RU142797U1 - DEVICE FOR SANITATION AND DECOMPRESSION OF TOLSTOLOCHINESCHNOE ANASTOMOSIS - Google Patents

Abstract

A device for the rehabilitation and decompression of a colonic anastomosis, containing a tube, inside the cavity of which there is a longitudinal partition forming channels, characterized in that the longitudinal partition divides the tube into two channels of different diameters, while the larger diameter channel has side openings and contains a conductor consisting of a flexible string having a fastening lock and individual metal segments, at the distal end of a double-lumen tube there is a hollow tip having a housing with holes communicating communicating with the gaps of the tube, as well as having nozzles for attaching a double-lumen tube, a conductor rod enters one of the holes of the tip, which rigidly fixes the string in the tip, at the proximal end the device has a handle in the form of a hollow cylinder with two covers, inside which there is a string lock and spring.

Description

The utility model relates to medicine and medical equipment and can be used to prevent colonic anastomosis insolvency after obstructive colon resection (Hartmann type surgery).

In diseases of the colon, such as diverticular disease with the phenomena of diverticulitis, complicated cancer, burns, traumatic injuries, developmental abnormalities, obstructive resection of the distal colon is currently the operation of choice. The frequency of using obstructive resections of the rectosigmoid colon in modern surgery does not tend to decrease [Volenko, A.V. et al., 2011; Kukosh V.I. et al., 2011]. The most widely used surgical intervention for complicated colorectal surgical pathology is Hartmann's surgery. The frequency of its use in the complicated course of the pathology of the colon varies from 37% to 62% [Maryshev A.A. et al., 2003; Timerbulatov V.M. et al., 2004]. The contingent of the operated patients, in this case, most often consists of patients of socially active and able-bodied age groups, which gives the problem social and economic significance [Volenko, A.V. et al. 2011 g; Vorobiev, G.I. 2001; Manihas G.M. et al., 2005;]. According to the State Research Center for Coloproctology of the Ministry of Health of Russia, the number of patients with ostomy in Russia is from 100 to 120 thousand, of which 38.2-50.8% are people of working age [Vorobev GI, 2001; Melnik V.M. et al. 2002].

It is known that reconstructive operations performed after obstructive resection of the colon (Hartmann-type operations) relate to traumatic and complex operations due to the massive adhesion process and technical difficulties in isolating the colon stump from surrounding tissues (especially with a short, less than 10 cm stump ) [Volenko A.V. et al., 2011; Timerbulatov V.M. et al., 2004].

The frequency of postoperative complications remains stably high, which requires the improvement of technologies for their prevention [A.V. Volenko et al. 2011]. So, the failure of the sutures of the anastomosis reaches 6-25%, suppuration of the postoperative wound - 26-40%, mortality associated with the development of complications, on average, is 5.2% [Vorobiev GI, 2001]. Most surgeons associate the development of complications with the features of intestinal sutures and anastomoses [Timerbulatov V.M. et al., 2004]. However, the widespread introduction of various modern types of instrumental mechanical sutures and modified techniques for applying anastomoses did not change the situation [Zhukov, B.N. et al., 2011; Ziganyshin R.V. et al., 2000]. At the same time, no objective systematic comparative assessment of the methods of intra- and postoperative prophylaxis of anastomotic insolvency has been carried out, and there are still no sound recommendations for the formation of an algorithm for the prevention of purulent-septic complications in restoring colon continuity after obstructive resections of its distal sections (Hartmann type operations) .

A device is known, a gastrointestinal probe (RF patent No. 2152807 of 04/01/1999) for prolonged decompression of the intestine or continuous evacuation of contents from any particular section of the intestine, in combination with the simultaneous introduction of the intestinal chyme.

This device has the following significant disadvantages:

- the device does not imply a metered volume supply of flushing fluid (antiseptic), as a result of which excessive intraluminal pressure is created in the anastomotic zone.

- the conduct and installation of the device into the lumen of the colon is technically complex, time-consuming and threatening trauma to the intestinal wall due to the lack of a flexible conductor.

- connecting the device to an electric suction can lead to suction of the intestinal wall to the lateral openings of the probe, which can cause necrosis of the intestinal area and perforation due to its local ischemia.

- the small diameter and tortuosity of the channels for outflow can lead to difficulty or complete cessation of intestinal contents discharge due to blockage of the channel, which leads to loss of function of this device

- the device has only one hole for the supply of drug solutions, which can lead to loss of function of the device due to its blockage.

