RU2072798C1 - Method for performing hemorrhoidectomy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves executing hemorrhoidectomy on anal canal wall turned with its inner surface outside. It is realizable by intrarectally introducing and later moving outside thick plastic tube having gauze bandage that is wound around its proximal end as ring of 7-8 cm diameter. EFFECT: sterile conditions in removing hemorrhoid nodes. 1 dwg

Description

 The invention relates to medicine, namely to surgery. Hemorrhoids are widespread diseases. With him, the act of defecation sharply suffers. The condition of patients worsens even more if hemorrhoidal bleeding and thrombosis of varicose nodes occur. For these reasons, this disease requires prolonged outpatient and inpatient treatment, including surgery. Based on the foregoing, the development of new, less traumatic and at the same time more effective surgical methods for the treatment of hemorrhoids is an urgent task of modern medical science.

 For hemorrhoids, various types of surgical interventions are used, which can be divided into 3 groups: 1 / ligation of internal hemorrhoids with a separate excision of external fringes, 2 / excision of hemorrhoids with a dull closure of the formed anal canal wounds, 3 / circular excision of the rectal mucosa according to UAITHEDU . Currently, most surgeons are used for hemorrhoids operation MILLIGAN - MORGAN. The technique of hemorrhoidectomy is described in detail in the works of A.N. Ryzhikh / cm. "Atlas of operations on the rectum and colon", 2nd ed. M. Medicine, 1968 /. The operation begins with a thorough diversion of the muscles of the anal sphincter. It is believed that a sign of sufficient relaxation of the muscles of the anus is the possibility of free reduction of the arms of the rectal mirror to failure when they tap against each other / cm. V.L. Rivkin, L.L. Kapuller "Hemorrhoids", 2nd ed. reslave. and add. 1984, M. Medicine, p. 112 /. With all methods of hemorrhoidectomy, a rectal mirror is necessarily used to visually monitor the ongoing manipulations in the anus. However, the use of this mirror has a number of disadvantages, which may affect the outcome of the operation. These disadvantages include: 1 / the implementation of technical methods occurs under conditions of constant infection of the wound due to mucus getting into it from the rectal lumen, 2 / the operation is performed with overgrown anal pulp, which is accompanied by additional trauma to both the mucous membrane and the pulp, 3 / during the surgery, you have to repeatedly change the position of the mirror, while the mucous membrane prolapses into the lumen of the mirror, which complicates topographic orientation and visual control s for hemorrhoidectomy, 4 / hemorrhoidectomy technically produced in a limited space in the depth of the cavity, which also makes it difficult to perform manipulations. As a result, the integrity of the skin-mucous "bridges" between the excised nodes, from which, as you know, the epithelization of perianal wounds begins, can be violated. To eliminate the aforementioned disadvantages in hemorrhoidectomy using a rectal mirror, a technique was proposed for diluting and fixing the edges of the anus using the ring of the dilator E.I. Menshenin in the modification of Rivkin and Kapuller / cm. V.L. Rivkin, L.L. Kapuller "Hemorrhoids" 2nd ed. 1984, M. Medgiz, p. 122 /. With this technique, a ring with a diameter of 150 mm with hooks is used. After stretching the anal pulp, this ring is fixed to the anus using 4 ligatures, which, according to the authors of the method, provides a good dilution of the edges of the anus, while there is no need for a second assistant / cm. Rivkin, Kapuller, "Hemorrhoids", 1984, 122 p. However, even with this method, a significant diversion of the muscles of the anal sphincter is necessary, which is inevitably accompanied by trauma to all tissues in the anus. The authors of the method themselves emphasize that the anal sphincter divulsion, especially in the elderly and senile, is dangerous, since it requires a long recovery period of its tone / cm. ibid., p. 122 /. Such an extension of the anus can lead to necrosis of the skin-mucous "bridges" due to damage to the vessels that provide them with food, which ultimately ends with cicatricial stenosis of the walls of the anus. In addition, the adaptation of the edges of the wound with overgrown tissues is not only difficult, but also dangerous due to additional trauma and imaged tissues below the dentate line, since it must be taken into account that nerve endings are concentrated in this area and if they are damaged, a marked pain reaction occurs and swelling / ibid., 112 pp. /. Significant tissue trauma forces the surgeons to leave the wounds open, but such wounds are more often infected than sutured / ibid., 113 pp. /.

 The aim of the present invention is to develop a simple, less traumatic and effective surgical method for the treatment of hemorrhoids.

 Objectives of the invention. Without damaging the anal pulp and mucous membrane in places where there are no hemorrhoidal nodes, subject to sterility of the field from the beginning to the end of the surgical procedure, under conditions of a stable surgical field and under strict visual control, remove both varicose-enlarged nodes and adapt the edges of the operating room wounds with protection against infection / from the rectal lumen /.

