RU2290084C1 - Method for obstructive colonic resection - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with surgical treatment of colonic cancer complicated with obstruction. In case of obstructive colonic resection it is not necessary to suture distal colonic stump; one should dissect serous layer of proximal colonic stump along tenia libera at the distance being equal to external diameter of distal colonic stump. One should locate distal stump perpendicular against proximal one, apply two rows of interrupted sero-serous sutures between distal stump and proximal stump being 5 mm below incision in serous layer, apply internal row of serous-muscular sutures; proximal colonic stump should be withdrawn outwards to be fixed toperitoneum and skin. In 1 mo after operation in case of rectoromanoscopy it is necessary to inflate distal stump. Then one should dissect mucous layer in area of anastomosis through a face foramen in proximal stump, the face foramen in proximal stump should be sutured in with a three-row suture, the stump should be applied into the stomach. The innovation enables to shorten the time for fulfilling the second stage of operative treatment in senile patients and, also, in those at severe accompanying pathology.

EFFECT: higher efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used in the surgical treatment of colon cancer complicated by intestinal obstruction.

A known method of two-stage resection of the colon (A. Shalimov, Surgery of the digestive tract. - Kiev. "Health". 1987, p.410), which consists in the following: after mobilization of the loop of the colon with a tumor at the base of the derived loop between its knees impose the anastomosis that remains completely in the abdominal cavity, the removed loop is fixed to the edges of the wound, in the presence of obstruction, the intestine is emptied through the rubber tube inserted into the leading segment and left there, after 2-4 days the removed loop of the intestine with the tumor and suturing is cut off both stumps of the colon are cured, as the wound heals for the second time, both stumps of the colon are gradually drawn into the abdominal cavity, the anastomosis applied during this operation immediately allows the intestinal contents to leave naturally.

However, the above method has a significant drawback: it cannot be used with a short abducent segment of the colon, since in the above method, it is necessary to remove the adducting and abducting stump of the intestine onto the skin.

As a prototype, we have chosen a method for the formation of an ileorectal anastomosis in case of subtotal colectomy (V. Yukhtin. Surgery of the colon. - M .: "Medicine". 1988, pp. 288-290), which consists in anastomosing the end of the stump of the rectum into the side of the terminal loop the ileum at a distance of 25 cm from its free end by double-row interrupted sutures, then form a small intestinal reservoir with a pulp ring from a double loop of the ileum by applying a lateral anastomosis 5 cm higher from the ileorectal anastomosis between the adductor and the anterior with a 15–17 cm long ileum segment with double-row sutures, the operation is completed by removing the terminal end of the ileum above the formed reservoir through a separate abdominal wall incision to the right of the midline and the formation of a temporary unloading ileostomy, 3-4 weeks after the operation under local anesthesia, the end ileostomy and drown tightly.

However, the above method has a significant drawback: the method is not applicable for colon cancer complicated by intestinal obstruction, since already at the first stage of surgical treatment the method involves the formation of anastomosis with an altered intestinal wall.

The aim of the invention is the formation of reliable anastomosis between the walls of the intestine and the prevention of ingestion of feces into the lumen of the anastomosis at the first stage of surgical treatment.

This goal is achieved by the fact that the distal stump of the colon is not sutured, the serous layer of the proximal stump of the colon is dissected along the free muscle tape (tenia libera), a three-row suture is inserted between the proximal and distal stump of the colon, without capturing the mucosa, the proximal stump of the colon is brought out , a month after the operation, the proximal stump of the intestine is mobilized, separating from the skin, sigmoidoscopy is performed, the distal stump of the intestine is inflated, the mucous layer in the anastomosis is dissected by two I make perpendicular cuts through the end opening in the proximal stump, without capturing the inner row of serous-muscular sutures, the end opening in the proximal stump is sutured with a three-row suture, and the stump is loaded into the abdomen.

The novelty of the invention is that during obstructive resection of the colon, the distal stump of the colon is not sutured, a corner clamp is applied to it, an angular clamp is placed on the end hole in the proximal stump of the colon, five centimeters retreat from the clamp, the proximal serous layer is dissected stump of the colon along the free muscle tape (tenia libera) at a distance equal to the outer diameter of the distal stump of the colon, have a distal stump perpendicular to the proximal two rows of separate nodular gray-serous sutures are placed between the distal stump and the proximal stump five millimeters below the incision in the serous layer, the inner row of serous-muscular sutures is applied, the serous-muscular layer of the proximal stump and distal stump is sutured, without capturing the mucous membrane, two of the next series of gray-serous sutures, the proximal stump of the colon is brought out, first fixed to the peritoneum in one centimeter from the outer row of sutures, then outside to the skin, a month after op walkie-talkies mobilize the proximal stump of the intestine, separating from the skin, perform sigmoidoscopy, inflate the distal stump of the intestine, while the mucous layer of the proximal stump in the anastomosis area is proliferated into its lumen, the mucous layer in the anastomosis section is cut with two perpendicular sections through the end opening in the proximal stump, without capturing the inner row of sero-muscular sutures, the end opening in the proximal stump are sutured with a three-row suture, the stump is loaded into the abdomen, the peritoneum and skin are sutured in the area of the previously existing stoma.

