SU1560111A1 - Method of organ saving operation of spleen - Google Patents

Abstract

This invention relates to surgery and can be used for injuries of parenchymal organs. The purpose of the invention is the reduction of postoperative complications associated with the flow of blood and exudate into the abdominal cavity and the reduction of trauma. After the hemostatic sutures are applied, the spleen is placed in a capsule with two necks. One of the necks, covering the leg of the organ, is stitched around successively with two semi-nets, the front ends of the threads of which are passed inside the tube and through the counteroperture taken out with the tube. A drainage tube is inserted into the opposite neck of the capsule, tightly wrapped around the capsule around the organ, and tied around it around the drainage tube. Then the drainage tube with the second neck is pulled out. After the separation by drainage of secretions is stopped, the knot of threads on the drainage tube is cut off and both threads are alternately removed through the turnstile tube, and the drainage tube is pulled, gas is introduced through it up to 100 ml through the capsule, after which the capsule together with the drainage tube is removed from the cavity. The method is recommended for use especially in case of significant damage. 2 Il.

Description

The invention relates to medicine, namely to surgery, and can be used in case of damage to parenchymal organs.

The purpose of the invention is the reduction of postoperative complications associated with the flow of blood and exudate into the abdominal cavity and the reduction of trauma.

FIG. 1 shows the abdominal cavity, placing the spleen in a capsule with two necks, cross section; in fig. 2 - the imposition of half-sets with the removal of ligatures out.

The method is carried out as follows.

After hemostasis of the spleen, the damaged organ is placed inside the elastic capsule 1, which has two necks. One of the necks 2, covering the leg of the body,

Stitched around successively with two half-net sutures, the two ends of the threads 3 of which are passed into the tube 4 and through the counteroperture made in the anterior abdominal wall, along with the tube 4, the threads are pulled out and fixed on the end of the tube. A drainage tube 6 is inserted into the opposite neck 5 of the capsule 1, the capsule is tightly wrapped around the organ and strapped 7 around the drainage tube as close as possible to the organ, keeping the capsule tight to the surface of the damaged organ. Then the neck 5 is re-tied with a thread 8 around the drainage tube 6 near the very edge and a drainage tube 6 together with the neck 5 is brought out to the outside through the counteroperture in the left hypochondrium. Contraperties are designed so that the axes of the tubes 4 and 6

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ABOUT

matched. Thus, the capsule, tightly crimping the damaged organ, provides compression of the wound edges, prevents seams from erupting and reduces bleeding from cracks and needle punctures, and if bleeding continues, a small amount of volume between the surface of the organ and the capsule shell is filled with a small amount of blood, which then coagulates and coagulates sources of bleeding. After the drainage discharge stops, the thread assembly 3 on the drainage tube 6 is cut off and both threads are alternately removed through the turnstile tube 4 in the front wall of the abdomen, after which the tube 4 is removed and the drainage tube is pulled out 30-50 mm (but not completely removed) and 50-100 ml of gas are introduced through the tube into the capsule, for example, using a Janet syringe. Under the pressure of the gas, the folds of the capsule 1 are straightened, the neck 2 of the capsule on the leg of the organ opens and the capsule together with the drainage tube is removed from the cavity.

Example. Patient L., 43 years old, was admitted with a diagnosis: Intra-abdominal bleeding, about which laparotomy was performed. Up to 700 ml of blood and clots were detected in the abdominal cavity. Diagnosed damage to the spleen in the form of two gaps on the inner surface. One of them is up to 3 cm long, up to 2 cm deep, and up to 16 cm wide crossed the spleen in the upper pole. Another cut up to 2 cm long and 0.5 cm deep was located in the gate projection. After mobilization and removal into the wound of the spleen and tail of the pancreas, the gaps were closed with catgut sutures and plastic surgery of the suture line with an omentum on the pedicle. In order to prevent secondary bleeding, the organ-preserving casing operation is completed by this method. The spleen is enclosed in an artificial polyethylene capsule with two necks. The sealing of the organ and its compression is achieved with the help of two semi-set seams. The cavity of the capsule is drained. Provided with radical hemostasis. On the second day, a symptomatic traumatic brain injury appeared. On the same day, an operation was performed — removal of the left epidural hematoma and the right subdural hematoma. The postoperative period was uneventful. On the eighth day, the capsule and drainage are removed from the abdominal cavity. Discharged for outpatient treatment on the twenty-sixth day after the injury. Follow-up examinations after two and three

0 years did not reveal the pathology of the abdominal cavity. The patient works.

The proposed method is recommended for use in health care practice, especially in cases of significant

organ damage as an alternative to splenectomy.

Claims (3)

1. The method of organ preservation operations on the spleen, including shrinking a damaged organ with a capsule with a throat in the vascular pedicle, characterized in that, in order to reduce postoperative complications associated with the outflow of blood and exudate into the abdominal cavity, the filaments overwhelm the vascular orifice, and through the opposite throat they enter drainage and after tightening the ligatures, drainage and throat edges are brought out, which are removed after 0 termination of exudate separation. 2. The method according to claim 1, characterized in that, in order to reduce the trauma when removing the vascular pedicle ligatures, two half-sets are applied at the gate of the organ with two threads, the front ends of which reach through the turnstile counter-barrier of the anterior abdominal wall, and the rear ends of these the ligatures are led out through the drainage tube of the counter-peri-posterior abdominal wall. 3. The method according to claim 1, characterized in that, in order to reduce the morbidity during the removal of the capsule, up to 100 ml of gas is introduced into the capsule inside it. five 0 FIG. one 6 / FIG. 2