RU2629631C1 - Method for extended drainage fixation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: during drainage installation, proximal part of the drainage is fixed to the surrounding tissues using a knot unleashed by traction of the ligature, brought to the body surface. The knot is formed as a simple one with a loop. The knot is tightened by pulling the loop with one hand and the single ligature with the second hand. Strengthening, if necessary, is performed by forming similar additional knots on top of it using the same thread. To form loops, the same ligature is used, for which the traction is performed to remove the knot. The number of fixation points along the entire drainage length is individual.

EFFECT: reduced risk of uncontrolled drainage displacement and likelihood of postoperative complications, high drainage efficiency of any anatomical zone during drainage and irrigation of cavities and canals of various localization and configuration.

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Description

The invention relates to medicine, namely to surgery, and can be used for drainage and irrigation of cavities and channels of various localization and configuration.

During a surgical operation, when placing drains, it is often necessary to arrange the drain so that it passes with bends in different planes and at different levels. But without fixing at the bend points of the drainage, this is almost impossible. Therefore, it is necessary to increase the number of delivered drains. If there is a need to arrange drainage in a convoluted channel, especially in different planes, it is necessary that all sections retain their original position, which is problematic in practice, and impossible to fix the drainage at one or two points. This problem becomes especially acute if the patient is not in a strictly horizontal position, but changes the position of the body or moves independently.

In addition, most conventional drainages, especially those placed in the abdominal cavity, require fixing at least their proximal part. Most often in this situation they are tied with hemming to local tissues (Gulman M.I., Vinnik Yu.S., Miller S.V. Atlas of drainage in surgery - Krasnoyarsk, Yenisei Znak, 2004. - 76 p.). But during the removal of the drainage, inconvenience is created: often it takes some effort to pull the drainage out of the fixing unit, which is fraught with uncontrolled injury to the surrounding tissues. In this case, the fixing node of the ligature remains undeleted, being a foreign body.

Modern studies of microbiologists have established that the implanted material, being foreign to the body, is very quickly colonized by pathogenic microflora, since all bacteria and multicellular fungi form reproductive communities protected from the environment by biofilms - additional membranes, which are, in fact, extracellular membranes. They provide bacteria with a significant increase in survival in the presence of aggressive substances and antimicrobial agents. As a result, microorganisms survive in the presence of antibiotics in a minimal inhibitory concentration of 10-100 times large quantities and are practically inaccessible to the immune defense factors of both cells and antibodies. The use of conventional and even elevated doses of antibiotics is ineffective or even ineffective, because blood concentrations of drugs that can cope with communities of microorganisms formed by bacteria and fungi are not created (Tets V.V. Microorganisms and antibiotics. Sepsis. - St. Petersburg: Aesculapius, 2003 - 154 p .; Deysine M. // Surgical Clinics of North America. - 1998, V. 78, No. 6. - P. 1105-1115 .; Ehlers S., Kaufmann SH Infection, inflammation, and chronic diseases: consequences of a modern lifestyle // Trends Immunol. - 2010 .-- Vol. 31. - P. 184-190.).

Also, the solution to the problem is not to use absorbable sutures - they usually resolve after the drainage period (Chemical and natural sutures for surgical suture materials / Kuzmina N.L., Biber B.L., Abakumova G.L., etc. - M .: NIITEKHIM, 1988. - 79 pp.), Which means that it entails problems with the removal of firmly strengthened drainage - when removed with the use of force, the risk of damage to surrounding tissues and, accordingly, the development of uncontrolled bleeding increases and there is a risk of additional infection of the cavity and in which the drainage catheter is located.