Closest to the claimed utility model is the device "Three-lumen probe for intubation of the colon" (patent for utility model RB No. 1290, published 2004.03.30), containing a tube, inside the cavity of which there is a longitudinal diametrical partition forming channels, with a number of side holes, characterized in that at the distal end the tube is equipped with plastic olive with a diameter of 16 mm, in the proximal section - an inflatable cuff (thickening) for sealing the intestinal lumen located at a distance of 1100 mm from the olive, cuff 50 mm, the volume of the introduced air 45 × 103 mm3; the partition inside the tube is made of a three-blade configuration and divides the probe into three channels with side holes; the diameter of the channel for decompression and aspiration of pathological colonic contents is 9 mm, with holes with a diameter of 5 mm throughout the working part of the probe with an interval of 60 mm; the diameter of the channel for supplying water and corrective solutions is 5 mm, with holes in the working part of the probe with a diameter of 3 mm, with an interval of 60 mm; the diameter of the pressure-controlling channel is 4 mm, with holes with a diameter of 2 mm, made with an interval of 120 mm and located at a distance of 1100 mm from the olive, with each channel at the proximal end of the probe equipped with an adapter for easy connection to the monitor intestinal cleaning system.

The disadvantages of the prototype are:

- the device does not imply a dosed supply of washing liquid (antiseptic), as a result of which excessive intraluminal pressure is created in the anastomotic zone.

- Carrying out and installing the device into the lumen of the colon is technically difficult, time-consuming and is accompanied by a high risk of damage to the intestinal wall due to the lack of a flexible conductor.

- The device does not allow for targeted dosing washing and sanitation directly of the intestinal anastomosis zone.

- There is no possibility of manual control of the surgeon over the installation of the device, which does not allow to advance the tip beyond the line of the anastomosis. Or is accompanied by an excessive likelihood of iatrogenic trauma of the intestinal wall.

- The presence in the proximal part of the device of a fixed inflatable cuff (thickening) for sealing the lumen of the intestine, leads to a limitation of the length of the device (1100 mm) and the impossibility of its movement in the lumen of the colon.

These shortcomings are eliminated in the inventive device.

The objective of the utility model is to develop a device for the rehabilitation and decompression of the colonic anastomosis, characterized by ease of installation, safety and ease of use at high efficiency.

The problem is solved in that a device was developed for the rehabilitation and decompression of a colonic anastomosis containing a tube, inside the cavity of which there is a longitudinal partition forming channels, characterized in that the longitudinal partition divides the tube into two channels of different diameters, while the channel of larger diameter has lateral holes and contains a conductor consisting of a flexible string having a fastening lock and individual metal segments, at the distal end of the double-lumen tube there is a hollow an end having a housing with holes communicating with the lumens of the tube, and also having nozzles for attaching a double-lumen tube, one of the holes of the tip includes a conductor rod that rigidly fixes the string in the tip, at the proximal end the device has a handle in the form of a hollow cylinder with two covers inside which are the lock of the string and spring.

The technical result achieved by the utility model consists in ease of installation, the possibility of safe use of the device under the control of the hand of the operating surgeon, aiming the device distally from the anastomosis, which ensures effective transanal decompression and the possibility of colon sanitation in the postoperative period to protect the colon anastomosis.

The utility model is illustrated by drawings 1-2, where are presented in figure 1 - General view of the device for the rehabilitation and decompression of colonic anastomosis, figure 2 - conductor design.

The device for the rehabilitation and decompression of the colonic anastomosis (Fig. 1) contains a tip 1 with holes 2, two pipes 3 and 4, a double-lumen drainage tube 5, a thin pipe 3 serves to attach a supply channel 6 of a double-lumen tube 5 on it to supply a solution antiseptic and thick pipe 4 - for attaching the evacuation channel 7 of the double-lumen tube 5, which has side openings 8 for the purpose of discharging the washing liquid (including the antiseptic solution), conductor 9, consisting of a flexible string 10 and individual met llicheskih segments 11, 12 of the handle with two covers the top 13 and bottom 14, the slit 15, the string lock 16 and spring 17, the tip of the conductor 18 with the rod 19 protruding outwardly.

