RU2311877C1 - Method for draining cavitary neoplasms of abdominal cavity - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: it is necessary to dissect a round ligament against anterior abdominal wall in umbilical area, introduce a button probe through distal end of a patient's round ligament in projection of anterior hepatic edge, apply a drainage tube through a round ligament of liver to withdraw it through the round ligament's peritoneum in area of anterior hepatic edge. One should introduce the drainage tube into the lumen of cavitary neoplasm in abdominal cavity, dissect a falciform ligament against the liver and the diaphragm with the help of two parallel incisions their length being twice as more the distance against anterior hepatic edge up to anterior abdominal wall. Then it is important to make a foramen in the cut fragment that corresponds to external diameter of the drainage tube to guide the latter through the foramen. The cut fragment of falciform ligament should be folded in two being above the part of drainage tube located between anterior hepatic edge and the foramen made, as for the drainage tube it should be withdrawn onto anterior abdominal wall. The innovation in question enables to exclude extravasation of cyst's content along the drainage tube and decrease the risk for the development of peritonitis.

EFFECT: higher efficiency of drainage.

3 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used for the treatment of pancreatic cysts and drainage of abdominal cavity formations.

There is a method of drainage of pancreatic cysts, which consists in removing its contents during puncture, opening the capsule, suturing the cyst wall to the parietal peritoneum (Matyashin IM, Gluzman A.M. "Directory of surgical operations." Kiev: Health, 1979, p.167).

The above method has a significant drawback: not in all cases it is possible to hem the cyst wall to the anterior abdominal wall without tension, which creates conditions for leakage of the contents of the cyst into the abdominal cavity with the development of peritonitis.

As a prototype, we have chosen a method consisting in transumbilical drainage of the common bile duct. (Halperin E.I., Kuzovlev N.F., Karagyulyan SR "Cicatricial strictures of the bile ducts". M: Medicine, 1982, p. 93). With transumbilical drainage of the biliary tract, drainage is carried out through the left hepatic duct and the awakened umbilical vein to the anterior abdominal wall. The above method has significant disadvantages.

1. There is a risk of venous fistula formation.

2. The method is not applicable for the drainage of formations located not in the gate of the liver.

3. Bleeding from the umbilical cord vein may occur during drainage or when it is removed.

4. Stagnant bile can serve as a source of purulent-septic complications of hematogenous infection during the formation of venous fistula.

An object of the present invention is to prevent leakage of contents from a cavity formation into the abdominal cavity.

This goal is achieved by mobilizing a round ligament, cutting it off from the anterior abdominal wall in the navel area, walking with a button probe of the tissue of the round ligament of the liver, introducing the button probe through the distal end of the round ligament, removing the button probe through the peritoneum of the round ligament in the projection of the anterior edge of the liver, fix the drainage tube to the button probe in the region of the distal end of the ligament, conduct the drainage tube through the round ligament of the liver, remove through the peritoneum of the round ligament in the region of the anterior edge of the liver, they call the remaining free part of the circular ligament at the level of the anterior edge of the liver, install a drainage tube into the lumen of the abdominal cavity formation, fix the distal round ligament with separate sutures to the tissues of the cavity formation, cut off the crescent ligament from the liver and from the diaphragm with two parallel sections twice as long the distance from the anterior edge of the liver to the anterior abdominal wall, in the middle of the distance between the anterior edge of the liver and the distal edge of the incised flap, make a hole with corresponding to the outer diameter of the drainage tube, carry out the drainage tube through the hole, fold the cut crescent-shaped ligament flap twice over the section of the drainage tube between the front edge of the liver and the hole made, separate sutures are placed on the free edges of the cut out flap, the drainage tube is brought out to the front abdominal wall, stitched with separate sutures the parietal peritoneum of the anterior abdominal wall and the cut out flap of the crescent ligament in the area of the holes through which the tube is drawn, the sutures are tightened.

The invention "A method for draining abdominal cavity formations" is new, since it is unknown from the level of medicine, namely in the surgery of diseases of the abdominal organs.

