RU2764499C1 - Method for treatment of epithelial coccygeal passage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely surgery and coloproctology, and can be used in the treatment of epithelial coccygeal passage. After radical excision of the epithelial coccygeal passage and its branches, hemostasis control, the surgical wound is closed by applying sparce nodular sutures every 1.5-2 cm. In this case, a needle with a thread is injected 3-4 mm from the edge of the wound on the one hand, capturing only the skin, then carried along the bottom of the wound through the sacrococcygeal ligament and pierced out 3-4 mm from the edge of the wound on the other side, also capturing only the skin. A knot is formed, bringing the edges of the skin together and with the bottom of the wound. A vacuum bandage is formed: foam rubber with a drainage tube in the thickness is applied to the wound on top of the matched skin edges, which is fixed to the wound with the remaining edges of the thread, sealed with an incisive film and a negative pressure of 115-120 mm Hg is created. The vacuum bandage is removed after 3-5 days, leaving skin sutures, further wound treatment is continued with bandages with an aqueous antiseptic solution.

EFFECT: invention provides ease of use of the method, eliminating a long stay of the patient in the hospital, minimizes the risks of suppuration in the postoperative period, provides adequate sanitation and drainage of all purulent congestion through the use of sparse nodular sutures with only skin grabbing, as well as applying a vacuum bandage.

1 cl, 2 ex

Description

The present invention relates to medicine, namely to surgery, in particular to coloproctology, and can be used in the treatment of epithelial coccygeal passage.

Epithelial coccygeal duct (ECC) in the general population is detected from 16 to 26 cases per 100,000 adults, accounts for 1-2% of all surgical diseases and ranks fourth in the frequency of occurrence of coloproctological diseases after hemorrhoids, paraproctitis and anal fissure. (20. Dultsev, Yu.V. Epithelial coccygeal passage / Yu.V. Dultsev, V.L. Rivkin. - M: Medicine, 1988.) ECC is diagnosed mainly in young people with a predominance of males over females in a ratio of 3: 1, and the clinical manifestations of the disease occur in the most able-bodied age from 15 to 30 years. Patients with ECC account for at least 10-12% at outpatient appointments with a proctologist. (29. Kandelis, B.L. Urgent proctology: a guide for physicians / B.L. Kandelis. - L.: Medicine, 1980.) Thus, the treatment of ECC is an important socio-economic problem

A known method for the treatment of epithelial coccygeal passage (Patent RU 2 685 760 C1 published 04/23/2019). The method is performed as follows: after 3-fold treatment of the surgical field with an antiseptic solution under intravenous anesthesia and staining of the fistula with a dye solution, the cyst and all stained and scar tissues are excised with two bordering incisions up to the sacral fascia. An active Redon drainage is installed in the postoperative wound for the purpose of vacuum aspiration of the wound contents. The postoperative wound is sutured with a 4.0 capron thread with separate Donatti sutures to the border of the middle and lower thirds of the wound. Separate interrupted sutures are applied to the skin of the lower third of the wound with a nylon 4.0 thread.

At a distance of 0.5 cm from the edges of the lower third of the postoperative wound along the gluteus maximus muscle, after stretching the skin of the intergluteal fold, two tapes 5 cm wide KTKinexib Kinesio-tape of the elastic type are glued next to each other on each side. The KTKinexib Kinesio Tape closest to the wound is glued without stretching, then the KTKinexib Kinesio Tape is stretched by 75% to the fixation point, which is the greater trochanter of the femur, the last 2 cm KTKinexib Kinesio Tape closest to the fixation point is also not stretched.

For better fixation, the corners of the KTKinexib Kinesio Tape are rounded off. Kinesio-tape KTKinexib is installed for 7 days, then the change is carried out according to the above method. The total period of use of KTKinexib Kinesio Tape is 14 days. Flaws:

1) The need for a long stay of the patient in the hospital

2) The need to use KTKinexib Kinesio Tape, discomfort for the patient.

3) Anatomy of the method (decrease in the depth of the intergluteal fold)

4) Strong tissue tension, which subsequently leads to the failure of the sutures and the formation of a large cavity, which is the cause of prolonged healing and, as a result, an increase in the period of disability.