The specified goal is achieved through the use of the following methods of operation. After local or epidural-sacral anesthesia, a thick plastic tube is inserted into the rectal lumen after processing it with an antiseptic solution / you can use a tube for endotracheal anesthesia /, at the end of which, by flashing, 6 pairs of thick dacron / kapron / threads and the end of a narrow and long a bandage moistened with 1% iodine solution or another antiseptic that does not cause a chemical burn of the mucous membrane. The end of the bandage is fixed with one of the pairs of threads. The threads to the end of the tube are fixed as follows. The first 3 pairs are carried out at approximately equal distance from each other / for example, at 3, 10, 17 hours / by calcining the tube wall from its lumen to the outside, retreating 1 cm from the edge of the tube. The site is located near the wall of the tube. The other 3 pairs of threads are fixed to the tube by bringing them under the node of the first pair of threads. Each pair of threads is marked with clips. After the end of the tube was inserted into the lumen of the rectum, 3 pairs of threads of the same type marked with moderate tension are pulled and bred at an angle of 45 65 ^{o to} each other. Then, round the tube and between the threads round to round, the bandage is wound 1/2 of its length onto the end of the tube, immersed in the lumen of the rectum so that a band of bandage is formed at the end of the tube. Following this, the bandage rounds are moderately pulled together by tying the ends of each pair of threads. After that, the ends of the other 3 pairs of threads are bred and the second half of the bandage is also wound and immersed in the lumen of the rectum and tightened with threads. So create a "bagel" / ring / from a bandage with a thickness of 3.5 4.0 cm / diameter on the outer surface of 7 8 cm /. We consider it necessary to indicate that if the bandage is not divided into two halves, then the possibility of arranging the bandage rounds not on the surface of each other, but along the length of the tube, which will complicate the operation, is possible. Double-decker winding the bandage around the end of the tube avoids this. After the "bagel" has been formed from the bandage, the ends of the threads do not cut off. A clamp is applied to the lower end of the tube. Then, by traction at the end of the tube and thread, a gauze “donut” is introduced into the anus, and it takes on a conical shape. So carry out the inversion of the walls of the anal canal instead of hemorrhoidal nodes, while the entire dentate line and the side walls of the canal are prolated. If the gauze donut does not occur, then you need to increase the number of rounds of the bandage. To give stability to the operation zone, if there is no second assistant, a load of 1 2 kg can be attached to the end of the tube through a system of blocks. The precipitated mucous membrane is thoroughly washed first with furacilin, and then with a 1% iodine solution. After that, hemorrhoidectomy is carried out under strict visual control by any method with the prophylaxis of stenosis of the anus / mucocutaneous ligaments between the wounds are flattened and fixed / and with the adaptation and suturing of the edges of all wounds tightly. After the operation, the clamp is removed from the end of the tube, but it and the bandage are not removed, but immersed in the rectal lumen so as to eliminate the prolapse of the rectal wall. The tube and bandage are left in the lumen of the rectum for 2 to 3 days, which ensures the free passage of gases, mucus and liquid feces. This greatly facilitates the care of both the wound and the patient. The anus area is sanitized twice a day and treated with antiseptic solutions. The chair is artificially delayed for this time with the help of Intestopan or Norsulfazole. With regard to the tube inserted into the rectum, one can cite the opinion of Rivkin and Kapuller that it should be introduced to discharge the gases. For 2 3 days, usually "gluing" of the edges of the wound. The bandage is removed by cutting circular threads. Following this, the tube is removed. On the 4th 5th day after the operation, the patient is prescribed an enema. The figure shows a general view of hemorrhoidectomy using a plastic tube with a bandage wrapped around the end of the bandage. It was shown that a tube 2 was inserted into the rectal lumen 1, at the end of which a “donut” was created from bandage 3, during traction of which the walls of the anal canal with hemorrhoids 4 fell out, and one of the nodes 5 is removed.

 The method was studied in an experiment on 3 corpses and tested in a clinic in Krasnodar for 10 patients, while all received a good treatment result.

 Patient L-in A.N. 42 and. N 7383 was admitted to the General Surgery Clinic on 05/18/93, with a diagnosis of hemorrhoidal bleeding. On the same day, a hemorrhoidectomy was performed according to Milligan-Morgan with the reduction of the walls of the anal canal using a tube with a gauze ring. There are no complications. Stool after an enema 4 days after surgery. Discharged 5 days after surgery.

 Patient K-no N.V. 53 g. 7644 was admitted to the hospital on 05/20/93 with a diagnosis of bleeding hemorrhoids. May 21, hemorrhoidectomy was performed using a tube with a bandage bandage. There are no complications. Discharged 5 days after surgery.

 Thus, the method of hemorrhoidectomy using a tube, on the end of which a bandage in the form of a ring is wound, can significantly reduce the invasiveness of the operation, perform it under sterile conditions, under strict visual control with the stability of the surgical field, which can reduce both the duration of postoperative treatment and reduce postoperative complications.

Claims (1)

 A method for the treatment of hemorrhoids, including the removal of hemorrhoidal nodes, characterized in that before the operation, the walls of the anal canal are brought out by intrarectal injection and then lowering the tube, at the proximal end of which a ring of bandage with a total diameter of 7.8 cm is preliminarily made.