RU2469655C1 - Method for management of rectal lower ampulla stump - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: single ligature is used to suture a centre of a machine stitch. It is followed by cutting 1 cm of the machine stitch directly 5 mm to the right and to the left from the ligature. The opening is closed by single sutures; a stylette of the suturing instrument is brought through a centre of a junction of handmade and machine stitches; a machine circular anastomosis is applied with a full line of a mechanical line stapler is removed with forming the anastomosis.

EFFECT: method provides higher reliability of the low machine colorectal anastomosis, reduces a number of purulent-septic complications.

1 ex

Description

The invention relates to medicine, namely to surgical treatment of diseases of the pelvic organs, and can be used in surgical treatment of patients with rectal cancer.

A known method for the formation of colonic anastomosis (Yukhtin V.I. Colon surgery. - M.: “Medicine”. 1988, p. 254), which consists in applying an end-to-end anastomosis with a two-row interrupted suture, the first row of serous-muscular nodular anastomosis sutures on the posterior wall of the anastomosis, the application of the second row of (internal) nodal sutures through all layers of the posterior wall of the anastomosis, the application of screw-nodal sutures on the anterior wall of the anastomosis (the inner row of sutures), the imposition of serous-muscle nodal sutures on the anterior wall of the anastomosis. However, this method has significant disadvantages: the method does not provide for the formation of reliable colorectal anastomosis. The use of this method is accompanied by frequent inconsistencies of the joints of the anastomosis.

As a prototype, we selected a method for suturing the stump of the rectum with a linear stapler “CONTOUR” (“Efficiency of a mechanical suture with low anterior resection of the rectum.” Khubezov DA, Ogoreltsev A.Yu. Coloproctology. No. 2 (20), 2007, p .27-30).

The above method has significant disadvantages. When using it, a high incidence of hardware anastomosis failure is high. In some cases, the eruption of the brackets in the corners of the suture is observed, intestinal necrosis is possible in the corner of the mechanical suture due to circulatory disorders.

The aim of the present invention is the prevention of insolvency of low colorectal hardware anastomosis during resection of the lower ampullar part of the rectum by removing the entire line of the mechanical suture of the linear stapler during the formation of the anastomosis.

This goal is achieved by flashing the center of the mechanical seam with a single ligature, conducting it under the brackets of the seam, pulling the seam up, cutting 1 cm of the mechanical seam directly under the brackets 5 mm to the right and left of the ligature, suturing the hole with single seams perpendicular to the axis of the mechanical seam, suturing the base part of the stapler is introduced transanally, the stylet of the stapler is carried out through the center of the junction of the manual and mechanical seams, and the formation of a hardware anastomosis is completed.

The invention "A method of treating a stump of the lower ampullar rectum" is new, since it is not known from the level of medicine, namely in the surgery of diseases of the rectum.

The novelty of the invention lies in the fact that they cut 1 cm of the mechanical seam directly under the brackets, suture the hole formed with single seams perpendicular to the axis of the mechanical seam, introduce the base part of the stapler transanally, the stylet of the stapler is carried out through the center of the junction of the manual and mechanical seams, complete the formation of a hardware anastomosis.

The invention has an inventive step, since for a specialist surgeon does not explicitly follow from the level of medicine in this field of surgery. In the available information sources of Russia, the CIS and foreign countries, we were not able to find a method similar to the proposed method for processing the stump of the lower ampullar part of the rectum.

The invention is industrially applicable, as it can be repeatedly repeated and used in health care for the surgical treatment of colorectal cancer in specialized medical institutions, especially oncology: oncology dispensaries, cancer research institutes.

The method is as follows. Stitch the rectal stump with a linear stapler "CONTOUR". The center of a mechanical seam is stitched with a single ligature, conducting it under the seam brackets. Pull the seam up. Cut 1 cm of the mechanical seam directly under the brackets 5 mm to the right and left of the ligature. The hole formed is sutured with single sutures perpendicular to the axis of the mechanical suture. Enter the base of the stapler transanalously. The stylet of the stapler is carried out through the center of the junction of the manual and mechanical seams.

A hardware circular anastomosis is applied, while the entire line of the mechanical seam of the linear stapler is removed during the formation of the anastomosis.

Example: Patient N-ev, 53 years old, medical history No. 4622 / o, was admitted to the thoracoabdominal department of the Rostov Cancer Research Institute on 04/14/2010 with a diagnosis of colorectal cancer T4N0M0 St II, column 2 04/19/2010 Under iv intravenous combined anesthesia with mechanical ventilation, a mid-lower middle laparotomy was performed with a length of 35 cm. During the audit: a rectal tumor 7 cm from the anus was dense, bumpy, 4 × 3 cm in size, no distant metastases were detected without invasion of adjacent organs. A decision was made to remove the tumor. The rectum with the tumor was mobilized. The stump of the rectum was stitched with a linear stapler "CONTOUR". The center of the mechanical seam was stitched with a single ligature, passing it under the seam brackets. They pulled the seam up. Cut 1 cm of the mechanical seam directly under the brackets 5 mm to the right and left of the ligature. The hole formed was sutured with single sutures perpendicular to the axis of the mechanical suture. The base of the stapler was transanally inserted. The stylet of the stapler was carried out through the center of the junction of the manual and mechanical seams. The tumor was removed. A circular colorectal anastomosis was applied. The abdominal cavity was drained with 2 silicone tubes installed in the pelvis through punctures in the hypogastrium on the left and right. The laparotomy wound was sutured in layers tightly, the suture was treated with iodine, an aseptic dressing was applied. The patient was discharged in satisfactory condition. Drainages removed on the 9th day. Sutures were removed on the 15th day. According to this technique, 5 patients were operated on, with good functional results. Anastomosis failure in the postoperative period was not noted.

The technical and economic efficiency of the method lies in the fact that the reliability of the apparatus colorectal anastomosis is increased, the number of insolvency and purulent-septic complications is reduced, which improves the quality of life of patients, reduces the hospital bed, reduces treatment costs.

Claims (1)

A method of treating a stump of the lower ampullar part of the rectum, including the application of a hardware suture, characterized in that the center of the mechanical suture is sutured with a single ligature, conducting it under the suture brackets, the suture is pulled up, the 1 cm of the mechanical suture is cut directly under the brackets 5 mm to the right and left of the ligature the sutured hole is sutured with single seams perpendicular to the axis of the mechanical suture, the base of the stapler is inserted transanally, the stylet of the stapler is carried out through the center of the junction of the manual and mechanical eskogo joints impose hardware circular anastomosis, the entire line of mechanical linear stapler is removed during formation of the anastomosis.