Patent RU 2 559 936 C1 on August 20, 2015 was accepted as the closest analogue. "A method for the treatment of epithelial coccygeal passage". The method consists in excising the ECH, applying a replaceable drainage bandage, for which a sponge bandage is placed in the wound, a wound drainage is installed, a bandage with an antiseptic is applied, after which a film coating is glued. Connect the drain tube to a negative pressure controlled therapy machine and perform 24/7 vacuum therapy in alternating mode. Round-the-clock vacuum therapy begins to be performed 24 hours after the operation of excision of the ECC according to the scheme: during the first 8 days with an initial negative pressure of 50 mm Hg. with an interval of 2 minutes and a final negative pressure of 125 mm Hg. with an interval of 5 minutes. Over the next 12 days, round-the-clock vacuum therapy is performed according to the scheme: with an initial negative pressure of 75 mm Hg. with an interval of 7 minutes and a final negative pressure of 125 mm Hg. with an interval of 2 minutes. The change of the drainage bandage and bandage with antiseptic is performed every 4 days after the start of vacuum therapy.

Flaws:

1) The need for a long stay of the patient in the hospital, long-term disability of the patient

2) In the proposed method, wound healing occurs according to the type of secondary tension, which takes a long time and a voluminous scar is formed.

3) Multiple painful dressings with the replacement of a vacuum dressing from an open wound.

Tasks:

1) Ensure the ease of use of the method, eliminating the long stay of the patient in the hospital

2) Minimize the risk of ischemia and necrosis of the skin edges of the wound, the possibility of using dermatension if necessary

3) Minimize the risks of suppuration in the postoperative period, ensure adequate sanitation and drainage of all purulent streaks

The technical result is achieved due to the fact that after radical excision of the epithelial coccygeal passage and its branches, careful control of hemostasis, the surgical wound is closed by applying rare interrupted sutures every 1.5-2 cm, which contributes to the free discharge of exudate, while the needle with the thread is injected into 3 -4 mm from the edge of the wound on one side, capturing only the skin, then it is carried out along the bottom of the wound through the sacrococcygeal ligament and punctured 3-4 mm from the wound edge on the other side, also capturing only the skin, which minimizes the risks of suppuration and ischemia fatty tissue, then a knot is formed, bringing the skin edges together and with the bottom of the wound, while avoiding excessive tightening of the knot, then foam rubber with a drainage tube in the thickness is applied to the wound over the matched skin edges, which is fixed to the wound with the remaining edges of the thread, sealed incised film and create a negative pressure of 115-120 mm Hg, thereby forming a skin vacuum bandage, contributing to the stabilization of the edges of the wound, the exclusion of the formation of cavities and pockets, as well as the acceleration of the exudative phase, the removal of the vacuum dressing is carried out after 3-5 days, leaving only skin sutures, further wound treatment is continued with dressings with an aqueous antiseptic solution. The simplicity and speed of the method allows it to be used in hospitals of all levels, and in the presence of compact devices for vacuum therapy, to provide the patient with activity and great rehabilitation potential. All the known therapeutic effects of vacuum therapy on the wound also appear.

The essence of the method lies in the fact that after radical excision of the epithelial coccygeal passage and its branches, careful control of hemostasis, the surgical wound is closed by applying rare interrupted sutures every 1.5-2 cm, while the needle with thread is injected 3-4 mm from the edge of the wound with on the one hand, capturing only the skin, then they are carried out along the bottom of the wound through the sacrococcygeal ligament and are punctured 3-4 mm from the edge of the wound; on the other hand, also capturing only the skin, they form a knot, bringing the skin edges together and with the bottom of the wound , while avoiding excessive tightening of the knot, further foam rubber with a drainage tube in the thickness is applied to the wound over the aligned skin edges, which is fixed to the wound with the remaining edges of the thread, sealed with an incise film and a negative pressure of 115-120 mm Hg is created, thereby thus forming a skin vacuum bandage, the vacuum bandage is removed after 3-5 days, leaving only skin sutures, further wound treatment is continued with dressings with an aqueous antiseptic solution. In case of profuse exudation from the wound, it is possible to re-apply the cutaneous vacuum bandage.

The method of surgical treatment of the epithelial coccygeal passage was tested on 23 patients who were treated in the department of purulent surgery of the district hospital and showed good results. In all patients, using this method of treatment, it was possible to quickly stop the inflammation, achieve a good cosmetic result, and also reduce the time spent in the hospital by 28%

