problems, searches, solutions) // Sapozhnikov A.Yu., Nikolsky V.I. // Penza: printing house of the Penza Instrument-Making Plant. - 1992. - 138 p.

4. Hanevich M.D. Features of drainage of the small intestine with peritonitis and intestinal obstruction // Acute abdomen in the practice of emergency ambulance. SPb. - 1995. - S. 94-95.

Claims (1)

A device for intubation of the small intestine in technically difficult conditions, consisting of an external elastic tube with a diameter of 12 mm, a length of 280-300 cm with holes at the caudal end, characterized in that an additional tube with a diameter of 3 mm is inserted into the lumen of the external tube along the entire length, to the caudal the end of which, brought out through the caudal end of the outer tube, is attached to a rubber balloon of longitudinal shape, at the end of which there is a dense olive moving relative to the outer tube, while the forward movement of the olive in light of the intestine is carried out by inflating and increasing the length of the balloon, and the device is promoted by fixing the olive in the lumen of the intestine due to the elastic contraction of the balloon after removing air from it.

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