RU2072785C1 - Method for performing endoscopic treatment of parenchymal organ traumatic injuries - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves using laparoscopy. New in the method is suturing wound with metal clamp which material possesses shape memory properties. Ligature is attached to the clamp. Suturing is carried out under control of laparoscope through additional trocar lumen in the projection of organ trauma all along the whole depth of the wound canal. The ligature is brought out through the internal lumen of drainage tube brought close to the clamp. It is removed by pulling the ligature through the internal lumen of drainage tube when healing takes place. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to the treatment of injuries of parenchymal organs by endoscopy.

 Recently, in the case of stopped bleeding and the absence of signs of peritonitis, in case of trauma to parenchymal organs, laparoscopic drainage of the abdominal cavity slopes with preliminary aspiration of blood is performed [1] With continued bleeding, a cavity operation (laparotomy) is performed, which aggravates the general condition of patients, accompanied by operational risk .

 As a prototype, endoscopic hemostasis was selected during laparoscopy [2] in which an electrosound is introduced through a separate puncture and coagulation is performed. The disadvantage of this method is that hemostasis is possible with superficial small damage, and in the presence of deep and large damage, this method is ineffective.

 For this, a method for treating injuries of parenchymal organs based on the use of laparoscopy is proposed, in which, under the control of a laparoscope, a metal bracket with a shape memory with a ligature attached to it through the lumen of an additional trocar is inserted into the projection of the organ injury and the said bracket is inserted into the damaged organ to the entire depth of the wound channel, the ligature is removed through the inner lumen of the drainage tube brought to the bracket, and after healing is completed, the bracket is removed for the ligature through the inner lumen of the drainage tube cutting.

 Consequently, suturing of parenchymal organs with metal brackets with shape memory through an additional trocar under the control of a laparoscope allows reliable hemostasis to be performed to the entire depth of the wound channel, which in turn forces one to refuse surgery (laparotomy).

 Thus, the claimed method meets the criteria of the invention is "novelty." Comparison of the claimed solution not only with the prototype, but also with other methods in this field of medicine, did not allow to reveal in them the signs that distinguish the claimed solution from the prototype, which allows us to conclude that the criterion of "significant differences".

 The method is as follows. A patient with a blunt abdominal injury, a penetrating knife wound of the abdominal cavity or with a suspicion of this diagnosis is performed laparoscopy under anesthesia according to the standard method. If damage to the parenchymal organ, such as the liver, is detected, an additional trocar is inserted directly above it through a puncture, its stylet is removed and a measuring ruler is drawn through the sleeve to determine the depth of the organ damage. If the defect is superficial, up to 5 mm, then with continued bleeding, coagulation with an electric probe is performed. If the latter is ineffective or the parenchymal organ defect is more than 5 mm deep, suturing is performed using a metal bracket with a shape memory whose length corresponds to the depth of the defect. To do this, a measuring ruler is introduced into the defect and the sleeve of the trocar is lowered along it until it stops into the surface of the damaged organ. The patient is asked to take a deep breath (and if he is on mechanical ventilation, then he should be disconnected from the device for 30 s) and hold his breath for 30 s, at this time a bracket made of metal with straight shape memory is held through the sleeve of the trocar along the measuring ruler with a clamp knees, pre-chilled, with a ligature attached to it and stitch the defect. With extended defects, it is possible to stitch with several brackets from one puncture for the trocar, for this it is necessary to use a physiological excursion of the abdominal organs together with the diaphragm (you can suture the distal organ displacement at the depth of inspiration; the proximal organ displacement and the intermediate position between them when holding the breath) .

 With several damage to organs in various areas, the above technique is repeated. A drainage is brought to the place of the bracket, through the lumen of which the ligature attached to the bracket is removed. The bracket is removed on the 4th day for ligature through the inner lumen of the drainage, and the last is removed on the 5th day.

