RU2709131C1 - Method for simultaneous drainage of pneumo- and hydrothorax and device for simultaneous drainage of pneumo- and hydrothorax - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions involving a method for simultaneous drainage of pneumo-and hydrothorax and a device for its implementation refers to medicine, namely to thoracic surgery. Standard size of the device is selected by pre-measuring the thickness of the fat fold in the fifth intercostal space using ultrasound. A skin incision in the fifth intercostal space along the middle axillary line is made in a position of patient lying on a back. Soft tissues are diluted in a blunt manner. Body of the device is inserted against the stop with a fixing limiter in the patient's body surface, placing the body through channels in a plane parallel to the ribs. Two drainages in the form of flexible tubes are passed into the holes of the body until sensation of drainage resistance. One drain tube is inserted into a dome of a pleural cavity, another – in a sinus. Device housing is removed. Drainages are left in pleural cavity fixing skin imperfection to skin. Device is made with a fixing limiter in the form of a platform and two through guide channels.

EFFECT: method enables simultaneous drainage of pneumo- and hydrothorax in traumatic hemopneumotorax with anatomically correct positioning of drainages in the pleural cavity and costal-diaphragmatic sinus, as well as possibility of its application by surgeons of general therapeutic network both in hospital, and in conditions of military field surgery.

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Description

The group of inventions, including a method for simultaneously draining pneumo-and hydrothorax and a device for its implementation, relates to the field of medicine, namely to thoracic surgery, and can be used for simultaneous drainage of pneumo-and hydrothorax in traumatic hemopneumothorax, as well as in urgent surgery, military field surgery.

Currently, the first and one of the most important stages of surgical treatment for traumatic hemopneumothorax is drainage of the pleural cavity.

Usually, in practice, with pneumo- and hemothorax, it is customary to impose two pleural cavity drainages for adequate drainage of the upper and lower hemithorax floors, which requires an increase in time to perform two or more accesses for draining the pleural cavity (applying two or more thoracoports instead of one).

A known method of drainage of the pleural cavity, including thoracocentesis, the introduction of a drainage tube and fixing it in the chest wall, (see the description of the invention to the patent of the Russian Federation No. 2270039 "Method of drainage of the pleural cavity and device for its implementation", IPC A61M 25/01, A61B 17 / 34, A61B 17/02, publ. 02.20.2006).

Thoracocentesis is performed using a trocar, which pierce the chest wall and remove the stylet from the sleeve. Then, a drainage tube is introduced into the sleeve, the corrugation being introduced in a folded state. Using a tubular pusher, the drainage tube behind the corrugation is advanced into the pleural cavity. After that, the sleeve and pusher are removed. The drainage tube is tightened until the corrugation comes in contact with the bone part of the parietal pleura. The fixing plate, together with a sterile cloth, with some interference, is put on the tube and tightened until it comes into firm contact with the skin.

For drainage of pneumo-and hydrothorax with traumatic hemopneumothorax in a known manner, the need to perform two accesses to the pleural cavity, which increases the access time and leads to excessive trauma to the pectoral muscles. In addition, it should be noted the difficulty of manipulating the drainage and the difficulty of removing the drainage.

A known method of drainage of the pleural cavity, adopted as a prototype, including dissection of the skin of the chest with a scalpel, the introduction of drainage tubes into the pleural cavity and their fixation (see the description of the invention to the patent of the Russian Federation No. 2402354 "Method of fractional drainage of the pleural cavity and device for its implementation" , IPC A61M 27/00, A61B 17/00, publ. 10/27/2010).

To remove purulent contents from the pleural cavity in the absence of air in the air balloon of the two-way catheter, under the mass of metal cargo, the two-way catheter is lowered to the bottom of the pleural cavity, and then the purulent contents are removed through the hole in the drain in the two-way catheter through the first channel of the evacuation tube, then through this the first channel of the evacuation tube is injected with an antiseptic.

To remove residual air from the pleural cavity through the second channel of the evacuation tube, air is pumped into the air balloon of the two-way catheter, and the two-way catheter is raised above the level of the antiseptic in the pleural cavity. After that, the residual air of the pleural cavity is pumped out through the first channel of the evacuation tube of the two-way catheter.

This method must be performed by a qualified thoracic surgeon under conditions of constant x-ray monitoring of the movements of the catheter in the pleural cavity, which requires a certain amount of time for manipulations and excludes the use of this method by general surgeons, especially in urgent surgery, which limits the possibility of its use.

The technical task and the result of the present invention is the possibility of simultaneous drainage of pneumo - and hydrothorax with traumatic hemopneumothorax with the anatomically correct positioning of the drains in the dome of the pleural cavity and costal-diaphragmatic sinus, as well as simplification of the method.