The inventive utility model differs from the prototype in that it has a conductor 9 (figure 2) which consists of a flexible string 10 and individual segments 11 placed on this string. The last segment is connected to the housing of the tip of the conductor 18, which contains a rod 19 with a thread and a hole 20. A section of the housing of the tip of the conductor shows the string assembly 10, which ensures its fixation when the string is tensioned.

The proposed device is used as follows.

The device works as follows: after applying a large intestine anastomosis, as instructed by the operating surgeon, one of the assistants takes the device in assembled form (Fig. 1), previously lubricated with glycerin, inserts it through the anus into the rectum. Due to its rounded streamlined shape, the tip 1 easily passes the bends of the colon without injuring the mucous membrane. Tip 1 is advanced beyond the anastomosis line under the control of the operating surgeon, the proposed shape makes the tip light, bulky, streamlined, with holes 8 for discharge of the washing fluid (including an antiseptic solution) located on the channel of a larger diameter of the double-lumen tube 5 - sufficient in diameter . The introduction of a double-lumen drainage tube 5 with a wide and narrow channel (7 and 6) is facilitated by the string 10 determining the stiffness of the segments 11 contained therein. After installing the working end of the double-lumen drainage tube 5 at a distance of 10-15 cm above the anastomosis, they begin to remove the conductor 9 of the device from the lumen of the drainage tube 5. Removing the conductor 9 is as follows. The handle 12 of the device is located with a slot 15 up in the left hand of the doctor, who, taking the bottom cover 14 with his right hand towards himself, guides the neck of the string lock into the slot of the handle 15, the cover leads along the slot 15 anteriorly, and the handle 12 pulls itself until it separate from the rest of the structure. In this case, the stretched string 10 relaxes, the conductor 9 (Fig. 2) loses its sharpness and is easily removed from the channel of a larger diameter 7 of the double-lumen tube 5, no matter what bends it does, repeating the bends of the intestinal tube. During removal of the conductor 9, the housing of the device tip 1 is slightly held through the intestinal wall above the anastomosis line. This is easily accomplished thanks to the embossed tip surface. The assistant, having injected a rifaximin water emulsion into Jean’s syringe through the supply channel 6 of the double-lumen tube 5, rinses the anastomosis zone under pressure “until clean water” for three purposes: a) make sure that the joints of the anastomosis are physically tight; b) aspirate blood clots and mucus from the lumen of the intestine in the area of the anastomosis, which are released through the wide channel of the two luminal tubes; c) act on the microflora in the lumen of the intestine using an antiseptic solution that has a local bactericidal effect on the mucous membrane of the colon without being absorbed into the systemic circulation.

After verifying the physical tightness of the joints of the anastomosis, in an adequate flushing system, a double-lumen drainage tube 5 protruding from the rectum is fixed to the perineal skin with a nylon seam. The surgeon completes the operation by suturing the wounds of the anterior abdominal wall. After the patient is delivered to the postoperative ward (or intensive care unit) and placed in the Fowler position, the dosed supply of the antiseptic is adjusted through the supply channel 6 of the double-lumen tube 5 with a constant speed of 20 ml per hour, using an infusomat. The wide channel 7 of the drainage tube 5 is lengthened, and its end is lowered into a vessel with a small amount of antiseptic solution. As this vessel is filled with discharge from the intestinal lumen, it is emptied and reinstalled. A continuous supply of intestinal antiseptics with an infusomat is carried out the first day. The next day, the supply of an antiseptic with an infusomat is connected three times for a duration of 3 hours, with intervals and a break for a night's sleep. Remove the device when active intestinal motility occurs. In typical observations, this occurs on 3-5 days.

An example of a specific use of the device.

Example 1. Patient 3-nd, 33 years old, medical history No. 040825/907 was admitted to the surgical department of the clinic on 09.12.2012 with complaints of the presence of an intestinal fistula. It is known that on August 5, 2012, the patient got into an accident in the city of Gelendzhik, Krasnodar Territory. He was taken to the city hospital with a diagnosis of blunt abdominal trauma, rupture of the mesentery of the sigmoid colon, necrosis of the sigmoid colon, hemoperitoneum. According to emergency indications, surgery was performed in the amount of laparotomy, resection of the sigmoid colon single-shaft sigmoidostomy. Objectively: on the anterior abdominal wall, a scar is determined after a 30 cm long laparotomy. It is pale pink in color with no signs of inflammation. On the anterior abdominal wall along the midclavicular line 6 cm below the left costal arch, a pink columnar sigmostoma of 30 × 30 × 20 mm is defined. lumen diameter 20 mm. without signs of inflammation, the skin around the stoma is non-macerated. With rectal digital examination, the sphincter tone is preserved. The ampoule is empty. There are no wall hangs. With rectoscopy, the length of the postcolostomy stump is 17 cm, the mucous membrane is loose, focal hyperemic, there are endoscopic signs of sabotage colitis.

