Atanasov, D.

Georgiev, G.

English

Varna Medical University Press: Journals

THORACIC DUCT DRAINAGE WITH AN A C U T E PERITONITIS T a b l e Ductus thorac icus drainage I n t e s t i n a l C o l o n i c B i l i a r y P a n c r e a t i t i s U r o g e n i c K i n d of p e r i t o n i t i s -M a l e s F e m a ­l e s m . f. ra. f. m . f. m . J . D e ­c e a s e d % ^ Reactive T o x i c CO T e r m i n a l 1 Total 1 0 100 Local jg c D i f f u s e Ш .2 G e n e r a l i z e d 1 Tota l 1 _ 2 2 0 100 G . Georgiev, D . Atanasov K e y - w o r d s : drainage — t h o r a c i c duct — acute p e r i t o n i t i s — depura t ion Thoracic duct drainage is one of contemporary methods for desintoxication w i t h the acute peritonitis. F irs t C . Costaiha (1922) performed a lymph drainage w i t h this purpose in a female patient wi th pneumococcic peritonitis (cited after 1). Cooke (1924) drained the thoracic duct in a female patient wi th diffuse suppura­tive peritonitis (cited after 1). Thoracic duct drainage is indicated in any cases of an acute diffuse peritonitis enterring the intoxication stage. According to A . M . K a r y a k i n (1982) drainage is most effective when it starts no later than 12 hours after the beginning of a perforative peritonitis and 24 hours when peritonitis wi th other etiology is concerned. I t is explained wi th the fact that at early stage of pe­ritonit is lymph capillary tone is s t i l l preserved and lymph transport is effective. The amount of drained lymph required daily is between 1 and 2 1. I n cases of i n ­crease or decrease of this quantity a dirigible drainage should be applied. The operative technique of thoracic duct drainage is wel l elaborated. We used Kummel 's section (1930) (cited after 4) — a horizontal section over the left £lavicle, cutting of the first and second cervical fasciae and the lateral leg of m. sternocleidomastoideus and uncovering of the internal jugular v e i n . The tho-racic duct is commonly located behind and laterally to i t . The thoracic duct is opened and cannulated by using a plastic cannula. Material and methods Our experience covered 10 patients wi th an acute peritonitis in advanced intoxication and part ial ly at terminal stage of the disease. One can see on table 1 108 G . Georg iev , D . Atanasov that two patients were w i t h diffuse peritonitis of intestinal origin, two ones of colonic one, three — of bil iary one, two wi th pancreatogenic peritonitis and one female patient w i t h diffuse urogenic peritonitis. 5 of a l l cannulated patients (at terminal stage of the disease wi th a diffuse suppurative peritonitis died. Results and discussion The following laboratory investigations were performed in these 10 patients: (table 2) the daily amount of dripped out lymph varied between 1000 and 2000 c m 3 T a b l e 2 D a y I I n d e x Q u a n t i t y 800—1000 m l 1000—1500 m l 1000—2000 m l S p e e d / m i n 20—40 droplets 30—50 droplets 40—60 d r o p l e t s 6 0 — 8 0 C e n t r a l v e n o u s pressure 40—60 50—80 I n m m HoO L y m p h pressure i n m m H 2 O 150—180 180—200 200—3000 1020—1024 L y m p h r e l a t i v e w e i g h t 1014—1018 1018—1024 B l o o d e r y t h r o c y t e s 3 — 3 , 5 m i l l 3—4 m i l l 3—4 m i l l L y m p h e r y t h r o c y t e s absent 100000—200000 500000—1000000 B l o o d t h r o m b o c y t e s 180000 200000 250000 L y m p h t h r o m b o c y t e s 170000 190000 200000 B l o o d leucocytes 11000 12000 17000 L y m p h leucocytes 7000—8000 12000—15000 14000—19000 B l o o d prote ins 6 - 7 , 2 g % 6 , 5 - 7 g % 6 , 5 - 7 , 5 g % L y m p h prote ins 3 - 3 , 6 g % 3 , 5 - 4 , 9 g % 4 - 4 , 4 g % B l o o d b i l i r u b i n 1,1 mg % 1 - 1 , 2 m g % 1 - 1 , 3 mg % L y m p h b i l i r u b i n 1,2 m g % 1 , 2 - 1 , 5 m g % 2 , 8 - 3 mg % B l o o d urea 20—30 m g % 30—60 m g % 60—85 mg % L y m p h urea 20—40 mg % 40—80 mg % 100—120 mg % B l o o d p o t a s s i u m 3 ,8—4 m E q u i v . 4 — 4 , 3 m E q u i v . 4 ,2—4,8 m E q u i v . L y m p h p o t a s s i u m 3 ,6—4 m E q u i v . 3 ,8—4,2 m E q u i v . 4 , 3 — 4 , 5 m E q u i v . B l o o d s o d i u m 118—120 m E q u i v . 120—124 m E q u i v . 118—122 m E q u i v . L y m p h s o d i u m 102 — 110 m E q u i v . 112—120 m E q u i v . 