RU2068276C1 - Device for curing and taking preventive measures against purulent-necrotic complications at destructive pancreatitis - Google Patents

Abstract

FIELD: medical equipment. SUBSTANCE: device has additional electrode connected to common terminal of current supply together with basic one, the second draining tube, the second catheter for feeding medicinal preparate and the second irrigator of calves. Two catheters are connected to aspiration system. Device also has porolon washer, inside which electrodes are disposed long the whole length of the washer. Electrodes are made in form square-shaped silver plates. Catheters are fixed at both sides at planes of electrodes. Catheters for feeding medicinal preparate are fixed at plane being perpendicular to electrodes. All catheters and draining tubes have perforations at their working part. Draining tubes are disposed along porolon washed outside it. EFFECT: improved efficiency of cure. 3 dwg

Description

 A device for electrophoretic treatment and prevention of purulent-necrotic complications in the surgical treatment of destructive pancreatitis.

 The invention relates to medicine, in particular to the treatment and prevention of purulent-necrotic complications in destructive pancreatitis.

 Closest to the claimed solution is a device for electrophoretic postoperative treatment of pancreatitis (ed. St. N 1681865).

 The aim of the invention is to reduce the number of purulent-necrotic complications in destructive pancreatitis.

 To achieve this goal, we proposed a device for electrophoretic treatment and prevention of purulent-necrotic complications in the surgical treatment of destructive pancreatitis, containing a plate electrode connected to a terminal of a current source, a drainage tube and a catheter for supplying a drug, connected to a microirrigator, characterized in that it is equipped an additional electrode connected with the main to the common terminal of the current source, the second drainage tube, the second catheter for feeding and a drug and a second microirrigator, two catheters connected to the aspiration system, and a foam pad, inside which along its length there are electrodes made in the form of silver rectangular plates, catheters connected to the aspiration system are fixed on both sides of the electrode plane, and in a plane perpendicular to the electrodes of the catheter for supplying the drug, while all catheters and drainage tubes are perforated in the working part, and the drainage tubes are located us along the foam pad outside it.

 Figure 1 shows the location of the device in the stuffing bag in relation to the pancreas and the location of the electrodes; figure 2 diagram of a device for the treatment and prevention of purulent-necrotic complications of destructive pancreatitis; figure 3 section aa in figure 2.

 Figure 2 indicates: 1 gasket made of polyurethane foam, 2 two double-lumen drainage, 3 catheter for the supply of drugs, 4 - drainage drainage, 5 silver plate electrode.

 The proposed device contains a foam pad 1 located between two double-lumen drains 2, which are necessary for the discharge of large sequesters and drainage of the stuffing bag after removing the pillow (1) from the cavity.

 The gasket is made of a synthetic material of polyurethane foam (foam rubber), which, in combination with drainage tubes located inside it (3 leading), (4 leading), is introduced into the stuffing bag and connected to two droppers and an aspiration system.

 Inside the strip 1 along its length are silver electrodes 5, made in the form of rectangular plates, connected by an insulated wire with an apparatus of direct current electric current "Potok-1".

 In the plane perpendicular to the electrodes, catheters for supplying the drug are fixed, perforated catheters connected to the aspiration system are fixed in the plane of the electrodes.

 To perform electrophoresis of the pancreas, droppers are filled with the necessary medicinal substance and connected to microirrigators for infusion 3. At the time of electrophoresis, the vacuum suction is turned off. Excess drug substance is poured independently through drains 2 and 4. The plate electrode 5 is connected to the negative pole of the Potok-1 apparatus. The positive electrode is located on the back side in the projection of the pancreas.

 We give an example of using the device in a clinic.

Clinical Observations
We used intracavitary electrophoresis in the clinic to treat 12 patients with acute destructive pancreatitis of biliary etiology and 1 with idiopathic. Patients were treated in the surgical department of the city hospital N 1 in Belgorod.

 According to the prevalence of the process, 1 patient showed small focal fatty, 3 large focal, 4 total-total hemorrhagic, 5 total-total mixed pancreatic necrosis.

 For the diagnosis of pancreatitis, clinical, laboratory and instrumental methods of research were used. The use of ultrasound, FGDS and laparoscopy made it possible to establish the etiology, form of the lesion and its complications.

 To illustrate, we provide an extract from the medical history 383.

 Patient Ch. 69 years old, was admitted 02.15.93 to the surgical department of 1 city hospital in Belgorod 26 hours after the onset of the disease with a clinical picture of acute destructive pancreatitis, diffuse peritonitis.

