Percutaneous puncture intervention under local anesthesia and ultrasound-guided with an abscess , and retroperitoneal hematomas
Science Articles / / August 12, 2017
AS Guryanov, AV Pankratov
Ultrasonic testing the puncture started to be applied in 1972.It was at this time there are first reports of razrabotkeipunktsionnyh ultrasonic sensors and percutaneous punctures of renal cysts under ultrasound guidance.With the creation of ultrasonic equipment operating in real time, with a set of linear and sector probes puncture, puncture percutaneous intervention with cystic disease of the retroperitoneal space significantly displace both angiographic methods of research and surgical treatment for these diseases.From 2001 to 2003 in the urology department number 2 Interdistrict urological center 3 patients treated with abscesses and 4 with the ration of retroperitoneal hematomas as described in "percutaneous diapevtiki".Retroperitoneal hematomas detected in the postoperative period in the period from 2 to 7 days in case of ultrasonic testing.Patients with retroperitoneal abscesses delivered within the time frame of 3 to 12 days, all the observed comorbidity in subcom
Technique puncture under ultrasound guidance includes the following steps:
- Laying of the patient, the processing of operational zero.
- Carrying ultrasound.
- Anesthesia selected places to puncture the skin incision with a pointed scalpel, apart of the dense layers of the skin clamp type "mosquito", a long needle anesthesia puncture on the course under ultrasound guidance.
- puncture cyst puncture needle with a stylet, and a fixed stop.
- Aspirate the contents to conduct cytological, bacteriological research.
This diagnostic program education puncture under ultrasound control ends and begins a therapeutic effect, the necessity and the scope of which depends on the nature obtained during diagnostic puncture the data size and location topical hematoma and abscess.
therapeutic effect of the puncture entities retroperitoneal space is divided into the following groups:
1. Aspiration content,
2. drainage cavity,
to puncture hematoma and abscess required: ultrasound machine that works in real time, provided with a puncture sensor.
The composition of tools and accessories for the puncture of cysts include: adapter for the needle;a set of needles of different diameter and length;pointed scalpel;clamp type "mosquito";syringes for anesthesia fluid aspiration kit sterile and conventional tubes for sampling of material for cytological and bacteriological research;a set of slides for cytological studies in the absence of liquid in punktiruemom education;solutions for local anesthesia.
If drainage cavity used to puncture drainage sets, consisting of a metal wire, radiopaque bougies of increasing diameter, radiopaque drainage tubes.
Laying the patient depends on the location and size of topical punktiruemyh liquid formations.When placing education at the upper, lower and middle segments of the posterior or lateral surface - patient position for puncture horizontal, lying on his stomach.When parapelvikalnyh and formations are located on the front surface of the kidney - the position of the patient lying on the opposite side.The puncture site and the direction of the puncture stroke but all cases chosen so that the puncture needle or did not pass through the kidney parenchyma.In all cases, in choosing the direction of puncture wounds exclude the possibility of kidney blood vessels and adjacent organs.The depth of the injection is determined by measuring the distance from the skin to the education center for ultrasound image on the device screen, and then the needle on the measured distance fix a special stopper.The whole process of moving the needle seen on a television monitor.After installing the two conductors of the wound channel dilatation was performed followed buzhami drainage cavity through amplats - tube.Intensive therapy in the postoperative period possible to avoid deaths in the said group of patients.The average stay in bed was 21.3 days.
Percutaneous puncture with subsequent drainage of the abscess and hematoma in patients with a high degree of anesthetic and surgical risks can be an alternative to traditional open surgery.