RU2343854C1 - Method of putting intestinal suture - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: carry out two ligatures from each edge of sewed wound of intestine. One carrying out of a ligature is performed through all covers of an intestine. The ligature is pulled through all covers on distance by of 5-7 mm from bridged edges of the wound. Second time the ligature is pulled only through muscular and serous covers of an intestine on distance by of 2-2.5 mm from wound edges. Pull together the wound edges. Fasten the knot outside.

EFFECT: improvement of quality of treatment at the expense of improvement of comparison of all layers of sewed wound of an intestine, creation of the greatest tightness and durability of seam, the prevention of abaissement of mucosa and depression of tension of tissues on suture line.

2 dwg, 1 ex

Description

The invention relates to the field of medicine, namely to surgical methods of treatment, and can be used if necessary by applying an anastomosis with the esophagus, small and large intestine.

Among the urgent tasks of modern surgery, an important place is occupied by the problem of inconsistency of intestinal sutures.

A known method of applying the intestinal suture of Lambert, used as the second (outer) row of double-row intestinal sutures (Chibis OA, Grabovskaya O.E., Bakhilova NN. Modern aspects of the technique of intestinal suture. - M: Publishing House of the Russian Peoples' Friendship University, 1996. - P.7).

When this suture is applied, the needle is injected 5-7 mm from the edge of the intestinal wound, completely muscle cover and punctured approximately 2-3 mm from the edge of the wound. The same manipulations, but in mirror image, are then carried out from the other side. This seam is used only in combination with other seams.

The disadvantages of this method are:

severe inflammation along the suture line;

lack of hemostatic properties;

insufficient strength due to the slowed down process of tissue regeneration with the formation of a massive shaft in the seam area;

prolapse of the mucous membrane, which does not provide good adaptation of the submucosal and mucous membranes.

Of great importance in the development of gastrointestinal surgery were the studies of the French anatomist and physiologist Bichat, who experimentally proved that gluing occurs between the serous membranes of the intestine easily and quickly, and therefore, for successful fusion, a wide contact of the serous integument is necessary.

There is also a method of applying an intestinal suture according to Pirogov, which includes injecting with a needle 2-3 mm from the edge of the wound and holding it with the ligature deeper so that the puncture is at the border between the mucous membrane and submucous membranes, and on the opposite edge of the wound it is made vice versa - between the mucosa and submucous membranes, and a puncture - on the serous membrane 2-3 mm from the edge of the wound (Semenov G.M., Petrishin V.L., Kovshova M.V. Surgical stitch. - St. Petersburg: Peter, 2001. - S.160). When tightening the ligature and tying the knot, all layers of the intestine turn inward, with a uniform comparison of the serous membranes of the anastomosed organs.

The disadvantages of this method of applying an intestinal suture are:

the formation of a tissue shaft in the area of the seam, narrowing the clearance;

the likelihood of the spread of the inflammatory process to other layers;

delayed healing in the suture area due to its partial rejection.

As a prototype, the method of applying the intestinal suture according to Motson, used when applying large intestinal anastomoses, includes two ligatures through all the shells of each side of the stitched organs with tying the ligature outside the intestine (Korepanov V.I., Mumladze RB, Markov I.N., Vasiliev I.T. Intestinal suture.Illustrated review of the literature.- M .: MPEI, 1995. - P.21). When tightening the ligature and tying the knot, all the walls of the intestinal wound are screwed inward, providing a comparison of the serous membranes of the anastomosed organs.

The main disadvantage of this method is that when the suture is applied, the mucous membranes are insufficiently compared, while the edge of the submucous membrane of one side can be far from the submucous membrane of the other side, which slows down the regeneration process and can lead to the formation of gross cicatricial changes in the anastomosis zone.

The technical result of the invention is to improve the quality of treatment by improving the comparison of all layers of the stitched intestinal wound, creating the greatest tightness and strength of the suture, preventing loss of mucous membrane and reducing tissue tension along the suture line.

A method for applying an intestinal suture is proposed, which includes two ligatures from each edge of the stitched intestinal wound, while one ligature is carried out through all shells, tightening the edges of the wound and tying the knot from the outside.

The difference is that through all the shells the ligature is carried out at a distance of 5-7 mm from the connected edges of the wound, and the second time the ligature is carried out only through the muscle and serous membranes at a distance of 2-2.5 mm from the edges of the wound.

In the proposed method of applying the intestinal suture due to the additional involvement of muscle and serous membranes in the suture, additional contact area is formed and screwing of the submucous and mucous membranes into the lumen of the applied loops is achieved, their reliable tight fixation and the best matching of all layers of the intestinal wound.

The following is an example implementation of the proposed method for applying an intestinal suture, which is illustrated in the drawing, where Fig. 1 shows the suturing, and Fig. 2 is a view of the suture at the time of knotting.

Patient E., 67 years old, was admitted to the surgical thoracic department for planned surgical treatment for cancer of the stump of the stomach T4N1M0. The disease history 3 months, 40 years ago, underwent distal resection of the stomach according to Billroth-2 for peptic ulcer disease, and 4 years ago - pneumonectomy on the right for central cancer T2N0M0.

The operation was performed: extirpation of the stomach stump with resection of the jejunum. Formed anastomosis according to Ru. The end-to-end esophageal-intestinal anastomosis was superimposed by a double-row suture of ligature 1 “polysorb 3/0”. On the front lip of the dirty row of the anastomosis, the above nodal sutures are superimposed. First, through the needle injection, the ligature was performed from the side of the serous membrane of the 2 intestines 6 mm from the edge of the slice through all the membranes, then an injection was made between the muscle 3 and submucous 4 membranes of the intestine with a puncture on the serous membrane 2 mm from the edge. On the wall of the esophagus, the ligature was performed in the reverse order: an injection from the outside 2 mm from the edge of the slice through the serous membrane with a puncture between the muscular and submucous membranes and, finally, a through injection from the mucous membrane 5 6 mm from the edge of the esophagus section. Tightening the edges of the wound and tying knots was carried out according to the usual method. The end-to-side inter-intestinal anastomosis is superimposed by a single-row continuous suture with polysorb 3/0 threads. The postoperative period was uneventful. Mouth-feeding started on the 6th day. X-ray control of the anastomosis was carried out on the 13th day: the patency of the anastomosis is free, there are no streaks. Discharged on the 14th day. The patient was examined after 2 months, there were no complaints related to the operation.

Thus, due to the totality of the features of the invention, an increase in the quality of surgical treatment is achieved, a decrease in the probability of inconsistency of the intestinal suture, the creation of the greatest tightness and strength of the suture, guaranteeing the best comparison of all shells of the intestinal wound, reduction of tissue tension along the intestinal suture and reduction of the time of inpatient and outpatient treatment.

Claims (1)

A method of applying an intestinal suture, including two ligatures from each edge of the stitched wound of the intestine, one ligature being carried out through all the shells, tightening the edges of the wound and tying the knot outside, characterized in that the ligature is passed through all the shells at a distance of 5-7 mm from the connected edges of the wound, and the second time the ligature is carried out only through the muscle and serous membranes at a distance of 2-2.5 mm from the edges of the wound.

Images