RU2195970C2 - Method for draining and healing intracavitary pathological focus - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: device has mounting polymer monofiber light guide member of 0.5 mm diameter and at least 40 cm in length after performing surgical intervention in risk zone. Its proximal end is melted in flame and fixed in a zone having no blood vessels. The distal end is fixed on skin surface. Laser radiation of low intensity is applied in postsurgical period. Wavelength is equal to 0.63 mcm, power is equal to 1.8-2.0 mW. The treatment is administered daily twice a day for 20- 30 min during 4-10 days. Complications occurring, drain is introduced via the light guide. Healing is carried out with sequentially applied solutions. Freshly prepared ozonized Ringer solution having 2.5 mg/l ozone concentration, electrochemically activated water as anolyte of 2.4-2.6 pH are applied twice a day during 7-14 days. EFFECT: enhanced effectiveness of postoperative purulent complication prophylaxis. 2 cl

Description

 The invention relates to medicine, in particular to surgery.

 The closest method of the same purpose to the claimed invention according to the totality of features is a method that includes summing up the drainage to the focus of pathology (see USSR author's certificate N1673070, class A 61 B 17/00, A 61 M 25/08, 1991), adopted prototype.

For reasons that impede the achievement of the following technical result when using the known method adopted for the prototype, is that in the known method:
1. Use a fishing line that is passively located in the area of the focus of the pathology as a drainage guide, but does not actively affect the focus of the pathology;
2. Do not fix to the pathology focus of the proximal end of the fishing line, which may shift away from the pathology focus and not fulfill its directing function to the pathology focus;
3. Do not carry out processing of the end face of the proximal end of the fishing line, which can cause traumatic injuries of the focus of pathology and the walls of the cavity.

 The invention consists in the following. The task of the invention is to increase the efficiency and quality of postoperative management of patients, prevention of postoperative purulent complications, ensuring adequate intracavitary drainage and rehabilitation of the pathological focus. The technical result is an increase in the efficiency and quality of postoperative management of patients, prevention of postoperative purulent complications, ensuring adequate intracavitary drainage and rehabilitation of the pathological focus. The specified technical result in the implementation of the invention is achieved by the fact that in the known method, under the general anesthesia after performing abdominal surgery in the risk zone for complications, a polymer monofilament fiber with a diameter of 0.5 mm and a length of at least 40 cm is installed, the proximal end of which is fused with flame and converted an end face in a hemispherical shape with a smooth surface without increasing the width of the fiber at the end, while the proximal end of the fiber is fixed with a thin catgut ligature 3/0 on the atraumatic needle in the cavity of the surgical intervention in the risk zone for complications in the avascular zone and bring the distal end of the fiber to the patient’s skin by piercing the cavity wall with a small-diameter trocar, strengthen the fiber twice to the patient’s skin with a ligature and medical adhesive plaster, carried out in the postoperative period laser irradiation of the surgical cavity in the risk zone of complications with low-intensity laser radiation with a wavelength of 0.63 microns and a power of 1.8-2.0 MW for 4-10 days twice daily for 20-30 minutes, fail when complications develop, in the form of a pathological lesion, along the fiber, as a guide, drainage to the pathology, remove the fiber after establishing drainage and do not reuse the fiber, carry out rehabilitation of the pathological focus sequentially with freshly prepared ozonized Ringer's solution with an ozone concentration of 2.5-3.0 mg / L and ionized volume-charged electrochemical activated tap water (anolyte) with a pH of 2.4-2.6 dv and once a day for 7-14 days and drain the pathological lesion by the failed drainage, remove the drainage after eliminating the pathological lesion.

 This ensures high efficiency and quality of postoperative management of patients, prevention of postoperative purulent complications, adequate intracavitary drainage and rehabilitation of the pathological focus.

Moreover, it is essential that the method:
1. Provides an active impact on the risk zone for the development of a complication by irradiating it with low-intensity laser radiation through a light guide, which is also used as a drainage guide to the source of a pathology. Irradiation of the risk zone for complications with low-intensity laser radiation improves tissue microcirculation, metabolic and other processes in the risk zone for complications, and in most cases prevents the occurrence of a possible complication.

 2. Provides fixation to the risk zone for complications of the proximal end of the fiber, which does not move away from the zone of formation of the pathology focus and precisely performs its guiding function.

 3. Provides processing of the end of the proximal end of the fiber and turns the end of the fiber into a hemispherical shape with a smooth surface, which prevents damage to the risk zone of complications and the walls of the cavity, which is very important.

 4. Allows for the prevention of postoperative purulent complications during the operation by refusing to establish cavity drainage in the operation to the risk zone of complications and excluding the secondary infection of the cavity where surgery was performed through its cavity.

 5. Provides tight and reliable fixation of the drainage in the channel formed by the light guide installed in the operation, when it is brought to the focus of the pathology.

