RU2242932C2 - Method for treating rectal cancer - Google Patents

Abstract

FIELD: medicine, surgery, oncology.

SUBSTANCE: the present innovation deals with surgical interferences upon gastro-intestinal tract. One should perform resection along the plasty of removed section of sigmoid flexure followed by applying vascular anastomoses. Moreover, one should mobilize ileocolic vein and artery to be crossed below bifurcation to achieve maximal arterial length. The obtained vascular pedicle should be rotated around vertebral axis from the right to the left, then one should apply two vascular anastomoses between the mouth of inferior mesenteric artery and ileocolic artery, terminal department of inferior mesenteric vein and ileocolic vein. The method enables to achieve improved venous efflux out of descended sigmoid flexure.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to surgical interventions on the gastrointestinal tract, and can be used in the treatment of terminal colon cancer.

A known method of treating colorectal cancer, which consists in abdominal-anal resection with releasing the sigmoid colon (Colorectal neoplasms. / Ed. By M.V. Stirns, 1983, p. 121).

The specified method has the following significant disadvantage. It does not improve blood supply to the reduced part of the sigmoid colon and does not provide for the creation of additional vascular anastomoses.

As a prototype, a method of restoring circulatory failure of the reduced sigmoid colon during sphincter-preserving operations for colorectal cancer (Actual problems of coloproctology. - Irkutsk, 1999, p.146-148), consisting in the fact that the colon is revascularized by creating vascular anastomoses:

1 - between the mouth of the inferior mesenteric artery and the end section of the superior mesenteric artery end-to-end,

2 - between the mouth of the inferior mesenteric artery and the end section of the superior mesenteric artery end-to-side,

3 - type end of the inferior mesenteric artery in the side of the common iliac artery,

4 - between the end of the inferior mesenteric artery and the deep femoral artery.

The specified method has the following disadvantage - there is no venous outflow into the mesenteric vessel system, as a result, venous stasis develops.

The aim of the invention is to improve the venous outflow from the reduced sigmoid colon.

This goal is achieved by mobilizing the iliac-vein and artery, which cross below the bifurcation, achieving the maximum length of the artery, the resulting vascular pedicle is rotated around the axis of the spine from right to left, two vascular anastomoses are placed between the mouth of the inferior mesenteric artery and the ileal-colon artery, section of the inferior mesenteric vein and iliac-vein vein.

The invention "A method for the treatment of colorectal cancer" is new, as it is unknown from the level of medicine in this field, namely surgery of the gastrointestinal tract.

The novelty of the invention lies in the fact that the restoration of insufficiency of blood supply to the reduced colonic transplant is achieved by mobilization of the iliac-vein and artery, intersection of the artery, rotation of the resulting, vascular pedicle around the axis of the spine from right to left, application of vascular anastomoses between the mouth of the inferior mesenteric artery and iliac arteries the final section of the inferior mesenteric vein and the iliac-colic vein.

In available sources of information from Russia, the CIS countries and foreign countries, it was not possible to find analogous to the proposed "Method for the treatment of colorectal cancer."

The invention "A method for the treatment of colorectal cancer" is industrially applicable, as it can be repeated and repeatedly reproduced during surgical interventions for cancer of the terminal part of the large intestine in hospitals of the surgical profile and specialized medical institutions of oncological profile.

The method is as follows.

The abdominal cavity is opened. During revision of the pelvic organs, a stump of the rectum was selected, the length of which is up to 3 cm, which does not allow to impose a colonic anastomosis. In this connection, the reduction of the sigmoid colon is performed.

The colon is mobilized in order to achieve the desired length of the moved part of the reduced intestine. During mobilization, the inferior mesenteric artery is temporarily pinched, while it is noted that there is a shortage of blood supply to the distal lower intestine. To restore insufficient blood supply to the reduced sigmoid colon, the ileo-colon vein and artery are mobilized, which cross below the bifurcation, achieving the maximum length of the artery, the resulting vascular pedicle is rotated around the axis of the spine from right to left, two anastomoses are placed between the mouth of the inferior mesenteric artery and the ileal-arterial artery section of the inferior mesenteric vein and iliac-vein vein. As a result, the blood supply to the distal gut is improved.

An example of a specific implementation of the method can serve as an extract from the medical history.

Patient L., born in 1939, medical history 1873 / f was admitted to the Thoracoabdominal Department of the Rostov Research Institute of Oncology on October 5, 2001, with a diagnosis of cancer of the ampullar rectum ST 2 CL. GR. 3 T2N0M0, condition after obstructive resection of the rectosigmoid rectal region. Histoanalysis No. 650317-moderately differentiated adenocarcinoma. The result of ultrasonography is diffuse changes in the liver, chronic cholecystopancreatitis. 10/11/2001, the patient was taken to the operating room. Under endotracheal anesthesia, after suturing the colostomy, the median postoperative scar is excised. The abdominal cavity is opened. Viscerolysis of the small and large intestine was performed; no data were found on the presence of distant metastases during the audit. During revision of the pelvic organs, a stump of the rectum was selected, the length of which is up to 3 cm, which does not allow to impose a colonic anastomosis. In this connection, it was decided to perform the reduction of the sigmoid colon. The stoma was carved from the anterior abdominal wall, and a section of the proximal sigmoid colon was resected together with the stoma.

The colon was mobilized in order to achieve the desired length of the moved part of the reduced intestine. During mobilization, the inferior mesenteric artery was temporarily pinched, while it was noted that there was a shortage of blood supply to the distal section of the reduced intestine. In order to restore insufficient blood supply to the reduced sigmoid colon, the iliac sheath vein and artery were mobilized, which crossed below the bifurcation, achieving the maximum length of the artery, the resulting vascular pedicle was turned around the axis of the spine from right to left, two vascular anastomoses were placed between the mouth of the inferior mesenteric artery and ileal arteries the final section of the inferior mesenteric vein and the iliac-colic vein. As a result, the blood supply to the distal part of the reduced intestine improved, the color of the latter turned pink.

On October 26, 2001, with Dopplerography, a satisfactory patency of the vascular anastomosis between the lower mesenteric and iliac colonic arteries was determined. At the control turnout on January 3, 2002, the condition is satisfactory, and does not present any complaints. When examining data for the progression of the process is not revealed.

The technical and economic effectiveness of the method consists in the fact that venous outflow allows avoiding toxic products from the vasculature of the sigmoid colon directly into the general bloodstream, and reduces the likelihood of developing colonic transplant necrosis. This improves the results of treatment of patients with colorectal cancer and improves their quality of life.

Claims (1)

A method for the treatment of colorectal cancer, including resection with plasty of the removed portion of the sigmoid colon and the application of vascular anastomoses, characterized in that they mobilize the ileo-colon vein and the artery that cross below the bifurcation, achieving the maximum length of the artery; the resulting vascular pedicle is rotated around the axis of the spine from right to left, two vascular anastomoses are applied between the mouth of the inferior mesenteric artery and the iliac-colon artery, the terminal section of the inferior mesenteric vein and the iliac-vein vein.