RU2145806C1 - Method of intraspleen reduction of blood flow in preset segment - Google Patents

Abstract

FIELD: medicine, surgery; applicable in organ-preserving operations in cases of spleen injuries. SUBSTANCE: method includes introduction of agraffe in region of organ hilus in direction perpendicular to the latter from front to rear edges in projection of wound on visceral surface. Agraffe made of material with shape memory is used with possibility of ensuring of compression of spleen intraorgan vessels with subsequent final hemostasis of wounds located in given segment. EFFECT: provided effective hemostasis of wounds located in given segment without disturbance of blood supply and function of nonaffected part of organ. 4 dwg, 1 ex

Description

 The invention relates to medicine, namely to surgery for organ-preserving operations in case of damage to the spleen.

 There are many methods of hemostasis of traumatic injuries of the spleen, for example, “A method for the treatment of spleen ruptures” (A.S. 1097292 USSR, MKI 3 A 61 B 17/00, E.G. Grigoriev, S.P. Chikoteev (USSR), which consists in suturing wounds of the spleen using a large omentum as a lining material in order to prevent eruption of sutures.

 The disadvantage of this method is that only the wound is sutured, without changing the blood supply to the organ. Given the abundant blood supply to the spleen, this method does not always achieve hemostasis. In addition, bleeding from needle sites may be difficult to stop.

 The method of organ-preserving surgery for traumatic ruptures of the spleen was selected as a prototype (A.S. 1602480 USSR, MKI 5 A 61 B 17/00, E.P. Safronov, V.I. Petrov, V.S. Chupyatova, USSR) consisting in ligation of the main trunk of the splenic artery in its supra-pancreatic department, distal to the discharge of the back artery of the pancreas, with the goal of hemostasis and to prevent bleeding from sutured wounds of the spleen.

 The disadvantage of this method is that the ligation of the main trunk of the splenic artery causes significant ischemia of the entire organ, and not just the damage zone and, therefore, is accompanied by a decrease in the function of the spleen in the early postoperative period. In addition, due to the presence of blood supply to the organ through collaterals in the system of the left gastrocolic artery, blood flow to the spleen wounds and continued bleeding are not excluded.

 The objective of the invention is to increase the effectiveness of hemostasis when performing organ-sparing surgeries on the spleen, simplifying the technique of surgery to finally stop bleeding, reducing the number of postoperative complications and maintaining the function of the organ in the early postoperative period.

 This problem is achieved by the fact that a bracket made of material with shape memory (MPF) is inserted perpendicular to the gate into the spleen tissue (but not to the edge of the wound) from its visceral surface in the direction from the front edge to the back, i.e., so that its legs are located parallel to the visceral surface of the organ.

 Taking the initial shape of the legs, the brackets squeeze the branch of the splenic artery, supplying this segment of the organ and causing a decrease in blood flow in it. In this case, the wound of the spleen, in whatever part of the segment it is located, ceases to bleed.

 Therefore, the method of intra-splenic blood flow reduction allows one to achieve reliable hemostasis only in the damaged part of the organ, without disturbing the blood supply to its undamaged sections, which means it ensures normal spleen function in the early postoperative period.

 Thus, the claimed method meets the criteria of the invention is "novelty." Comparison of the claimed solution not only with the prototype, but also with other technical solutions in this field of medicine, did not allow us to identify signs that distinguish the claimed solution from the prototype, which allows us to conclude that the criterion of "significant differences" is met.

 The invention is illustrated by drawings, where in Fig. 1 a bracket from MPF is shown, in Fig. 2 is a modified bracket from MPF before it is inserted into the tissue of the spleen, Fig. 3 is a diagram of the staple in the tissue of the spleen, Fig. 4 shows segmental blood supply to the spleen .

 The method is as follows. After laparotomy is performed, the abdominal organs are revised.

