RU2815509C1 - Method of temporarily stopping abdominal bleeding - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: invention can be used when performing abdominal operations. Bleeding is stopped by pressing the vessel along the edges of the wound with silicone rollers with a density of 40 units according to the A. Shore scale. Then the rollers are shifted by 5–6 cm in the distal and proximal directions relative to the bleeding defect.

EFFECT: due to silicone rollers that reliably compress the vessel the method allows to stop blood flow and ensure the cessation of internal bleeding, while the elasticity of the roller allows to reduce the trauma of the vessel; improves exposure of the surgical field due to the mobility of the device.

1 cl, 2 ex

Description

The present invention relates to medicine, namely to surgery, and can be used when performing abdominal operations.

Every surgeon encounters intraoperative bleeding when performing any manipulation. Widely known methods for temporarily stopping internal bleeding, which include: finger pressure of a vessel in a wound, application of a hemostatic clamp, temporary bypass of a vessel, wound tamponade [Gostishchev V.K. General Surgery, 5th edition, 2015; 121-122]. In order to mobilize, isolate, mark, retract and tighten delicate structures such as veins, arteries, tendons, nerves, silicone vascular tourniquets of various manufacturers and properties (DEV-O-LOOPS, DEVON™ Vessel Loops) are widely used in surgery [Evaluation Criteria effectiveness of using a turnstile / S.A. Savchanchik [and others] // Military medicine. - 2015. - No. 2. - P. 131-135].

There is a known method for stopping bleeding in case of pelvic injuries (patent RU 2143235 C1, 04/14/1998) using a device that has a pointed spoke with a tail part. Bleeding is stopped by squeezing the tissue in the area of the bleeding vessels by inserting wires into the bone. The tail part of the spoke is made with a loop for hooking onto a device-like element, creating a chain. To press the parietal peritoneum along with bleeding vessels to the bone tissue, the middle part of the needle is bent at an angle of 90° at a distance of at least 15 mm from the pointed end, which is made in the form of a fish hook. The method is carried out by introducing it into the pelvic bones in the area of the hematoma through one cortical layer using an instrument and a hammer. By turning the device, they prevent its displacement and form a rigidly fixed chain around the perimeter of the hematoma, which helps stop bleeding.

Disadvantages: the ability to stop bleeding only from small-diameter vessels; trauma to surrounding soft tissues and larger-diameter vessels cannot be ruled out.

The closest analogue is known - a self-expanding sheath tampon for temporarily stopping bleeding in wound canals (invention under patent No. RU 165680 U1 published on October 27, 2016), containing an elastic tensile shell, which is fixed on one side of a polymer hollow tubular applicator with a hole on the free cut , equipped with perforation and a mushroom-shaped tip for attaching an elastic tensile shell around the applicator; a sealed threaded connector is installed on the applicator on the same side, to which is connected a balloon with a valve containing a two-component aerosol mixture to create a self-expanding self-hardening polyurethane foam, which is pumped into the wound channel and stopped bleeding.

Disadvantages: the inability to adequately assess the degree of compression of a bleeding vessel, due to the simultaneous application of self-hardening foam, without the possibility of removing the device before the substance hardens. The low elasticity of the foam can further injure the vessel being pressed. Complete filling of the surgical field with foam reduces exposure and limits the possibility of surgical action.

The objectives of the method for temporarily stopping abdominal bleeding are:

1. Ensuring a reliable temporary stop of internal bleeding of vessels of various diameters;

2. Reducing trauma to the pressed vessel;

3. Improving the exposure of the surgical field.

Technical result:

Due to the silicone roller, which reliably compresses the vessel, blood flow stops and internal bleeding is stopped, while the elasticity of the roller reduces the likelihood of vessel injury. The reliability of stopping blood flow and the mobility of techniques makes it possible to improve the exposure of the surgical field.

The method was tested on 10 patients. Using a silicone roller, in all cases it was possible to reliably compress the vessel, stopping internal bleeding. Elastic pressure on the vessel allows gentle compression of the vessel and surrounding soft tissue. By reliably stopping blood flow, the exposure of the surgical field is improved.

