RU2267298C1 - Method for suturing in splenic stump at its resection - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should tighten vessels that supply affected splenic part with blood followed by applying a pressing ligature at the border of ischemic area. Then it is necessary to perform the first puncture in with a direct needle with doubled ligature leaving 0.8 cm against cutting line and 2 cm against splenic edge. Then needle should be removed. One should apply initial end of ligature around splenic edge through the loop developed, apply another end of ligature into the needle to perform the second puncture in at the distance of 2 cm against the first one. The needle should be removed. One should direct initial end of ligature through the loop, apply successively two sutures more, tighten the ends of ligatures, remove pressing ligature before suturing in patient's abdominal cavity. The technique suggested prevents ligature's sliding and decreases splenic tissue ischemia.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, in particular to emergency surgery of abdominal organs, and can be used to treat victims with damage to the spleen.

There is a known method of hemostasis of a resected spleen stump, where a xenoperitone is used as a plastic material in the form of a plate with stitching by single or Z-shaped sutures, or a cap fixed to the spleen pole with a continuous catgut suture (V.N. Bordunovsky, 1999).

There is a known method of hemostasis by plasty with a muscle flap in an experiment with stitching with a continuous continuous hemostatic suture (V.Z. Makhovsky, A.V. Nikolayev, 2001).

A known method of hemostasis using a flap formed from a large curvature of the stomach, and holding nodal sutures through the serous-muscular layer of the bottom of the stomach and over the spleen (M.D. Urman, 1999; Walter V.G., Odishelashvili G.D., Kutukov V .V., 2000).

There is a method in which hemostasis is achieved by tightening a circular catgut ligature around the spleen with plastic by a strand of a large omentum with threads held for compressing ligature (K.A. Apartsin, V.E. Pak, 1998).

At the same time, a number of authors believe that the use of the suture method to stop bleeding is unpromising (A.A. Litvin, G.N. Tsybulyak, 1999).

Closest to the proposed by us is a method of treating victims with damage to the spleen using compressive catgut ligatures and locks of a large omentum to achieve hemostasis.

Its disadvantages are the possibility of slipping the compressive ligature from the spleen tissue and the resumption of bleeding, the need in some cases for additional stitching of bleeding vessels on the cut. In addition, there is a violation of blood supply and ischemia of spleen tissue due to its compression.

The purpose of the invention: improving the treatment of patients with injuries of the spleen based on the developed method of suturing the stump of the spleen during its resection.

The method is used for injuries of the spleen of 3-4 degrees according to the classification of the American Association of Trauma Surgeons (Moore et al., 1991) and is carried out as follows: for these injuries, a spleen resection is performed based on its segmental structure. After ligation of the vessels supplying the damaged part of the spleen, the zone of ischemia is determined, at the border of which a compressive catgut ligature is applied. Resection of the damaged part of the organ is performed, retreating 1.2 cm from the ligature. Hemostasis of the resection pole is achieved through through stitching of the spleen, previously enveloped in the omentum, with a continuous catgut suture. The suture technique is as follows: retreat from the cut line by 0.8 cm and from the edge of the spleen by 2 cm, make the first puncture with a straight needle with a double thread (Figure 1). The needle is removed and then removed. The initial end of the thread is carried around the edge of the spleen and through the loop formed. The other end of the thread is carried out into the needle, and at a distance of 2 cm from the first puncture, a second puncture is made (Figure 2). Again remove the needle and through the loop, spend the initial end of the thread. The other two seams are also sequentially applied (Figure 3; 4). The ends of the threads are tied at the opposite edge of the spleen (Figure 5). The compressive ligature is removed before suturing the abdominal cavity.

In our opinion, the proposed method allows for reliable hemostasis of the stump of the resected spleen. The technique is technically simple, does not require expensive tools and materials, the highly specialized surgeon.

Example 1

Patient A., 24 years old, medical history No. 11322.

Delivered by an ambulance team with complaints of malaise, weakness, and abdominal pain. The pain appeared 1 hour ago after hitting the abdomen during sports. A closed abdominal injury is suspected. Performed laparocentesis - blood in the abdominal cavity. For this reason, median laparotomy was performed under endotracheal anesthesia. An operation revealed a rupture of the spleen in the area of the gate with moderate bleeding. The amount of blood loss within 1 liter. Ligation of blood vessels supplying the damaged part of the spleen (lower pole segment) was performed. A compressive catgut ligature was applied at the border of the ischemic zone to temporarily stop bleeding. Resection of the damaged part of the organ, retreating 1.2 cm from the ligature. Hemostasis of the resection pole due to through stitching of the spleen, previously shrouded in the omentum, with a continuous catgut suture, developed by us. The compression ligature was removed before suturing the abdominal cavity.