 6. Provides control and adequacy of drainage of any cavity where surgery was performed.

 7. Allows you to refuse repeated surgery to drain the pathological lesion in the cavity where surgery was performed and where a complication occurred in the risk zone of complications.

 8. Allows you to adequately reorganize the resulting focus of the pathology with the development of complications in the cavity of the surgical intervention.

 This ensures high efficiency and quality of postoperative management of patients, prevention of postoperative purulent complications, adequate intracavitary drainage and rehabilitation of the pathological focus.

 An analysis of the prior art by the applicant, including a search by patent and scientific and technical sources of information and identification of sources containing information about analogues of the claimed invention, made it possible to establish that the applicant did not find a source characterized by features that are identical (identical) to all essential features of the claimed invention. The definition from the list of identified analogues of the prototype, as the closest in the totality of the features of the analogue, allowed us to establish a set of significant distinctive features in relation to the applicant’s perceived technical result in the claimed method set forth in the claims.

 Therefore, the claimed invention meets the condition of "novelty."

To verify the compliance of the claimed invention with the condition "inventive step", the applicant conducted an additional search for known solutions in order to identify features that match the distinctive features of the claimed method from the prototype. The search results showed that the claimed invention does not follow explicitly from the prior art for the specialist, since the influence of the transformations provided for by the essential features of the claimed invention is not revealed from the prior art determined by the applicant to achieve a technical result. In particular, the claimed invention does not provide for the following transformations:
- addition of a known product by any known part (s) attached to it (by) according to known rules, in order to achieve a technical result in respect of which the effect of such an addition is established;
- replacement of any part (s) of a known product with another known part to achieve a technical result, in respect of which the effect of such a replacement is established;
- the exclusion of any part (element, action) of the product with the simultaneous exclusion of its function and the achievement of the usual result for such exclusion (simplification, reduction of mass, dimensions, material consumption, increased reliability, reduced process time, etc.);
- an increase in the number of elements of the same type, actions to enhance the technical result, due to the presence in the tool of just such elements, actions;
- the implementation of a known tool or part (s) of a known material to achieve a technical result due to the known properties of this material;
- the creation of a tool consisting of known parts, the choice of which and the relationship between them are based on known rules, recommendations, and the technical result achieved in this case is due only to the known properties of the parts of this tool and the relationships between them.

 The described invention is not based on a change in a quantitative sign (s), the presentation of such signs in relationship or a change in its form. This refers to the case when the fact of the influence of each of these characteristics on the technical result is known, and new values of these signs or their relationship could be obtained on the basis of known dependencies and patterns.

 Therefore, the claimed invention meets the condition of "inventive step".

 Information confirming the possibility of carrying out the invention with obtaining the above technical result: under general anesthesia after performing abdominal surgery in the risk zone for complications, a polymer monofilament fiber with a diameter of 0.5 mm and a length of at least 40 cm is installed, the proximal end of which is fused with flame and turns its end in a hemispherical shape with a smooth surface without increasing the width of the fiber at the end, while the proximal end of the fiber is fixed with a thin catg with a 3/30 new ligature on an atraumatic needle in the surgical intervention cavity in the risk zone for complications in the avascular zone and bring the distal end of the fiber to the patient’s skin by piercing the cavity wall with a small diameter trocar, strengthen the fiber twice to the patient’s skin with a ligature and medical adhesive plaster, the postoperative period, laser irradiation of the cavity of the surgical intervention in the risk zone of complications by low-intensity laser radiation with a wavelength of 0.63 μm and with a power of 1.8-2.0 mW for 4-10 days, twice daily for 20-30 minutes, fail when complications develop, in the form of the formation of a pathological focus, along the optical fiber as a guide, drainage to the pathology focus, the optical fiber is removed after the drainage is established and the fiber is not used again, sanitation of the pathological focus is carried out with successively freshly prepared ozonated Ringer's solution with an ozone concentration of 2.5-3.0 mg / l and ionized volume-charged tap drinking water activated by the electrochemical method (anoli om) at pH 2.4-2.6, twice a day for 7-14 days and drain pathological center let down drainage, drainage removed after elimination of pathological nidus.

