RU2266101C2 - Method for intensifying hemocirculation of suturing strip for protecting inter-intestinal anastomosis - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the innovation deals with squeezing abdominal aorta in projection being above bifurcation site which should be started 5 d before the onset of operation. During the first 2 d one should squeeze aorta partially by keeping pulsation of femoral arteries. Since the 3d d - till escape of pulsation. In post-operational period for 5-7 d one should squeeze simultaneously two femoral arteries at the background of elastic bandaging patient's inferior limbs. One should conduct 4 seances daily at equal intervals, each séance consists of 6 procedures. The duration of the first procedure is 40 sec at its subsequent lengthening by 40 sec, an interval between procedures lasts for 2 min. The innovation enables to improve circulation in intestinal wall for preventing inter-intestinal anastomosis failure.

EFFECT: higher efficiency of intensification.

Description

The invention relates to medicine, namely to surgery. The role of hemocirculation of the suture band in the healing mechanism of the intestinal anastomoses is known. Intestinal sutures, especially during the formation of a multi-row anastomosis, themselves appear to be “intramural vascular bundles”, which significantly reduce blood supply and, accordingly, further tissue repair (Segal Z.M. et al., 2000).

In the process of postnatal ontogenesis, the body acquires the most advanced mechanism for compensating for impaired blood supply to tissues in the form of collateral blood flow. The high vascular tone, due to the stress activation of the pituitary-adrenal system, is, albeit short-lived, compensatory-adaptive in nature. It is aimed at increasing intravascular perfusion pressure to overcome the critical pressure of capillary closure and ensure adequate tissue perfusion (Oppel V.A., 1928). In conditions of metabolic acidosis due to insufficient vascularization, nonspecific metabolites and local hormones accumulate in the tissues. They regulate transcapillary blood flow, stimulating smooth muscle, expanding small vessels and improving the “shunting blood flow paths” (Shabanov A.N., Kotelnikov V.P., 1983; Gondzhiashvili V.G., 1992; Puchkov K.I. et al. , 97; Lewis GP 1960; Russe R, 1978; Richard H.S., 1984).

Thus, the quality of healing of the anastomosis depends on the degree of reduction of the roundabout blood flow in the intestinal wall. Consequently, the main attention of surgeons in the application of inter-intestinal anastomoses should be paid not only to the technique of anastomosis with the maximum preservation of the vessels of the suture band, but also to the mobilization of the anatomical and functional reserves of collateral circulation. As a prototype taken "Method for the treatment of erectile dysfunction", application No. 2000-131238 / 14 from 12.13.2000, Ramazanov M.R., Gusniev N.M.

The essence of the method is that:

1) first, both femoral arteries are squeezed under the pupartic ligament from 30 sec to 1 min and gradually increase the time to 3 min. In total, 4 sessions of 6 procedures are carried out each day for 4-6 days.

2) the next 6-8 days transplant the femoral arteries to 3 minutes. 4 sessions of 6 procedures each.

3) the remaining 6-8 days compress the femoral arteries for 3-5 minutes for 4 sessions per day, each session consists of 4 procedures. A break between procedures 1-2 minutes. In total, 16-24 procedures are performed per day. The course of treatment lasts 15-21 days.

The aim of the invention is to improve blood circulation in the intestinal wall for the prevention of insolvency of the intestinal anastomoses.

The goal is achieved using the apparatus according to copyright certificate No. 1442194 of 08.08.88. Under the control of pulse, A / D and breathing 5 days before the operation, the abdominal aorta is squeezed in the projection above the site of aortic bifurcation; in the first 2 days - partially with the preservation of pulsation of the femoral arteries, starting from 3 days - until the disappearance of their pulsation. In the postoperative period, both femoral arteries are transplanted simultaneously for 5-7 days against the background of elastic bandaging of the lower extremities. There are 4 sessions per day at regular intervals, each session consists of 6 procedures. The duration of the first procedure is 40 seconds, in the future with a daily increase in its duration by 40 seconds. with a break between procedures of 2 minutes

An example of the method in the experiment.

The effectiveness of the proposed method for intensifying hemocirculation of the suture band to protect the intestinal anastomosis was determined by its testing in animals with a model of colonic obstruction according to the results of dynamic morphofunctional studies of the intestinal wall in the anastamosis area (vital biomicroscopy, angiotensiometry, conductivity, histological examination). In experimental animals from the main group (16 dogs) with training for collateral circulation compared with experimental animals from the control group (9 dogs), the following were revealed:

1. A significant expansion of the network of intramural collaterals.

2. Increased pressure in the intramural vessels.

3. Improving microcirculation.

There were no cases of postoperative complications in dogs from the main group, while in one dog from the control group, suture failure was observed on day 6 after application of the anastomosis.

Distinctive features from the prototype.

1. The use of this method in abdominal surgery, namely, increased blood circulation in the suture band of the interloop anastomosis, ie using the known method for a new purpose.

2. Development of an optimal scheme for using the method for maximum stimulation of circulatory circulation. In the prototype method, only the femoral arteries are squeezed to increase blood flow during erectile dysfunction and the course of treatment lasts 15-21 days. In the proposed method, to improve blood circulation in the intestinal wall, the aorta is squeezed in the preoperative period, and femoral arteries in the postoperative period. The course of treatment is 10-12 days.

3. The use of the method in the postoperative period in combination with tight bandaging of the lower extremities allows, by reducing the venous depot of blood in the lower extremities and accelerating its outflow, to further intensify hemocirculation in the intestinal wall, as well as to prevent possible thromboembolic complications.

The usefulness of the treatment method lies in the fact that an improvement in blood circulation in the intestinal wall is achieved, thereby preventing the incidence of interintestinal anastomoses.

Claims (1)

A method of intensifying hemocirculation of the suture strip during the formation of an intestinal anastomosis, characterized in that 5 days before the operation, the abdominal aorta is squeezed in the projection above the bifurcation site, the aorta is partially squeezed during the first 2 days, maintaining the pulsation of the femoral arteries, from the third day until they disappear pulsations, in the postoperative period both femoral arteries are crushed simultaneously for 5-7 days against the background of elastic bandaging of the lower extremities, 4 sessions are performed per day through equal intervals, each session consists of 6 treatments, duration of the first treatment is 40 s, with a further increase in its daily with 40, with an interval between treatments at 2 min.