SU1431743A1 - Method of inserting catheter in case of blockade of retroperitoneal nervous formations - Google Patents

Abstract

The invention relates to medicine, in particular to surgery, and is intended for the prevention and treatment of postoperative dynamic intestinal obstruction. The goal is to increase the efficiency of the blockade by firmly fixing the catheter, reducing the likelihood of adhesions in the abdominal cavity, and providing a reliable dosed block of retroperitoneal nerve formations that innervate their abdominal organs. For this, a catheter is inserted through the puncture of the side wall of the abdomen with transcutaneous-retroperitoneal, under the control of the fingers, to the area of the intended retroperitoneal plexus.

Description

four

00

vj

NP

WITH

The invention relates to medicine, namely to surgery, and is intended for the prevention and treatment of postoperative dynamic intestinal obstruction.

The aim of the invention is to increase the efficiency of the blockade by firmly fixing the catheter, as well as reducing the possibility of adhesions.

The method is carried out as follows.

During the operation, after the usual skin treatment, the skin and the front aponeurosis are punctured at a point on the left side of the abdomen, along the axillary line, in the middle of the distance between the 2nd rib and the iliac crest. With the fingers of his left hand, the surgeon pulls off the descending colon anteriorly and using a long curved clamp holds a thin PVC catheter under the control of the fingers in the retroperitoneal space, under the posterior leaflet of the parietal peritoneum, and places it in the root of the mesentery of the small intestine between the upper non-mesenteric artery and duodenal-to-jaw-intestinal junction for the blockade of the superior mesenteric plexus (VVS) or 2-3 cm below the duodeno-junctional junction - for the blockade of the inferior mesenteric plexus (NBS), or eter under the body of the pancreas, to the zone of the isthmus for the blockade of the celiac plexus and the gland itself. The catheter is fixed with a suture to the skin. During the operation and in the postoperative period, a predetermined amount of novocaine solution or drug mixture is injected through the catheter 2-3 times per day.

An example. Sick A., 18 years old, was admitted to the hospital with a diagnosis of multiple penetrating wounds of the abdominal cavity with damage to the omentum, the mesentery of the transverse colon and small intestine, diffuse peritonitis. The operation is completed by retroperitoneal drainage of the inferior mesenteric plexus. The catheter 3 times a day was administered Novocain 100 ml of 0.25% solution. Peristalsis was performed for 2 days, there were no complications, recovery.

Example 2. Patient M., operated on for adhesive disease (intermittent form), underwent total intestinalis, resection of the ileum 80 cm with anastomosis end to end. The operation is completed by retroperitoneal drainage of the superior mesenteric plexus. 2 times a day, 120 ml of 0.25 ° / o-novocaine solution was added to the catheter with the addition of 1 ml of a 0.05% solution of proserin. No signs of postoperative intestinal paresis were observed, and peristalsis was observed on day 3. The catheter is removed. In the evening there was an independent chair. The postoperative course without complications. Recovery.

In the proposed method, the abdominal catheter is prevented from flowing the pumped novocaine into the abdominal cavity, thereby achieving dosage accuracy ensuring the stability of the blockade. Installing a catheter on surgeries under control eliminates the possibility of novocaine getting into the vascular bed, the absence of a catheter in the abdominal cavity eliminates trauma to the intestinal loops and reduces the likelihood of adhesions in the postoperative period. All this ensures the reliability of the proposed method parmanentnogo blockade of the retroperitoneal plexus.

Claims (1)

Invention Formula The method of conducting a catheter during the blockade of retroperitoneal nerve formations, including intraoperative catheter insertion, characterized in that, in order to increase the effectiveness of the blockade by firmly fixing the catheter, and to prevent adhesions, the descending colon is displaced anteriorly and after incision of the skin in the skull point along the axillary line with a long curved clip, the catheter is guided under the control of the fingers in the retroperitoneal tissue up to the mesenteric vessels, and the distal end of the installed catheter is fixed to the skin. 0