RU2738683C1 - Method for pleural cavity drainage following pulmonectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to a method for pleural cavity drainage following pulmonectomy. Method involves inserting into the drained cavity of two tubular drainages of the first intercostal space in VI-VII along a back axillary line, the second intercostal space in II-III. Proximal end of the first drainage, depending on the level of the diaphragm dome standing, is installed in the lower cavity of the cavity drainage, and its distal end is lowered under water into the reservoir for underwater passive aspiration and exudate control. Second drain made of silicone material with internal section of 0.8 cm, with five additional perforations is installed through counter-puncture into a dome of pleural cavity. Proximal end of the second drainage is intrapleurally fixed to the parietal pleura by the absorbable ligature, and a bacterial filter is attached to the distal end of the same drainage at distance of 12 cm from the external skin. Filter is used in the respiratory circuit of the apparatus for artificial pulmonary ventilation, which ensures decontamination of air into the drained cavity and establishment of a balance between intracavitary and atmospheric pressure.

EFFECT: prophylaxis of displacement of mediastinum organs, reduction of load on stump of bronchial tubes and blood vessels and reduced risk of infection of drained cavity.

1 cl, 2 dwg

Description

The invention relates to medicine, namely to thoracic surgery and can be used to drain the pleural cavity after surgery on the lung.

There is a known method for draining the pleural cavity (Errors, hazards 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 is installed in the lower parts of the pleural cavity, closed with a clamp, and its end was lowered under the water. During the first day, the drainage was opened 2-3 times a day, to control the contents of the pleural cavity, or to wash it with an antiseptic solution.

The disadvantage of this method is the impossibility of objective control of filling the pleural cavity with liquid - blood, due to the onset or completed bleeding, or exudate. In addition, the closed cavity forms negative pressure at the time of coughing and intensive inhalation, which leads to a load on the stumps of the bronchus, arteries and veins.

There is also known a method without drainage management 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 the accumulating fluid in the pleural cavity, as well as the formation of negative pressure in the postoperative cavity, which creates a load on the bronchus stump and can lead to its failure. Frequent pleural punctures bring additional suffering to the patient and increase the risk of infection of the pleural cavity.

The closest solution to the claimed one is a method in which, 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. Bisenkov, S. V. Grishakov, S. A. Shalaev, 1998, pp. 303-305).

The disadvantage of this method is the presence of drainage tubes in the pleural cavity, communicating with the environment, thereby increasing the risk of infection of the pleural cavity.

The technical result of the invention is to reduce the load on the stump of the bronchus, arteries and veins, as well as to minimize the risk of infection of the pleural cavity.

The technical result is achieved using the proposed method for draining the pleural cavity after pulmonectomy, including the introduction into the drained cavity of two tubular drainages of the first in the VI-VII intercostal space along the posterior axillary line, the second in the II-III intercostal space, moreover, the proximal end of the first drainage, depending on the level standing of the dome of the diaphragm, set at the lower point of the cavity drainage, and its distal end is lowered under water into a container for underwater passive aspiration and exudate control, the second drainage made of silicone material with an inner section of 0.8 cm, with five additional perforations, set through the counterperture into the dome of the pleural cavity, then the proximal end of the second drainage is intrapleurally fixed to the parietal pleura with an absorbable ligature, and a bacterial filter used in the respiratory tract is attached to the distal end of the same drainage, at a distance of 12 cm from the outer skin. the contour of the apparatus for artificial ventilation of the lungs, which ensures the flow of disinfected air into the drained cavity, and the establishment of equilibrium between the intracavitary and atmospheric pressure. The drainage operates for the required number of days. Then it is removed.

The invention is illustrated by images in which:

FIG. 1 is a general view of the installation of drains and an air filter;

FIG. 2 - X-ray of the chest organs in direct projection.

