RU2220670C2 - Uninterrupted-interrupted adventitialmuscular-submucous single-row suture of bladder - Google Patents

Abstract

FIELD: medicine, surgical urology. SUBSTANCE: one should fix ligature in wound's angle. X-shaped counter sutures are applied by fixing with surgical knot. Sutures should be applied with two needles from adventitia towards submucosa of wound's one edge and vice versa in wound's another edge without puncturing mucosa. The same operations should be carried out with the second ligature by beginning from wound's opposite edge. Surgical knots are located outwards. The method enables to adapt the edges of sutured organ by layers by keeping hermetic nature of a suture. EFFECT: higher efficiency of operation. 10 dwg, 3 ex

Description

 The invention relates to medicine, namely to urology, can also be used in surgery of hollow organs.

 The prototype of the invention may be a suture of the bladder according to Karpenko - copyright certificate 993920, published. BI 5 from 09/07/83. Seam Karpenko is as follows. At the corner of the wound of the bladder, a curvy suture is applied from the outside inward with the knot outward (Fig. 1). Then, the ends of the suture carry out a continuous continuous-nodal suture from the inside out - inject into the mucosa, poke in the adventitia of the first edge of the wound with one thread, then the other performs the same with the second edge, the threads are connected by the surgical node, the steps are repeated until the wound is closed (figure 2) .

However, the described method has several disadvantages:
1) the filaments are interpolated along the seam line, which complicates the healing process of the wound (insufficient closure of the edges, inflammatory reaction during hydrolysis of the filaments) (figure 3);
2) there is no proper adaptation of the layers of the wall of the bladder. From a knot located outside, a stitch is made from inside to outside so that when tying the layers of the same name are not matched (figure 4);
3) the application of a through seam leads to bacterial contamination of the threads with infected urine.

 The objective of the invention is to adapt layer by layer the edges of the sutured organ while maintaining the tightness of the suture, to eliminate the overlap of the second row of sutures, which will speed up the regeneration process in the suture area and shorten the postoperative period.

 The objective of the invention is achieved in that the integrity of the wall of the bladder is restored by a single-row continuous-nodal adventitious-muscular-submucosal suture. The wound angle is sutured with an 8-shaped adventitious-muscular-submucosal suture with the long ends of the threads remaining. The last surgical needles are carried out X-shaped from the outside to the inside of one wall, from the inside to the outside of the other wall without trapping the mucosa. The second thread performs the same actions, but starting from another wall. The threads are tied outside with a surgical knot. The sequence of actions is repeated until the wound is completely closed with a deaf seam of the bladder. If drainage is necessary, sutures are applied from two corners of the wound to drainage.

The invention is illustrated by the following figures:
figure 5 shows the overlay on the corner of the wound with a long absorbable thread of an 8-shaped nodal suture without puncture of the mucosa;
figure 6 shows the method of applying a continuous-nodal adventitious-muscular-submucosal single-row suture of the bladder;
Figures 7 and 8 depict a technique for applying a continuous-nodal adventitious-muscular-submucous single-row deaf seam of the bladder (explanation in the text);
figure 9 shows the imposition of 8-shaped sutures on the corners of the wound during drainage of the bladder;
in FIG. 10 shows a sequence of overlaying a continuous-nodal adventitious-muscular-submucosal single-row suture during drainage of the bladder.

 The method is as follows.

 After performing the main stage of the operation, cystoraphy is started. At the corner of the wound with a long absorbable thread, a nodal 8-shaped suture is applied without puncture of the mucosa, leaving the long ends of the threads, as shown in Fig.5. An injection and puncture is performed at 0.5 cm from the edge of the wound, from the corner of the wound, the first injection is also performed at a distance of 0.5 cm. Next, one end of the thread using a surgical needle is successively carried out from the adventitia side through the muscle layer with a puncture in the submucosa of the first edge of the wound. , and through the layers of the second edge in the reverse order (submucosal, muscle layer, adventitia). The injection and puncture are also performed 0.5 cm from the edge of the wound and 0.5 cm along the wound from the node or previous injection so that 1.5 cm of the wound converges in one cycle (Fig. 6). The second thread performs the same actions, but starting from the other (second) edge of the wound. The threads are tied outside with a surgical unit (Fig. 7). With deaf closure of the bladder, the described actions are cyclically repeated until the wound is completely closed (Fig. 8). If it is intended to drain the bladder through the wound, a suture is placed on the stoma on both sides (Figures 9 and 10).