120—128 m E q u i v . B l o o d a m m o n i u m 150 200 400 L y m p h a m m o n i u m 200 400 600 A m y l a s e 280 U I 300 U I 420 U I A m y l a s e ( i n pancrea - 300 U I 800 U I 760 U I t i t i s ) on the first day, between 1000 and 1500 c m 3 on the second and between 800 and 1000 c m 3 on the third day. The daily amount of drained lymph must be between 1 and 2 1 to produce a depuration effect. When this quantity is smaller one can not produce the necessary effect while the loss of a greater amount involves a con-siderable ion, enzyme and protein substance elimination from the organism. I n such cases one uses the dirigible drainage by means of methods for suppression or stimulation, respectively, of the amount of dripped out lymph. The speed of lymph drainage was between 40 and 60 drops per min. on the first day, between 30 and 50 ones on the second and between 20 and 40 ones on the third day. The Thoracic duct drainage w i t h . 109 R E F E R E N C E S 1 . Д е р я б и н , И. И . , M . Н. Л и з а н е ц. Перитонеальный диализ . М . , Медицина , 1977. — 2 . К а р я к и н, А. М . , и др . Хирургия ( М ) , 1982, № 9, 54. — З. Ш а л и м о в , А . А . , и др . Острый перитонит. К и е в , 1981. — 4. М а л х а с я н, В . А . , и др . Д р е н и р о в а ­ние грудного лимфатического протока в хирургической практике . М . , Медицина, 1979. Д Р Е Н А Ж Г Р У Д Н О Г О ПРОТОКА П Р И ОСТРОМ П Е Р И Т О Н И Т Е Г . Георгиев, Д . Атанасов Р Е З Ю М Е Приведены наблюдения 10 больных острым диффузным перитонитом, которым б ы л н а ­ложен д р е н а ж грудного протока. На основе клинических наблюдений и л а б о р а т о р н ы х и с с л е ­дований сделано заключение, что умеренный лимфатический д р е н а ж о к а з ы в а е т определен­ный депурационный эффект на кинины, мочевину, билирубин, амилазу и д р у г и е шлаки о р ­ганизма больного перитонитом, а т а к ж е понижает интоксикацию в р е з у льтате перитонита. lymph pressure was 200—300 mm H 2 0 column on the first day, 180—200 mm H 2 0 column on the second and 150—180 mm H 2 0 column on the th i rd . The relative weight of the lymph varied between 1014- and 1024. The cytological examinations revealed between 500 000 and 1 m i l l erythrocytes per m m 3 on the first day, a de­crease down to 100- 1 m i l l per m m 3 on the second and a lack of erythrocytes on the third day. Both leukocyte and thrombocyte count corresponded to that in blood during the whole period. L y m p h proteins were by 30 per cent lower than that in blood on the first day, (4—4,4 g % ) ; they decreased down to 3,5—4 g % on the second and almost to the half level (3—3,6g % ) on the third day. B i l i r u b i n was twofold more in the lymph than in the blood on the first day (2,8—3 mg % ) . I t was reduced on the second and normalized on the third day (1,2 mg % ) . Urea in the lymph was also twofold more on the first day (100—120 mg % ) and then it reduced to normal levels (20—40 mg % ) . Sodium and potassium ion levels corres­ponded to those in the blood without any abnormalities. Ammonium level was by 30 per cent higher than that in the blood and began to decrease on the next days. Amylase was considerably increased in pancreatogenic peritonitis patient's only . Иг The c l inical and laboratory results obtained demonstrate that lymph drainage possesses certain depuration properties concerning the k inins , b i l i rub in , urea and ammonium i n blood and reduces significantly the level of peritonitis intoxication. T h e lethality i n our cases (50 % ) is due to rather late lymph drainage applica­t i o n — at terminal stages of the disease when lethality is very high (85—95 % ) (3) . The loss of proteins, ions, enzymes and nutri t ive substances are restituted i n our patients i n concordance wi th the indexes studied by using infusions of blood, proteins, water-electrolyte solutions, and vitamines. There were no complications after lymph drainage application. I n any cases lymph fistula closed up sponta­neously under pressing bandage for several days after cannula extraction. 

THORACIC DUCT DRAINAGE WITH AN ACUTE PERITONITIS

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THORACIC DUCT DRAINAGE WITH AN ACUTE PERITONITIS

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