 Example 1. Patient L., 35 years old. He was admitted to the hospital for treatment of gallstone disease in an emergency. The patient was operated on. In the operation, acute gangrenous cholecystitis was diagnosed. A cholecystectomy was performed with treatment of the gallbladder bed with high-intensity laser radiation and a polymer monofilament fiber with a diameter of 0.5 mm and a length of 40 cm was brought to the bottom of the bed, the proximal end of which was fused with flame until its end turned into a hemispherical shape with a smooth surface without increasing the fiber width by end, while the proximal end of the fiber was fixed with a thin catgut ligature 3/0 on an atraumatic needle in the bottom of the gallbladder bed in the risk zone of complications and the distal the end of the fiber to the skin by piercing the abdominal wall with a small-diameter trocar, the fiber was strengthened twice to the skin with a ligature and a medical adhesive plaster, in the postoperative period, laser irradiation of the operative cavity and the risk zone of complications with low-intensity laser radiation with a wavelength of 0.63 μm was performed and capacity of 2.0 mW for 4 days every day twice in 20 minutes. On the fifth day after the operation, a control ultrasound examination of the abdominal organs in the area of the bottom of the gallbladder revealed a hypoechoic formation with a diameter of 3 cm. As a guide, a drain was brought to the focus of the pathology, the fiber was removed after the drain was established, and 4 ml of turbid liquid was evacuated through the drain , sanitized the pathological lesion with successively freshly prepared ozonated Ringer's solution with an ozone concentration of 2.5-3.0 mg / L and ionized volume-charged activated elec ical method potable tap water (anolyte) having a pH 2.4-2.6, twice a day for 10 days and performed external drainage pathological focus set drainage, drainage removed mounted after the elimination of pathological nidus. The patient was discharged from the department after 12 days from the moment of surgery in satisfactory condition.

 Example 2. Patient D., 30 years old. Received treatment in a clinic for acute cholecystitis. Conducted conservative therapy did not give the desired result. The patient was operated on. In the operation, acute gangrenous cholecystitis was diagnosed. A cholecystectomy was performed with treatment of the gallbladder bed with high-intensity laser radiation and a polymer monofilament fiber with a diameter of 0.5 mm and a length of at least 45 cm was brought to the bottom of the bed, the proximal end of which was fused with a flame until its end turned into a hemispherical shape with a smooth surface without increasing width the fiber at the end, while the proximal end of the fiber was fixed with a 3/0 thin catgut ligature on an atraumatic needle in the bottom of the gallbladder bed in the risk zone of complications and brought the distal end of the fiber to the skin by piercing the abdominal wall with a small-diameter trocar, the fiber was strengthened twice to the skin with a ligature and medical adhesive plaster, in the postoperative period, laser irradiation of the surgical intervention cavity and the risk zone of complications with low-intensity laser radiation with a wavelength of 0.63 μm was performed and power of 1.8 mW for 5 days every day twice for 30 minutes. On the sixth day after the operation, a control ultrasound examination of the abdominal organs in the area of the bottom of the gallbladder revealed a hypoechoic formation with a diameter of 3.5 cm. The fiber was guided to the pathology site as a guide, the fiber was removed after the drain was established, 5 ml was evacuated by drainage turbid fluid, sanitized the pathological focus sequentially with freshly prepared ozonated Ringer's solution with an ozone concentration of 2.5-3.0 mg / l and ionized volume-charged activated electric ktrohimicheskim method piped drinking water (anolyte) having a pH 2.4-2.6, twice a day for 13 days and performed external drainage pathological focus set drainage, drainage removed mounted after the elimination of pathological nidus. The patient was discharged from the hospital in satisfactory condition 14 days after the operation.

 The method was originally applied in 36 patients. Only in 10 patients there was a need to establish drainage to the focus of pathology due to the developed complications. Moreover, prevention of postoperative purulent complications was performed in 26 patients, and adequate intracavitary drainage and active rehabilitation of the pathological focus were performed in 10 patients, which led to recovery.

 During operations in patients, we noted all the manifested positive aspects of our proposed method of intracavitary drainage and rehabilitation of the pathological focus.

 The feasibility of applying the method is obvious.

Thus, the above information indicates the fulfillment when using the claimed invention (method) of the following set of conditions:
- a tool embodying the claimed method in its implementation, is intended for use in industry, namely in medicine, in particular in surgery;
- for the claimed method in the form described in the independent clause of the claims, the possibility of its implementation using the means and methods described in the application or known prior to the priority date is confirmed.

 Therefore, the claimed invention meets the condition of "industrial applicability".

Claims (2)

 1. A method of sanitizing a pathological focus, including bringing drainage to the pathological focus, characterized in that after performing abdominal surgery in the risk zone for complications, a polymer monofilament fiber with a diameter of 0.5 mm and a length of at least 40 cm is installed, the proximal end of which is melted and fixed in the avascular zone, and the distal end is strengthened on the skin; in the postoperative period, laser irradiation is performed with low-intensity laser radiation with a wavelength of 0.63 μm and a power of 1.8-2.0 mW for 4-10 days daily twice for 20-30 minutes.  2. The method according to p. 1, characterized in that during the development of complications along the fiber, drainage is brought to the pathological focus and its sanitation is carried out successively with freshly prepared ozonated Ringer's solution with an ozone concentration of 2.5-3.0 mg / l and activated by the drinking water electrochemical method water in the form of anolyte with a pH of 2.4-2.6 twice a day for 7-14 days