RU2295302C1 - Method for draining pleural cavity after pulmonectomy - Google Patents

Abstract

FIELD: medicine, thoracic surgery.

SUBSTANCE: the present innovation deals with draining pleural cavity after surgical interference upon a lung. On carrying out manipulations upon a lung of desired volume in the upper aperture of hemithorax one should form a fold of parietal pleura to apply a drainage tube through this fold. The drainage should be kept open under sterile bandage till the moment of exudate excretion out of pleural cavity. The method enables to control the process o filling in the pleural cavity with liquid, remove accumulated gas in due time that leads to accelerated development of fibrothorax and, also, minimize the risk of pleural cavity infecting.

EFFECT: higher efficiency of drainage.

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Description

The invention relates to medicine, namely to surgery.

A known method of drainage of the pleural cavity (Errors, dangers and complications in pulmonary surgery / Edited by E.A. Wagner, V.M. Tavrovsky, 1977, pp. 226-227), which consists in the fact that the drainage installed in the lower pleural cavity, closed with a clamp, and its end falls into the water. During the first day, the drainage opens 2-3 times a day (this should be done by the doctor), to control the contents of the pleural cavity, or to rinse it with antiseptic solutions. When the fluid has leaked out, air begins to flow through the drainage and is closed.

The disadvantage of this method is the lack of objectivity in controlling the filling of the pleural cavity with liquid - blood with bleeding or exudate.

Also known is a method without drainage of the pleural cavity (Errors, dangers and complications in pulmonary surgery / Edited by E.A. Wagner, V.M. Tavrovsky, 1977, p. 226). With pulmonectomy, there is no need for constant removal of gas and liquid, and their periodic extraction is easily carried out by pleural punctures.

The disadvantage of this method is the inadequate removal of accumulating fluid in the pleural cavity, and frequent pleural punctures bring additional suffering to the patient and increase the risk of infection of the pleural cavity.

Closest to the claimed is the method proposed by L.N. Bisenkov and others (1998). Without fail, after pulmonectomy, drainage is left in the VI-VII intercostal space along the posterior axillary line. The second drainage is installed in the II-III intercostal space (Surgery of lung cancer in advanced stages of the disease / Edited by L.N. Bisenkova, S.V. Grishakova, S. A. Shalaeva, 1998, pp. 303-305).

The disadvantages of this method are: with a low location of drainage, in the region of the costal-diaphragmatic sinus, its patency may be impaired due to the closure of the raised dome of the diaphragm; touching the dome of the diaphragm with a drainage tube causes a pronounced pain effect that is difficult to stop even with narcotic analgesics, and the presence of two drainage tubes in the pleural cavity increases the risk of infection of the pleural cavity.

The technical result of the invention is to increase the objectivity of filling the pleural cavity with fluid, timely removal of gas, minimizing the risk of infection of the pleural cavity.

The technical result is achieved by the fact that the drainage tube is made of silicone material with an internal cross section of 0.7 cm, with three additional holes (drawing) is installed in the II-III intercostal space along the mid-clavicular line, through contraception (1), the inner end of the drainage tube is passed through the formed fold of the parietal (costal) pleura (2), which holds it in the upper aperture of hemithorax. The drainage tube is fixed outside with a nylon seam and remains open under a sterile dressing until the pleural discharge from it appears. Drainage functions the required number of days until the hemithorax is completely filled with exudative fluid, without a gas bubble and stabilization of the pleural contents, which accelerates the formation of fibrothorax.

Patient A., medical history No. 6630 Diagnosis: Central cancer of the right lung. Operation: extended pulmonectomy, lymphadenectomy 05/20/03.

A right anterolateral thoracotomy was made in the V intercostal space, a lung was isolated, during revision a tumor 10 × 18 cm in size grows on the bronchus to the beginning of the main bronchus. The vessels of the lung were isolated, the vessels were bandaged and crossed. The bronchus is stitched with a UKL-30 apparatus, cut off 0.5 cm from Karina, strengthened with an atraumatic thread, and pleuritized.

The stump of the bronchus was checked for leaks, no blowing was detected. Thorough hemostasis, control of foreign bodies - no.

In the III intercostal space, along the mid-clavicular line, a drainage is installed through the contraperture, an intrapleural drainage tube is drawn through the formed fold of the parietal pleura, and it is laid in the upper aperture of hemitrax. The outer end is open, laid under an aseptic dressing. The chest wound is sutured in layers, sutures on the skin, dressing. The patient is laid with a raised head end. On the drainage on the 3rd day there was a donated discharge, the drainage is blocked. 20 ml of a 1% dioxidine solution were injected daily into the drain. On days 4, 6, and 8, 150 ml of pleural contents were removed.

The patient was hospitalized from 06/17/04 to 07/15/03. The drainage was removed on the 8th day, the sutures were removed on the 11th day, and was discharged for outpatient treatment in satisfactory condition. Operated hemithorax without a gas bubble, filled with liquid.

Using the proposed method improves the objectivity of filling the pleural cavity with fluid, allows you to timely remove the gas bubble of the pleural cavity, minimizes the risk of infection of the pleural cavity, accelerates the formation of fibrothorax.

Bibliography

Errors, dangers and complications in pulmonary surgery / Ed. E.A. Wagner, V.M. Tavrovsky. - 1977, - 226-227 s.

Surgery of lung cancer in advanced stages of the disease / Ed. L.N. Bisenkova, S.V. Grishakova, S. A. Shalaev. - 1998, - 303-305 s.

Claims (1)

A method for draining the pleural cavity after pulmonectomy, characterized in that a drainage tube is installed in the pleural cavity in the upper aperture of the hemitrax, passing it through the formed fold of the parietal pleura, while the drainage is left open under a sterile dressing until the exudate leaves the pleural cavity.