Example 1
Patient I. Valikov, born on 03.03.1925, was admitted to the urology department of the Belgorod city hospital on 07.08.2001, the medical history number was 7905. As a result of the examination, the diagnosis was established: Benign prostatic hyperplasia, stage III, acute urinary retention. Ischemic heart disease. Cardiosclerosis Ventricular and supraventricular extrasystole. CH IIA stage. The bladder was drained by a urethral catheter. 07/16/2001 a delayed simultaneous transvesical adenomectomy was performed. July 16, 2001 10 ⁴⁰ -11 ²⁵ . Operation protocol. Operation: Transvesical adenomectomy.

 The bladder is filled with 300.0 ml of oxygen. Under epidural anesthesia, after treating the surgical field with iodonate solution three times, strictly in the midline between the pubis and the umbilicus, the skin and subcutaneous tissue are dissected until aponeurosis. The surgical field is limited to napkins. The aponeurosis is also dissected along the midline, the rectus and pyramidal muscles are dilated stupidly, after which the prebubular fascia is transversely dissected closer to the pubis and the prebubular fiber is bluntly peeled along with the transitional fold of the peritoneum upward, the anterior wall of the bladder is taken up as high as possible and opened between the latter. Revision of the bladder: the lumen of the latter without features, adenomatous nodes are determined in the neck. The anterior commissure is bimanally divided and adenomatous nodes about 60.0 ml in volume are hatched. The bed is swabbed with a cloth with hydrogen peroxide for 5 minutes. Revision of the bed, bleeding slightly. The bed is plugged with a Foley 20 Ch catheter balloon filled with 60.0 ml of furacilin. The bladder is sutured with a single-row continuous-nodal adventitious-muscular-submucosal suture with a polysorb 2-0, drained with a 32 Ch PVC pipe. The irrigation system is washed with furatsillin solution, good hermeticity, wash water without clots, slightly stained with blood. Hemostasis during the operation. Layered seam on the wound. Aseptic dressing.

 Operated by Shkodkin S.V.

 Assisted Kryukov A.Z.

 Oper. sister Sedykh E.V.

 Anesthesiologist Baksheev A.N.

 The postoperative period was uneventful, the urethral catheter was removed on the 3rd day, the suprapubic fistula was healed by 10 days, and free urination was restored. Postoperative wounds healed by first intention. With recovery, the patient was discharged.

Example 2
Patient Gubriy N.G., born on 10/22/1926, was admitted to the urology department of the Belgorod city hospital 2 July 29, 2001, the medical history number was 7564. Three years ago, a one-stage transvesical adenomectomy was performed at the Central Hospital. In the postoperative period, obstructive and irritative symptoms persisted and gradually increased. As a result of the examination, the diagnosis was established: Bubble. Intramural urethral stricture traversed for urine. Chronic urinary retention. Ischemic heart disease. Cardiosclerosis CH IIA stage. With urethroscopy, it was not possible to detect the course, therefore, an intervention was made on an open bubble. 08/15/2001 performed a planned wedge-shaped resection of the neck of the bladder. August 15, 2001 13 ²⁵ -14 ¹⁰ . Operation protocol. Operation: Wedge resection of the neck of the bladder.

Under epidural anesthesia, after treatment of the surgical field with iodonate solution three times, with excision of the postoperative scar, the skin and subcutaneous tissue are dissected strictly in the midline between the pubis and the navel until aponeurosis. The surgical field is limited to napkins. The aponeurosis is also dissected along the midline, the rectus and pyramidal muscles are dilated stupidly, after which the prebubular fascia is transversely dissected closer to the pubis and the prebubular fiber is bluntly peeled along with the transitional fold of the peritoneum upward, the anterior wall of the bladder is taken up as high as possible and opened between the latter. Revision of the bladder: the lumen of the last without features, cicatricial deformity of the neck of the bladder is determined, the internal opening of the urethra is displaced anteriorly, narrowed to the point - it hardly passes the ureter catheter 4. For 2 cm from the internal opening of the urethra, at 5 and 7 hours of the conditional dial, to the depth of the prebubble, the neck of the bladder is dissected by an electric knife. The top of the formed triangle is captured in the clamp "Alice", pulled up and cut off with an electric knife at the base of the triangle. Coagulation hemostasis. The bladder is sutured with a single-row continuous-nodal adventitious-muscular-submucosal suture with a polysorb 2-0, drained with a polyvinyl chloride tube 14 Ch and a urethral catheter Foley 16 Ch. The irrigation system is washed with a solution of furatsillin, the tightness is good, the wash water is clean. Hemostasis during the operation. Layered seam on the wound. Aseptic Dressing
Operated by Shkodkin S.V.

