RU2599375C1 - Method of elimination of the residual cavity of the fibrous capsule of the liver - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to surgery. Fiber laparotomy is made by access of Kocher in the right hypochondrium. Between two handlers make a longitudinal discission of a fibrous capsule. Free edges of the fibrous capsule, mobilized along an upper and lower edge is dissect. From the fibrous capsule formed plates, which are pulled up and sutured with interrupted sutures to the bottom of cavity. Plates of the fibrous capsule are sutured among themselves after preliminary placing between them hemostatic plates of Tahoe Comba.

EFFECT: method provides the prevention of risk of recurrence, reducing of terms of treatment of patients due to single-stage radical eliminating of residual cavity of the fibrous capsule after liver echinococcectomy.

1 cl, 1 ex, 1 dwg

Description

The invention relates to medicine, namely to abdominal surgery. Due to the increasing incidence of not only rural but also urban population of echinococcosis, there is a need for timely diagnosis and development of radical treatment methods that prevent complications and relapses of the disease in the postoperative period. Recently, methods have been proposed for the medical treatment of liver echinococcosis. However, many issues of surgical treatment, in particular, radical and simultaneous elimination of the residual fibrous cavity that occurs after echinococcectomy, have not been resolved, preventing both complications from the residual cavity of the fibrous capsule and relapse of the disease, which reach up to 10-12%.

Analogs

Many methods have been proposed and used in practice to eliminate the residual cavity of the fibrous capsule, which can be grouped:

- open

- half closed

- closed.

The disadvantages of the known methods are:

- suppuration of the residual cavity of the fibrous capsule,

- the formation of biliary, gall-purulent fistulas, requiring repeated surgical interventions,

- the formation of non-healing rigid cavities,

- in this regard, cachexia of patients, degeneration of internal organs,

- long-term inpatient treatment.

Prototype

As a prototype, we used the method of invagination of the fibrous capsule into the liver cavity, described in the book of B.V. Petrovsky, O.B. Milonova, P.G. Deenichina "Surgery of echinococcosis", Medicine, Moscow; “Medicine and Physical Education”, Sofia, 1985, pp. 112-167.

The essence of the prototype method is as follows.

After removal of the chitinous membrane, the edges of the fibrous capsule are screwed into the cavity of the fibrous capsule by screwing seams and an additional drainage tube is inserted into the cavity. The method is not widely used in practice due to the inability to achieve tightness, the preservation of “dead spaces” between the immersed fibrous capsule and the walls of the cavity, the lack of tightness between the joints, where effusion usually accumulates, which can later transform into an abscess inside the cavity.

The purpose of the invention

The aim of the invention is to prevent the occurrence in the postoperative period of complications within the cavity and relapse of the disease, reducing the treatment time of patients. The goal is achieved by a simultaneous radical elimination of the residual cavity of the fibrous capsule that occurs after echinococcectomy of the liver.

SUMMARY OF THE INVENTION

The method is illustrated in FIG. 1, which shows a diagram of an operation using immersion plates cut from a fibrous capsule, with the help of which radical elimination of the residual cavity of the fibrous capsule that occurs after echinococcectomy of the liver is carried out. In FIG. 1, pos. 1 shows a longitudinal section of the fibrous capsule along the inner surface of the cavity, pos. 2 marked plates of fibrous capsule, pos. 3 indicates the suturing of the plates to the bottom of the cavity, pos. 4 shows the peritonization of these plates.

The essence of the proposed method is as follows.

Access through Kocher in the right hypochondrium is a layered laparotomy. Between the two holders produce a longitudinal section of the fibrous capsule (Fig. 1, position 1). The free edges of the fibrous capsule are taken to hemostatic clamps and mobilized along the perimeter with a length of 4-5 cm. Then, the mobilized fibrous capsule along the upper and lower edges is dissected within the mobilized limits, forming plates from the fibrous capsule (Fig. 1, item 2). In the course of mobilization of the fibrous capsule, electrocoagulation of blood vessels and bile ducts is performed. Then, the mobilized plates of the fibrous capsule on the hemostatic clamp are pulled up and hemmed with interrupted sutures to the bottom of the cavity (Fig. 1, item 3). Then these plates of the fibrous capsule are sewn together with each other by the second and third row of continuous sutures after preliminary placement of the Tahoe Comb hemostatic plates between them. Then produce peritonization of these plates (Fig. 1, item 4).