The novelty of the invention lies in the fact that they mobilize the round ligament, cut it off from the anterior abdominal wall in the umbilicus region, walk around with a button probe of the tissue of the round ligament of the liver, insert the button probe through the distal end of the round ligament, and remove the button probe through the peritoneum of the round ligament in the projection of the anterior edge of the liver , fix the drainage tube to the button probe in the region of the distal end of the ligament, draw the drainage tube through the round ligament of the liver, withdraw through the peritoneum of the round ligament in the region of the anterior edge of the liver, bind the remaining free part of the circular ligament at the level of the anterior edge of the liver, install a drainage tube into the lumen of the abdominal cavity formation, fix the distal round ligament with separate sutures to the tissues of the cavity formation, cut off the crescent ligament from the liver and from the diaphragm with two parallel sections twice as long the distance from the anterior edge of the liver to the anterior abdominal wall, holes are made in the middle of the distance between the anterior edge of the liver and the distal edge of the incised flap corresponding to the outer diameter of the drainage tube, draw the drainage tube through the hole, fold the cut crescent-shaped ligament flap twice over the section of the drainage tube between the front edge of the liver and the hole made, separate sutures are made on the free edges of the cut flap, the drainage tube is brought out to the front abdominal wall, stitched separately seams parietal peritoneum of the anterior abdominal wall and a cut flap of the crescent ligament in the area of the holes through which the tube is drawn, the sutures are tightened.

In the sources of information we were not able to find a method similar to the proposed drainage of abdominal cavity cavities.

The invention "A method for draining abdominal cavity formations" is industrially applicable, since it can be repeatedly repeated and used in healthcare for the surgical treatment of diseases of the abdominal organs in all medical institutions of a surgical profile.

The method is as follows. Establish drainage into the abdominal cavity formation transumbilical through the awakened umbilical vein. The round ligament is mobilized, it is cut off from the anterior abdominal wall in the umbilicus region, a bellied probe is used to tissue the round ligament of the liver, a button probe is inserted through the distal end of the round ligament, a button probe is inserted through the peritoneum of the round ligament in the projection of the anterior edge of the liver Figure 1 (3), fix the drainage tube to the button probe in the region of the distal end of the ligament, conduct the drainage tube through the round ligament of the liver, remove through the peritoneum of the round ligament in the region of the anterior edge of the liver, bandage the remaining free tea a round ligament at the level of the anterior edge of the liver, install a drainage tube into the lumen of the abdominal cavity formation, fix the distal round ligament with separate sutures to the tissues of the cavity formation, cut off the crescent ligament from the liver of Fig. 1 (4) and from the diaphragm of Fig. 1 (5 ) two parallel sections with a length twice the distance from the anterior edge of the liver to the anterior abdominal wall, in the middle of the distance between the anterior edge of the liver and the distal edge of the incised flap of Fig. 2 (6) make a hole corresponding to the outer diameter of the drainage tube, draw the drainage tube of Figure 2 (8) through the hole of Figure 2 (7), fold the cut flap of Figure 2 (9) of the crescent ligament in half Figure 3 (10) over the section of the drainage tube of Figure 3 ( 11) between the front edge of the liver and the hole made, separate sutures of Fig. 3 (12) are applied to the free edges of the cut flap, the drainage tube is brought out to the front abdominal wall, the parietal peritoneum of the anterior abdominal wall and the cut crescent-shaped ligament flap in the area of the openings are sutured with separate sutures, through which on the tube joints are tightened.