An example of the implementation of the method

The method of draining the pleural cavity after pulmonectomy is carried out using an air filter 1, a second drainage 2 and a first drainage 3 (Fig. 1). Two tubular drainages 2 and 3 made of silicone material are introduced into the drainage cavity, the second drainage 2 has a diameter of 0.8 cm with five additional perforations to create a pressure equal to atmospheric pressure in the cavity. The proximal end of the lower drainage is installed at the lower point of the cavity drainage along the posterior axillary line in the VI-VIII intercostal space (depending on the level of the diaphragm dome), and its distal end is lowered under water into a container for underwater passive aspiration of exudate control. The proximal end of the upper drainage is installed in the II-III intercostal space for drainage of the dome of the cavity, the drainage is intrapleurally fixed to the parietal pleura with an absorbable ligature, and a bacterial filter is attached to the distal end of the same drainage, at a distance of 12 cm from the outer skin integument, providing entry into the drained cavity disinfected air, and the establishment of balance between intracavitary and atmospheric pressure. The drainage operates for the required number of days, then it is removed.

Clinical example No. 1. The patient was hospitalized in the tuberculosis pulmonary surgical department of the OGKUZ "Anti-tuberculosis dispensary" from 06.11.2018 to 14.12.2018 with a diagnosis of Peripheral multicentral cancer of the left lung T ₄ N ₀ M ₀ stage III A ₁₁ The cavity was drained with two drains, the upper drainage made of silicone material with an inner section of 0.8 cm, with perforations, was installed in the II intercostal space through the counterperture into the dome of the pleural cavity and fixed to the parietal pleura with an absorbable ligature. To the distal end of the same drainage, at a distance of 12 cm from the outer skin, a bacterial filter is attached, which ensures the supply of disinfected air into the drained cavity, and the establishment of an equilibrium between the intracavitary and atmospheric pressure. The proximal end of the second (lower) drainage was installed at the lower point of the cavity drainage along the posterior axillary line in the VI intercostal space, and its distal end is lowered into a container for underwater passive aspiration and exudate control. Both drains functioned for 3 days, then they were removed. The result is shown in Fig. 2, where on the right is the cavity after pulmonectomy, drained according to the described method. The mediastinal organs are not displaced.

Clinical example No. 2. The patient was hospitalized in the tuberculous pulmonary surgical department of the OGKUZ "Anti-tuberculosis dispensary" from 02/14/2019 to 05/13/2019 with a diagnosis of Peripheral multicentral cancer of the right lung T4N0M0 stage III A 03/05/2019 an operation was performed, the right pulmonectomy was also drained ... The upper drainage, with an internal section of 0.8 cm, was installed in the III intercostal space through the counterperture into the dome of the pleural cavity. A bacterial filter is attached to the distal end of the same drain, at a distance of 12 cm from the outer skin. The lower drain is installed in the VIII intercostal space along the posterior axillary line. Its proximal end was positioned at the bottom of the drainage point of the cavity, and the distal end was lowered into a reservoir for underwater passive aspiration and exudate control. The operating cavity was drained for 3 days, then it was filled with a solution with an antibacterial drug and the drains were removed.

The use of the proposed method for draining the pleural cavity after pulmonectomy avoids displacement of the mediastinal organs due to the absence of a difference between the intracavitary and atmospheric pressure and prevents infection of the drained cavity due to the bacterial filter attached to the upper drainage. The use of this invention allows to improve the results of treatment of patients by preventing intracavitary bleeding, prevention of bronchial stump failure.

Claims (1)

A method for draining the pleural cavity after pulmonectomy, including the introduction into the drained cavity of two tubular drainages of the first in the VI-VII intercostal space along the posterior axillary line, the second in the II-III intercostal space, characterized in that the proximal end of the first drainage, depending on the level of standing of the dome of the diaphragm, installed at the lower point of the cavity drainage, and its distal end is lowered under water into a container for underwater passive aspiration and exudate control, a second drainage made of silicone material with an inner section of 0.8 cm, with five additional perforations, is installed through a counterperture in the dome of the pleural cavity, then the proximal end of the second drainage is intrapleurally fixed to the parietal pleura with an absorbable ligature, and a bacterial filter used in the respiratory circuit of the ventilator is attached to the distal end of the same drainage, at a distance of 12 cm from the outer skin. lungs, providing the flow of disinfected air into the drained cavity, and establishing an equilibrium between the intracavitary and atmospheric pressure.

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