RU2286097C1 - Method for cavitary draining after surgical interference upon small pelvic organs - Google Patents

Abstract

FIELD: medicine, coloproctology.

SUBSTANCE: one should fulfill cavitary drainage after surgical interference upon small pelvic organs due to access at cavitary side being at 3-4 cm against transitional fold in projection of sciatic-rectal fossa of 4-6 cm length at keeping ano-coccygeal ligament. One should introduce drainage, a sanitizing tube with perforation openings which should be fixed at skin level. Then it is necessary to fulfill cavitary sanitation with antiseptic solutions. Drainage is designed as a corrugated fan-shaped sheet made of polyethylene. Part of drainage to be introduced into cavity should be divided into three lobes with two incisions coming from the upper edge towards inferior one for two thirds against drainage height. According to decreased cavitary exudation one should remove drainage gradually. So, it is useful to fulfill additional incisions from drainage inferior edge being opposite those incisions that come from the upper edge and connect incisions. Moreover, one should fulfill at first one incision from inferior edge and remove one marginal lobe, then - the second incision from inferior edge and remove the second marginal lobe. After that, it is necessary to remove sanitizing tube with central lobe. Thus, in case of minimally traumatizing access the present innovation provides better cavitary sanitation and drainage after carrying out surgical interference upon small pelvic organs due to improved drainage construction applied.

EFFECT: higher efficiency of draining.

1 ex, 3 dwg

Description

The invention relates to medicine, in particular to coloproctology.

Modern medicine has many methods for drainage of the pelvic cavity, but not one of them is not optimal. (“Prevention of postoperative, purulent-inflammatory complications in colorectal surgery”, Krasnoyarsk, AA Vakharchenko, 1999.)

The need for this drainage arises among coloproctologists and surgeons as one of the final stages in operations on the pelvic organs.

By the nature of the drainage of the pelvic cavity can be divided into 4 groups:

A known method of drainage of the pelvic cavity with a gauze swab inserted from a partially unstitched crotch. ("Neoplasms of the rectum and sigmoid colon" S. A. Holdin, 1977, p. 237.)

The disadvantages of the method:

1. The lack of adequate drainage due to the impregnation of the tampon and violation of the outflow of wound discharge.

2. High risk of infection.

3. A long period of wound healing.

Known staging microirrigation and drainage of various diameters for washing the pelvic cavity with antiseptic solutions from multiple sections in which the tubes are located. (“Clinical operative coloproctology” by G.I. Vorobyov, VL Rivkin, 1994, p. 217). From the perineum, the surgeon makes additional cuts of the skin and subcutaneous tissue to the left behind the anal canal at a distance of 3-4 cm and right front from him at the same distance. Through these cuts from the side of the abdominal cavity, a drainage tube and a microirrigator are alternately held with multiple perforations at their ends, which are placed in the pelvic cavity. The left posterior drainage and microirrigator are laid along the front surface of the sacrum so that the microirrigator is 3-4 cm above the drainage tube. The right front drainage and microirrigator are fixed to the tissues so that the microirrigator is 2-3 cm above the drainage tube. Wash the pelvic cavity with a large amount of liquid solution with the addition of antibiotics to the last portion. The fluid that is injected into the pelvic cavity is poured through the drainage tubes on the perineum into the bottles.

The disadvantages of the method:

1. Late activation of the patient.

2. Obstruction of drainage systems with blood clots.

3. The need for frequent changes in underwear and bedding.

4. Significant consumption of antiseptic agents and dressings.

5. High probability of infection.

The closest is the method of drainage with a silicone tube, which is installed, fixed. The method includes performing access on the side of the cavity 3-4 cm from the transitional fold in the projection of the sciatic-rectal fossa 4-6 cm long. A drain is introduced, a sanitizing tube with perforations that are fixed at the skin level. Sanitation of the cavity is carried out with antiseptic solutions. ("Colorectal cancer" VD Fedorov, 1987, p. 256.)