The method of treatment is performed as follows: a radical excision of the epithelial coccygeal passage and its branches is performed according to the standard method (Dultsev Yu.V., Rivkin V.L. Epithelial coccygeal passage. - M: Medicine, 1988, S. 92-94), careful control hemostasis, then close the surgical wound by applying rare interrupted sutures every 1.5-2 cm, which contributes to the free discharge of exudate, while the needle and thread are injected 3-4 mm from the edge of the wound on one side, capturing only the skin, then carried out along the bottom of the wound through the sacrococcygeal ligament and are punctured 3-4 mm from the edge of the wound on the other side, also capturing only the skin, which minimizes the risks of suppuration and ischemia of fatty tissue, then form a knot, bringing the skin edges together and with the bottom of the wound, with At the same time, avoiding excessive tightening of the knot, further, foam rubber with a drainage tube in the thickness is applied to the wound over the aligned skin edges, which is fixed to the wound with the remaining edges of the thread, and the inci heat film and create a negative pressure of 115-120 mm Hg, thereby forming a cutaneous vacuum bandage that helps stabilize the edges of the wound, eliminate the formation of cavities and pockets, as well as accelerate the exudative phase, the vacuum bandage is removed after 3-5 days, leaving only skin sutures, further wound treatment is continued with dressings with an aqueous antiseptic solution. In case of profuse exudation from the wound, it is possible to re-apply a cutaneous vacuum bandage. The absence of daily painful dressings increases the patient's rehabilitation potential in the early stages. In addition, with the help of directed negative pressure, adaptation and retention of the skin edges of the wound in a matched position is carried out until they stabilize, which minimizes the risks of wound divergence, as well as the use of a skin vacuum helps to prevent the formation of cavities and pockets in the wound and promotes exudate discharge.

Example 1. Patient Z, 26 years old.

10/07/2020 He was admitted to the surgical department of the district hospital for the planned treatment of the epithelial coccygeal tract.

On admission to the hospital, the patient's condition was satisfactory. NPV=16 per min. Pulse 70 bpm in 1 minute. BP=120/80 mm Hg Body temperature 36.6 C. The tongue is wet. The abdomen is painless on palpation in all departments. C-we have negative peritoneal irritations.

In the intergluteal fold, there is a pinpoint fistulous opening with a scanty turbid discharge. Surrounding tissues are not inflamed.

On 10/08/2020, a surgical intervention was performed as planned: Radical excision of the coccygeal passage according to the standard technique (Dultsev Yu.V., Rivkin V.L. Epithelial coccygeal passage. - M .: Medicine, 1988, pp. 92-94), careful control hemostasis, then the surgical wound was sutured by applying rare interrupted sutures every 1.5-2 cm (3 sutures were applied in this patient), while the needle with thread was injected 3-4 mm from the edge of the wound on one side, capturing only the skin, then along the bottom of the wound through the sacrococcygeal ligament and punctured 3-4 mm from the edge of the wound on the other side, also capturing only the skin, then a knot was formed, bringing the skin edges together and with the bottom of the wound, while avoiding excessive tightening, in further, foam rubber with a drainage tube in the thickness was applied to the wound over the aligned skin edges, which was fixed to the wound with the remaining edges of the threads, sealed with an incise film and created a negative pressure of 115-120 mm Hg, thereby forming a skin vacuum bandage.

On 10/13/2020, the skin vacuum dressing was removed, a clear comparison of the wound edges, the absence of inflammation and exudation, as well as the absence of edge ischemia were noted. On October 15, 2020, the patient was discharged for the outpatient stage of treatment.

Example 2. Patient B, 34 years old

On December 19, 2020, he was admitted to the surgical department of the district hospital for the planned treatment of the epithelial coccygeal tract.

On admission to the hospital, the patient's condition was satisfactory. NPV=16 per min. Pulse 70 bpm in 1 minute. BP=120/80 mm Hg Body temperature 36.6 C. The tongue is wet. The abdomen is painless on palpation in all departments. C-we have negative peritoneal irritations.

In the intergluteal fold there is a fistulous opening with a purulent discharge, 0.7 cm in diameter. Moderate parafistulous infiltration of soft tissues.

20.12.20 in a planned manner performed surgery as described in example 1 method.

On December 25, 2020, the vacuum skin dressing was removed, a clear comparison of the wound edges, the absence of inflammation and exudation, and the absence of edge ischemia were noted. On December 27, 2020, the patient was discharged for the outpatient stage of treatment.

Claims (1)

A method for treating the epithelial coccygeal tract, which consists in the fact that after radical excision of the epithelial coccygeal tract and its branches, hemostasis control, the surgical wound is closed by applying rare interrupted sutures every 1.5-2 cm, while the needle with the thread is injected 3-4 mm from the edges of the wound on the one hand, capturing only the skin, then pass along the bottom of the wound through the sacrococcygeal ligament and are punctured 3-4 mm from the edge of the wound on the other side, also capturing only the skin, form a knot, bringing the edges of the skin together and with the bottom of the wound; then a vacuum bandage is formed: foam rubber with a drainage tube in the thickness is applied to the wound over the matched skin edges, which is fixed to the wound with the remaining edges of the thread, sealed with an incise film and a negative pressure of 115-120 mm Hg is created. Art., removal of the vacuum bandage is performed after 3-5 days, leaving skin sutures, further wound treatment is continued with dressings with an aqueous antiseptic solution.