RU2834559C2 - Decompression and early enteral feeding device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to abdominal surgery, and can be used for decompression and early enteral nutrition in the postoperative period when applying anastomoses with upper gastrointestinal tract. Device for decompression and early enteral nutrition in postoperative period with application of anastomosis with upper gastrointestinal tract consists of gastric probe for decompression and probe for early enteral nutrition. Probe for early enteral feeding is longer than gastric probe by 30 cm, its diameter is 2 mm. Probe for early enteral feeding is placed in one of the side holes of the gastric probe in the direction of port at 3 cm and is configured to exit from the lateral opening of the gastric probe and straighten in the abducting intestine while pulling the gastric probe to move its end through the anastomosis into the adducting intestine. Technical task is to create a new device for decompression and early enteral nutrition in order to improve the results of treating the patients with the upper gastrointestinal anastomoses.

EFFECT: wider range of technical means by creating a device for decompression and early enteral nutrition.

2 cl, 3 dwg, 1 ex

Description

The invention relates to medicine, namely to abdominal surgery, and can be used for decompression and early enteral nutrition in the postoperative period when anastomoses are applied to the upper sections of the gastrointestinal tract.

Existing analogs of gastric and intestinal tubes do not provide for separate removal of the decompression portion of the tube while leaving the feeding tube or, conversely, removal of the intestinal feeding tube while preserving the decompression tube. They are not intended for use in the imposition of anastomoses with the upper sections of the gastrointestinal tract.

Well-known analogues include the combined gastrointestinal two-channel tube (GIT) [1]. GIT is designed to evacuate gastric contents in case of gastrostasis and simultaneous tube enteral nutritional support (distal to the Treitz ligament). The tubes provide easy insertion using endoscopic equipment, reducing the risk of damage to the mucous membrane of the nasopharynx and gastrointestinal tract at the insertion stage and during long-term use. The tube is a gastric canal made of a silicone tubular element with an external diameter of 7.0 mm (No. 21) or 8.0 mm (No. 24) with 5 side holes, 1000 mm long, inside which there is an intestinal canal made of a radiopaque polyurethane tube with an external diameter of 3.0 mm (No. 9). The distal end of the intestinal canal is equipped with a polyurethane radiopaque ring tip for convenient endoscopic installation of the probe into the lumen of the small intestine. At the proximal end of the probe there is an adapter with a cover. The intestinal canal hermetically exits the gastric canal by means of a conical radiopaque silicone adapter. The length of the effective part of the intestinal canal is 500 mm. At the proximal end of the probe, the gastric and intestinal canals are separated using a Y-shaped connector. The total length of the ZZHKK probe to the Y-shaped connector is 1500 mm.

The disadvantages of the ZGKK tube include the inconvenience of its use when forming anastomoses in the upper gastrointestinal tract. In this case, it is not always possible to position the decompression and enteral channels of the ZGKK in the case of a shortened stomach after its resection or removal. The tube does not provide for separate removal of the decompression channel with the retention of the feeding tube or, conversely, removal of the intestinal channel for feeding with the retention of the decompression tube.

The closest to the claimed technical solution in terms of technical essence and achievable technical result is the Freka double-lumen nasojejunal tube [2]. This tube consists of two tubular structures, through one channel of the tube the nutrient mixture is introduced into the small intestine, and through the other channel the drainage (decompression) of the stomach is carried out. The disadvantages of this design are the impossibility of separate removal of the gastric tube and the enteral nutrition tube, as well as the high cost of this design.

The technical objective is to create a new device for decompression and early enteral nutrition in order to improve the treatment results of patients undergoing anastomoses in the upper gastrointestinal tract.

The technical result that is manifested in solving the above-mentioned problem is the expansion of the arsenal of technical means by creating a device for decompression and early enteral nutrition.

The features and advantages of the invention will become apparent from the following description and the accompanying drawings, in which:

Fig. 1 shows the component parts of the device: a gastric tube for decompression 1 and a tube for early enteral nutrition 2 with a diameter of 2-3 mm and a length of more than 30 cm than the gastric tube;

Fig. 2 illustrates the assembly of the device, carried out by inserting a tube for early enteral feeding through one of the four side openings located at the end of the gastric tube 3;

Fig. 3 illustrates the passage of a tube for early enteral nutrition through the lumen of a gastric tube towards the port by 3-4 cm.

