RU2704477C1 - Method for prevention and treatment of pyoinflammatory complications of colostomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and can be used for prevention and treatment of pyoinflammatory complications of colostomy. Around the hole for stoma, deviating from the hole edge by 3–4 cm, the first catheter with through holes is installed throughout the pre-peritoneal space of the paracolostomy zone by fixing to the parietal peritoneum with two interrupted sutures of the absorbable material, ends of the catheter are brought out on the anterior abdominal wall through a separate opening – counterpuncture on the skin, deviating 2.0 cm from the lower edge of the skin wound. Second catheter with through holes along the entire length is placed in the neuropathic space around the stoma opening, having deviated from the edge of hole by 3–4 cm, by fixing to the aponeurosis with two interrupted sutures of the absorbable material, ends of the catheter are brought out on the anterior abdominal wall through a separate opening – a counterpuncture on the skin, extending 2.0 cm from the upper edge of the skin wound. In the postoperative period, local anesthesia for anesthesia and an antibacterial preparation for preventing and treating pyoinflammatory complications are successively administered by catheters.

EFFECT: method provides preventing pyoinflammatory complications.

1 cl, 1 dwg

Description

The invention relates to medicine, namely to surgery and oncology, and can be used in the surgical treatment of malignant neoplasms of the large intestine for the prevention and treatment of purulent-inflammatory complications of colostomy.

The frequency of purulent-inflammatory complications during colostomy formation reaches 45%. Suppuration of a parastomal wound contributes to the occurrence of subsequent complications, such as retraction of the colostomy, necrosis of the intestinal wall, paracolostomy abscesses, eventation of other parts of the intestine, intestinal abscesses, deformation of the colorectal anastomosis. The developed methods and devices are mainly aimed at treating colostomy complications, and not at their prevention. All this indicates the need to create and improve methods for the prevention and treatment of complications of colostomy.

There is a method of colostomy, the essence of which is the direct conduct of the sigmoid colon in the left iliac region through the "window" in the abdominal wall, formed by stitching the parietal peritoneum to the skin, with its uncut ligatures fixed to the peritoneal skin suture (Hartmann H. Technigue de la colostomie Revue de Chirurgie. 1990. V. 22, p. 613-620). The specified method of colostomy does not prevent the complications that arise in most cases due to incomplete isolation of paracolostomy tissues from colonic contents.

The known method (RF patent for the invention No. 2491891, publ. 09/10/2013, Bull. No. 25), taken as a prototype, in which a caudally paracolostomy wound is expanded by 5-10 cm, a double-lumen drainage is placed in it, directed towards the bottom of the iliac fossa . The ostomy intestine is brought out over the paracolostomy wound and fixed by grasping the edges of the intestine with mini clamps on elastic rods and fixed to rigid supports, which are the lower support - the lower base of the structure, which is installed on the outer surface of the skin along the periphery of the paracolostomy wound and fixed to the skin with sutures, and the second support on racks. A double-lumen drainage with perforations at the level of the preperitoneal tissue of the paracolostomy wound is placed around the ostomy intestine with a loop. An intubation tube for the colon with an obturator for passive abduction of intestinal contents is installed in the lumen of the intestine. All double-lumen drains are connected to the antiseptic supply module and the active drainage apparatus.

The reasons that impede the achievement of the technical result indicated below when using this method include the fact that this method is aimed at treating purulent-inflammatory complications of a colostomy that have arisen and does not allow their prevention.

The objective of the invention is to provide a method for the prevention and treatment of complications of colostomy in malignant colon tumors by draining the preperitoneal and subaponeurotic space of the paracolostomy zone and administering local anesthetics, antibacterial drugs for drainage in the postoperative period.

The technical result is achieved by the fact that a hole is formed in the anterior abdominal wall in the direction of the projected stoma projection, nodal sutures are applied between the skin, aponeurosis, parietal peritoneum and colostomy is fixed with these uncut ligatures, a feature is that before nodal sutures are applied around the stoma opening , departing from the edge of the hole by 3-4 cm, the first catheter is installed with through holes throughout the preperitoneal space of the paracolostomy zone by fixing to the parietal peritoneum with two interrupted sutures from absorbable material, the ends of the catheter are brought to the front abdominal wall through a separate hole (contraperture) on the skin, departing 2.0 cm from the lower edge of the skin wound, the second catheter with through holes throughout is placed in the subaponeurotic space around the hole for the stoma, having departed from the edge of the opening by 3-4 cm, by fixing to the aponeurosis with two interrupted sutures from absorbable material, the ends of the catheter are displayed on the anterior abdominal wall through the In the postoperative period, a local anesthetic for analgesia and an antibacterial drug for the prophylaxis and treatment of purulent-inflammatory complications are alternately administered via catheters in the postoperative period, using a catheter hole on the skin, departing 2.0 cm from the upper edge of the skin wound.

The invention is illustrated in FIG. one.

FIG. 1 illustrates the formed hole in the anterior abdominal wall in the direction of the intended projection of the stoma, the installation of catheters:

1 - formed hole,

2 - anterior abdominal wall,

3 - aponeurosis,

4 - parietal peritoneum,

5 - the first catheter,

6 - preperitoneal space,

7 - two nodal sutures on the parietal peritoneum fixing the first catheter,

8 - a separate hole (contrapper) on the skin 2.0 cm from the lower edge of the skin wound,

9 - the lower edge of the skin wound,

10 - second catheter,

11 - subaponeurotic space,

12, 13 - two nodal sutures on the aponeurosis fixing the second catheter,

14 - a separate hole (contrapper) on the skin 2.0 cm from the upper edge of the skin wound,

15 - the upper edge of the skin wound.

