RU2162309C1 - Surgical excrement receiver - Google Patents

Abstract

FIELD: medical instruments, in particular, devices used during operation for emptying of proximal sections of intestines at obturation and strangulation ileus. SUBSTANCE: the excrement receiver is made in the form of a hose-shaper elastic bag with one plugged end, and the other open end is made as a neck in the form of a truncated cone screwed in the hose gap with the narrow base of the cone, whose walls serve as an extension of the hose walls. The wide base of the truncated cone of the neck is provided with a link, having a band retainer located in a circulating duct of doubled bag walls, two pockets of a different size are located opposite each other on the bag walls, the base of the larger on the outer side is also provided with a link, having a band retainer located in a circulating duct of doubled bag walls, a cutting device with a cutting member extending from its body inside the hose cavity is positioned inside the smaller pocket. From the outside the elastic bag is provided with two handles located between the bag pockets. EFFECT: prevented disturbance of asepsis during emptying of the proximal sections of intestines at obturation and strangulation ileus. 2 cl, 8 dwg

Description

 The claimed technical solution relates to medical instruments, in particular to devices used during surgery to empty the proximal intestines in obstructive and strangulated intestinal obstruction.

 A device [1] is known, consisting of a tubular body and an obturator, which is inserted into the lumen of the cecum through the cecotomy opening in the presence of intestinal obstruction. In this case, first through a separate incision a cecostomy is formed. The device is assembled and connected to an electric suction pump. A purse string suture is placed on the wall of the rectum, in the center of which a cecotomy is made. The device is introduced into the intestine through the cecotomy opening, while removing the intestinal contents of the electric suction pump. The obturator is removed and the intestine is intubated with a probe for further decompression.

 The disadvantages of this device are the need to remove the dome of the cecum on the abdominal wall, which may be accompanied by a violation of the integrity of its wall in the presence of decompensated obstruction. The imposition of a purse string suture on the thinned intestine and cecotomy in conditions of severe intestinal obstruction will lead to aseptic disturbance during surgery.

 A device [2] is known, used "for opening the lumen of the cecum and aspirating gases and liquid stool", which consists of a thin-walled metal tube with a length of up to 15 cm and a diameter of 1.5-2.0 cm with six holes with a diameter of 2- 3 mm at the end. The free end of the tube is connected to the suction hose, and a transparent plastic cap is put on the other (with holes), the outer diameter of which is 3 cm. " An aspirator tube with a cap is placed on the proposed opening of the intestinal lumen inside the imposed purse string suture and an electric suction device is turned on. The end of the tube and cap are attached to the wall of the intestine. Then, an active coagulator electrode is applied to the metal tube. Around the circumference of the aspirator tube, the intestinal wall coagulates and cuts. Through the hole formed, the intestinal contents and gases enter the aspirator. After aspiration of intestinal contents, an elastic drainage tube is introduced into the opening of the intestinal wall and a purse string suture is tightened.

 The disadvantages of this device are the need to remove the dome of the cecum on the abdominal wall, which may be accompanied by a violation of the integrity of its wall in the presence of decompensated obstruction. The imposition of a purse string suture on the thinned intestine in conditions of severe intestinal obstruction can lead to a violation of the integrity of the intestinal wall and, as a result, to a violation of aseptic surgery. In addition, after burning the wall of the cecum, the vacuum between the intestinal wall and the cap will be violated due to the fact that gas from the intestinal lumen will enter the cap through the side openings. Violations of the vacuum between the cap and the dome of the cecum will lead to leakage of intestinal contents between the wall of the intestine and the tube, and accordingly to a violation of asepsis.

 A known method of decompression of the intestine on the operating table with intestinal obstruction using a probe inserted through the open lumen of the intestine, mobilized, crossed distal to the tumor and brought outside the surgical field [3]. The delimitation of the intestine from the abdominal cavity is carried out using a plastic film and towels.

 The disadvantage of this method of colon decompression on the operating table is the high probability of infection of the abdominal cavity due to the inability to completely isolate it from the intestinal contents using towels and a plastic film.

 A known method of evacuating the contents of the intestine with obstruction [4] using a conductor tube with a probe inserted through the open lumen of the intestine, removed from the surgical field. Differentiation of the intestine from the abdominal cavity is done with oilcloths and towels.

 The disadvantage of this method of colon decompression on the operating table is also a high probability of infection of the abdominal cavity due to the impossibility of its complete isolation from intestinal contents with oilcloth and towels.