An example of a specific implementation of the method can serve as the following extract from the medical history. Patient X, case history No. 14227 / f, 64 years old, was treated at the place of residence in the Krasnodar Territory for acute pancreatitis in February 2005. He was admitted to the thoracoabdominal department of the Rostov Cancer Research Institute on July 21, 2005 with a diagnosis of Cyst pancreas ", where on July 22, 2005, with a laparotomy, a pancreatic cyst 4 cm in diameter was found. No other pathology in the abdominal cavity was detected. Given the current situation, it was decided to perform external drainage of the pancreatic cyst using the transumbilical method of drainage of abdominal cavity formations. A round ligament was mobilized, cut off from the anterior abdominal wall in the navel. Tissues of a round liver ligament tissue are puffed with a button probe. A button probe was inserted through the distal end of the circular ligament. A button probe was removed through the peritoneum of the round ligament in the projection of the anterior edge of the liver, a drainage tube was fixed to the button probe in the region of the distal end of the ligament. A drainage tube was drawn through the round ligament of the liver. Bred through the peritoneum of the circular ligament in the region of the anterior edge of the liver. Bandaged the remaining free part of the circular ligament at the level of the anterior edge of the liver. A drainage tube was installed into the lumen of the abdominal cavity. The distal round ligament is fixed with separate sutures to the tissues of the cavity formation. The crescent ligament is cut off from the liver and from the diaphragm with two parallel sections twice as long as the distance from the anterior edge of the liver to the anterior abdominal wall, a hole corresponding to the outer diameter of the drainage tube is made in the middle of the distance between the anterior edge of the liver and the distal edge of the incised flap. A drainage tube is drawn through the hole. A cut flap of the crescent ligament is doubled over the section of the drainage tube between the front edge of the liver and the hole made. Separate seams were laid on the free edges of the cut flap. The drainage tube is removed to the anterior abdominal wall. The parietal peritoneum of the anterior abdominal wall and the cut-out flap of the crescent-shaped ligament are sewn in separate sutures in the area of the openings through which the tube is drawn. The seams are tight.

The transumbilical technique used to drain abdominal cavity formations made it possible to exclude leakage of the cyst contents along the drainage tube and reduce the likelihood of peritonitis in the postoperative period. The proposed technique for installing drainage in the abdominal cavity formation ensured safe discharge of the patient on the 7th day.

The proposed method for drainage of abdominal cavity formations was used in the treatment of 17 patients. In no case in the postoperative period were there any complications.

The technical and economic effectiveness of the method lies in the fact that transumbilical drainage reduces the number of purulent-septic complications by eliminating leakage of the contents of the cyst along the drainage and after its removal. Carrying out transumbilical drainage can reduce the bed-day and significantly improve the quality of treatment. The transumbilical technique of draining abdominal cavity formations allows avoiding a cosmetic defect on the skin, which is impossible when draining using glove rubber along the drainage tube.

Claims (1)

A method of draining abdominal cavity formations, including installing drainage into the abdominal cavity formation transumbilically through the awakened umbilical vein, characterized in that they mobilize a round ligament, cut it off from the anterior abdominal wall in the umbilicus, wound with a bellied probe of tissue of the round ligament of the liver, enter the umbilical cord through the distal end of the round ligament, the button probe is removed through the peritoneum of the round ligament in the projection of the anterior edge of the liver, the drainage tube is fixed to the button zone In the region of the distal end of the ligament, a drainage tube is passed through the round ligament of the liver, the round ligament is removed through the peritoneum in the region of the anterior edge of the liver, the remaining free part of the round ligament is ligated at the level of the anterior edge of the liver, a drainage tube is placed into the lumen of the abdominal cavity, and the distal is fixed the division of the round ligament with separate sutures to the tissues of the cavity formation, cut off the crescent ligament from the liver and from the diaphragm with two parallel sections twice as long from the front edge of the liver to the anterior abdominal wall, a hole is made in the incised flap corresponding to the outer diameter of the drainage tube, the drainage tube is drawn through the hole, the cut crescent-shaped ligament flap is folded twice over the drainage tube section between the front edge of the liver and the hole made, separate sutures are made the free edges of the cut flap, bring the drainage tube to the front abdominal wall, stitch the parietal peritoneum of the anterior abdominal wall and the cut l Scoot sickle ligament in the holes through which the tube is carried out, the joints are tightened.

Images