The method is as follows.

The method includes forming an opening 1 in the anterior abdominal wall 2 in the direction of the planned projection of the stoma, applying nodal sutures between the skin, aponeurosis 3, parietal peritoneum 4 and fixing the colostomy with these uncut ligatures, a feature is that before applying the skin-aponeurotic abdominal nodal sutures, around openings for the stoma, departing from the edge of the opening by 3-4 cm, the first catheter 5 is installed with through holes throughout the preperitoneal space 6 of the paracolostomy zone by fixing to the parietal peritoneum 4 with two interrupted sutures 7 made of absorbable material, the ends of the catheter are brought to the front abdominal wall through a separate hole 8 (contraperture) on the skin, departing 2.0 cm from the lower edge 9 of the skin wound, the second catheter 10 with through holes is installed throughout into the subaponeurotic space 11 around the opening for the stoma, departing from the edge of the opening by 3-4 cm, by fixing to the aponeurosis with two interrupted sutures 12,13 of absorbable material, the ends of the catheter are led to the anterior abdominal wall through a separate opening (contraperture) 14 on the skin, departing 2.0 cm from the upper edge 15 of the skin wound, in the postoperative period, a local anesthetic for analgesia and an antibacterial drug for the prevention and treatment of purulent-inflammatory complications are introduced through catheters.

The application of the developed method provides the prevention of purulent-inflammatory complications, effective pain relief.

Clinical example

Patient C. 1971 was admitted to the 6th surgical department of the State Health Institution “Ulyanovsk Regional Clinical Center for Specialized Medical Assistance” on June 11, 2014, at 10 a.m. with a diagnosis of Acute obstructive colonic obstruction. Survey conducted.

Diagnosed with Acute obstructive colonic obstruction. Local peritonitis.

Operation: June 11, 2014 11 h 25 min - 12 h 10 min. A mid-low midline laparotomy of 20 cm long was performed. About 300 ml of serous-fibrinous effusion in the abdominal cavity. Loops of the small intestine expanded to 40 mm, loops of the large intestine expanded to 90 mm. When revising the abdominal cavity, a tumor-like formation of a rectosigmoid colon was revealed, which circularly obstructs the intestinal lumen.

Obstructive resection of the rectosigmoid region was performed. The distal section of the resected intestine is sutured. At the planned point, the stomas formed a hole in the anterior abdominal wall in the left iliac region. For this, the skin with the underlying fiber was excised in a circular incision, the aponeurosis was dissected, the muscles were stratified, and the peritoneum was opened. Before applying the skin-aponeurotic abdominal nodal sutures, around the stoma hole, 4 cm away from the edge of the hole, the first catheter was inserted with through holes throughout the preperitoneal space of the paracolostomy zone by fixing to the parietal peritoneum with two nodular sutures from absorbable material, the ends of the catheter brought to the anterior abdominal wall through a separate hole (contraperture) on the skin, departing 2.0 cm from the lower edge of the skin wound, a second catheter with through holes throughout they were inserted into the subaponeurotic space around the opening for the stoma, 4 cm back from the edge of the opening by fixing to the aponeurosis with two interrupted sutures of absorbable material, the ends of the catheter were brought to the anterior abdominal wall through a separate opening (contraperture) on the skin, departing 2.0 cm from the upper edges of the skin wound, in the postoperative period, 20 ml of a 1% solution of novocaine for pain relief and ceftriaxone (antibacterial drug) 1.0 g 2 times a day for the prevention and treatment of purulent inflammatory complications.

The end of the removed intestine was fixed directly around the circumference to the imposed nodal sutures between the skin, aponeurosis, parietal peritoneum.

Intestinal decompression through colostomy, debridement and abdominal drainage were performed.

Diagnosis: Cancer of the rectosigmoid colon. Acute obstructive colonic obstruction. Common serous fibrinous peritonitis.

The postoperative period was uneventful, smooth, the patient received complex pathogenetic therapy.

Pathological examination. Moderately differentiated adenocarcinoma.

The wounds of the anterior abdominal wall healed by primary intention. In satisfactory condition, 06/22/2014, the patient was discharged from the hospital under the supervision of a surgeon in the clinic at the place of residence. Surveyed September 14, 2014. Condition is good. No complaints. No specific paracolostomy complications were noted.

Thus, the application of the developed method provides the prevention of purulent-inflammatory complications.

Claims (1)

A method for the prevention and treatment of purulent-inflammatory complications of a colostomy, including the formation of an opening in the anterior abdominal wall in the direction of the planned projection of the stoma, the application of nodal sutures between the skin, aponeurosis, parietal peritoneum and colostomy fixation with these uncut ligatures, a feature is that before applying the skin-aponeurotic the abdominal nodal sutures, around the stoma opening, departing from the edge of the opening by 3-4 cm, the first catheter is installed with through holes throughout the peritoneal space of the paracolostomy zone by fixing to the parietal peritoneum with two interrupted sutures of absorbable material, the ends of the catheter are brought to the anterior abdominal wall through a separate hole — a contraperture on the skin, departing 2.0 cm from the lower edge of the skin wound, the second catheter with through holes throughout set in the subaponeurotic space around the opening for the stoma, departing from the edge of the opening by 3-4 cm, by fixing to the aponeurosis with two interrupted sutures from absorbable material, con catheter cysts are brought to the anterior abdominal wall through a separate hole - a contraperture on the skin, departing 2.0 cm from the upper edge of the skin wound; in the postoperative period, a local anesthetic for analgesia and an antibacterial drug for the prevention and treatment of purulent-inflammatory complications are introduced through catheters.

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