 As a prototype, a device was chosen, which is a bag for placing organs [5], consisting of a 40x40 cm cellophane container with double walls along the edge, a braid for tightening the edges, fastening elements to the operating linen, which coincides in technical essence.

 The disadvantages of the bag are that it cannot be used for intraoperative decompression of the colon with tumor obstruction due to the lack of a mechanism for reliable fixation of the colon in its lumen, the need to open the lumen of the intestine outside the cavity of the bag. In this regard, the use of a bag for intraoperative decompression of the colon with tumor obstruction will inevitably lead to infection of the surgical field.

 The invention solves the problem of ensuring aseptic emptying of the proximal intestines during surgery for obstructive and strangulation intestinal obstruction.

 The task is carried out by the fact that the device for emptying the proximal intestine during the operation is an operating stall receiver, made in the form of an elastic bag in the form of a sleeve with a plugged one end, and the other open end of which is made in the form of a neck in the shape of a truncated cone, screwed into the lumen of the sleeve a narrow base of the cone, and the walls of which are a continuation of the walls of the sleeve, while the wide base of the truncated cone of the neck is equipped with a drawstring containing a tape retainer located in there are two pockets of different sizes on the walls of the bag opposite each other, in addition, the base of the larger pocket on the outside is also equipped with a drawstring containing a belt clip located in the circular channel from the double walls of the bag, and inside the smaller pocket a cutting device is installed with a cutting element that extends from its housing into the cavity of the sleeve, and on the outside the elastic bag is equipped with two handles located between the pockets of the bag. The cutting device is made of a housing, a clamp and a blade, the housing being connected to the clamp using a pin, and the blade is made of elastic material, one end of which is pointed and plays the role of a blade, the other is curved in radius and plays the role of a spring between the housing and the clamp.

 These significant distinguishing features of the claimed kalopriemnik provide a solution to the problem, which consists in ensuring aseptic emptying of the proximal intestines during surgery, reliable isolation of intestinal contents and remote preparation from contact with personnel, maintaining a strict sanitary regime in the operating room.

The essence of the inventive kalopriemnik illustrated by illustrations:
FIG. 1 - General view of the inventive kalopriemnik;
FIG. 2 - cutting device;
FIG. 3 - the intersection of the intestine stitched with a hardware suture below the obstacle;
FIG. 4 - placing the crossed intestine with a tumor in a large pocket of the sleeve;
FIG. 5 - fixation of the intestine in a large pocket of the bag by the drawstring of a large pocket;
FIG. 6 - opening of the lumen of the stretched proximal part of the intestine inside the bag;
FIG. 7 - emptying of intestinal contents (feces and gases) into the sleeve of the bag;
FIG. 8 - flashing and cutting off the proximal part of the intestine located in the sleeve of the bag, and isolation of the removed preparation from feces.

 The inventive kalopriemnik consists (Fig. 1) of an elastic bag in the shape of a sleeve 1 with a muffled end 2, the other open end 3 is made in the form of a neck 4 in the shape of a truncated cone, screwed into the lumen of the sleeve 1 with a narrow base of the cone, the walls of which are an extension of the walls of the sleeve, the wide base of the truncated neck cone 5 is equipped with a drawstring 6 containing a tape retainer 7 located in a circular channel from doubled walls of the bag, two pockets of different sizes are located on the walls of the bag opposite each other, the base 8 is larger of the first pocket 9 is provided on the outside with a drawstring 10 containing a belt clip 11 located in the circular channel of the double walls of the bag, inside the smaller pocket 12 there is a cutting device 13, which consists (Fig. 2) of the housing 14, which is pulled out by pressing the movable handle 17 of the cutting element 15, which slides back under the influence of the spring 18 into the housing of the cutting device after the pressure on the handle ceases, from the outside the elastic bag is equipped with two handles 16 located between the pockets of the bag.

 The inventive kalopriyemnik use so.

