SU1097292A1 - Method of treatment of spleen ruptures - Google Patents

Abstract

A METHOD FOR TREATING A SPLEEN'S BREAKDOWN using a large omentum, characterized in that, in order to preserve the organ by preventing the eruption of sutures and bleeding into the wound cavity, the pre-omentum is divided into three strands, then the outermost lines are laid parallel to the edges of the rupture the spleen, then through the folded strands and the edges of the rupture, individual sutures are placed, and the middle strand is inserted into the wound of the spleen, and after the itch sutures are tied.

Description

The invention relates to medicine, namely to surgery, and can be used for injuries of the spleen.

A known method for the treatment of splenic ruptures consists in the application of individual silk sutures on the wound edges of the injured organ and their subsequent fixing. 1.

The disadvantage of this method is the eruption of the grooves superimposed on the edges of the wound, and bleeding into the wound cavity of the spleen.

There is also known a method for the treatment of spleen ruptures, including the use of a large omentum. After the individual tears of silk or catgut sutures are applied to the edges of the rupture, they are tied, then the spleen is wrapped with a large omentum, followed by its cross-stitching 2.

However, when wounds of silk or catgut sutures are applied to the wounds due to the fragility of the spleen tissue, their eruption is possible. As a result of the eruption of the grooves, bleeding from the spleen tissue may continue into the wound cavity and lead to intraperitoneal bleeding.

The purpose of the invention is to ensure organ preservation by preventing the eruption of sutures and bleeding into the wound cavity.

This goal is achieved in that, according to the method for treating splenic ruptures using a large omentum, the pre-omentum is divided into three strands, then the outer strands are laid parallel along the edges of the spleen's rupture, then separate seams are laid through the folded strands and rupture edges. , and the middle strand is inserted into the wound of the spleen, after which the sutures are tied.

The division of the greater omentum into three strands allows, regardless of the location (with the exception of the organ gate) and the size of the rupture of the spleen, an organ-preserving operation.

The choice of the size of the strands depends on the size of the rupture of the spleen and its localization.

Laying the two extreme strands parallel to the edges of the rupture of the spleen and stitching through them reduces the stress on the tissue of the organ when the seams are tied and prevents the spleen from erupting, since the straps serve as a gasket on which the main load extends and therefore fulfills the supporting for seams function.

The insertion of the middle spinal cord into the spleen's wound, followed by its fixation with superimposed schmites, creates compression of the spleen's tissue and

prevents bleeding into the wound cavity, i.e., performs the role of a biological hemostatic tampon, which is reinforced by sutured seams. 5 FIG. 1 shows a spleen with a damaged lower pole and a greater omentum divided into three strands; in fig. 2 — the outermost strands are laid along the edges of the rupture, and through them and the rupture edge individual seams are laid, the middle strand is laid down; in fig. 3 - the middle part of the spleen is laid in the wound of the spleen.

In the drawings, the following symbols are used; 1 - spleen, 2 - its gap; 3 - a large gland; 4 - extreme strand; packing gland; 5 - middle ping gland.

The method is carried out as follows.

After treatment, the operative floor in a known manner opens the abdominal cavity and inspects a damaged village. Then a large omentum is removed from the abdominal cavity and, using scissors, known techniques, are divided into three strands.

The two outermost strands are laid parallel to the edges of the tear of the fabric so that they correspond to its length. Thereafter, individual seams are inserted through the laid glands and the edges of the rupture, which do not tangle. The middle strand is placed in the spleen wound and after

In this case, the previously applied stitches tie. After drying the abdominal cavity, the abdominal wall is sutured.

Example. Patient B, 24 years old, was taken to the clinic by ambulance on January 21, 1982 at 22 o'clock with complaints of pain in the left child, radiating to the left supraclavicular region.

From the anamnesis, it is clear that three hours before admission she received a blunt trauma (hit the left half of the chest on the protruding part of the porch).

Upon admission, the condition of the patient is closer to satisfactory, the consciousness is clear, the position is active, but a change of position caused an increase in abdominal pain, weakness appeared. On palpation, it is an edetment of et5 with soreness in the left hypochondrium, with deep palpation in this zone in the position on the left side, pain radiating to the left half of the chest. Symptoms of peritoneal irritation are dubious, peristalsis is bugged. Liver is not

0 enlarged, the renal areas are not changed, there is no dysuric disorders. Pulse - 100 beats per 1 minute, satisfactory qualities, blood pressure 110/70 mm Hg. Art.

To clarify the diagnosis, an abdominal ultrasonography was performed, during which the presence of free fluid in the left half of the abdominal cavity was detected.

Under local anesthesia, laparacentesis was performed - blood was obtained from the abdominal cavity.

The patient is diagnosed - closed blunt abdominal trauma, spleen rupture. The patient was taken to the operating room. After 1.5 hours from the time of admission, the patient was operated on. Under endotracheal anesthesia, upper median laparotomy is performed. In the abdominal cavity a significant amount of liquid blood and clots. A revision of the left hypochondrium revealed a splenic rupture: the wound is up to 5 cm long and 2 cm deep, spreads along the inner surface to the gates of the spleen, the wound edges are uneven, bleeding continues. It was decided to close the spleen wound. An epiploon is attached to the spleen, divided into three strands 10 cm long. The two extreme strands are laid parallel to the margin of the wound. Four separate interrupted sutures are laid in such a way that the shot and pierce pass through the extreme strands and edges of the spleen wound. Medium is laid in the spleen wound. After tightening the sutures, the median strand was firmly fixed in the wound. Bleeding stopped. Abdominal cavity drained. Drainage is put in the left subphrenic space, it is brought out through a separate section. The abdominal cavity is sewn tightly. Sticker.

The postoperative period was uneventful, without complications, sutures were removed for 9 days, healing by primary tension. Discharged in good condition for 11 days. Examined after 1.5 months. The condition is good, no complaints. The function of the spleen is preserved.

Thus, the application of the proposed method makes it possible to reliably sew up the rupture of the spleen, prevent the eruption of sutures and bleeding from the wound, and preserve the organ. The known methods did not guarantee reliable suturing of traumatic injuries of the spleen, since the eruption of the sutures and the recurrence of bleeding were not excluded.

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Claims (1)

A METHOD of TREATING SPLEEN RIPPES using a large omentum, characterized in that, in order to ensure the preservation of the organ by preventing suturing and bleeding in the wound cavity, the large omentum is first divided into three strands, then the extreme strands are laid parallel to the edges of the spleen rupture, then through the laid strands and the edges of the gap separate the sutures, and the middle strand is inserted into the wound of the spleen, after which the sutures are tied.