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INVENTION
Patent of the Russian Federation RU2214180

METHOD OF TREATMENT FOR ACUTE OBSTURATION CHOLECYSTITIS

The name of the inventor: Bedin VV; Arkhangel'skii VV; M. Tavobilov; Starykh VS
The name of the patentee: Kemerovo City Clinical Hospital No.3 named after. M.A. Podgorbunsky
Address for correspondence: 650099, Kemerovo, Glavpochtamt, PO Box 22, VS Old
The effective date of the patent: 2002.04.29

The invention relates to medicine, in particular surgery, can be used for acute obstructive cholecystitis. Conduct a catheter with a stethoscope under the control of ultrasound in the cavity of the gallbladder to its neck. Remove the stylet. The contents of the gallbladder are withdrawn through the catheter. Enter into the gallbladder drug solution. If the obturation is preserved in the neck of the gallbladder, a drug solution is introduced through the catheter of the second device with a smaller lumen. The second catheter is brought to the bottom of the gallbladder. The drug solution is introduced into the volume of the liquid withdrawn from the gallbladder cavity through the first catheter. Stop the infusion after the disappearance or significant decrease in the leaky fluid of pathogenic microbes. In a particular case, the outer end of the first catheter is positioned below the horizontal plane through the lower surface of the gallbladder. The method allows to speed up the sanation of the gallbladder.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, in particular to surgery and resuscitation, namely to treatment with acute obstructive cholecystitis.

A method for the treatment of acute destructive calculous occlusive cholecystitis is described in patent RF 2022547, which includes the application of microcholecystostomy and the dissolution of concretes with a solvent. In this case, drugs are injected into the cavity of the gallbladder through a tube with an external diameter of not more than 2.8 mm. The method involves suctioning the contents from the bladder and replacing the tube with microcholecystostomeric drainage.

The disadvantage of this method of treatment is the absence in it of techniques that enhance the quality and speed up the sanation of the gallbladder.

A method of external drainage of the gallbladder according to RF patent 2019201 is known, which includes transhepatic drainage of the tube through the manipulation trocar sleeve under the control of a laparoscope. After removal of the sleeve of the trocar and the conductor, a puncture channel is surrounded by a tube.

The disadvantage of this method is the absence in it of methods of washing the gallbladder and other signs that increase the quality and speed up its sanation.

In addition, a method for percutaneous percutaneous cholecystostomy according to RF patent 2,077,344 is known, comprising percutaneous puncture by a thin gallbladder needle under the control of ultrasound scanning with removal of the contents of the bladder, administration of antiseptic agents into the gallbladder cavity, additional puncturing and drainage of the gallbladder and removal of the fine needle.

The disadvantage of this method of treatment is the lack of techniques to improve the quality and more accelerated sanitation of the gallbladder.

The closest to the technical essence and the result achieved to the claimed device is the method of RF patent 2,077,344, which we take as a prototype, and its shortcomings are set out above.

The technical result of the invention consists in improving the treatment by improving the quality and accelerating the sanation of the gallbladder.

The technical result of the invention is achieved by the fact that the method of treatment for acute obstructive cholecystitis includes a cutaneous incision, through it, liver tissue and the bed of the gall bladder into the cavity to its neck under the control of the ultrasound of the working end of the device containing a stylet catheter, removal of the stylet, Liquid content from the gallbladder, the introduction of a drug solution into it, holding the end of the catheter of the second device into the cavity of the gallbladder. If the obturation in the neck of the gallbladder is retained in the catheter of the second device with a lower than that of the first lumen brought to the bottom of the gallbladder, the drug solution is introduced into the volume of simultaneously excreted fluid from the cavity of the gallbladder through the catheter of the first device. The infusion is stopped after the appearance of bile in the flowing fluid and the disappearance or significant reduction in it of the amount of pathogenic microbes.

In a preferred embodiment of the method, the technical result is achieved by setting the outer end of the first catheter below the horizontal plane through the lower surface of the gallbladder.

