RU2551189C1 - Method for treating residual cavity following marsupialisation and open echinococcectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: two-duct drain tube is intraoperatively inserted into a residual cavity. The tube is delivered onto an anterior abdominal wall. The cyst cavity is irrigated with 0.05% chlorhexidine every day from the second postoperative day that is followed by administering the preparation of 10% povidone iodine with the drain tube pinched for 3-5 minutes. The procedure is performed until the cyst cavity is eliminated completely.

EFFECT: method provides the reliable treatment of the residual cyst cavity following marsupialisation and open echinococcectomy, as well as prevents the postoperative complications by achieving the aseptic inflammation of the inner surface of the fibrous capsule surface followed by the cyst cavity obliteration.

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Description

The invention relates to medicine, namely to surgical treatment of liver echinococcosis, and can be used to close the residual cavities after marsupialization and open echinococcectomy.

From the practice of medicine, methods for treating the residual cavity are known: gauze plugging, suturing from the inside with interrupted, Z-shaped multi-row sutures (Agaev R.M. Surgical treatment of liver echinococcosis and its complications. Surgery 2001; 2: 32-36).

The disadvantages of the known methods are:

- slow filling of the residual cavity;

- bleeding;

- bile leakage;

- accumulation of pathological fluid with possible abscess formation;

- the duration of the patient's stay in a hospital bed;

- prolonged disability and possible disability;

- the formation in the late postoperative period of cysts that require repeated surgical intervention;

- the possibility of the formation of postoperative hernias in the field of hemming of the fibrous capsule to the anterior abdominal wall.

The closest prototype analogue is a method for treating a residual cavity: plugging a cyst cavity formed by suturing the edges of the fibrous capsule to the wound of the anterior abdominal wall (marsupialization), an ointment swab and / or a thick drainage tube (Sergiev V.P., Legonkov Yu.A., Poletaeva OG, Tumolskaya NI Echinococcosis cystic (single-chamber) clinic, diagnostics, treatment prophylaxis. Information and methodological manual, Moscow 2008; p. 21).

The invention is aimed at improving the reliability of processing the residual cavity after marsupialization and open echinococcectomy and the prevention of postoperative complications.

The specified technical result is achieved by the fact that during the operation, a two-channel drainage tube is installed in the residual cavity, which is displayed on the anterior abdominal wall, and then in the postoperative period, on the second day, the cyst cavity is rinsed with a solution of chlorhexidine with 0.05% followed by the administration of povidone- iodine 10% and squeezing the drainage tube for 3-5 minutes, and the procedure is performed until the cyst cavity is completely eliminated.

The introduction into the residual cavity after marsupialization and open echinococcectomy through a two-channel drainage tube according to the principle of irrigation and aspiration of a chlorhexidine solution of 0.05%, followed by the introduction of 10% povidone-iodine solution, and squeezing the drainage tube with an exposure of 3-5 minutes, causes aseptic inflammation of the internal the surface of the fibrous capsule, which subsequently contributes to the formation of connective tissue, with the help of which obliteration of the residual cavity occurs.

The present invention was tested on 6 patients in Design Bureau No. 2 of the Federal State Institution YuOMTs FMBA of the Russian Federation, Astrakhan during 2012-2013.

Below are the results of testing.

Example 1. Patient A., born in 1967, was hospitalized in the surgical department of KB No. 2 of the Federal State Institution YuOMTs FMBA of Russia from 11/08/12 with a diagnosis of Echinococcosis of the liver. From the anamnesis: the patient considers herself since 2004, when pain in the right upper quadrant first appeared. An ultrasound scan revealed a liver cyst. CT on 10/17/12 - CT data for a solitary fluid cyst of 7-8 segments of the right lobe of the liver, size 8.0´4.0´4.0 cm, parasitic etiology. 11.11.12 was operated on as planned, an echinococcectomy with marsupialization was performed, during the operation, a two-channel drainage tube was installed in the residual cavity, which was brought to the anterior abdominal wall, and then, in the postoperative period, the cyst cavity was daily washed with chlorhexidine solution 0.05% s subsequent administration of the drug povidone-iodine 10% and squeezing the drainage tube for 3 minutes, the procedure was performed until the cyst cavity was completely eliminated. During a dynamic ultrasound examination on the 4th day after the operation (see Fig. 1) a cavity of up to 4.0´2.0 cm in size, on the 7th day after the operation (see Fig. 2) with a dynamic ultrasound examination of the cavity cysts in the standing of the drainage tube were not detected. 12 months after surgery, no relapse was noted.

Example 2. Patient R., born in 1959, was hospitalized in the surgical department of Design Bureau No. 2 of the Federal State Institution YuOMTs FMBA of Russia from 04.04.13 with a diagnosis of Echinococcosis of the liver. From the anamnesis: he considers himself sick since 2009, when pain in the right upper quadrant began to bother for the first time. During the CTBP examination dated March 25, 13, CT data for a parasitic cyst of 7 segments of the liver measuring 7.0´3.5´2.4 cm. On 08.04.13, surgery was performed as planned, echinococcectomy with marsupialization was performed: during surgery, the residual A two-channel drainage tube was installed in the cavity, which was brought out to the anterior abdominal wall, and then in the postoperative period on the second day the cyst cavity was washed daily with a 0.05% chlorhexidine solution and 10% povidone-iodine was injected with the drainage tube pressed for 5 minutes, the procedure performed the complete elimination of the cyst cavity. On the 8th day after the operation, a dynamic ultrasound examination of the cyst cavity at the standing position of the drainage tube was not determined. 6 months after surgery, no relapse was noted.

The proposed method is achieved:

- improving the reliability of processing the residual cavity after marsupialization and open echinococcectomy;

- the fastest filling of the residual cavity with connective tissue;

- prevention of postoperative complications;

- the exclusion of bleeding and bile flow;

- the exception of the accumulation of pathological fluid in the cavity of the cyst;

- the exclusion of long-term disability;

- the exclusion of the formation of secondary cysts in the area of operation;

- the exception of the formation of postoperative hernia at the site of hemming of the fibrous capsule to the anterior abdominal wall.

Claims (1)

A method of treating a residual cavity after marsupialization and open echinococcectomy by plugging a cyst cavity formed by suturing the edges of the fibrous capsule to the wound of the anterior abdominal wall with a drainage tube, characterized in that during the operation, a two-channel drainage tube is inserted into the residual cavity, which is discharged to the anterior abdominal wall, and then, in the postoperative period, on the second day, a daily washing of the cyst cavity with a chlorhexidine solution of 0.05% is carried out with the subsequent administration of the drug povidone-iodine 10% and squeezing the drainage tube for 3-5 minutes, and the procedure is performed until the cyst cavity is completely eliminated.

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