RU2178671C2 - Method for preventing inconsistency of large-to-small intestine anastomosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves draining gastroenteric tract from the area of not formed large-to-small intestine anastomosis in proximal direction using temporary probe. The temporary probe is conducted through the rhinostomatopharynx, esophagus, duodenum, small intestine to the anastomosis area. Fibrocolonoscope is used for draining inn in distal direction. The fibrocolonoscope is introduced through the anus, rectum, colon to the anastomosis area. The ends of the through drain are fixed in the nasal passage area and in the anal area. Anastomosis creation being done, the probe is withdrawn. EFFECT: enhanced effectiveness of gastroenteric tract decompression. 5 dwg

Description

 The invention relates to medicine, namely to surgery, and can be used in the treatment of small intestinal fistula in conditions of peritonitis, acute intestinal obstruction, mesenteric intestinal thrombosis.

 To prevent the failure of anastomoses in surgical practice, various methods of decompression of the gastrointestinal tract are widely used. Known methods for the prevention of insolvency of anastomoses by decompression of the small intestine with a nasogastrointestinal probe when the stomach and the entire small intestine are splinted (Nechaev E.A. et al. "Drainage of the small intestine". - St. Petersburg, 1993, 238 S.).

 Methods of decompression of the small intestine by conducting a probe through the rectum, colon, blind, ileum and jejunum are described (L. Lyubenko et al. "Prolonged intestinal decompression in acute peritonitis and intestinal obstruction" // Clinical Surgery. - 1987. - 4 . - S. 30-32; Griffen W. Discussion in: Wargelt JW Complications and result of 160 Baker tube plications // Am. J. Surg. - 1980. -Vol. 140, N 6. -P. 814-815) . There are reports when at the same time as intubation of the small intestine with a nasointestinal probe, intubation of the colon is performed (Sumin V.V., Zhizhin F.S., Izhevsk, 1992, 109 pp.; Sapozhkov A. Yu., Nikolsky V.I. Decompression of the intestine. Penza, 1992, 136 pp.).

 Method L. A. Lyubenko et al. (1987) is taken as a prototype, since there are common signs with the claimed object: during the operation, the colon and small intestine are intubated with one probe conducted through the anus.

Significant disadvantages of the prototype are:
1. Intubation of the small intestine through the rectum, colon, and cecum is technically very difficult.

 2. The probe, with the help of which decompression of the gastrointestinal tract is carried out through the colon, can be obstructed, attached to the wall of the intestine, since its outlet section is located on one side, namely from the anus.

 3. Intubation of the small and large intestines with a probe installed on the anus side does not allow replacement after surgery with probes of other diameters after surgery.

 4. The passage of the probe from the anus into the small intestine infects the upper sections of the small intestine.

 The essence of the claimed method consists in through drainage of the gastrointestinal tract through the nasal passage, oral cavity, esophagus, stomach, duodenum, small intestine, small intestine anastomosis, colon, rectum, anus with the removal of the ends of the drainage probe with many lateral openings to the outside : proximal through the nasal passage, distal through the anus, which is removed after the final formation of the anastomosis.

 The method is as follows. During surgery for formed or unformed small intestinal fistulas, complicated by peritonitis, acute small bowel obstruction, acute mesenteric thrombosis (Fig. 1), in which a small intestine 3 or part of the small intestine with a colon is required to be resected, requiring a small intestine due to intestinal anastasis along the length of the remaining sections of the intestine, ensuring without enteric insufficiency the normal functioning of the patient, with the aim of preventing insolvency anastomosis oditsya bowel intubation. To do this, from the side of the oral cavity A (Fig. 2), a “temporary” 1 silicone or polyvinylvinyl gastrointestinal tube with a diameter of 8 mm is inserted, which is sequentially inserted through the esophagus B, into the stomach C and small intestine G, D to the resection level with simultaneous evacuation from these departments of chyme. A fibrocolonoscope is introduced from the anus to the site of the proposed application of the small intestinal anastomosis Z, while removing the chyme and introduced air.