Upon admission, the patient is in serious condition. The pulse is 112 per minute, rhythmic. HELL 180/100. The tongue is dry, the abdomen is somewhat swollen, painful in the epigastric region and in the right hypochondrium. Muscle tension of the anterior abdominal wall on the right. Symptom Shchetkina-Blumberg positive. 02/15/93, urine amylase 370 mg / chml, blood sugar 3.33 mmol / L, white blood cells 11.4 • 10 ⁹ / L, red blood cells 4.0 • 10 ¹² / L, total protein 86 g / L, bilirubin total 18.95 μmol / l, direct 3.39 μmol / l, indirect 15.59 μmol / l, general urine analysis is normal. (The operation was performed by V.M. Voronin).

 02/15/93 after preoperative preparation performed median laparotomy. During the audit found: in the abdominal cavity up to 250 ml of hemorrhagic effusion; tense, enlarged, dark crimson gall bladder, in the lumen of which there are many stones. Pancreas of wood density, peritoneum covering the gland, black. On the border of the body and tail foci of necrosis.

 Diagnosis: Acute biliary subtotal mixed pancreatic necrosis. ZhKV. Acute phlegmonous cholecystitis. Spilled enzymatic peritonitis.

 Performed a cholecystectomy from the neck. Intraoperative cholangiography was performed. On the R-gram, the common bile duct is 9 mm in diameter, contrast freely enters the duodenum. The choledoch drained to Halsted-Pikovsky. The bubble bed is sutured. The pancreas is abdominated. Last swollen, dense, black. Peritoneal incisions were made on the front and rear surfaces of the body and tail over interlobular grooves. An attempt was made to interlobular drainage of the pancreas in the area of the body and tail along its front surface. However, to complete it in full failed.

 The stuffing bag is drained by the device developed by us, which allows for flow-aspiration drainage, intracavitary electrophoresis, create a depot of drugs and save the cavity of the stuffing bag.

 The abdominal cavity is washed with a solution of furatsilina and drained by glove-tube drains.

 In the postoperative period, active conservative therapy was carried out, including infusion therapy, antispasmodics, antibiotics.

 Starting from 02.17.92, a constant effect of PET on the walls of the cavity of the stuffing bag with double intracavitary electrophoresis with drugs was started.

Laboratory data: Blood sugar 5, mmol / l; general blood test: Er - 3.2 • 10 ¹² / l, Hb 103 g / l, CP 0.9; leukocytes - 9.4 • 10 ⁹ , e 0, p / 2, s / 69, l 12, m 2, ESR 13 mm / h. urine amylase 128 mg / ml; total bilirubin 12.8 μmol / l; creatinine 0.103 mmol / l; chlorides 116 mmol / l, urea 8.72 mmol / l, total cholesterol - 4.86 mmol / l; total protein 57 g / l; ALT 0 nkat / l, AST 0.32 nkat / l.

 02/19. Exudation from the abdominal cavity to amylase 612 mg / ml.

02.21.92: Blood sugar 4.8 mmol / L. general blood test: Er - 3.4 • 10 ¹² / l, Hb 107 g / l, CP 0.9, white blood cells - 9.0 • 10 ⁹ / l, ESR 20 mm / h; amylase 21.2 mg / ml; urine 128 mg / ml; total bilirubin 10.26 μmol / l; creatinine 0.071 mmol / l; chlorides 116 mmol / l, urea 8.72 mmol / l, total cholesterol 3.6 mmol / l; total protein 62 g / l; ALT 0.88 nkat / l, AST 0.32 nkat / l.

 02.22. The state of moderate severity. Transferred from resuscitation to 1 surgical department for further treatment.

 02.24. The effect of PET on the stuffing bag was terminated and the flow-suction system was removed.

 From 02.28. drainage tubes from the stuffing bag were gradually tightened and completely removed on 4.03.92. General blood test (2.03.92) within normal limits, amylase 11 mg / hl. Discharged in satisfactory condition for outpatient treatment 12.03.92.

Claims (1)

 A device for electrophoretic treatment and prevention of purulent-necrotic complications during surgical treatment of destructive pancreatitis, containing a plate electrode connected to a current source terminal, a drainage tube and a catheter for supplying a drug, connected to a microirrigator, characterized in that it is equipped with an additional electrode connected to the main to the common terminal of the current source, the second drainage tube, the second catheter for supplying the drug, the second microirrigator , two catheters connected to the aspiration system, and a foam pad, inside which along its length there are electrodes made in the form of silver rectangular plates, catheters connected to the aspiration system are fixed on both sides of the electrode plane, and catheters for the catheters in the plane perpendicular to the electrodes supply of the drug, while all catheters and drainage tubes are perforated in the working part, and the drainage tubes are located along the foam pad outside it.

Images