Unremovable ligatures and knots made of threads have a number of negative factors: umptification of the nodes with the formation of a fibrous connective tissue capsule, ligature fistulas when an infection is attached, getting into the suture of a nerve and, as a result, pain and violation of trophic tissue in this area, a focus of dormant infection, infiltration into areas of the suture (Samoilov, A.V. Complications of prosthetic ventroplasty / A.V. Samoilov // Bulletin of herniology. - 2006. - Issue II. - P. 168-171; Timerbulatov V.M. Abdominoplasty during operations for ventral hernias / V.M. Timerbulatov, O . S. Popov, O. V. Popova // Surgery. - 2006. - No. 4. - P. 24-27.) And its teething with the possible development of secondary bleeding, suppuration, in some cases this can lead to the formation of abscesses and other purulent-inflammatory complications. (Milkov B.O. Tissue connection in surgery - Chernivtsi, 1992 - 111 s .; Sleptsov I.V., Chernikov R.A. Knots in surgery. - St. Petersburg: Salit-Medkniga, 2000. - 176 s .; Khromova VN Analysis of the structure of late post-hospital chronic recurring purulent wound complications after operations on the organs of the abdominal cavity and retroperitoneal space / Saratov Journal of Medical Scientific Research. 2010. - Volume 6, No. 3 - P. 722-727 .; Complications in abdominal surgery. A guide for doctors / V.V. Zhebrovsky, A.D. Timoshin, S.V. Gauthier, etc. - M .: MIA LLC, 2006. - 448 p .; Inflammation. A guide for doctors / ed. V.V. Serova, B.C. Paukova. - M .: Medicine, 1995. - 640 p.)

For drainage of various sites, sloping places, and adjacent zones of the abdominal cavity, several drainages are often used with the removal of each through counter-holes (Gulman M.I., Vinnik Yu.S., Miller S.V. Atlas of drainage in surgery - Krasnoyarsk, Yenisei Znak, 2004 . - 76 p.). This creates not only cosmetic defects, but often leads to the development of postoperative ventral hernias and other complications.

In view of the foregoing, in this situation it is advisable, as far as possible, to minimize the amount of foreign material in the body, including during drainage.

The closest is a method of treating peritonitis, the essence of which is to install irrigators and middle drainage along the anterior abdominal wall in flat places of the abdomen (patent No. 2147444 from 12.15.1996). This method helps to increase the therapeutic effect of the treatment of peritonitis.

The disadvantage of this method is the possibility of uncontrolled displacement of irrigators and drainage and, as a result, an increase in the morbidity of surgical intervention and the likelihood of postoperative complications, a decrease in the quality of life of patients in the postoperative period, and a low cosmetic result due to the removal of several drainage tubes to the surface of the abdominal wall.

The technical result of the invention is the absence of the risk of uncontrolled drainage displacement, the reduction of the surgical trauma and the likelihood of developing postoperative complications, the provision of high drainage efficiency of any topographic and anatomical zone, complex cavities, canals and problem areas, the expansion of the drainage functionality, the increase in the treatment efficiency, the reduction of the operation time and terms treatment, improving the quality of life of patients in the postoperative period, are highly th cosmetic result.

The technical result is ensured by the fact that when installing the drainage, the proximal part of the drainage is fixed to the surrounding tissues using a knot untied by traction of the ligature brought to the surface of the body; the knot is formed as simple with a loop: the ends of the threads are gripped by the hands, change the position of the ends of the threads in the hands, forming a cross that is fixed between the second and first fingers of the left hand, and the first and second fingers of the right hand fix the end of the thread, pull it and bring under the protruding end the nail phalanx of the second finger of the left hand, then by turning the left hand with a nodding movement of the second finger, the middle part of the thread is drawn into the gap between the ligatures, thereby forming a loop, pulling the loop with one hand, and the second for the single league Ur, delay node; if necessary, it is strengthened by forming the same additional knots on top of it with the same thread, and the same long ligature is used to form the loops, for which traction is performed to remove the knot; the number of fixation points along the entire length of the drainage is determined individually, in accordance with the possible need for laying drainage with bends in different planes and at different levels.

The invention is illustrated by the figures:

FIG. 1. The node at the stage of loop formation.

FIG. 2. Formed node.

FIG. 3. Tubular drainage fixed to the sutured bed of the gallbladder after cholecystectomy with the removal of the ligature along with drainage.

FIG. 4. Multiple points of fixation of drainage with bends in different planes and at different levels with the removal of ligatures to the surface of the body.

1 - drainage

2 - leather

3 - drainage fixation points

The method is as follows.