The device is simple in design, universal in its structure and can be assembled from two PVC probes (Fig. 1). One of them is a gastric tube of suitable diameter, preferable, in terms of comfort for the patient, small diameter probes of size (Ch/Fr) No. 16, No. 18, No. 20. The second part of the device is also a PVC probe (a thin probe), which should be significantly thinner and enter the lumen of the gastric tube through a side opening, its diameter should be 2-3 mm. The thin probe should be 30 cm longer than the gastric tube. The device is assembled by inserting the thin probe through one of the four side openings located at the end of the gastric tube (Fig. 2) and passing it through the lumen in the direction of the port by 3-4 cm (Fig. 3). The finished device for decompression and early enteral nutrition is installed after anastomosis with the upper sections of the gastrointestinal tract. A thicker tube, a gastric tube, is used in this case as a guide for passing a thin tube behind the anastomosis. First, the device is passed through one of the patient's nasal passages into the esophagus and then into the stomach or intestine. In the abdominal cavity, the device is passed under the manual control of the operating surgeon through the anastomosis into the efferent colon. The surgeon fixes the thin tube in the efferent colon with two fingers. Then, the gastric tube is pulled up until the end of the tube moves through the anastomosis into the afferent section for its decompression. At this point, the thin tube fixed with the surgeon's fingers comes out of the lateral opening of the gastric tube and straightens in the efferent colon. Both tubes are fixed to the wing of the nose. In the postoperative period, the decompression gastric tube is used for passive drainage of the afferent sections, and the thin tube, located behind the anastomosis in the efferent section, is used for early enteral nutrition.

The device for decompression and early enteral nutrition is used when creating anastomoses with the upper gastrointestinal tract.

The device has been tested and successfully used in more than several thousand patients.

Clinical example

Patient Zh., 68 years old, diagnosis: pancreatic head cancer T3N0M0, functioning cholecystostomy. Before the planned surgical intervention, a device for decompression and early enteral nutrition was assembled, consisting of a standard gastric tube No. 18, 120 cm long, and a thin intestinal tube with a diameter of 2.5 mm, 150 cm long. The thin tube was inserted into the side opening of the gastric tube and moved in the lumen of the gastric tube towards the port by 3-4 cm.

A planned pylorus-preserving pancreatoduodenal resection with cholecystectomy was performed through a laparotomy approach under combined endotracheal anesthesia. During the surgical intervention, after the resection and reconstructive stages, a device for decompression and early nutrition was installed. On the first postoperative day, the patient's condition was assessed as stable, of moderate severity due to the extent of the surgical intervention. Hemodynamics were stable, body temperature was 37.4°C. The abdomen was of normal shape, pain syndrome was moderate. On palpation, the abdomen was soft, moderately painful in the area of the surgical intervention. Peritoneal symptoms were negative. Peristalsis was not heard. The patient urinated independently. 800 ml of gastric discharge was heard through the gastric tube (0 ml was introduced into the thin tube; 0 ml of liquid was drunk).

The patient is activated within the bed, drinking up to 500 ml is recommended, and 500 ml of broth is administered intravenously through a tube.

The second day after the operation. The condition is moderate. Hemodynamics are stable, body temperature is 37.2°C. The abdomen is of normal shape, pain syndrome is moderate. On palpation, the abdomen is soft, moderately painful in the area of the surgical intervention. Peritoneal symptoms are negative. Peristalsis is heard as single peristaltic waves. There was no stool, gases are not released. Active within the bed, sits up with the help of medical personnel. Over the past day, 1100 ml of stagnant gastric discharge was discharged through the gastric tube, drank 300 ml of water, 500 ml of broth was introduced into a thin tube.

Drinking up to 1000 ml is allowed; the introduction of 1000 ml of broth into a thin tube is planned.

