RU2248756C2 - Method for surgical treatment of diverticular disease of large intestine - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: on should perform serosotomy due to affecting large intestinal wall along its mesenteric edge with radio-frequency electromagnetic waves at the frequency of 3 x 10⁶ - 3 x 10¹⁰ Hz and the density of power flow being 20-30 kW/cm, at the mode of cutting and coagulation. The innovation enables to decrease traumaticity and normalize motor system of large intestine.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to abdominal surgery, and is intended for operations on the descending colon and sigmoid colon.

Some authors [Vorobev G.I. Diverticulosis of the colon. // Abstracts of the regional scientific-practical conference. - Kuibyshev, 1990. - P.7-9; E.V. Eusebie, M.M. Eisenberg, Natural Hiistory of diverticular Disease of the colon in Young Patents // Amer. J. Ofsurg. - 1983. - V.125, No. 3.-P.308-311; D.I. Mehdiev. Diagnosis and treatment tactics in complicated forms of diverticular colon disease. / Abstract. diss. doc honey. sciences. - Perm. - 1995. - S.-30] believe that 21-26% of patients suffering from diverticulosis, require surgical treatment.

Known neurotomy of the branches of the inferior mesenteric nerve plexus innervating the left half of the colon, which leads to a decrease in intestinal pressure [Mehdiev DI Diagnosis and treatment tactics in complicated forms of diverticular colon disease / Abstract. diss. doc honey. sciences. - Perm. - 1995. - 30 C .; Timer-Bulatov V.M., Sakhautdinov V.G. Diverticular disease of the colon - M. Publishing House “Success”, “Triad-X” -2000. - S.192]. According to this method, the peritoneum is dissected along the lower mesenteric vessels along the medial surface of the mesentery of the sigmoid colon, these arteries, nerves running parallel to them and located on the front and back surfaces are exposed. Nerves are taken into thin ligatures, bandaged and excised.

The prototype is a method of surgical treatment of the hyperkinetic type of diverticular colon disease - serosomyotomy according to Reilly-Hodgson. This method consists in dissecting the colon wall to the submucosal layer, which leads to a decrease in the intestinal pressure and normalization of the motility of the colon. The essence of the operations is as follows: a longitudinal serosomyotomy is performed with a scalpel in a length of 15-20 cm, starting 2-3 cm above the pelvic peritoneum according to Reilly, and a transverse teniotomy 2 cm long 5-8 times according to Hodgson in a staggered manner.

However, despite the simplicity of the above methods, they have several disadvantages: firstly, conventional cutting tools are used for the operation, therefore it is often accompanied by bleeding from the muscle layer of the intestine and it is impossible to accurately determine the depth of the incision, which is fraught with perforation of the intestine, and in the first method, damage to the wall arteries and arterial bleeding, secondly, it is traditionally performed from the laparotomic access, which leads in the postoperative period to the formation of adhesions of the abdominal cavity and postoperative central hernias.

The technical result is a decrease in intestinal pressure, normalization of the motility of the colon, a decrease in the invasiveness of the operation, a decrease in intraoperative and postoperative complications. This technical result is achieved by performing a serosotomy, without performing a myotomy, using radio frequency electromagnetic waves with a frequency of 3 × 10 ⁶ -3 × 10 ¹⁰ Hz, a length of 1 dm and a power flux density of 20-30 kW / cm.

The proposed method for the surgical treatment of diverticular disease of the colon is as follows: the patient is given endotracheal anesthesia. A Surgitron radiosurgery unit, a Technotreid International corporation, manufactured by Ellman USA, is connected to the network. Prepare the device for work. An antenna panel is installed under the patient. The electrode is installed in the manipulator. After processing the surgical field, a lower middle laparotomy is performed. After revision of the abdominal organs, the sigmoid and descending colon are removed into the wound. Perform radio frequency serosotomy with a wave frequency of 3 × 10 ⁶ -3 × 10 ¹⁰ Hz, a wavelength of 1 dm and a power flux density of 20-30 kW / cm spherical electrode along the entire length of the sigmoid colon to the middle third of the descending colon, starting at 2-3 cm above the pelvic peritoneum, along the mesenteric edge of the intestine on both sides, departing from the site of attachment of the mesentery 2-3 mm. In this case, there is no need to dissect the entire wall to the submucosal layer, since the destruction of nerve endings located in the zone of exposure to the electromagnetic field occurs, which we proved in an experiment on dogs, as well as histological studies. Unlike a scalpel, dissection with an electrode is performed without pressure by a light, even and continuous movement. To do this, waves with a frequency of 3 × 10 ⁶ -3 × 10 ¹⁰ Hz, a wavelength of 1 dm and a power flux density of 20-30 kW / cm are used, in the cutting and coagulation mode a fully rectified waveform. When conducting a radiosurgical incision, the absence of bleeding, burns and tissue necrosis is visually noted. After radiosurgical serosotomy, the disappearance of a pathological spasm is visually noted and hyperemia of the colon appears.

We operated on 19 patients with diverticular colon disease according to our technique. Compared with the analogue and prototype, the advantage of this operation is the reduction of trauma, intraoperative bleeding, preservation of blood supply and intestinal motor-evacuation function, the absence of edema and necrotic changes in the incision area, and the rapid healing of postoperative wounds. This intervention is advisable to perform from minilaparotomic accesses or laparoscopically, which leads to a decrease in the invasiveness of the operation, the likelihood of adhesions of the peritoneum and the appearance of postoperative ventral hernias is reduced, the patient’s postoperative bed day and the patient’s average incapacity for work are reduced.

This is due to the fact that when using radio-frequency electromagnetic waves, it is not tissue coagulation that occurs, but evaporation of the layer of cells directly in contact with the waveguide, the mechanical and thermal trauma of the tissues when applying them is minimal, reliable and fast hemostasis is not combined with deep tissue coagulation, which is beneficial distinguishes the effect of these waves from the action of an electric scooter, which we studied in an experiment on 25 outbred dogs, confirmed by histological studies.

Example No. 1. Patient V. 52, was admitted to the surgical department No. 1 BSMP 12.12.02 (medical history No. 17001) with a diagnosis of diverticular disease of the sigmoid colon. As planned, December 16, 02. After a clinical examination, a laparoscopic radiofrequency serosotomy was performed according to the proposed method. The postoperative period was uneventful. Wound healing by primary intention. Independent stool for 3 days after surgery. Sutures were removed on the 7th day. On the 8th day after the operation, she was discharged home.

Example No. 2. Patient S. 64, was admitted to the surgical department of BSMP on 09/23/02 with a diagnosis of diverticular disease of the sigmoid colon. After a clinical examination and preoperative preparation in a planned manner 09/27/98, the operation was performed: minilaparotomy, radiofrequency serosotomy according to the proposed method. The postoperative period was uneventful. Independent stool for 3 days. Healing by first intention. Sutures were removed on the 7th day. On the 8th day after the operation, she was discharged home.

Claims (1)

A method for surgical treatment of diverticular disease of the colon, including serosotomy, characterized in that the intestinal wall along the mesenteric edge of the intestine is exposed to radio frequency electromagnetic waves with a frequency of 3 · 10 ⁶ -3 · 10 ¹⁰ Hz, power flux density of 20-30 kW / cm in cutting mode and coagulation.