CATHETERIZATION OF UMBILICAL VESSELS (grech, katheter the probe) — a way of an extra peritoneal exposure of umbilical vessels (a vein and arteries) with introduction to their gleam of catheters in the therapeutic and diagnostic purposes.
Catheterization of an umbilical vein
Theoretical premises for extra peritoneal catheterization of an umbilical vein were the topografo-anatomic researches of D. G. Doviner (1958) which showed that the umbilical vein is obliterated not completely. At adults the umbilical vein turns into a connective tissue tyazh only throughout 4 — 6 cm beginning from an umbilical ring, on other extent (10 — 12 cm) the gleam of an umbilical vein is executed by friable connecting fabric.
G.E. Ostroverkhov, A. D. Nikolsky and T. A. Suvorova (1963) in details developed a technique of an extra peritoneal exposure, bougieurage and catheterization of an umbilical vein in an experiment, and in 1964 applied this technique in clinic to X-ray contrasting of vessels of portal system at some diseases of a liver (tumors, cirrhosis). In an experiment it was shown that at transumbilikalny infusion concentration of medicines in vessels of a liver is 2 — 3 times higher, than at usual intravenous injection. It was confirmed in clinic.
Similar observations were published by Bailey and Gonsalez (J. Bailey, S. Gonzales, 1964). They recommended to cannulate an umbilical vein at surgical interventions on a liver and bilious ways to carry out the prolonged therapy by solutions of glucose, glutaminic to - you, vitamins and hormones.
Catheterization of an umbilical vein is carried out at a portogepatografiya (see. Portografiya ), for the purpose of the prolonged antibioticotherapia at purulent cholangites, abscesses of a liver, after operation for purulent cholecystitis, for infusional therapy. Besides, it allows to carry out biochemical, control of the blood taken from an umbilical vein and a manometriya for the diagnostic purposes. The prolonged catheterization of an umbilical vein was applied L. V. Moroz (1968) to introduction of tsitostatik at treatment of primary tumors of a liver.
Contraindications: local inflammatory processes, diseases of a portal vein, the tumors of kidneys squeezing a portal vein.
Catheterization of an umbilical vein is made in the operating room or in a special angiographic office. As contrast agents solutions of Cardiotrastum (Diodonum), triombrin (Hypaque), Urografinum use 50 and 70%.
The exposure and allocation of an umbilical vein produce under local anesthesia 0,25% solution of novocaine. On the centerline of a front abdominal wall, is 3-4 cm higher than a navel, layer-by-layer make a section of skin 4 — 5 cm long, a hypodermic fatty tissue, an aponeurosis of the white line of a stomach and a cross fascia. The peritoneum is not cut and the peritoneal cavity is not opened. Find in preperitoneal cellulose dense tyazh an umbilical vein which lies on 1 — 2 cm lateralno from the centerline (fig. 1). The trunk of an umbilical vein is taken on a ligature and removed in a wound. A scalpel or scissors make cuts a wall of a vein before emergence of a gleam of 0,5 — 1,5 mm. At the same time a little blood sometimes appears. If the gleam of a vein is filled with friable connecting fabric, then it is expanded with special metal buzh (fig. 2) or ureteric catheters. For this edge of a dissect vein take artery forceps and enter it into a gleam buzh (fig. 3), advancing it carefully up in the direction of a projection of umbilical cutting of a liver. After bougieurage the gleam of a vein manages to be expanded to 1 cm in the diameter.
As an indicator of a successful rekanalization of an umbilical vein serves emergence of blood after extraction of a buzh.
On depth of 15 — 17 cm enter a polyethylene catheter into a gleam of an umbilical vein to dia. 0,5 cm. The more deeply the catheter gets into a vein, the blood is emitted more considerably. The catheter is fixed to a vein deligation. Long stay of a catheter in an umbilical vein (10 — 15 days), as a rule, is not followed by thrombosis. This results from the fact that blood of portal system has the lowered coagulability.
To carry out a portogepatografiya, previously enter 20 ml of 0,25% of solution of novocaine for elimination of a vascular spasm and after this pour in 40 — 60 ml of solution of a contrast agent in two steps on 20 — 30 ml in 2 — 3 sec. each dose into a vein. At these moments carry out a X-ray analysis in the field of a projection of a liver.
For performance of a portomanometriya a catheter connect with flebotonometry Valdman. For implementation of long transumbilikalny infusion the catheter is connected to system for infusion (fig. 4).
The equipment of catheterization of an umbilical vein for treatment of acute inflammatory processes in bilious ways in the postoperative period has the features. In such cases before sewing up of a wound of an abdominal wall cut a round ligament of a liver, find in it a gleam of an umbilical vein, enter into it a polyethylene catheter which is fixed a ligature. The free end of an umbilical vein with a catheter is brought to a surface between seams on an operational wound and connect it to system for drop transfusion.
In certain cases catheterization of umbilical veins or the left branch of a portal vein is used for jet injection of blood (500 — 600 ml) at the phenomena of shock during operation.
Complications: impossibility to razbuzhirovat an umbilical vein, break of a wall of a vein, a possibility of thrombosis at long use of a method. Such complications are observed in 10 — 12% of cases, but they do not involve dangerous frustration.
Catheterization of an umbilical artery
Catheterization of an umbilical artery for the first time in 1963 Ainsworth with soavt, was used for hemotransfusion at asphyxia of the newborn and at hemolitic jaundice of the newborn. For this purpose in sterile conditions cross an umbilical cord and enter a polyethylene catheter which is connected to system for hemotransfusion into one of arteries of an umbilical cord. Pour usually 40 — 50 ml of odnogruppny blood under pressure of 160 — 180 mm of mercury.
Catheterization of an umbilical artery found application in pediatrics for an aortografiya. Umbilical arteriography (a transumbilikalny aortografiya) eliminates need of use of any main vessel, reducing these danger of development of vascular complications.
Indications: hemotransfusion the newborn at resuscitation and hemolitic jaundice, arterio-and an aortografiya at children. Contraindications: local inflammatory processes in a navel and skin of a stomach.
Equipment: having made a section of skin, hypodermic cellulose, an aponeurosis of an outside oblique muscle and having moved apart fibers of an internal oblique muscle in inguinal area 2 — 3 cm higher than an inguinal sheaf, get into preperitoneal cellulose and allocate an umbilical artery. Enter the probe into a gleam of an artery and under control of a X-ray apparatus establish it on the right place (an ileal artery, an abdominal aorta). After that on a catheter under pressure force solution of radiopaque substance and make an angiography. Having completed a research, delete a catheter, and tie up an artery.
Complications: impossibility to razbuzhirovat an umbilical artery, bleeding, hematomas as a result of perforation of an artery buzhy or a catheter, suppuration.
Bibliography: Akopyan V., ides of river. Problems of experimental and clinical surgery of a liver and bilious ways, M., 1968; Ostroverkhov G. E., From a uvo-rov T. A. and Nikolsky A. D. Venografiya of a liver and its diagnostic value, Surgery, N» 5, page 84, 1964; Ostroverkhov G. E., etc. Transumbilikalnaya portogepatografiya, M., 1969, bibliogr.; Ostrovsky A. G. The portal vein of a liver of the person is normal also at some diseases, Petrozavodsk, of 1973; Shapkin V. S. and Malyshev A. F. Vnutriportalnkya infusion of pharmaceuticals at acute and chronic hepatitises and postnecrotic cirrhoses of a liver, Vladivostok, 1974, bibliogr.