The technical result is achieved by the fact that the method of simultaneous drainage of pneumo-and hydrothorax involves dissecting the skin of the chest with a scalpel, introducing tubes into the pleural cavity, their fixation, using the device for simultaneous drainage of pneumo-and hydrothorax according to claim 2, for which the size is selected first of this device, having previously measured the thickness of the fat fold in the fifth intercostal space using ultrasound, then in the patient’s position lying on his back, a skin incision is made in the fifth intercostal space along the middle axillary lines, soft tissues are diluted in a blunt way, the device body is inserted all the way with a fixing stop into the surface of the patient’s body, placing the body through channels in a plane parallel to the ribs, after which two drainages in the form of flexible tubes are made into the body openings until the drainage resistance is felt, one drainage is introduced into the dome of the pleural cavity, the other into the sinus, after which the device body is removed, and the drainage is left in the pleural cavity, fixing to the skin by suturing of the skin defect.

Using the device, the housing of which contains two through channels with outlet openings directed in opposite directions from each other, makes it possible to simultaneously drain the upper floor of the pleural cavity and posterior sinus, when it becomes necessary to purposefully establish drainages in a given area for more adequate functioning.

It is known that a device containing a housing and holes for installing drainage pipes (see the description of the invention for USSR copyright certificate No. 585 840 Troakar, IPC A61B 17/34, published on January 17, 1978).

The trocar contains a tube with holes in the side walls at the working end and a stylet with a handle mounted in the tube with a gap. The tube is made of elastic material with a conical working end, and the inner diameter of the tube is made with a step transition to a smaller diameter at the conical end.

The well-known trocar is intended for drainage of the bladder, leaving constant bladder drainage, during drainage of the pelvis (nephrotomy), cavernous and abscessed cavities of the lung and other organs and cannot be used while draining pneumo- and hydrothorax, which is its drawback.

The well-known trocar cannot be used to correctly position conventional (flexible) drains, through it you can insert a tool with a slight bend into the pleural cavity, which implies that it is problematic to install drainage in the pleural sinus.

A device is known, adopted as a prototype, containing a housing and a drainage tube for installation in the pleural cavity (see the description of the utility model for patent No. 40188 "Trocar for installing the drainage tube in the pleural cavity", IPC A61M 27/00, published on 09/10/2004 )

Known trocar is intended for installation in the pleural cavity of one drainage tube containing a straight working section and a curved section. The curved section is made with a hole located on the axis of the rectilinear section through which the stylet is placed in the section. The stylet is made with a handle and a stop-limiter for the entrance of its piercing-cutting part into a straight section of the tube.

The disadvantage of this trocar is the unreliably accurate positioning of the drainage in the given sections of the pleural cavity, as well as the need for two thoracoports to drain the upper and lower floors of the pleural cavity and the difficulty of manipulating the trocar.

The technical task and the result of the invention is the creation of a device that provides the possibility of anatomically correct positioning of the drainage in the dome of the pleural cavity and costal-diaphragmatic sinus while draining pneumo - and hydrothorax.

The technical result is achieved by the fact that the device for simultaneous drainage of pneumatic and hydrothorax contains a housing with holes for installing drainage pipes, the housing is made with a fixing stopper in the form of a platform, and with holes in the form of two through guide channels consisting of a straight and curved the radius of the plot, while the straight sections of the channels are parallel to each other, and the inlet openings of the straight sections for installing drainage pipes are located in the middle Asti fixing stopper along its long side, and the outlets of curved portions are directed oppositely away from each other.

The body can be made of bio-inert material in the form of a truncated pyramid with rounded ribs, with a base in the form of a rectangle, and a locking stop located at a larger base.

The housing can be made of bio-inert material in the form of a truncated pyramid with rounded ribs, with a base in the form of an elongated hexagon, and a locking stop located at the larger base.

The housing can be made of bio-inert material in the form of two hollow tubes interconnected, consisting of a section curved along the radius and a straight section connected to a fixing stop.

The locking limiter can be made in the form of a polygon with rounded corners or an oval.

Through channels can be made of one or different diameters.

The proposed device has a simple structure, allowing the drainage of the pleural cavity by surgeons of the general medical network in the conditions of urgent, military field surgery, and does not require the presence of a qualified doctor - thoracic surgeon.

The proposed method for the simultaneous drainage of pneumo-and hydrothorax and a device for the simultaneous drainage of pneumo-and hydrothorax is illustrated by drawings, where: in FIG. 1 shows a General view of the device (option 1); in FIG. 2 is a plan view of FIG. 1, "a" and "b"; in FIG. 3 is a section AA in FIG. 1; in FIG. 4 - section bB in FIG. 1, “a” and “b”; in FIG. 5 is a cross-section BB in FIG. 1; in FIG. 6 is a general view of a device with a housing in the form of a truncated prism; in FIG. 7 is a view D in FIG. 6; in FIG. 8 - the location of the device (option 1) in the fifth intercostal space "a" and "b"; in FIG. 9 is a section DD in FIG. 8; in FIG. 10 - location of the device with a housing of connected tubes in the fifth intercostal space.