 Example 1. The patient was admitted 5 hours after a household injury with a diagnosis of penetrating stab wound of the abdominal cavity. Hemodynamics is stable. There are no signs of ongoing internal bleeding and peritonitis. Knife wound in the epigastrium. Under local anesthesia, laparoscopy was performed: in the center of the III segment of the liver, a stab wound 3.5x0.2 cm, bleeds slightly, fresh blood in the sloping places of the upper floor of the abdominal cavity. An additional trocar was inserted into the abdominal cavity through a puncture of the abdominal wall closest to the liver wound, the sleeve of which was brought close to the liver wound, the depth of the wound channel (wound length 5 cm) was measured. Alternately, 2 surgical brackets of 5 cm length made of metal with shape memory were introduced through the sleeve of the trocar in a cooled state, the legs of which were held, departing 03 cm from the edges of the liver wound along the longitudinal axis of the wound channel. First, dacron threads were fixed to the brackets. Hemostasis has come. Drainage of the electric pump from the blood of the abdominal cavity. Drainage is connected to the brackets through the sleeve of the additional trocar, through the lumen of which the lavsan threads are removed. The laparoscope and trocar sleeves are removed, the drainage is fixed to the skin with a suture. The primary surgical treatment of a knife wound of the abdominal wall was performed. A seam on the skin at the injection site of the trocar for a laparoscope.

 The postoperative period is smooth. Surgical braces were removed on day 4 using dacron threads through the inner lumen of the drainage tube. Last deleted on the 5th day. Skin sutures were removed on the 7th day. During the control ultrasound examination of the left lobe of the liver, the echo-homogeneous structure of the liver was preserved. Biochemical and general clinical blood counts did not change. The patient was discharged on the 8th day in satisfactory condition.

 Example 2. A patient was admitted 3 hours after a household injury with a diagnosis of suspicion of a penetrating knife wound in the abdominal cavity. In order to clarify the diagnosis under local anesthesia, laparoscopy was performed according to a standard technique. On the border of the V-VI segments on the diaphragmatic surface of the liver 3.5 cm from the edge, a stab wound 1.5x0.3 cm was revealed, it bleeds moderately, in the right hypochondrium and along the lateral flank of the abdominal cavity, a small amount of fresh blood coming from bile wounds of the liver. An additional trocar was inserted into the abdominal cavity through a puncture of the abdominal wall closest to the wound of the liver, the sleeve of which was brought close to the wound of the liver, the depth of the wound channel was measured (length was 9 cm). A surgical bracket made of metal with a shape memory of 9 cm long was inserted through the sleeve of the trocar in a cooled state, the legs of which were held at a distance of 0.3 cm from the edges of the liver wound along the longitudinal axis of the wound channel. Previously, the lavsan thread is fixed to the bracket. Hemo- and gallstasis came. Drainage of the abdominal cavity by electric suction from blood and bile. Through the sleeve of the trocar, a drainage is brought to the bracket, through the lumen of which the lavsan threads are removed. Laparoscope and trocar sleeves removed. The drain is hemmed to the skin. The primary surgical treatment of a knife wound of the abdominal wall was performed. A seam on the skin at the injection site of the trocar for a laparoscope. The postoperative period is smooth. The surgical staple was removed after 3 days using dacron thread through the inner lumen of the drainage tube. Last deleted on the 5th day. Sutures were removed after 7 days. Laboratory blood counts (general clinical and biochemical) have not changed. A control ultrasound of the liver revealed a homogeneous echo structure without signs of venous and biliary hypertension. The patient was discharged on the 9th day in satisfactory condition.

 Thus, the use of metal braces with shape memory for laparoscopy with deep damage to the parenchymal organs and ineffective endoscopic hemostasis allows for less traumatic hemostasis and reject cavity surgery (laparotomy).

Claims (1)

 A method of treating injuries of parenchymal organs, including performing manipulations under the control of a laparoscope, characterized in that a brace with straight knees, made of metal with shape memory with a ligature attached to it, is inserted through an additional trocar into the area of the organ injury and is inserted into the damaged organ to the entire depth the wound channel, while the ligature is removed through the inner lumen of the drainage brought to the bracket, and the bracket for the ligature is removed at the end of the wound healing.