RU2132651C1 - Method for putting-in stitches of adaptation intestine suture - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves sewing hollow organ wall layer-by-layer from inside to outside. Thread are crossed in the hollow organ wall on the muscular and submucous layer boundary. EFFECT: full adaptation of all layers of hollow organ walls. 6 dwg

Description

 The invention relates to medicine, namely to surgery, to methods of surgical treatment, and can be used for suturing wounds and applying anastomoses to the organs of the gastrointestinal tract.

Two-row intestinal sutures are known: I. Kirpatovsky suture (I. Kirpatovsky. Intestinal suture. M .: Medicine, 1964), Albert's suture (Yu.S. Gilevich et al. Anastomoses in abdominal surgery, Stavropol, 1978), Cherni suture (I. Kirpatovsky Intestinal suture. M .: Medicine, 1964), suture Chernousova et al. with a separate seam of the mucous membrane (ed. certificate N 632350, class A 61 B 17/00), however, having a number of disadvantages:
1) significant injury to the edges of the wound;
2) the formation of an intense tissue shaft;
3) contaminates the deep layers of the intestinal wall;
4) when flashing the mucosa, sections of the mucous membrane with the formation of mucous cysts fall into the wall thickness;
5) when flashing the first and second rows of seams, tunnels (voids) are formed,
6) leaves a significant number of threads, which complicates their teething (Dmitruk Y.D. Bulletin of surgery, 1958, 1, pp. 95-97; Mateshuk VP The simplest and most perfect technique for suturing wounds of the intestines author diss. academician, Doctor of Medical Sciences, Yaroslavl, 1945; Kirpatovsky ID, Intestinal suture M.: Medicine, 1964; Kanshin N.N. Bulletin of Surgery, 1972, 6, pp. Z3-36 ; Skobenkin OK et al. Herald of Surgery, 1986, 6, pp. 53-57; Mauria SD at al. Jnr. Surg. 1984, 69, 4, p. 339-340; Motson RW at al. Ann. Roy. Cell . surg. Engl., 1984, 66, 1 p. 19-21; Izzal at al. Ann. Ital. Chiz, 1985, 57, 5, p. 354-406).

The closest in technical essence are the intestinal sutures of Yu.N. Mokhniuk and A.P. Poida (ed. Certificate N 990199, class A 61 B 17/00), Vesienne suture (Kirpatovsky I. D. Intestinal suture M. : Medicine, 1964) having the following disadvantages:
1) poor adaptation of the edges of the wound and layers, in connection with which there is a delay in epithelization;
2) less tightness and strength compared to a two-row seam;
3) requires frequent suturing, injuring the edge of the wound;
4) holding the thread through the infected organ lumen;
5) poor hemostasis of the organ mucosa;
6) an upheaval of the intestinal mucosa;
7) there is no control over the comparison of layers from outside to inside from “clean” to “dirty” (Oboremko NN Surgery, 1960, 2, p. 125; Kupriyanov P. Ya. Surgery 1959, 11, p. 134; Shilovtsev S.P. Surgery, 1954, 3, pp. 22-26; Gilevich Yu.S. et al. Anastomoses in abdominal surgery, Stavropol, 1978; Kirpatovsky I. D. Intestinal suture. M .: Medicine, 1964 .; Geitel G. at al. Surg. Gynec. Obst., 1966, 123, 6, p. 1219-1227; Nockerman P. Chirurg, 46, 9, p. 421-422).

 The objective of the invention is the complete and strict adaptation of all layers of the wall of the hollow organs, creating optimal conditions for wound healing while preserving trophic tissue in the area of the formed suture.

 The task is achieved in that the edges of the wound are stitched with one ligature with two needles at the ends, first, the serous and muscle membranes, then a cross is made at the border between the muscle and submucous membranes, after which the submucous and mucous membranes are stitched. The strength of the suture is achieved by the fact that a submucosa is fixed with a separate suture, which determines the main strength of the wall of the hollow organ. The creation of optimal conditions for wound healing is carried out by preserving the vessels of the muscle and submucosal layers with restoring the initial values of tissue pressure.

The method is as follows:
- in outbred dogs weighing 7-20 kg under air-ether anesthesia, median laparotomy is performed;
- the wall of the stomach is brought out into the wound, holders are applied, tissue pressure is measured in the serous-muscular layer (50 ± 3 mm water column), after which these layers are dissected, then tissue pressure is measured in the submucous-mucous layer (40 ± 3 mm water Art.) and cut, the length of the cut is 4.0-5.0 cm;
- the ligature with two needles at the ends of the serous and muscle membranes is stitched sequentially from both edges (Fig. 1);
- then the ligatures cross (Fig. 2) and stitch the submucous and mucous membranes (Fig. 3),
- when tightening the threads restore full adaptation and the original value of tissue pressure in the serous and muscle membrane (figure 4);
- at the same time, the first node leads to initial values of tissue pressure in the submucous and mucous membranes, fix the second node;
- the next stitch is applied at a distance of 0.7 cm from each other, the last stitch is double-rowed in the modification of Kirpatovsky ID;
- the operation is completed by layer-by-layer suturing of the abdominal cavity.