The disadvantages of the method:

1. The need for staging from 2 to 4 drainage tubes.

2. The increase in the diameter of the tubes.

3. Limiting the activity of the patient.

4. Obstruction of drainage tubes with blood clots.

5. High probability of infection.

6. High probability of a pressure sore.

The objective of the invention with minimally traumatic access is to provide better sanitation and drainage of the cavity formed after performing surgery on the pelvic organs, due to the design of the drainage.

When using the proposed method improves drainage of the cavity due to the larger area of rehabilitation. Clots do not form on the smooth surface of the drainage, and it is not impregnated with the discharge, this improves the outflow. Drainage occurs on both surfaces of the drainage, which has a significantly larger area than the known drainage.

The efficiency of rehabilitation is also improved due to the fact that the drainage is divided into three petals and when the cavity is sanitized, the solution can wash both planes of the drainage.

The method allows to accelerate the early activation of the patient. Reduce the risk of postoperative complications. Reduce the period of disability and improve the quality of life of the patient.

The task is achieved in that the drainage of the cavity after surgery on the pelvic organs is performed by access on the side of the cavity 3-4 cm from the transition fold in the projection of the sciatic-rectal fossa 4-6 cm long, while preserving the ano-coccygeal ligament. A drain is introduced, a sanitizing tube with perforations that are fixed at the skin level. The cavity is sanitized with antiseptic solutions. The drainage is made in the form of a corrugated fan-shaped sheet of polyethylene. The part of the drainage introduced into the cavity is divided by two cuts going from the upper edge to the lower edge by 2/3 of the drainage height into three petals. The sanitizing tube is placed at the level of the middle lobe. As exudation decreases from the cavity, drainage is removed in stages. To do this, perform additional cuts from the lower edge of the drain opposite the cuts going from the upper edge, connect the cuts. In this case, one cut is first made from the lower edge and one extreme lobe is removed, then a second cut is made from the lower edge and the second extreme lobe is removed. After that, the sanitizing tube with the central lobe is removed.

The novelty of the proposed method is that:

- The drainage is made in the form of a corrugated fan-shaped sheet of polyethylene. Use food polyethylene, which is inert, is easily cut, which allows you to simulate it in place depending on the size and shape of the cavity. Drainage is easily trimmed, shortened.

The shape of the surface of the drainage contributes to a better outflow of exudate from the wound. The surface is smooth and no clots form on it. Both surfaces of the drainage work, due to the corrugation, the drainage area increases, and the bends better ensure the collection and flow of exudate from the wound.

- The shape of the drainage in the form of a fan-shaped sheet allows you to cover the entire cavity.

- The part of the drainage introduced into the cavity is divided by two cuts going from the upper edge to the lower edge by 2/3 of the drainage height into three petals.

Cuts allow aseptic solutions to evenly distribute in the cavity and penetrate to another surface of the drainage. The design provides further phased removal.

- The sanitizing tube is placed at the level of the middle lobe.

Which contributes to a uniform distribution of the supplied aseptic solution.

- As the exudation from the cavity decreases, the drainage is removed in stages. To do this, perform additional cuts from the lower edge of the drainage opposite the cuts going from the upper edge, connect them. First, make one cut from the bottom edge and remove one extreme lobe. As the cavity closes and its volume decreases, a second cut is made from the lower edge, connect it to the upper cut, and the second extreme lobe is separated and removed.

During treatment, there is a decrease in the cavity and a decrease in exudation, so the need for a large drainage disappears, and the design allows it to be reduced if necessary.

- Remove the sanitizing tube with the central lobe.

Our proposed method has a new set of essential features that are not found by us in previously published sources. The method gives, when using it, a new technical result that allows to improve the rehabilitation of the cavity, significantly reduce the risk of postoperative suppuration of the pelvic cavity, produce early activation of the patient and get good functional results.

The method is illustrated by the drawings shown in Fig.1-3.

Figure 1 - shows a drainage diagram in a direct projection.

Figure 2 is a side view.

Figure 3 is a bottom view.