In the postoperative period, a comprehensive conservative treatment was performed. Discharged home 12 days after surgery in satisfactory condition.

Example 2

Patient D., 19 years old, medical history No. 632.

Delivered by an emergency medical team in serious condition. According to the victim, about 1 hour ago, he had an accident. Complaints of shortness of breath, pain in the abdomen, chest and spine. Diagnosis at admission: Combined injury. Closed abdominal injury. Fracture of 7, 8, 9 ribs on the left. Hemopneumothorax on the left. Fracture of 1, 2 cervical vertebrae?

Ultrasound of the abdominal cavity was performed, a large amount of free fluid was detected. For this reason, median laparotomy was performed under endotracheal anesthesia, and chest drainage on the left in the 2nd and 7th intercostal spaces was performed by a traumatologist. An audit of the abdominal cavity revealed a rupture of the spleen in the area of the portal with ongoing bleeding. A compressive catgut ligature was imposed on the spleen above the rupture to temporarily stop bleeding. Blood loss - 1.3 liters. Reinfusion of 600 ml of blood. Resection of the damaged part of the organ, retreating 1.2 cm from the ligature. Hemostasis of the resection pole due to through stitching of the spleen, previously enveloped in the omentum, with a continuous catgut suture, developed by us. No other abdominal pathology was found. The compression ligature was removed before suturing the abdominal cavity.

In the postoperative period, a comprehensive conservative treatment was performed in the trauma unit. Discharged home 1.5 months after surgery in satisfactory condition.

Example 3

Patient L., 22 years old, medical history No. 1681.

Delivered by an ambulance team complaining of a chest wound on the left, chest and abdominal pain, weakness. According to the victim, about 2 hours ago, during a fight, he received a stab with a knife.

Under local anesthesia, a PHO of the wound was performed - it penetrates the pleural and abdominal cavities. For this reason, median laparotomy was performed under endotracheal anesthesia. In the abdominal cavity, blood with clots of about 1 liter. During the audit, a wound of the diaphragm on the left and a through wound of the upper pole of the spleen with active bleeding were found. A compressive catgut ligature was imposed on the spleen below the wound to temporarily stop bleeding. Resection of the damaged part of the organ, retreating 1.2 cm from the ligature. Hemostasis of the resection pole due to through stitching of the spleen, previously shrouded in the omentum, with a continuous catgut suture, developed by us. Aperture seam. No other abdominal pathology was found. The compression ligature was removed before suturing the abdominal cavity.

In the postoperative period, a comprehensive conservative treatment was performed. Discharged home 10 days after surgery in satisfactory condition.

Information sources

1. Grigoriev EG, Apartsin K.A., Matinyan N.S. and other organ-sparing surgery of the spleen. - Novosibirsk: Nauka, 2001 .-- XXX p.

2. Bordunovsky V.N. Savings surgery for injuries and focal formations of the spleen // Surgery. - 1999. - No. 6. - S. 38-42.

3. Makhovsky V.Z., Nikolaev A.V., Makhovsky V.V. Surgery 2001; 2: 27-31.

4. Timerbulatov M.V., Khasanov A.G., Fayazov R.R., Kayumov F.A. M .: MEDpress-inform, 2004, 224 p.

Claims (1)

A method of suturing a spleen stump during resection, including resection and suturing, characterized in that after ligation of the blood vessels supplying the damaged part of the spleen, a compressive ligature is applied at the border of the ischemic zone, and the following suture technique is used to stop bleeding from the resection surface of the spleen: they retreat from cut lines of 0.8 cm and 2 cm from the edge of the spleen, make the first puncture with a straight needle with a double thread, remove the needle, then remove and the initial end of the thread is carried around the edge of the spleen through a developed loop, and the other end of the thread is drawn into the needle and a second puncture is made at a distance of 2 cm from the first puncture, the needle is removed again and the initial end of the thread is drawn through the loop, two more stitches are sequentially sewn, the ends of the threads are tied, and the compression ligature is removed before suturing abdominal cavity.

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