SU1204193A1 - Obturator - Google Patents

Description

The invention relates to medicine, namely to surgery, to obturators for bronchoplerotocaracal fistulas.

The aim of the invention is the provision of the obstruction of chronic bronchopleumatoral fistulas after pneumonectomy.

The drawing shows schematically an obturator, a general view.

The obturator is made in the form of a body of rotation, perforated in the form of a hollow truncated cone 1 with a filled end 2 at the small base and a flange 3 at the large base.

The obturator is made of synthetic fabric-differentiated material (silicone and silicone rubber compounds 52-366 and 52-336 / 4, used in medical practice).

For work it is necessary to have a set of obturators of different diameter and length.

Re-rotocotomy is performed (re-opening of the chest cavity) along the 4th intercostal space between the anterior and posterior armpit. The skin, the subcutaneous cellular tissue is opened, the subperiosteal is punctured by IV and V ribs for 12–15 cm within the axial lines (less traumatic access). Dissect the pleura and open the residual pleural cavity. The cavity and fistula are inspected, cleaned of necrotic tissues, washed with antibiotic solution, dried with napkins, and then the lumen of the fistula and the walls of the cavity are wiped with napkins moistened with alcohol. The fistula and tissues around the orifice are smeared with a 25% solution of silver nitrate (ly pure).

Then from the set choose the obturator in diameter and length of the fistulous passage. The absorbed fistula walls and the outer surface of the obturator are smeared with medical glue. A bell-shaped probe bent at a right angle is inserted into the hollow part of the obturator, under the control of the eye with a probe, the obturator is brought to the fistula opening and inserted into its lumen up to the stop until the flange of the obturator touches the tissues surrounding the opening tightly mediastinal wall. The residual pleural cavity after the operation is sutured naked and the chest is completely closed. Treatment of the cavity in the postoperative period is carried out by the puncture method.

Medical glue holds the connected tissue for more than 2 months. During this period, the mucous membrane of the fistulous passage grows through the holes in the hollow part of the obturator and securely holds it in the attached position. The obturator flange is similarly overgrown with tissues.

Thus, the obturator is immured in a tissue, the bronchial fistula is eliminated.

Example. Patient, 59 years old, in April

1978 transferred the removal of the right lung due to abdominal pneumonia with bronchoectases. The postoperative period was complicated by empyema of the residual pleural cavity with the development of bronchopleural fistula. An attempt at puncture treatment was unsuccessful. Two months after the operation, a repeated operation was performed on the retoracotomy and the residual cavity tamponade according to the method of A. V. Vishnevsky. From the proposed thoracoplasty refused. Discharged from the hospital with the presence of a bronchoplerothoracic fistula to continue treatment at the place of residence in the clinic.

Upon re-admission to the institute, the patient's condition is satisfactory, Tonj.eH is irritated, complains of a persistent cough with a mucopurulent microtect and discharge from an old wound hole located on the right side of the chest, shortness of breath, a feeling of extreme lack

air at the time of changing the dressing plug, which, due to coughing over 4 years, is forced to change 2-3 times a day. The examination revealed the presence of a large, direct bronchopleurothoracic fistula.

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On March 22, 1982. an operation was performed - re-retracotomy with resection of the IV rib along the axial lines. On examination, the residual pleural cavity with a capacity of up to 500 ml (0.5 l), its surface and fistulous course is covered with succulent pink easily bleeding tissues; bronchial fistula size of 1.2 cm in diameter, 2 cm in length, with a funnel-shaped passage from the side of the medio-stenotic wall. There is pussy mucus in the lumen of the fistula, two tantalum brackets hang down at the border with the trachea, the trachea and the main left bronchus are freely visible through the fistula opening. The residual cavity and the fistula tract are treated with alcohol, the tantalum brackets are removed, the mucous fistula and tissues, the surrounding holes, are smeared with a 25% silver nitrate solution. The surface of the obturator, matched by the size of the fistula, and the walls of the bronchial lumen are smeared with medical glue. The obturator is inserted into the lumen of the fistulous course, its flange is tightly pressed against the mediastinal wall, the residual cavity is protected tightly, the rib cage is completely closed, leaving nipple rubber drainage.

The postoperative period is smooth. 15 days after the operation, the drainage was removed, the wound healed by primary tension. The general condition of the patient is satisfactory,

312041934

there is no dyspnea, the patient is active, after 2 mass is good, active, has added to

after the operation, he was discharged home in general; he did all the homework and a satisfactory state. Through 9 months in the specialty - the vet assistant.

Claims (1)

OBTURATOR for the fistula, made in the form of a body of revolution, characterized in that, in order to ensure obstruction of the chronic broncholleurorothoracic fistula after pneumectomy, it is made perforated in the form of a hollow truncated cone with a blanked end at the small base and a flange at the large base.