The patient underwent FCC from 12/12/12, the endoscope was taken to the stump of the transverse colon, 18 cm from the anus. The mucous membrane is pale pink, the vascular pattern is pronounced, the folds of the mucous membrane are of medium caliber, and the bowel tone is reduced. Peristalsis can be traced, sluggish. Through the colostomy, the endoscope is inserted into the dome of the cecum.

Considering the presence of a single-barrel colostomy, complete intestinal fistula, indications for surgery were determined; on December 21, 12, under general anesthesia, surgery was performed in the amount of laparotomy, viscerolysis, restoration of intestinal tube continuity with the application of end-to-end mechanical rectosigmoanastomosis, decompression of the anastomosis zone according to the original method , rehabilitation, drainage of the abdominal cavity. In the postoperative period, a rifaximin suspension was dosed with an infusomat at a rate of 20 ml per hour of the active substance, continuously during the first day and three times a day for 3 hours on the following days. The device for debridement and decompression of the colonic anastomosis was removed on the 4th day of the postoperative period, when the patient appeared active peristalsis, the gases went away. In the postoperative period, complex therapy was performed, including antibacterial drugs, analgesics, parenteral nutrition, anti-inflammatory and antisecretory therapy according to traditional schemes. Daily dressings were performed.

The postoperative period was uneventful, without complications. At the control examination after 3 months, a colonoscopy was performed, the apparatus was inserted 80 cm to the cecum. The examined mucous membrane of the colon of a pale pink color has retained the vascular pattern, normal peristalsis, and medium-sized folds. At 14 cm from the anus, the line of the anastomosis was visualized without signs of inflammation and ulceration. Conclusion: the condition after resection of the intestine, the imposition of an intestinal anastomosis.

The advantages of the claimed device are as follows.

The utility model can be used regardless of the constitution of the patient, and accordingly the length of the colon, in any hard-to-reach areas of the colon.

The presence of the tip 1 allows under manual control to install the device in the intended area proximal to the anastomosis and provides a message of the end sections of the channels of larger and smaller diameters.

The use of flexible conductor 9 makes it possible to quickly install the device without deformation and kinks of the tube and, most importantly, without the risk of injury to the intestinal wall. The use of the conductor 9 and the handle of the device 12, equipped with a spring 17, provides the necessary stiffness and elasticity for optimal conduct of the device proximal to the anastomosis, as well as easy and safe removal of the conductor after installing the device.

The design of the double-lumen drainage tube 5 allows, in the presence of a tip 1, to carry out targeted flushing of the anastomosis zone with an adequate outflow of flushing fluid (antiseptic), due to which there is no excessive intraluminal pressure in the anastomosis zone and there is no risk of mechanical eruption of the joints. Connecting the device to the infusomat allows the delivery of an antiseptic in a strictly dosed manner, in compliance with optimal dosages and control of the volume of injected fluid.

The proposed device can be used for interventions on any part of the colon, but practice has shown that the potential threat to the failure of anastomotic sutures due to increased pressure in the lumen of the intestinal tube exists more during reconstructive operations on the distal colon. This is due to functional features, inflammatory changes (sabotage colitis) and the nature of the microflora of the disconnected part of the colon.

The inventive device can be widely used in medicine, namely when restoring the continuity of the colon after performing obstructive resection of the colon (surgery such as Hartmann) and therefore meets the criterion of "industrial applicability".

Claims (1)

A device for the rehabilitation and decompression of a colonic anastomosis, containing a tube, inside the cavity of which there is a longitudinal partition forming channels, characterized in that the longitudinal partition divides the tube into two channels of different diameters, while the larger diameter channel has side openings and contains a conductor consisting of a flexible string having a fastening lock and individual metal segments, at the distal end of the double-lumen tube there is a hollow tip having a housing with holes communicating communicating with the gaps of the tube, as well as having nozzles for attaching a double-lumen tube, a conductor rod enters one of the holes of the tip, which rigidly fixes the string in the tip, at the proximal end the device has a handle in the form of a hollow cylinder with two covers, inside which there is a string lock and spring.