Third day after surgery. Moderate condition. Hemodynamics are stable, body temperature is 37.3°C. The abdomen is of normal shape, symmetrically participates in the act of breathing, is not swollen. Soft on palpation, moderately painful in the area of the surgical intervention. Peritoneal symptoms are negative. Peristalsis is auscultated. There was no stool, gases are passing. Active within the bed, sits up on her own. Over the past 24 hours, up to 740 ml of gastric discharge was discharged through the gastric tube, she drank 500 ml of water, 1000 ml was inserted into a thin tube.

Drinking up to 1000 ml is allowed, and the introduction of 1500 ml of broth into a thin tube is planned.

Fourth day after surgery. Moderate condition. Hemodynamics are stable, body temperature is 37.0°C. The abdomen is of normal shape, participates evenly in the act of breathing, is not swollen. Soft and moderately painful on palpation. Peritoneal symptoms are negative. Peristalsis is auscultated. There was no stool, gases are passing. Active within the bed, sits up independently. Over the past day, up to 800 ml of discharge was excreted through the gastric tube, 1000 ml of water per os, 1000 ml was introduced into a thin tube.

Drinking up to 1000 ml is allowed, and the introduction of 1500 ml of broth into a thin tube is planned.

The fifth day after the operation. The patient's condition is satisfactory. Hemodynamics are stable, body temperature is 37.0°C. The abdomen is of normal shape, symmetrically participates in the act of respiration, and is not distended. Soft on palpation, slightly painful in the area of the surgical intervention. Peritoneal symptoms are negative. Peristalsis is auscultated. There was no stool, gases are released. The patient is active. Over the past 24 hours, 590 ml of gastric discharge was released through the gastric tube, she drank 1000 ml of liquids, 1500 ml were introduced into a thin tube. On the 5th day, the thin tube was removed. A decompression gastric tube was left to assess the motor-evacuation function of the stomach. On the 5th day, the diet was expanded (liquid and mushy food).

The sixth day after the operation. The patient's condition is satisfactory. Hemodynamics are stable, body temperature is 36.8°C. The abdomen is of normal shape, participates in the act of breathing. On palpation, the abdomen is soft, slightly painful in the area of the surgical intervention. There are no peritoneal symptoms. Peristalsis is auscultated. There was no stool, gases are released. Over the past day, 250 ml of discharge through the nasogastric tube, she eats and drinks. Having confirmed the satisfactory evacuation function of the stomach, a decrease in discharge through the gastric tube, a decision was made to remove the nasogastric tube. The early postoperative period was unremarkable. Stool on the 7th day. The patient was discharged in a satisfactory condition on the 14th day after the operation.

If the course is uncomplicated and the anastomosis patency is restored, the gastric tube is removed on the 6th day, and the thin feeding tube on the 5th day.

In case of anastomosis or anastomosis failure, this device for decompression and early enteral nutrition can be used for an unlimited time until the integrity and patency of the imposed anastomosis is completely restored. This is the expediency of the developed device in terms of improving the treatment results of patients with the imposition of anastomoses in the upper gastrointestinal tract.

1. http://medsilyug.ru/zond-zheludochno-kishechnyj-dvukхkanalnyj-kombinirovannij-zzhkk

2. https://www.fresenius-kabi.com/ru/%D0%BF%D1%80%D0%BE%D0%B4%D1%83%D0%BA%D1%82%D1%8B/freka-easy-in

Claims (2)

1. A device for decompression and early enteral nutrition in the postoperative period when an anastomosis is created with the upper sections of the gastrointestinal tract, consisting of a gastric tube for decompression and a tube for early enteral nutrition, characterized in that the tube for early enteral nutrition is 30 cm longer than the gastric tube, its diameter is 2 mm, and the tube for early enteral nutrition is placed in one of the side openings of the gastric tube in the direction of the port by 3 cm and is designed with the possibility of exiting the side opening of the gastric tube and straightening in the efferent section of the intestine when pulling the gastric tube to move its end through the anastomosis into the adductor section of the intestine. 2. The device according to item 1, characterized in that the probes are made of polyvinyl chloride.

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