RU2290083C1 - Method for creating intussuscepting colonorectal anastomosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves stitching two traction sutures 3 cm far from end face opening rim. Needle holder is placed in colon lumen. Musculomucosal layer of the intestine is sutured along the mesenterial margin to 1/3 of diameter in perpendicular to intestine axis. Rectoromanoscope is introduced through anus and rectum stump. Both traction ligatures are brought through colonoscope lumen to the perineum. The colonoscope is withdrawn. Two meticulous sutures are put in on colon and rectum wall on the left and right wall. The sutures are tightened. Meticulous row of sutures is put in over anterior anastomosis lip. The anastomosis is first turned 90° to the right about the sutured organs axis, by pulling outer suture ligatures. Right half of posterior anastomosis lip is stitched with meticulous sutures. The anastomosis is also turned 90° to the left about the sutured organs axis, by pulling outer suture ligatures. Left half of posterior anastomosis lip is stitched with meticulous sutures. The ligatures brought out through the anus to perineum skin and the afferent organ is invaginated 3 cm far into the efferent organ lumen. The second row of sutures is first placed on anterior anastomosis lip. Using the abovementioned sutured organs rotation procedure, sutures are put in over posterior anastomosis lip. Ligatures are removed via the anus by pulling the free end of each of them.

EFFECT: prevented inflammatory changes in anastomosis sutures hindering its inconsistency development.

Description

 The invention relates to medicine, namely to surgery, and can be used in reconstructive surgery for cancer of the colon and rectosigmoid colon. There is a method of forming an invagination esophagoejunoanastomosis (Shalimov AA, Surgery of the digestive tract. - Kiev. "Health". 1987, p. 279), which consists in the fact that the intestinal loop crossed and mobilized for the formation of anastomosis is carried out through the window in the mesentery of the transverse colon intestines, two catgut sutures are passed through the intestine and punctured at a distance of 15 cm from the oral edge of the intestine, a suture is placed on the posterior lip of the anastomosis, the ends of previously performed kettut sutures are sutured from both sides through all layers of the esophagus from the intestine , the threads are tied, the front wall of the anastomosis is sutured with nodules inward, pulling the catgut threads and pushing the intestine to the esophagus, invaginate it into the intestinal lumen to a depth of 2 cm, 3-4 cm of the suture between the esophagus and the intestine are placed in front and behind, the intestine is fixed at the anastomosis to the diaphragmatic-esophageal sheet of the peritoneum, catgut sutures are cut off, the puncture site is sutured.

However, the above method has a significant drawback. This method of intussusception cannot be applied in the formation of a colonic rectal anastomosis. As a prototype, we have chosen a method for the formation of colonic anastomosis (VI Yukhtin. Surgery of the colon. - M .: "Medicine". 1988, p. 254), which consists in the application of an anastomosis "end to end" with a two-row interrupted suture, the application of the first row sero-muscular nodal sutures on the posterior wall of the anastomosis, the application of the second row of (internal) nodal sutures through all layers of the posterior wall of the anastomosis, the application of screw-nodal sutures on the anterior wall of the anastomosis (inner row of sutures), the application of serous-muscular nodal sutures on the anterior wall of the an astomosis. However, this method has significant disadvantages:

1) does not allow the formation of a reliable colonic invaginate;

2) during the formation of such an anastomosis, the ligatures of the inner row of sutures remain in the lumen of the intestine, which contributes to the penetration of infection due to the “wicked” properties of the ligatures in the suture of the anastomosis.

The aim of the invention was the formation of a reliable invagination colon-rectal anastomosis. This goal is achieved by the fact that when the colonic rectal anastomosis is formed, two suture-holders are applied three centimeters from the edge of the end hole, for which they place the needle holder in the lumen of the colon, the mucous-muscular layer of the intestine is sewn along the mesenteric edge one third of the diameter perpendicular to the axis of the intestine suture the mucus-muscular layer along the mesenteric margin by one third of the diameter perpendicular to the axis of the intestine, conduct a sigmoidoscope through the anus and the stump of the rectum, and both ligatures-holders through the colonoscope grows on the perineum, the colonoscope is removed, two precision sutures are applied to the wall of the colon and rectum along the right and left walls, the sutures are tightened, a number of precision sutures are applied to the anastomosis front lip, pulling over the ligatures of the extreme sutures, the anastomosis is initially rotated 90 ° to the right around the axis of the stitched organs. Apply precision sutures to the half of the posterior lip on the right, sipping the ligatures of the extreme sutures, unfold the anastomosis to the left around the axis of the stitched organs also by 90 °, impose precision sutures to the half of the posterior lip of the anastomosis to the left, pull the ligatures removed through the anus to the perineal skin, and invaginate leading organ into the lumen of the abduction by three centimeters, first impose a second row of sutures on the front lip, and then, using the above-described rotation of the stitched organs, on the back, remove the ligatures through the anus to the outside, sweating ivaya for one of the free ends of each of them.