Specific example 1 of the method. Patient P., 73 years old (case history 12103), was hospitalized in the surgical department on the fourth day after the onset of acute pain in the abdomen with the diagnosis: Gallstone disease, acute obturation calculous cholecystitis. Infusion-spasmolytic therapy, conducted for 4 hours, did not relieve pain, did not eliminate hypertension in the cavity of the gallbladder and inflammation in it. Carry out the invented way so. On the skin of the anterior abdominal wall, an ultrasound transducer is installed so that the scanning plane passes simultaneously through the liver parenchyma and the maximal longitudinal plane of the gallbladder. After preliminary anesthesia, 40 ml of 0.25% solution of novocaine with a scalpel is dissected for 1-1.5 cm skin, subcutaneous fat and aponeurosis of the external oblique abdominal muscle. Drainage of the gallbladder is carried out with a device containing a stylet and catheter ("pig tail" type) with an external diameter of 9 F on the scale of the Shayer (3 mm) and a length of 30 cm, which, like a casing, is put on a metal stiletto. Introduction of the device is performed by one smooth movement through the surgical incision, the liver tissue and the bed of the gallbladder in the direction of its neck at an angle to the diaphragmatic surface of the liver until the working end of the device is installed in the lumen of the gallbladder at the neck. Monitor the position of the working end of the device on the monitor of the ultrasonic device. While holding the catheter in the intended position, remove the stylet. The catheter is fixed with a nodular suture from the silk thread to the skin and through it an aqueous solution of chlorhexidine bigluconate is introduced into the cavity of the gallbladder in a volume equal to the capacity of the gall bladder, which was 120 ml. With the help of the ultrasound sensor, the absence of an airflow from the gallbladder cavity is controlled. The introduction of medicamental fluid and excretion from the cavity of the gallbladder continues twice a day for five days. Introduce the drug solution in a volume equal to the volume of the pathological fluid withdrawn. After a lapse of five days from the start of treatment, the obstruction in the neck of the gallbladder and the inflammatory process in the gall bladder are preserved. Through the previously established catheter, the cavity of the gallbladder is filled with liquid until the initial one is restored before draining its volume. After anesthesia with 0.25% solution of novocaine through a cut of skin in the right upper quadrant under ultrasound control, a second device containing a stylet and a catheter (Lunderquist type) with an external diameter of 4 F on a scale of Sharyer (1.67 mm) and at an angle to the diaphragm surface of the liver Length of 25 cm, which, like a casing, is worn on top of a metal stiletto.

The working end of the catheter is guided into the cavity of the gallbladder to its bottom, i.e., to the opposite site relative to the localization of the working end of the first catheter. Remove the stylet and fix the catheter to the skin. The outer end of the first catheter is positioned below the horizontal plane through the lower surface of the gallbladder. Through the first inserted catheter, liquid is aspirated from the cavity of the gallbladder, and through the second, at an infusion rate of 50-100 drops per minute, an antiseptic solution with a temperature of 38 ^° C. in a volume equal to the volume of the withdrawn liquid is poured. Simultaneous administration of drug solution and removal of pathological fluid from the gallbladder cavity is carried out until the appearance of bile in the withdrawn liquid and the disappearance or significant reduction in the number of pathogenic microbes, which is established by microscopic examination of the liquid obtained by washing the cavity of the gallbladder. After carrying out the invented method, abdominal pain in the abdomen decreased, and then disappeared, body temperature returned to normal, clear bile separated from the drainage. Both catheters are removed. Later, the patient underwent laparoscopic cholecystectomy, after which on the fourth day the patient was discharged home in a satisfactory condition.

The essential difference between the invented method is as follows. The introduction of drug liquid through a thinner catheter with the simultaneous removal of pathological fluid from the gallbladder through a catheter with a large lumen allows to prevent hypertension in the cavity of the bladder and to flush it with the removal of its microflora from its cavity or its decrease and a decrease in inflammation in the bladder. The introduction of drug solution and the removal of pathological fluid from different parts of the cavity of the gallbladder provides a more complete washing of it. The introduction of a drug liquid in a volume equal to the volume of the excreted pathological fluid excludes the increase in the hydraulic pressure in the cavity of the gallbladder. Infusion of drug liquid before the appearance of bile in the flowing fluid indicates the elimination of obstruction of the biliary tract, and rinsing before the disappearance or decrease in the outflowing fluid of pathogenic microbes indicates the effectiveness of sanation. Placement of the outer end of the catheter through which fluid is introduced below the horizontal plane through the lower surface of the gallbladder provides an improvement in the outflow of pathological fluid from the gallbladder cavity, improving quality and speeding up its sanitation.

Thus, due to the combination of all the features, the invented method improves the treatment in acute obstructive cholecystitis by improving the quality of the more accelerated sanation of the gallbladder.

Application of the invention is possible in military field surgery and veterinary medicine.

CLAIM

2. The method of claim 1, wherein the outer end of the catheter of the first device is positioned below the horizontal plane through the lower surface of the gallbladder.

print version
Date of publication 28.01.2007gg

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