SU1146005A1 - Method of treatment of epithelial coccygeal passage - Google Patents

Abstract

A method for treating an epithelial cannula by cutting it out and applying vertical-nodular nodular silk sutures, characterized in that, in order to shorten the time of treatment of patients and prevent recurrence of the disease, during the excision of the coccygeal tract, trapezoidal section of the tissue and traumatic swelling of the tissue and prevent recurrence of the disease, during the excision of the coccygeal tract, trapezoidal section of the tissue and traumatic swelling of the disease and prevention of recurrence of the disease, during the excision of the coccygeal tract, trapezoidal section of the tissue and traumatic swelling of the diseased and the smaller one behind the external opening of the coccygeal stroke, the parallel lines of the discharge continue at the corners of the trapezoid by 3-6 mm, then the bottom of the wound and parallel cuts are sutured with catgut nodes and seams, and through them vertically superposed mattress sutures.

Description

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The invention relates to medicine, in particular to proctology, and can be used in the surgical treatment of the epithelial coccygeal duct.

There is a method of treating an epithelial coccygeal duct by cutting it out and secondary fistulous passages, hemming the wound edges to the bottom and inserting a tampon with an antiseptic 1 into the wound.

The disadvantage of this method is the large number of postoperative complications. Thus, according to the department of proctology, out of 919 operated patients, 53 patients (5.7 / o) experienced postoperative complications such as subcutaneous infiltrates, necrosis of the wound edges, partial seam divergence, etc. In addition, long-term follow-up revealed gross postoperative scars, complaints of painful sensations in the sacral-coccygeal region.

There is also known a method for treating the epithelial coccygeal passage, according to which the coccygeal passage is excised by cutting in the form of an oval to the level of the periosteum of the coccyx; The seams are alternately tied with a high tension by a triple knot to bring the wound walls closer to the plane: then the wound is closed with gauze dressing with an antiseptic | 2.

The disadvantages of the known method of treatment of the epithelial coccygeal duct are also a significant number of postoperative complications caused by uneconomic excision of tissues when performing an oval incision, which also leads to uneven tension of the sutures and rigid attachment to the periosteum of the vertical mattress silk sutures. As a result, up to 50% of cases of the known method are accompanied by divergence of the wound edges, hematoma suppuration, recurrences and diseases.

The duration of hospital stay and the number of days of incapacity for work are increasing.

The purpose of the invention is to reduce the duration of treatment of patients and prevent the recurrence of the disease.

The goal is achieved by the method of treating an epithelial coccygeal duct by cutting it out and superimposing vertically mattress knotted silk sutures, while excising the coccygeal duct, produces a trapezoid incision of the tissues, with a larger base in front, and a smaller one behind the outer aperture of the tail bone parallel the incision is continued at the corners of the trapezoid by 3-6 mm, then the bottom of the wound and parallel incisions are sutured with catgut interrupted sutures, and through them vertically mattress seams are placed.

The method is carried out as follows.

The patient is placed on the abdomen with a raised pelvis and lowered, elongated legs. Local anesthesia is carried out along the lines of the future incision, covering the coccygeal passage and the adjacent fistulous openings, and the methylene blue solution is previously introduced into the outer opening of the coccygeal passage. The coccygeal passage is excised, the wire with a scalpel is two transverse parallel cuts with a width of 4–7 cm in front and 2–5 cm at the back (depending on the area of tissue damage) and two divergent, straight linear longitudinal cuts that form a trapezoid with cut lines extending beyond trapezoid angles of 3-6 mm. This interval is optimal: at less than 3 mm approach values; cutting through the trapezoid angle makes it difficult to ensure a tight fit of the wound edges and uniform tension of the sutures; with a larger than 6 mm incision approach per trapezoid angle, unnecessary unnecessary tissue trauma takes place. Gradually, the skin is removed from top to bottom along with elements of the coccygeal stroke, without damaging the tailbone periosteum. Bleeding from the wound is stopped during the excision of the skin graft with a swab with hydrogen peroxide or electrocoagulation of the vessels. The catgut sutures are placed on the bottom of the wound and on the extension of the incisions along the trapezoid corners. Then on the edges of the wound they impose a vertical mattress knotTiOBbie silk grooves, passing them through

