RU47647U1 - DEVICE FOR TEMPORARY ENDOSCOPIC OBTURATION OF STOMACH PERFORATION AND ITS ACTIVE DRAINAGE - Google Patents

Abstract

The invention relates to medicine, surgery, can be used in the treatment of perforations of the stomach with ulcerative, tumor, traumatic and other etiology. In the absence of conditions for surgical treatment, adequate preoperative preparation is required in combination with a reliable cessation of toxic contents from the stomach from entering the abdominal cavity. For the first time, a device has been proposed for temporary endoscopic correction of gastric perforation, containing a thin inner rubber tube at the distal end hermetically connected to a balloon for obstructing the perforated hole, which is located in the lumen of the outer rubber tube having several lateral holes on its distal end for active aspiration of gastric contents. The proposed device for temporary endoscopic obstruction of the perforation of the stomach in combination with active drainage of the stomach is simple in technical design, it does not require expensive video laparoscopic equipment, it provides reliable sealing of the obstructed opening, and it allows creating conditions for sanitation of the stomach and adequate surgical intervention. The above advantages allow you to use this new endoscopic method as an important step in the treatment of perforations of the stomach.

Description

The utility model relates to medicine, surgery, and can be used in the treatment of gastric perforations of ulcerative, tumor, traumatic, and other etiologies.

In some cases of gastric perforations, surgical intervention is impossible due to the severity of the patient’s condition, concomitant pathology, lack of technical ability to intervene, patient refusal from surgery, etc. In the absence of conditions for surgical treatment, adequate preoperative preparation is required in combination with a reliable cessation of toxic contents from the stomach from entering the abdominal cavity.

Known endoscopic devices for suturing the defect (A. S. Balalykin et al. Actual issues of laser medicine and operative endoscopy. - M., 1994. - S. 136-137). Conservative methods for treating gastric perforations include nasogastric aspiration using a rubber tube with lateral openings at the distal end. The technique was proposed in 1945 by Taylor (Surgery. A guide for doctors under the editorship of Yu.M. Lopukhin and V. S. Savelyev. - M ..: GEOTAR. Medicine, 1998. - p. 344). However, this method does not provide

reliable cover of the perforated hole, which leads to high mortality.

In abdominal surgery with the aim of adequate nasogastrointestinal drainage, 2 and 3-channel tubes are widely used to carry out active aspiration according to the Abbott-Muller technique (Surgery. Manual for doctors, edited by Yu.M. Lopukhin and V.S. Savelyev. - M .: GEOTAR. Medicine, 1998 .-- p.277). However, these options for intubation are not used for aspiration drainage from the stomach during perforation of its wall.

We first proposed a device for temporary endoscopic correction of perforation of the stomach, containing a thin inner rubber tube at the distal end hermetically connected to the balloon for obstructing the perforated hole, which is located in the lumen of the outer rubber tube having several side holes at its distal end for active aspiration of gastric contents .

The essence of our device lies in the fact that it is a thin inner tube of elastic rubber 60 cm long and 0.3-0.4 cm in diameter, the distal end of which is hermetically connected to a balloon made of thin silicone rubber for medical purposes, intended for obturation of a perforated openings of the stomach. The specified tube is enclosed in the lumen of the outer tube of elastic rubber with a length of 60 cm and a diameter of 0.5-0.6 cm, having on its distal

parts of several (2-3) lateral openings designed for active aspiration from the stomach. At the oral end of the outer tube, designed to be connected to active aspiration, there is a side opening with a diameter of 0.3 cm, through which the lumen of the oral end of the inner tube is hermetically outwardly designed to inflate the balloon.

The proposed device is shown in figure 1, where: 1 - the inner tube; 2 - balloon in a swollen state; 3 - oral end of the inner tube; 4 - an external tube; 5 - side holes; 6 - oral end of the outer tube; 7 - a stomach; 8 - perforated hole; 9 - free abdominal cavity.

The device is used as follows: sequentially conduct fibrogastroduodenoscopy with an assessment of localization, size of the perforated aperture of the stomach and the etiological cause of the disease. Next, tube 1 (inner) is inserted into the stomach 7 and, under the control of a fibrogastroscope, a balloon 2 located at its distal end is passed through a perforated hole 8 into the free abdominal cavity 9. Then, as through a conductor, the outer tube 4 is passed into the stomach, the distal end which, having several side holes 5, reaches the distal part of the inner tube. After that, the oral end of the inner tube 3 is hermetically removed through a side hole at the oral end of the outer tube 6. 50-70 ml of physiological saline is injected through the oral end of the inner tube

or sterile distilled water, the balloon is dosed inflated and the tube is pulled until it is in full contact with the stomach wall. The selected volume is fixed by clamping the lumen of the tube at its oral end. Active aspiration from the stomach cavity is carried out through the oral end of the outer tube. The fibrogastroduodenoscope is removed. Exposure to obturation can be 24 hours. After emptying the balloon, the inner tube is removed during mandatory surgery that corrects the perforation of the stomach, and the outer tube is left for 2-3 days to conduct active aspiration.

We carried out a clinical and experimental justification of the action of the proposed device on the esophagus-gastric complexes (unfixed cadaveric material). At the same time, techniques were developed for open and endoscopic obstruction of the perforated hole. The length and diameter of the inner tube with the cylinder, as well as the diameter, number and location of the side holes on the outer tube are determined. It was found that the length from the teeth to the pylorus is 45-50 cm, the appropriate diameter of the inner tube is 0.3-0.4 cm, and the outer tube is 0.6-0.8 cm, 2-3 lateral ones are enough for aspiration on the side surface holes. It was determined that the volume of liquid for inflating the balloon is 50-70 ml, and the negative pressure during aspiration from the outer tube is 40-50 mm Hg, and active aspiration should be carried out for 15 minutes with the same pause. The degree of tightness and its adequacy were assessed by control filling of the stomach.

Acceptable dates for postoperative aspiration are established taking into account the effectiveness of debridement and decompression of the stomach (2-3 days). The data obtained during the experiment allowed us to introduce this method into clinical practice.

Thus, the proposed device for temporary endoscopic obstruction of the perforation of the stomach in combination with active drainage of the stomach is simple in technical design, it does not require expensive video laparoscopic equipment, it provides reliable sealing of the obstructed opening, and it allows creating conditions for sanitation of the stomach and adequate surgical intervention. The above advantages allow the use of this device for endoscopic obstruction and active drainage in the treatment of perforations of the stomach.

Claims (1)

A device for temporary endoscopic obstruction of the perforation of the stomach and its active drainage, comprising an external elastic tube with through lateral holes at the distal end, characterized in that it is additionally equipped with an elastic inner tube of a smaller diameter, the distal end of which is hermetically connected to a balloon made of thin siliconized rubber and located inside the outer tube, the oral end of the inner tube being hermetically removed through the side opening of the outer tube.