The method is carried out as follows: two silicone rollers are pressed to the distal and proximal parts relative to the defect of the bleeding vessel at a distance of 5.0-6.0 cm from the edges, and the effect of temporarily stopping the bleeding is achieved.

Example No. 1. Patient N, 28 years old, was admitted to the emergency surgical department with a diagnosis of duodenal ulcer. Perforation” 6 hours after the appearance of the first clinical signs of peritonitis. After laparotomy, during inspection of up to 1200 ml of intestinal contents with fibrin in the abdominal cavity, along the anterior wall of the duodenal bulb, in the corporal section, a perforated hole with a diameter of up to 0.9 cm was discovered, from which duodenal contents with an admixture of bile flow. A transverse duodenotomy was performed through the perforation. Upon inspection of a perforated ulcer, it was revealed that the ulcer on the mucosal side was an ulcerative crater up to 1.5 cm in diameter. The infiltration zone around the ulcer crater is up to 2.0 cm, the edges are dense. Intraduodenal inspection revealed on the posterolateral wall with a transition to the greater curvature, an ulcer crater up to 3.0 cm in size, up to 0.4 cm deep, with a transition to the side wall with penetration into the head of the pancreas and the hepatoduodenal ligament. The hepatoduodenal ligament is infiltrated, the infiltrate spreads along the greater curvature of the duodenal bulb, is swollen, and covered with fibrin. There are ulcers in the bottom of the pancreas penetrating the head; two thrombosed vessels with a diameter of up to 0.15 cm. Considering the large size of the ulcer, the risk of recurrent bleeding, the young age, and the stability of the patient’s condition, a decision was made to perform segmental duodenoplasty. Mobilization of the duodenal bulb according to Kocher has begun. During mobilization, the patient experienced profuse bleeding from the area of the hepatoduodenal ligament, where the ulcer penetrates. An attempt to identify the source of bleeding was complicated by the fact that the surgical field, when the pressure was removed, was instantly filled with a large amount of venous blood. An attempt to achieve hemostasis by applying a clamp and a silicone vascular tourniquet was not possible due to severe infiltration of the hepatoduodenal ligament. A decision was made: in order to identify the source of bleeding, two silicone rollers with a density on the A. Shore scale of 40 units were taken. diameter 20.0 mm, length 60.0 mm By pressing the proximal and distal parts of the hepatoduodenal ligament and displacing it in the proximal and distal directions by 5.0-6.0 cm, the bleeding was stopped. During the audit, it was revealed that the ulcer penetrates into the portal vein, which is located atypically, above the common bile duct. The portal vein was mobilized and sutured with 5/0 prolene. The pressure is removed, blood flow is restored. A segmental duodenoplasty was performed with a duodeno-duodenal anastomosis using a single-row suture using a 5/0 biosin monofilament thread.

Example No. 2. The patient was admitted to the emergency surgical department with the diagnosis: “Penetrating wound of the anterior abdominal wall, severe hemorrhagic shock.” During the inspection, a wound was found in the hepatoduodenal ligament, the inferior vena cava up to 13.0 cm long, two loops of the ileum, and the mesentery. It was not possible to carry out temporary hemostasis or apply vascular tourniquets due to hemorrhagic imbibition of the surrounding soft tissues and hematoma in the area of the inferior vena cava. By pressing the distal and proximal parts of the vein, followed by sliding (rolling) 5.0-6.0 cm from the edge of the defect, silicone rollers with a density according to the A. Shore scale of 40 units. with a diameter of 50.0 mm, a length of 120.0 mm with minimal trauma, temporary hemostasis was performed. Clear exposure of the bleeding vessel made it possible to assess the level and size of the defect and mobilize the vein with further suturing with a monofilament thread (Prolene 4/0). This method of stopping abdominal bleeding made it possible to minimize the amount of blood loss, improve the exposure of the surgical field and achieve final hemostasis with minimal time without traumatizing the vessel and surrounding tissues.

Claims (1)

A method for temporarily stopping abdominal bleeding, including pressing the vessel, characterized in that the bleeding is stopped by pressing the vessel along the edges of the wound with silicone rollers with a density of 40 units. according to the A. Shore scale, followed by a shift of the ridges by 5-6 cm in the distal and proximal directions relative to the bleeding defect.