During a surgical operation, when installing drainage, its proximal part is fixed to the surrounding tissues using a knot untied by traction of the ligature brought to the surface of the body; the knot is formed as simple with a loop (Fig. 1, Fig. 2): the ends of the threads are gripped by the hands, change the position of the ends of the threads in the hands, forming a cross that is fixed between the second and first fingers of the left hand, and the end is fixed by the first and second fingers of the right hand thread, pull it and bring under the protruding end of the nail phalanx of the second finger of the left hand, then by turning the left hand with a nodding movement of the second finger, the middle part of the thread is held in the gap between the ligatures, thereby forming a loop, pulling one loop on the loop, and the second - on one chnuyu ligature, knot tightened; if necessary, it is strengthened by forming the same additional knots on top of it with the same thread, and the same long ligature is used to form the loops, for which traction is performed to remove the knot. When the node is formed, two ligatures are formed. Depending on the specific operating situation, there are two options: you can leave only one long ligature (Fig. 3) to bring to the surface of the body, which formed a loop of the node, and cut the second at a distance of 1.5-2.5 cm from the node or leave both ligatures. Both threads are left to secure and prevent accidental exposure to one ligature (if there is no certainty that in the postoperative period there will be no accidental uncontrolled exposure to a single ligature). When twitching simultaneously for 2 ligatures, the knot does not untie. If two ligatures are removed, the thread for which traction will be performed is marked with any available method — stained with indelible dye, knotted at the end of the thread, etc. If the fixation points are few in length and they are located close to each other, the ligatures can be removed along with the drainage, along it and fixed to the drainage from the outside by tethering or with a rubber ring, adhesive tape or to the skin surface with adhesive plaster. When removing the threads separately from the drainage, the ligatures brought to the surface of the skin are fixed to the skin with an adhesive plaster.

Throughout the entire length of the drainage, there can be several fixation points, which is determined by the possible need for laying drainage with bends in different planes and at different levels - at points of change in the direction of drainage (Fig. 4). It is possible to fix the drainage over its length by the proposed method by tying it with a ligature around the drainage or piercing it with a ligature needle, and sewing it to the other object or tissues in the area of the drainage standing by the second end of the ligature, or in another convenient way, as applied to a specific situation. From the cavities where they are located (pass), from the fixation points, the free ends of the threads are brought to the surface of the skin using a surgical needle, tucking the ends of the threads into the eye of the needle and making a puncture from the inside out through all the layers. If the drainage is located in the abdominal or chest cavity, then leave the free area of the ligatures and drainage between the last fixation point inside the cavity and the surface for excursion during breathing without tension.

Due to the fixation over the proposed method, it is possible to change the location of the drainage in the cavity in which it is located, removing only a part of the fixing intermediate ligatures, and it is also possible to fix various types of drains.

Drainage with this arrangement throughout can be used not only for outflow of fluid, exudate, but also for the introduction of drugs, flushing cavities, etc. In addition to deep body cavities, the proposed method can be used for drainage and irrigation of intermuscular spaces and subcutaneous adipose tissue with a complex profile of the drained channel, with sagging.

Examples of specific applications.