 Assisted Utkin A.A.

 Oper. sister Sedykh E.V.

 Anesthesiologist Baksheev A.N.

 The postoperative period was uneventful, the urethral catheter was removed for 1 day, the suprapubic fistula was healed by 7 days, and free urination was restored. Postoperative wounds healed by first intention. With recovery, the patient was discharged.

Example 3
Patient Maslov VN, was admitted to the urology department of Belgorod city hospital 2 05/15/2001, medical history number - 4936. Four years ago, a fall from a height - fractures of the bones of the legs, pelvis, compression fracture L ₂ -L ₃ , lower paraparesis, spinal bladder. Upon receipt complained of severe dysuria. As a result of the examination, the diagnosis was established: ICD. Bladder stone 5x4x4 cm. Condition after injury lower paraparesis. Ultrasound and cystoscopy did not reveal any residual urine, the volumetric rate of urination was 16 ml / s, so the volume of intervention is limited by cystolithotomy.

05/23/2001 11 ⁴⁰ -12 ⁰⁰ . Operation protocol. Operation: Cystolithotomy.

The bladder is filled with 300.0 ml of oxygen. Under epidural anesthesia, after treating the surgical field with iodonate solution three times, strictly in the midline between the pubis and umbilicus, the skin and subcutaneous tissue are dissected until aponeurosis. The surgical field is limited to napkins. The aponeurosis is also dissected along the midline, the rectus and pyramidal muscles are dilated stupidly, after which the prebubular fascia is transversely dissected closer to the pubis and the prebubular fiber is bluntly peeled along with the transitional fold of the peritoneum upward, the anterior wall of the bladder is taken up as high as possible and opened between the latter. Revision of the bladder: in the lumen of the latter, a calculus of 5 • 3 • 3 cm is determined, removed, the mucous membrane is pale pink, the vascular pattern is normal, the mouth is typically located at 5 and 7 hours of the conditional dial, light urine flows bolus, the neck of the bladder without features, external the urethral opening passes the phalanx of the index finger. The bladder is sutured with a deaf single-row continuous-nodal adventitious-muscular-submucosal suture Polysorb 2-0, drained transurethrally by a Foley 18 Ch catheter. Hemostasis during the operation. Layered seam on the wound. Aseptic Dressing
Operated by Shkodkin S.V.

Assisted Kryukov A.Z.
Oper. sister Sedykh E.V.

 Anesthesiologist Aulova V.F.

 The postoperative period was uneventful, the urethral catheter was removed on day 7, and free urination was restored. Postoperative wounds healed by first intention. With recovery, the patient was discharged.

 Thus, this method of cystoraphy can be recommended for clinical use in urology. With this method of closing the wound of the bladder, a layer-by-layer adaptation of the edges is achieved due to the fact that the injection is made into the layer from which the thread was located. And since if the mucous membrane is not captured, then it covers the seam line from the inside and prevents the infection of the thread. This speeds up the regeneration of the wound. What is not when suturing according to Karpenko. In addition, the hermeticity of the wound due to the presence of stationary surgical nodes is ensured. Perhaps the use of this method in the surgery of hollow organs: gastrointestinal tract, uterus.

Claims (1)

The continuous-nodal adventitial-muscular-submucosal single-row suture of the bladder consists in securing the thread in the corner of the wound, followed by X-shaped oncoming sutures with fixation by a surgical node, characterized in that the thread is fixed in the corner of the wound with an 8-shaped suture, leaving long ends, the sutures are laid with two needles from adventitia to the submucosa of one edge of the wound and vice versa in the other edge of the wound without puncture of the mucosa, the second thread performs the same operations, but starting from the opposite edge of the wound, while the surgeon The female nodes will be located outside, and the line of sutures from the inside will be covered by the mucosa.

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