The device implementing the proposed method is made in the form of a housing 1 with a locking stop 2 and guiding through channels 3 and 4.

The housing 1 can be made in the form of a truncated pyramid with rounded ribs, with a fixing stop 2 in the form of a platform (stop) located at the larger base and with the base in the form of a polygon, for example a rectangle (see Fig. 2) or an elongated hexagon.

The housing can be made in the form of two interconnected hollow tubes 5 and 6 of the same or different outer diameter. Hollow tubes 5 and 6 can be made as the same height, and different in height. Hollow tubes 5 and 6 consist of a rectilinear section connected to the fixing stop 2 and a guide section curved along the radius, for example, 18-20 mm, the outlet openings of which are directed in different directions to ensure directional passage of the drainage tubes 7 and 8.

The locking limiter 2 is designed to prevent unnecessarily deep immersion of the body 1 in the pleural cavity. The locking limiter 2 of the device is made in the form of a platform with a height (thickness) of 5.5-6 mm located at the larger base of the housing 1 (see Fig. 2, "a" and "b"). The locking stop 2 may be in the form of a polygon, for example a rectangle or an elongated hexagon with rounded corners and holes in the middle part for drainage tubes 7 and 8 or an oval.

Each through channel 3 and 4 consists of a rectilinear section and a guide radius-curved, for example, 18-20 mm section, providing directional passage of the drainage tube 7 and 8. The straight sections of the through channels 3 and 4 are located parallel to each other inside the housing 1. The inlet openings of the straight sections of the through channels 3 and 4 are located in the middle part of the locking stop 2 (along its larger axis) (see Fig. 5, “a” and “b”), and the outlet openings of the curved sections are directed in opposite directions from each other (see Figs. 2 and 3).

Guide through channels 3 and 4 can be made of the same diameter or of different diameters, for example 6.5-7.5 mm or 9.5-10.5 mm for conducting flexible drainage tubes 7 and 8 with a diameter of 7 mm or 10 mm .

Channel 3 is designed for directional drainage to the sinus (into one of the pleural sinuses), and channel 4 is intended for directional drainage to the pleural cavity (to the dome of the pleural cavity).

The device is a ruler of various sizes, the length of the part immersed in the pleural cavity (the length of the intrapleural ends) depends on the thickness (size) of the fat fold in the fifth intercostal space, determined during drainage by measuring the thickness of the subcutaneous fat according to ultrasound.

The size of the device (body height 1) is selected depending on the individual anatomical and topographic characteristics of the patient at the time of installation of the drainage device.

The device is made of a bio-inert material, for example, a medical polymer, a material that complies with the biocompatibility requirements of ISO 10993 / USP class VI.

The proposed method for the simultaneous drainage of pneumo-and hydrothorax is carried out in the following way.

To select the size of the device necessary for optimal drainage, first measure the thickness of the fat fold in the fifth intercostal space using ultrasound. Then, in the patient’s supine position, a skin incision is made in the fifth intercostal space along the mid-axillary line. After a skin incision, soft tissues are diluted with a Billroth clamp in a blunt manner, then the body 1 is inserted into the pleural cavity with a stopper 2 into the body surface 9 until it stops, having the inlet openings of the through channels 3 and 4 in a plane parallel to the ribs 10 and 11. For drainage of the pleural cavity through the through channels 3 and 4, conduct two drainages in the form of flexible tubes 7 and 8 (one through each channel) until the drainage resistance is felt, which indicates that the drainages are in the specified places (the upper one in the dome evralnoy cavity bottom in sinus). After that, the housing 1 is removed, and the tubes 7 and 8 are left in the pleural cavity, fixing to the skin by suturing the skin defect. Then the tubes 7 and 8 are connected to a device for active aspiration or passive aspiration of the contents of the pleural cavity. If there is no air discharge or exudation through drains for at least 3 days, the tubes 7 and 8 are removed according to the generally accepted method, the skin defect is sutured.

An advantage of the proposed group of inventions is the ability to perform simultaneous drainage of the pleural cavity during pneumo- and hydrothorax by surgeons of the general medical network, both in the hospital and in the field of military surgery.