An experimental study was conducted on 8 dogs. All surgical interventions were performed from the upper middle laparotomic access under intravenous hexenal anesthesia. The drug was administered at a rate of 30 mg / kg of animal weight. Premedication was performed with atropine 0.1 ml of a 0.1% solution and diphenhydramine 0.2 ml of a 1% solution, which was administered intramuscularly 30 minutes before surgery. In addition, all animals underwent infusion therapy with a 5% glucose solution and a solution of mafusol in a volume of 150 to 250 ml. Resection of the left external lobe of the liver with the application of a double spiral continuous hemostatic hepatic suture (Method for applying a double spiral continuous hemostatic hepatic suture: application No. 2014152368/14 of the Russian Federation, IPC A61B 17/04 / Perkov AA, Lazarenko VA, Lazarenko S .V. - No. 2566213 C1; filed Dec. 23, 2014; publ. October 20, 2015, Bulletin No. 29) was carried out as follows. After processing the surgical field with a 1% solution of chlorhexidine bigluconate, a mid-median laparotomy was performed. The elements of the glisson and caval systems of the left external lobe of the liver were ligated. After that, the left triangular ligament intersected with the subsequent separation of the left external lobe of the liver in a blunt and sharp way along the interlobar groove and an elastic clip was applied to the stump of the remaining part of the liver. The left lobe of the liver was completely removed and additional hemostasis was performed on large vascular-bile formations, clearly visible on the wound surface of the liver, which we were stitching and ligated with lavsan. Then a double spiral continuous hemostatic suture was applied. After that, the wound surface of the stump of the liver was wrapped around the area of the greater omentum on the leg, while pulling the omentum over the entire area of the wound surface of the liver until it was in full contact with the upper and lower surfaces of the liver. The gland was hemmed with interrupted seams. Tubular polyvinyl chloride drainage was carried out from the upper third of the left lateral canal with horizontal bending and passing near the resection site, in the subhepatic space, then transitioning in the anteroposterior direction into the subphrenic space and from there, down the right lateral canal to the pelvis, where on the anterior abdominal wall. Oval holes were made along the entire length of the drainage. The fixation points of the drainage are in the area of the liver resection, in the places of bends, in straight areas as necessary, and the proximal part of the drainage to the parietal peritoneum was also fixed in order to avoid undesirable displacements. At the indicated fixation points, by means of a puncture with a needle, long ligatures from the fixation nodes were removed onto the skin and fixed on the skin with strips of adhesive plaster. A latex stretch receiver was attached to the distal part of the drainage by a separate ligature to collect the discharge. Then hemostasis was controlled and the postoperative abdominal wound was sutured in layers tightly. Blood loss directly during resection was not more than 30 ± 5 ml. For a day on drainage - about 20.0 ± 4.0 serous-hemorrhagic discharge. After a day, the drainage was removed - first the fixation points were freed from the ligatures, and then, by pulling at the distal end, the entire tubular drainage. The postoperative period in all animals was satisfactory. All animals survived the operation.

Patient P., 62 years old, was admitted to the surgery clinic of KSMU on November 11, 2015 with complaints of pain in the right hypochondrium, nausea, and vomiting mixed with bile. As a result of the examination, the diagnosis was made: Gallstone disease. Acute phlegmonous appendicitis. Cholecitectomy from the bottom was performed. The phlegmonous gall bladder with many small calculi was removed. The bubble bed is sutured with catgut. A tubular drainage is brought to the bed, which is hemmed to the bed through one of the holes in its proximal part. The knot was tied according to the proposed method. One - long - the ligature was brought along the drainage to the surface of the body and attached to the drainage with a rubber ring, the second - cut off 2 cm from the site. In the postoperative period, a solution of antibiotics was administered through the drainage to the gallbladder bed and discharge from the abdominal cavity was controlled. On the third day, having released the ligature coming from the knot, and pulling it, the knot fixing the proximal end of the drainage to the bed of the bladder was untied, and the ligature was removed from the abdominal cavity along with the drainage.

Thus, the authors proposed method of fixing drainage throughout allows to reduce the invasiveness of surgical intervention and the risk of developing postoperative complications, provides high drainage efficiency of any topographic anatomical zone, complex cavities, canals and problem areas, extends the functionality of drainages, increases the effectiveness of treatment, reduces the time of surgery and terms of treatment, improves the quality of life of patients in the postoperative period with a high cosmetic result.

Claims (2)

1. A method of fixing drainage throughout, including installing a drainage, characterized in that the proximal part of the drainage is fixed to the surrounding tissues using a node untied by traction of the ligature, brought to the surface of the body; the knot is formed as simple with a loop: the ends of the threads are gripped by the hands, change the position of the ends of the threads in the hands, forming a cross that is fixed between the second and first fingers of the left hand, and the first and second fingers of the right hand fix the end of the thread, pull it and bring under the protruding end the nail phalanx of the second finger of the left hand, then by turning the left hand with a nodding movement of the second finger, the middle part of the thread is drawn into the gap between the ligatures, thereby forming a loop, pulling the loop with one hand, and the second for the single league uru, tighten knot. 2. The method according to p. 1, characterized in that, if necessary, the drainage is strengthened by forming the same additional knots on top of it with the same thread, and the same long ligature is used to form the loops, for which traction is performed to remove the knot; the number of nodes imposed along the entire length of the drainage is determined by the need to fix the drainage with bends in different planes and at different levels.

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