An example of a specific implementation of the method.

The patient was admitted to the clinic on November 17, 2014 with a diagnosis of suppurative echinococcosis of the right lobe of the liver. An ultrasound scan performed on an outpatient basis - in the zone of 7-8 segments of the liver, revealed a thick thick-walled cavity formation with dimensions of 76 × 46 mm containing hypoechoic structures. After preliminary preoperative preparation, access by Fedorov in the right hypochondrium produced a layered laparotomy. After isolation of the liver from the free abdominal cavity with Mikulich's napkins moistened with 2% formalin solution, puncture of an echinococcal cyst was performed with a trocar connected through an conductor to an electric suction pump followed by aspiration of the contents of the cyst. A solution of furatsilin with chymotrypsin 30 mg, heated to 50 ° С, was poured into the cyst cavity through a trocar. After 10 minutes of exposure, the furatsilin solution was aspirated. This procedure was repeated twice. Then, between the two holders dissected fibrous capsule. The cavity was dried. Two plates (right and left) were cut out from the fibrous capsule, their free ends were fixed with interrupted sutures to the bottom of the cavity. Then these plates were sewn together by half-mesh seams. Peritonized with hemostatic plate Tahoe Comb. Subphrenic drainage. Layered seams on the wound of the abdominal wall. Aseptic dressing. The postoperative period was uneventful. Drainage from under the liver space was removed on the 4th day. After a month, the patient's condition is satisfactory, no complaints.

Signs of the invention, distinctive from the prototype:

- simultaneous elimination of the residual cavity of the fibrous capsule,

a mobilized fibrous capsule along the upper and lower edges is dissected in mobilized limits,

- the mobilized plates of the fibrous capsule on the hemostatic clamp are pulled up and hemmed with interrupted sutures to the bottom of the cavity.

- these plates of the fibrous capsule are sewn together with each other by the second and third row of continuous sutures after preliminary placement of the Tahoe Comb hemostatic plates between them.

Prototype

According to the prototype, after immersion of the capsule of the cyst in the fibrous cavity, the cavity is drained by a drainage tube.

The technical result obtained by using the proposed method

The proposed method for eliminating the residual cavity of the fibrous capsule that occurs after echinococcectomy of the liver is fast and easy to perform, low invasiveness. The developed method allows you to completely prevent complications from the cavity inherent in existing methods of eliminating the residual cavities of the fibrous capsule that occur after echinococcectomy of the liver. Positive signs: prevention of complications on the part of the cavity, short healing time of the cavity, reduction in the length of stay of patients in the hospital, prevention of the development of biliary and biliary-festering fistulas, accessibility and technical simplicity in execution, low trauma.

The present invention can be used to treat liver echinococcosis in both uncomplicated and complicated course of the disease. With planned and emergency surgical interventions without any negative consequences for the life and health of the patient. The method is highly effective prevention and good long-term results.

The source of information

B.V. Petrovsky, O.B. Milonov, P.G. Deenichina "Surgery of echinococcosis", Medicine, Moscow; "Medicine and physical education", Sofia, 1985, pp. 112-167 (prototype).

Claims (1)

The method of eliminating the residual cavity of the fibrous capsule of the liver, which consists in the fact that after removing the chitinous membrane, the edges of the fibrous capsule are screwed into the cavity of the fibrous capsule, characterized in that the fibrous capsule at the clamps is pulled to the wound and mobilized around the perimeter for 4-5 cm, the mobilized fibrous capsule of the liver along the upper and lower edges is dissected within the mobilized limits, forming plates from them, which are sutured to the bottom of the cavity with interrupted sutures, then these plates are sutured together polukisetnymi continuous sutures after pre-stacking between hemostatic plates Tahoe Comba.

Images