FIELD: medicine.
SUBSTANCE: in the treatment of acute purulent mediastinitis, drainage of the mediastinum is performed by dorsal access. Drainage is performed by a percutaneous puncture method under fluoroscopic control in the horizontal position of the patient lying on the abdomen. The puncture needle is inserted to the right of the 4 intercostal space on a 3-4 cm from the median line, along the lateral surface of the body 4 of the thoracic vertebra to its front surface in a perpendicular direction to the frontal plane. Further, the needle is carried out with constant aspiration until the purulent discharge is released. Introduce a water-soluble radiocontrast preparation in an amount of 20-30 ml. A metal conductor is installed over the needle. On the conductor, a drainage tube of the pigtail type is installed in the zone of the greatest accumulation of pus, with diameter of 3-4 mm. The holes are located along the entire length of the drainage pipe. Drainage is fixed to the skin with two seams. Wash the mediastinum with antiseptic solutions.
EFFECT: method provides the possibility of a passive outflow of purulent contents in the patient's position on the back, minimal trauma and reduces the risk of general and local postoperative complications due to drainage of the anterior and posterior mediastinal by percutaneous dorsal access without opening the soft tissues and resection of the ribs.
1 ex, 1 dwg