catgut sutures placed on the bottom of the wound. Silk sutures are tightened with a double knot until the edges of the wound approach. On the wound impose a pad, - moistened with a solution of chlorhexidine in 70% alcohol. Patient after surgery prescribed bed rest for 1-2 days. On the 8th-9th day, silk sutures are removed, on the 10-11th day after the operation, the patient is discharged home.

Example. Patient K. for 27 years enrolled

The Leningrad Proctological Center on 09/21/81 with complaints of pain in the coccygeal region, frequent inflammatory processes (abscesses in the inter-annual fold were revealed three times), the presence of purulent fistula in

the region of the mascot. Sick for about two years, the disease is associated with an injury while skiing. When examining the coccygeal region at 8 cm from the anus, up the inter-annual fold, two funnel-shaped retractions are noted, located

one 0.5 cm higher than the other. There was a fistula with purulent discharge above a 4 cm wide wedge. A fistula was surrounded by a small infiltration of 1.5x2.0 cm2, which pus was released upon pressure. Diagnosed: epithelial coccygeal passage (fistular form). The operation was performed on 09.23.81. A trapezoidal incision was made under local anesthesia: 8 cm lateral sides, parallel incisions — 5 cm in front of the coccygeal passage (closer to the patient’s head) and 1 cm behind the coccyxular passage; the trapezoid is 0.6 cm, and the incision in the back is 0.3 cm. The patient is located along the Duppez (on the stomach with divorced legs). Funnels, fistula and infiltrate were included in the trapezium, all removed as a single unit. Carefully removed all the modified tissue at the bottom of the wound, hemostasis diathermy. The bottom of the wound is protected by knotted catgut sutures. On the skin, 1.5 cm from the wound, four vertical mattress sutures are applied. Kra wounds while tightly adjoined. On the continuation of a parallel incision in front, two catgut schva were imposed, on the continuation of a incision in the back - one suture. The wound is covered with a label with chlorhexidine solution in 70% alcohol. Stitches are removed on the 10th day, healing by primary tension. Long-term results are good.

The proposed method allows an economical excision of the tissue, a tighter fit of the wound edges due to straight cuts forming the contour of the trapezium and extending beyond its corners, and uniform tension of the seams. The intertwining of catgut and slit shvov allows you to create an elastic spatial structure that can withstand much greater effort than when passing only vertical mattress slit seams through the periosteum. As a result, the likelihood of the occurrence of postoperative complications associated with divergence of the schv and inflammatory processes is significantly reduced.

Of the 75 patients who were operated on at the Leningrad Proctological Center, only one patient had a postoperative complication of hematoma, and the spores were removed on the 3rd day. Patients on bed rest are reduced from 10-11 days (with a known method) to 1-2 days; Cleavage is done on the 8th-9th day instead of the 9-11th day after the operation. All this makes it possible to reduce the average bed time with epithelial coccygeal disease, as well as the number of days of temporary disability.

Long-term results were followed up in 72 patients; no relapses; patients are able-bodied.

The proposed method provides simplicity and radical cure for patients and is recommended for wide use in 30 surgical practice.

Claims (1)

METHOD FOR TREATING AN EPITELIAL SMOKEY STROKE by excising it and applying vertically mattress nodal silk sutures, characterized in that, in order to reduce the treatment time for patients and prevent relapse, a trapezoidal incision is made during excision of the coccygeal passage, with a larger base placed in front, and smaller behind the outer opening of the coccygeal passage, parallel discharge lines continue beyond the trapezoid angles by 3-6 mm, then the bottom of the wound and parallel incisions are sutured with catgut interrupted sutures mi, and through them impose vertically mattress stitches. 1,146,005