| 摘要 |
FIELD: medicine, surgery. ^ SUBSTANCE: the present innovation deals with surgical ways of cannulating patient's thoracic lymphatic duct. One should dissect patient's skin in left-hand clavicular area, separate thoracic and clavicular part of nodding muscle both bluntly and sharply, lance venous angle, isolate thoracic lymphatic duct, dissect its wall to introduce one end of cannula made of polymeric material. Another end of cannula should be fixed at skin surface with fixing suture. Onto a ductal wound one should apply blanket suture with stitches with a ligature top tighten it for hermetical sealing the cannula mentioned. Then one should withdraw both ends of ligatures through skin incision which should be sutured up, as for a ligature it should be bound upon a gauze ball at skin surface. Then comes the course of lymph detoxication, on finishing this course one should dissect a fixing suture to remove the cannula applied. Ligature of blanket suture should be additionally tightened and bound upon a gauze ball at skin surface till the moment of wound healing, then ligature should be cut and removed. In peculiar case, immediately after operation one should apply a tube-tourniquet into skin-muscular wound and both ends of ligature should be applied through this tourniquet immediately against the suture on thoracic duct followed by binding ligatures' ends upon a gauze ball at skin surface. In peculiar case, one should apply one end of ligature through the tourniquet only, and the second end should be applied along tourniquet's external wall, then the first end should be bound with the second directly at tourniquet's walls. In peculiar case, right after introducing a cannula, being above and below incision one should apply sutures-holders and apply each ligature through its own tourniquet. Ends of ligatures should be withdrawn outwards to be bound at their own gauze balls. The second variant should be performed according to the following technique: one should apply a purse-string suture onto anterior wall of internal jugular vein. In its center it is necessary to lance the vein to introduce cannula' end out of polymeric material into this lumen. Moreover, protruding ends of both cannulas should be connected via elastic tube with unilateral valve that delivers lymph flow in one direction of thoracic vein into the vein. The loop with elastic tube should be located subcutaneously. Lymph sampling for its further detoxication should be carried out due to puncturing this elastic tube with a needle percutaneously. The third variant deals with introducing a metal probe through incision in the wall of thoracic lymphatic duct to direct it along the duct through lymphovenous anastomosis, onto the wall of subclavicular vein in area of transillumination of probe's button thickening followed by applying a purse-string suture. In its center the vein should be lanced to withdraw thickenings through micro-incision to be connected with the cannula. This construction should be withdrawn back up to incision in the wall s of thoracic lymphatic duct, where the probe should be disconnected against the cannula and removed. Cannula should be directed to the site of the most intensive lymph secretion, then the wound upon thoracic duct should be tightly sutured up. On finishing the course of detoxication one should introduce a fish line-conductor through cannula's external end. Then cannula should be removed. Fish line-conductor should be applied by rings into subcutaneous fiber followed by wound suturing up. If necessary, one should apply a new cannula along the above-mentioned fish line-conductor. The innovation enables to conduct multiple courses of lymph detoxication and keep functional properties of thoracic duct. ^ EFFECT: higher efficiency of cannulation. ^ 6 cl, 5 dwg, 1 ex |