Example 1

Case history No. ... Patient G., 22 g. Diagnosis: Severe combined trauma, concussion of the brain of moderate severity, fracture of 4-8 ribs on the left, traumatic hemopneumothorax on the left. Fracture of the left clavicle. Fracture of the left humerus with displacement of bone fragments. Two days before admission, he suffered in a traffic accident, entered the surgical department of the Central District Hospital. Immobilization was performed, intercostal novocaine blockade was performed, thoracocentesis was performed, and in the 2 intercostal space on the left, along the midclavicular line, a drainage from the tube from a single-use intravenous infusion system was installed. The patient's condition did not improve, as a result of which, on the second day, he was transferred to a level 2 trauma center. Upon receipt, the condition is serious. The drain pipe is not functioning. The distal opening of the tube is under the skin. After an X-ray examination, uncured hydropneumothorax was detected. Non-functioning drainage in the 2nd intercostal space is removed. After local anesthesia in the patient’s position on the back, a skin incision was made on the left in the fifth intercostal space along the middle axillary line, soft tissues were bluntly diluted, a device was introduced into the pleural cavity for simultaneous drainage of pneumo-and hydrothorax, through which two drains were inserted. The device is removed, the drains are fixed to the skin, an active aspiration system is established. The total operation time was 8 minutes. Stand out up to 700 ml of hemorrhagic exudate, up to 1500 ml of gas. With control x-ray, the lung is straightened. On the 4th day, exudation practically stopped from the pleural cavity, drainage tubes were removed.

Example 2

Case history No. ... Patient L., 44 years old. Diagnosis: fracture of the 7th and 8th ribs on the right, traumatic hemopneumothorax on the right. She received an injury 4 days before admission as a result of a fall from her own height, she did not contact the doctors. The condition gradually worsened, caused KSP, delivered to the State Budgetary Healthcare Institution “State Clinical Hospital”, where an X-ray examination revealed a fracture of the 7th and 8th ribs on the right with a horizontal fluid level at the level of the sixth rib. Upon admission, a moderate condition, soft tissue hematoma along the rear axillary line at the level of the 6th and 9th ribs on the right. After local anesthesia in the patient’s position on the back, a skin incision was made on the right in the fifth intercostal space along the middle axillary line, soft tissues were stupidly diluted, with the help of Billroth clamp, a device was introduced into the left pleural cavity for simultaneous drainage of pneumo-and hydrothorax, through which two drains were inserted. The device is removed, the drains are fixed to the skin, an active aspiration system is established. The total operation time was 9 minutes. Stand out up to 1300 ml of hemorrhagic exudate, up to 1200 ml of gas. With control x-ray, the lung is straightened. On the 6th day, exudation practically stopped from the pleural cavity, drainage tubes were removed.

Claims (9)

1. A method for simultaneous drainage of pneumo-and hydrothorax, including dissection of the chest skin with a scalpel and insertion of tubes into the pleural cavity and their fixation, characterized in that they use the device for simultaneous drainage of pneumo-and hydrothorax according to claim 2, for which the size of this is first chosen devices, having previously measured the thickness of the fat fold in the fifth intercostal space using ultrasound, then in the position of the patient lying on his back, perform a skin incision in the fifth intercostal space along the mid axillary line, soft tissue times dressed in a blunt way, insert the device body all the way into the patient’s body surface with a locking stop, positioning the body through channels in a plane parallel to the ribs, after which two drainages in the form of flexible tubes are made into the body openings until the drainage resistance is felt, one drain is introduced into the dome of the pleural cavity and the other into the sinus, after which the device body is removed, and the drainage is left in the pleural cavity, fixing to the skin by suturing of the skin defect. 2. Device for the simultaneous drainage of pneumatic and hydrothorax, comprising a housing with holes for installing drainage pipes, characterized in that the housing is made with a locking stop in the form of a platform and two through guide channels consisting of a straight and radius-curved portion, while being straight sections of the channels are parallel to each other, the inlet openings of straight sections for installing drainage pipes are located in the middle of the fixing limiter along a long e on the side, and the outlet openings of the curved sections are directed to opposite sides of each other. 3. The device according to p. 2, characterized in that the housing is made of bioinert material in the form of a truncated pyramid with rounded ribs, with a base in the form of a rectangle and a locking stop located at a larger base. 4. The device according to p. 2, characterized in that the housing is made of bioinert material in the form of a truncated pyramid with rounded ribs, with a base in the form of an elongated hexagon and a locking stop located at a larger base. 5. The device according to p. 2, characterized in that the casing is made of bioinert material in the form of two hollow tubes rigidly interconnected, consisting of a section curved along the radius and a straight section connected to a fixing limiter. 6. The device according to p. 2, characterized in that the locking limiter is made in the form of a polygon with rounded corners. 7. The device according to p. 2, characterized in that the locking limiter is made in the form of an oval. 8. The device according to p. 2, characterized in that the through channels are made of the same diameter. 9. The device according to p. 2, characterized in that the through channels are made of different diameters.

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