 Example. Patient M., medical history No. 522, was admitted on February 18, 1998 with a diagnosis of cancer of the sigmoid colon, stage 3, acute intestinal obstruction. After unsuccessful attempts to conservatively resolve intestinal obstruction, the patient was taken for surgery. They performed a laparotomy, revision of the abdominal organs: the loops of the colon are sharply swollen, the tumor is localized in the initial section of the sigma. Palpation in the liver and other organs of metastases was not found. It was decided to perform a primary reduction radical left-sided hemicolectomy with emptying the extended intestinal loops during surgery using the inventive device. The sigmoid and descending colon, splenic angle and distal part of the transverse colon were mobilized. Below the tumor, 4 cm the intestine was stitched with a hardware suture twice and dissected between the sutures (Fig. 3). The mobilized proximal intestine along with the tumor was inserted through the neck 4 into a large pocket 9 (Fig. 4) and fixed in it by tying the tape lock 11 of the drawer 10 above the tumor (Fig. 5). Having pressed the movable handle 17 of the cutting device 13, the cutting element 15 was pulled out of its body 14, which opened the lumen of the extended intestine above the tumor (Fig. 6). The contents of the extended colon were evacuated into the bag (Fig. 7). The drawer 6 was tightened with the retainer 7 until the intestinal lumen completely overlapped at the level of its resection border, after which the intestine was sutured with a hardware suture proximal to the fixation and cut off (Fig. 8). The removed preparation with intestinal contents was taken out in a bag from the operating room, where the contents of the intestine were separated from the preparation, the sleeve of 1 bag was bandaged with two ligatures, crossed between them. The contents isolated in the bag were disposed of, the drug was sent for histological examination. The operation was completed by the primary restoration of continuity of the colon with end-to-end duplicate anastomosis. The postoperative course is smooth. Bacteriological culture from the operating room did not reveal the growth of pathological flora.

 Using the inventive kalopriemnik operated 11 patients with tumors of the right and left half of the colon, rectosigmoid department. No purulent-septic complications were noted.

 The advantages of the inventive kalopriemnik are that the stage of emptying the extended intestinal loops is isolated from the surgical field and the operating environment, minimizes the risk of purulent-septic and peritoneal complications and failure of anastomotic sutures. Reliable fixation of the intestine with the tumor in the bag, which is achieved by tying the tape fixator over the tumor, placed in a large pocket, ensures reliable retention of the intestine with the tumor in the lumen of the bag even after the intestine begins to change its diameter after the emptying begins when the lumen is opened. Using a cutting device with a retractable cutting element eliminates the violation of the integrity of the elastic bag as a result of accidental injury to the bag by the cutting element.

 Literature.

 1. Zyubritsky N.M., Slabinsky V.V. The use of intestinal decompression in case of obstruction // Clinical surgery. - 1991. - N 2. - S. 24-26.

 2. Butsenko V.N., Dzherelyi B.N., Akhrameev V.B. The method of decompression in obstructive obstruction of the colon of tumor etiology // Clinical Surgery. - 1988. - N 5. - S. 66-67.

 3. Topuzov EG Diagnosis and treatment of acute intestinal obstruction in colon cancer // Bulletin of Surgery. - 1989. - N 12. - S. 76-78.

 4. Durda I.I. The method of simultaneous evacuation of intestinal contents during obstruction // Clinical Surgery. - 1990. - N 4. - S. 77-78.

 5. Senyutovich R.V. Bag for placement of organs. Patent of the Russian Federation N 2028162, A 61 M 25/00. Announced on 02.27.91. Published 02/09/95. Bull. N 4.

Claims (2)

 1. Operational kalopriemnik containing an elastic bag-collector and fixation elements, characterized in that the bag-collector is made in the form of a sleeve with a muffled one end, and the other open end is made in the form of a neck in the shape of a truncated cone, screwed into the lumen of the sleeve with a narrow base the cone and the walls of which are a continuation of the walls of the sleeve, while the wide base of the truncated neck cone is equipped with a drawstring containing a tape retainer located in the circular channel from the double walls of the bag, in addition, and on the walls of the bag opposite each other there are two pockets of different sizes, the base of the larger pocket on the outside being also equipped with a drawstring containing a belt clip located in the circular channel from the double walls of the bag, and a cutting device with a cavity extending from its body inside the smaller pocket is installed sleeves with a cutting element, while on the outside the elastic bag is equipped with two handles located between the pockets of the bag.  2. The kalopriemnik according to claim 1, characterized in that the cutting device is located inside the smaller pocket, is equipped with a cutting element that extends into the cavity of the sleeve and consists of a housing, a clip and a blade, the housing being connected to the clip using a pin, and the blade is made of elastic material and the working end is pointed, and the other is bent along the radius and plays the role of a spring between the body and the clamp.

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