Known sources of information of the CIS and foreign countries do not contain similar to the proposed method of obstructive resection of the colon.

The method of obstructive resection of the colon "can be applied in general surgical and specialized oncological hospitals.

The method is as follows: the distal stump of the colon is not sutured, an angular clamp is applied to it, an angular clamp is applied to the end hole in the proximal stump of the colon, five centimeters retreat from the gut, and the serous layer of the proximal stump of the colon is cut through the free muscle tape (tenia libera) at a distance equal to the outer diameter of the distal stump of the colon, have a distal stump perpendicular to the proximal (Fig. 1 (2)), impose two rows of separate nodes th gray-serous seam between the distal and proximal stumps stump five millimeters below the cut in the serous layer. The inner row of sero-muscular sutures is imposed, the sero-muscular layer of the proximal stump and distal stump is stitched without capturing the mucous membrane, two subsequent rows of gray-serous sutures are sequentially applied (Fig. 1 (3)), the proximal stump of the colon is brought out (Fig. 1 (1)), first fix to the mesentery in one centimeter from the outer row of sutures, then outside to the skin (Fig. 1 (4)), a month after the operation, the proximal stump of the intestine is mobilized, separating from the skin, sigmoidoscopy is performed, and the distal stump is inflated intestines, with In this case, the mucous layer of the proximal stump in the anastomosis zone is proliferated into its lumen, the mucous layer in the anastomosis region is dissected with two perpendicular sections through the end opening in the proximal stump, without capturing the inner row of serous-muscular sutures, the end hole in the proximal stump is sutured with a three-row suture, and the stump is abdomen, sutured peritoneum and skin in the area of the previously existing stoma.

An example of the use of this method in clinical practice is the medical history No. 7063 / s of a patient K., born in 1936, who was admitted to the thoracoabdominal department of the RNII on 07.15.03 with complaints of cramping pain in the left iliac region, an admixture of blood and mucus in the feces, with examination revealed cancer of the sigmoid colon T ₃ N ₀ M ₀ tbsp. III, the tumor was located at a distance of 25 cm from the anus, 07/07/03 obstructive resection of the sigmoid colon was performed, while the above method of obstructive resection of the colon was used, the postoperative period was smooth, the drainage was removed on the 7-8th day, the sutures were removed on the 10th day, the patient was discharged on the 11th day in satisfactory condition, a month later, using a rectoscope, the mucous layer was dissected in the anastomosis between the proximal and distal stump of the colon, the end hole in the proximal stump was sutured hryadnym seam stump immersed in the stomach, in the region of the stoma previously been sutured peritoneum and skin, postoperative period smooth chair naturally on the second day on the 4th day the patient was discharged in satisfactory condition.

The technical and economic effectiveness of the method lies in the fact that in elderly patients, as well as in patients with severe concomitant pathology, the execution time of the second stage of surgical treatment is reduced, which reduces the length of stay of patients in a surgical hospital, and the number of therapeutic and surgical complications decreases.

Claims (1)

A method of obstructive resection of the colon, including the removal of the proximal stump of the intestine on the skin, characterized in that the distal stump of the colon is not sutured, an angular clamp is applied to it, an angular clamp is applied to the end hole in the proximal stump of the colon, five retreat from the clamp centimeters, dissect the serous layer of the proximal stump of the colon along the free muscle tape (tenia libera) at a distance equal to the outer diameter of the distal stump of the colon, position the distal stump perpendicular to the proximal stitch, lay two rows of separate nodular gray-serous sutures between the distal stump and the proximal stump five millimeters below the incision in the serous layer, apply the inner row of serous-muscular sutures, stitch the serous-muscular layer of the proximal stump and distal stump, without capturing mucous membrane, sequentially impose two subsequent rows of gray-serous sutures, the proximal stump of the colon is brought out, first fixed to the peritoneum in one centimeter from the outer row of sutures, then, outside the skin, a month after the operation, the proximal stump of the intestine is mobilized, separated from the skin, sigmoidoscopy is performed, the distal stump of the intestine is inflated, while the mucous layer of the proximal stump in the anastomosis area is proliferated into its lumen, the mucous layer in the anastomosis region is cut with two perpendicular sections through the end hole in the proximal stump, without capturing the inner row of serous-muscular sutures, the end hole in the proximal stump is sutured with a three-row suture, the stump is loaded into the stomach, the abdomen is sutured Well, the skin in the previously existing stoma.