In the drawings: 1 - skin, 2 - rectum, 3 - sacrum, 4 - fan-shaped corrugated drainage, 5 - sanitizing tube, 6 - ano-coccygeal ligament.

The method is as follows: access is made by oval skin incision 1 of a length of 4-6 cm, from 3 to 5 hours to the left of the anus 3-4 cm from the transition fold in the projection of the sciatic-rectal fossa, while maintaining the ano-coccygeal ligament 6. Through the ischiorectal fossa with dilution of the levators with a “blunt” method starts drainage 4 in the form of a corrugated fan-shaped sheet made of polyethylene. The part introduced into the cavity is divided by two cuts extending from the upper edge to the lower edge at 2/3 of the height into three petals. A sanitizing tube 5 with perforated holes at the apex is fixed to the central petal in the center and to the skin. In the early postoperative period (from 1 to 4 days), the pelvic cavity is sanitized with antiseptic solutions with the discharge of wound exudate, blood clots along corrugated fan-shaped drainage from polyethylene 4. In the next day, as the cavity decreases and exudation from the wound, the side lobes are phased out preservation of the central lobe of the drainage and the sanitizing tube 5, which allows, if necessary, to continue active rehabilitation, with the subsequent removal of the remaining drainage system. Phased drainage is as follows. An additional incision is made from the lower edge of the drainage, which protrudes from the wound, opposite the incision going from the upper edge to their connection. One petal is thus completely separated from the drainage 4 and removed from the wound. Then, a second incision is made similarly and the second marginal lobe is removed. Then remove the sanitizing tube 5 with a central lobe. Since polyethylene is easily cut with scissors, you can cut its lower edge under the bandage. It is easy to model the height of the drainage by cutting it off and the area by changing the degree of fan opening, depending on the volume and size of the postoperative cavity.

Clinical example. Patient K., aged 59, was hospitalized in the hospital with complaints of constipation, blood stool, weakness, and malaise. During the examination, the patient was diagnosed with cancer of the middle ampullar part of the rectum (lower edge of the tumor in 6 centimeters). The patient underwent surgery: peritoneal anal resection of the rectum with sigmoid reduction into the anal canal, with the application of a coloanal anastomosis. The pelvic cavity is drained by drainage in the form of a corrugated fan-shaped sheet of polyethylene and a sanitizing tube, which are fixed to the skin. From the first day, the tube is elongated and lowered into a container for collecting exudate. From 2 days, the pelvic cavity was sanitized with antiseptic solutions. On the 3rd day, the drainage was cut under the bandage, which allowed for early activation of the patient. On the 5th day, one of the lateral parts of the three-leaf corrugated fan-shaped drainage was removed and on the 6th day the subsequent one. On the 9th day, the entire remaining drainage system was removed. After removal, the wound closed on its own within two weeks.

This method was used in 57 patients; there were no complications associated with this method of drainage.

Our method of draining the pelvic cavity after surgical interventions can significantly reduce the risk of postoperative suppuration, shorten the period of temporary disability and significantly improve the quality of life of patients and can be recommended in practical coloproctology and oncology.

Claims (1)

A method for draining a cavity after surgery on the pelvic organs, including accessing on the side of the cavity 3-4 cm from the transitional fold in the projection of the sciatic-rectal fossa 4-6 cm long, introducing drainage, a sanitizing tube with perforations fixed at the skin level sanitation of the cavity with antiseptic solutions, characterized in that the drainage is made in the form of a corrugated fan-shaped sheet of polyethylene, part of which is introduced into the cavity by two cuts extending from the upper edge to the lower edge at 2/3 of the drainage height by three petals, the sanitizing tube is located at the level of the middle petal, as the exudation decreases from the cavity, the drainage is removed in stages, for which additional cuts are made from the lower edge of the drainage opposite to the cuts going from the upper edge, connect they are first made one cut from the lower edge and remove one extreme petal, then a second cut is made from the lower edge and the second extreme petal is removed, after which the sanitizing tube with the central petal is removed.

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