 Then, the small intestine, and, if necessary, the right half of the colon is resected, and proceed to the formation of the small intestinal anastomosis with the first row of sero-muscular sutures between the small and large intestines I. After opening their lumen and applying the inner row of sutures through all layers by 2 / 3 diameters of the suspected anastomosis (Fig. 2), the distal end of the “temporary” probe 1 is sequentially inserted into the lumen of the incomplete anastomosis, to which the proximal end 2 of the permanent PVC drainage probe is fixed and with multiple side holes with a diameter of 6 mm, which differs from the "temporary" greater elasticity. Pulling the "temporary" probe from the side of the nasopharynx, establish a constant probe in the proximal direction. Then, from the colon of the colon F, a fibrocolonoscope 3 is inserted into the lumen of the anastomosis I, a farsolate is passed through its channel, to which the distal end of the "permanent" probe 2 with the ligature K is attached to it. When the fibrocolonoscope 3 is removed, a "permanent" probe is installed in the intestinal lumen into distal direction and out through the anus. The formation of the anastomosis is completed by the imposition of the inner row of sutures and sero-muscular sutures on the anterior lip of the small intestine anastomosis And (Fig. 4). After applying the anastomosis, decompression of all the remaining sections of the gastrointestinal tract and the area of the formed anastomosis is performed using the installed through drainage, discharged through the nasal passage on the one hand and through the anus on the other, connecting it to the active aspirator (Fig. 5).

 The method is used in the treatment of two patients.

 Example 1. Patient Z., 29 years old (and / b 64154/4), diagnosis: multiple fistulas of the small and large intestines, condition after 5 relaparotomies for blunt trauma of the abdomen with rupture of the intestine, adhesive intestinal obstruction, diffuse peritonitis on the right and left side channels.

 The operation of November 16, 1996: relaparotomy is the sixth, resection of the ileum with fistulas, right-sided hemicolectomy, end-to-end transverse anastomosis, end-to-end drainage of the entire gastrointestinal tract with the goal of decompression. In the postoperative period of November 28, 1996, through the established drainage, a contrast study of the anastomotic region was performed, the latter being consistent.

 Example 2. Patient V., 60 years old (and / b 65028/1), diagnosis: multiple small intestinal unformed fistulas, abscesses of the abdominal cavity, limited peritonitis.

 Operation 23.12.96, the elimination of small bowel obstruction and fistula, by resection of the small intestine, carrying fistula, opening of abscesses of the abdominal cavity, ileotransverse anastomosis, sanitation and drainage of the abdominal cavity, through drainage of the gastrointestinal tract. 8.01.97 g. X-ray examination of the gastrointestinal tract - the area of the anastomosis is wealthy.

 The proposed method for the prevention of small bowel anastomosis insolvency has reduced the likelihood of anastomosis insolvency and mortality associated with this complication.

Thus, the essential advantages of the proposed method for the prevention of insolvency of the small bowel anastomosis compared with the prototype are:
1. Ensuring effective decompression of the gastrointestinal tract and anastomotic region after surgery.

 2. The possibility of displacement of the probe along the length and its replacement during treatment with probes of larger or smaller diameters.

 3. Creating favorable conditions for the restoration of the motor-evacuation function of the gastrointestinal tract in the postoperative period.

 4. Through drainage allows you to lay intestinal loops and thus exclude the occurrence of intestinal obstruction in the early postoperative period.

 5. Installation of the probe from two sides: from the stomach and rectum, reduces infection of the upper digestive tract.

 6. Through drainage of the gastrointestinal tract allows for effective lavage of all its departments.

Claims (1)

 A method for the prevention of insolvency of the small intestinal anastomoses, including drainage of the gastrointestinal tract, characterized in that the drainage of the gastrointestinal tract is performed from the area of the unformed thin-thick-walled anastomosis in the proximal direction through a "temporary" probe through the rhinopharynx, esophagus, stomach, duodenum to the region of the anastomosis, and in the distal direction with the help of a fibrocolonoscope conducted through the anus, rectum, colon to the region and anastomosis, and after the formation of the abdominal cavity sutured anastomosis, and the ends are fixed respectively through drainage in the nasal passage and the anus and at the end of the formation of the anastomosis the probe is removed.

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