The novelty of the invention lies in the fact that the mucus-muscular suture-holders, brought out through the anus, allow the front lip of the anastomosis to be formed first without tensioning the sutures, after which, pulling the suture-holders and unfolding the anastomosis, first to the left and then to the right by 90 °, form the posterior lip of the anastomosis by applying precision sutures, after which the leading section of the intestine is invaginated into the outlet section and a second row of sutures is applied using the above rotation. Known sources of information from the CIS and foreign countries do not contain a similar method to the formation of an invagination colon-rectal anastomosis.

"A method of forming an invagination colon-rectal anastomosis" can be applied in general surgical and specialized oncological hospitals.

The method is as follows: put two suture-holders in three centimeters from the edge of the end opening, for which they place the needle holder in the lumen of the colon, suture the mucous-muscular layer of the intestine along the mesenteric edge one third of the diameter perpendicular to the axis of the intestine, suture the mucous-muscular layer along the mesenteric edge is one third of the diameter perpendicular to the axis of the intestine, a sigmoidoscope is passed through the anus and the stump of the rectum, both ligatures are held through the lumen of the colonoscope on the perineum, the count is removed noskop impose two precision seam in the wall of the colon and rectum on the right and on the left wall, the joints are tightened, impose a number of precision welds on the front lip of the anastomosis, sipping for ligatures outer seams are deploying anastomosis first at 90 ° to the right about the axis linkable bodies. Apply precision sutures to the half of the posterior lip on the right, sipping the ligatures of the extreme sutures, unfold the anastomosis to the left around the axis of the stitched organs also by 90 °, impose precision sutures to the half of the posterior lip of the anastomosis to the left, pull the ligatures removed through the anus to the perineal skin, and invaginate leading organ into the lumen of the abduction by three centimeters, first impose a second row of sutures on the front lip, and then, using the above-described rotation of the stitched organs, on the back, remove the ligatures through the anus to the outside, sweating ivaya for one of the free ends of each of them.

As an example, we cite the medical history of patient M, born in 1948, medical history No. 14303 / о, who was being treated at the Thoracoabdominal Department of the RNII from 2.02.04 to 02.15.04 for cancer of the rectosigmoid rectum T ₃ N ₀ M ₀ , article II, clinical group III. 02/05/04 performed anterior-upper resection of the rectum, with the formation of an anastomosis, the above method was used. The postoperative period was uneventful. The first chair - on the 4th day. Drainages removed without features on 8-9 days. The patient was discharged on the 10th day of the postoperative period in satisfactory condition.

The technical and economic effectiveness of the method lies in the fact that the method prevents the development of inflammatory changes in the joints of the anastomosis, which prevents the development of its failure and prevents the formation of cicatricial narrowing of the anastomosis in the postoperative period.

Claims (1)

A method of forming an invagination colon-rectal anastomosis, including the application of precision sutures on the walls of stitched intestines, characterized in that two suture holders are applied three centimeters from the edge of the end hole, for which a needle holder is placed in the lumen of the colon, the intestinal mucosal muscle layer is sutured the mesenteric edge is one third of the diameter perpendicular to the axis of the intestine, the mucosal muscular layer is sutured along the mesenteric edge one third of the diameter perpendicular to the axis of the intestine, is passed through the anus and rectal stump sigmoidoscopy, both ligatures-holders are brought out through the lumen of the colonoscope to the perineum, the colonoscope is removed, two precision sutures are placed on the wall of the colon and rectum along the right and left walls, the sutures are tightened, a number of precision sutures are applied to the anastomosis front lip, sipping for the ligatures of the extreme sutures, first unroll the anastomosis 90 ° to the right around the axis of the stitched organs, place precision sutures on the half of the posterior lip on the right, pulling the ligatures of the extreme sutures, unfold the anastomosis h to the left around the axis of the stitched organs also by 90 °, impose precision sutures on the half of the posterior lip of the anastomosis on the left, pull the ligatures removed through the anus on the perineal skin and invaginate the adduct organ into the lumen of the abduction for three centimeters, impose the second row of sutures first on the front lip and then, using the above-described rotation of the stitched organs to the back, the ligatures are removed through the anus to the outside, sipping at one of the free ends of each of them.