Establish the nature of damage to the spleen. Next, the spleen is sutured in any known manner, for example with catgut, with brackets from MPF. If, after suturing a wound from the last or from the injection site, continued bleeding is observed, blood flow is reduced in the damaged segment of the spleen. To do this, the bracket from the MPF with a predetermined shape in the form of crossed legs (Fig. 1) is modified in a cooled antiseptic solution at 0 ^° C so that the legs of the bracket are moved apart and become parallel to each other (Fig. 2), and inserted into the spleen tissue with a clip . In FIG. Figure 3 schematically shows how a bracket is inserted into spleen tissue. The bracket is inserted from the visceral surface of the spleen (1), and the injection site of the legs (2) is at a distance of 1.5-2.0 cm from the gate of the spleen in the direction of the front edge.

 The bracket is inserted into the tissue of the spleen in the direction of the posterior edge, perpendicular to the gates of the organ (3), striving so that the legs of the bracket (4) are parallel to the visceral surface and do not significantly deepen in the direction of the diaphragmatic surface of the spleen. The wound (5) serves as a guideline for the level of insertion of the brace relative to the "length" of the spleen, the wound itself or its projection on the visceral surface of the organ should be located between the legs of the bracket. Due to contact heating of the legs (4), the brackets tend to come closer and squeeze the vessels (6) located between them. Since the blood supply to the spleen is segmental and the segments are like a "pile of coins" (Fig. 4), the compression of the vessels in the area of the gate of the spleen causes a reduction in blood flow throughout the segment and provides final hemostasis, regardless of which part of the segment the wound is located. The operation is completed by drainage of the left subphrenic space. Drainage is removed 3-4 days after surgery. The MPF bracket is left in the spleen tissue, since the nickelide-titanium from which the above bracket is made has mechanical, biochemical compatibility with body tissues and has no carcinogenic and toxic properties.

 Clinical example. Patient V., 42 years old, was admitted to the hospital with a diagnosis of perforated gastric ulcer. During an emergency operation - resection of 2/3 of the stomach - the spleen was damaged by a liver mirror. An audit of the spleen revealed a linear rupture in the middle third of the visceral surface with a length of 20 mm, a width of 5 mm and a depth of 10 mm with heavy bleeding. An attempt to stop bleeding by electrocoagulation is not effective. The spleen rupture was sutured with a brace from MPF, however, hemostasis was not achieved: the wound continues to bleed. Then, the blood flow was reduced in the damaged segment of the spleen by setting the brackets from the MPF in the area of the organ gates and perpendicular to the latter, in the direction from the front edge to the back, outside the gap. After contact heating of the brace, hemostasis occurred. The operation was completed by drainage of the left subphrenic space. Sanitation of the abdominal cavity was performed, the wound was sutured in layers.

 The postoperative period was uneventful. Drainage was removed 3 days after surgery. After 11 days, a control ultrasound examination of the abdominal cavity of the spleen was performed: the organ structure is homogeneous, hyperesogenic formations (brackets) are dosed in the middle third. After 12 days, control radiography of the abdominal cavity was performed: brackets are located in the projection of the spleen. The patient was discharged 11 days after surgery in satisfactory condition.

 Thus, the use of the intrasplenic blood flow reduction method allows reliable hemostasis with the inefficiency of conventional splenoraphy; increase the number of organ-containing operations on the spleen, simplifies the technique of surgery and is not accompanied by a violation of the blood supply to the intact areas of the spleen, which ensures its full function in the early postoperative period.

Claims (1)

 The method of intra-splenic blood flow reduction in a given segment, based on the compression of blood vessels supplying the damaged spleen segment, characterized in that a bracket made of memory material is inserted into the area of the organ gate and perpendicular to the latter in the direction from the front edge to the back in the projection of the wound onto the visceral surface forms, with the possibility of providing compression of the intraorgan vessels of the spleen, followed by final hemostasis of the wounds located in this segment, without disturbance of blood supply tions and functions of the body intact.

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