 An example of a specific application. In dog No. 11, an abdominal cavity was opened in layers under ether-air anesthesia with a midline incision. The wall of the stomach is brought out into the wound, holders are applied, tissue pressure is measured in the serous-muscular layer (51 mm Hg), dissected, then pressure is measured in the submucous and mucous layers, dissected, the incision length is 5.0 cm. Adaptive intestinal sutures are applied under the control of a device that records tissue pressure, after 0.7-0.8 cm, the latter is applied bilinearly in the modification of I. Kirpatovsky. The abdominal cavity is sutured in layers tightly. After three days, the animal moves freely around the cage, normal behavior, drinks water, takes food. On the 10th day, with repeated surgery, a resection of the experimental site was performed, the wound of the stomach was sutured, the animal was withdrawn from the experiment. Macroscopically: the seam area is free of the omentum, there is no swelling of the inflammation. Microscopically: there is no complete and strict adaptation of layers, hematomas and microabscesses in the suture area, reparative processes in all membranes, no mucous diastases.

 The experiment was conducted on 20 outbred dogs in 2 series - control and experimental, in each of them 10 animals. Duration of observation of 10, 20, 60 days. No complications were observed. In the experimental group on the 10th day macroscopically: the surface of the serous membrane is free of omentum, there is no edema infiltration. Microscopically: strict adaptation of the layers, reparative processes in all layers, hematomas and microabscesses are not observed, there are no diastases of the mucosa (Fig. 5, where 1 is the suture line, evenly restored mucous and submucosal layers; 2 - encapsulated suture threads). On the 20th day, macroscopically: there is no inflammation in the suture area, microscopically: complete adaptation of the layers, microabscesses are absent, the submucous and mucous membranes are slightly thickened. On the 60th day, macroscopically: half of the sutures cut into the lumen of the organ, there is no swelling of infiltration, microscopically: a complete restoration of the integrity of all membranes, there is almost no scar in the area of the suture.

 In the control group, Yu.N. Mokhniuk and A.P. Poida (prototype) were sutured on the same wound. In dog No. 2, an abdominal cavity was opened layer-by-layer under air-ethereal endotracheal anesthesia with a midline incision. The wall of the stomach is withdrawn into the wound. The holders were placed, the wall was cut, the cut length was 5.0 cm, sutures were placed on the wound. The longitudinal muscle layer is flashed with a needle with a needle, then the circular, submucosal and mucous layers are flashed on the opposite side, after which the opposite edge is flashed from the mucosa side along with the submucosa and circular muscle layer and, after the cross between the muscle layers, the longitudinal muscle layer is flashed. The application is completed with additional serous-muscular sutures. The seams are laid relative to each other after 0.5 cm. After this, deformation of the wall was noted in the area of the stitched seams. On the 10th day, with repeated surgery, a resection of the experimental site was performed. The wound of the stomach is sutured, the animal is withdrawn from the experiment. Macroscopically: an oil seal is soldered in the seam area. Microscopically: there is a significant deformation of the muscle layer, necrosis of smooth muscle cells of hematoma and microabscess, similar processes are noted in the submucosa, tissue trophism in the area of the forming scar is significantly impaired, the thickness reaches 1000 μm (Fig. 6, where 1 is the inversion of the mucous membrane into the suture area and its partial necrosis; 2 - encapsulated suture threads; 3 - microhematomas; 4 - microabscess). Ha 20th day macroscopically: in the seam area the gland is soldered, microscopically: poor adaptation of the layers, regenerative processes in all layers, microabscesses in the seam area. On the 60th day, macroscopically: in the seam area, the omentum is soldered, there is no swelling of infiltration, microscopically: restoration of the stomach wall, however, in the seam area there is a significant scar, thickened structures of the mucous-submucous layer.

Significant differences of the proposed method for applying the adaptive intestinal suture:
1) the application of the adaptive intestinal suture is carried out in a single row with the strict adaptation of all layers;
2) sequential comparison of the layers of the organ wall from the outside inward from “clean” to “dirty” with one ligature;
3) creating optimal conditions for wound healing by restoring the initial values of tissue pressure in the layers and sections of the applied intestinal suture;
4) holding the needle through uninfected tissue and lumen;
5) a combination of single-row and double-row intestinal sutures, that is, the "total effect".

The study revealed the following advantages compared to the prototype:
1) full and strict adaptation of all layers of the organ wall with one ligature;
2) minimal injury to the edges of the wound;
3) sequential comparison from outside to inside;
4) strength;
5) tightness;
6) hemostatic;
7) creating optimal conditions for healing by restoring the initial values of tissue pressure.

Claims (1)

 The method of applying an adaptive intestinal suture, including a cross of threads in the wall of a hollow organ, characterized in that the flashing of the wall of the hollow organ is carried out from inside to inside, and the cross is carried out at the border of the muscle and submucosal layers.

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