RU2466683C1 - Method for mechanical closure of left atrial stump with using auto- or allografts - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: depending on the width of pericardial resection from pericardial fragments or from synthetic vicryl prolene mesh, 2 flaps are cut out. The flaps are fixed on branches by adhesion. The branches are brought to a line of left atrial resection, brought together to form 2 lines of tantalum staples.

EFFECT: method provides reliable fixation of borders of the left atrial defect to provide reliable hemostasis.

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Description

The invention relates to medicine, in particular to surgery and oncology, and can be used in the surgical treatment of locally advanced lung cancer.

Known analogues: Application No. 2003111555/14, 04.21.2003, Sidorenko Yu.S. Zinkovich S.A. "METHOD OF CONTROL OF PNEUMOSTASIS IN THORAL SURGERY"; Application No. 2206275, 06/20/2003, Bokeria L.A., Kagramanov I.I., Kokshenev I.V. “METHOD OF TOTAL CIRCUIT OF RIGHT HEART DEPARTMENTS”; Application No. 2202960, 03/27/2003, "METHOD FOR FORMING A FULL CAVOPULMONAL ANASTOMOSIS IN EXPERIMENT"; Application No. 2106112, 03/10/1998, Schukin B.C .; Trump A.M .; Parygin AA, “METHOD OF EXPOSURE OF THE MITRAL VALVE DURING OPERATIONS ON A DRY HEART FROM LEFT-HAND ACCESS IN THE CONDITIONS OF PERFECT-FREE HYPOTHERMIC PROTECTION"; Application No. 2090148, 09/20/1997., Fursov B.A .; Malashenkov AI, “METHOD OF SURGICAL TREATMENT OF ANCIENT ANALYSIS OF AN ACCIDENT AORTA”; Application No. 2025089, 12/30/1994., Kutepov E.N .; Bazanov AI, “METHOD FOR OPERATIONAL TREATMENT OF PERICARDIAL CELOMIC CYSTS”. All known analogues do not describe resection of the left atrium for lung cancer.

Currently, in the surgical treatment of locally advanced lung cancer, a hardware method of suturing the left atrial stump is used, and a manual suture can be used. In the literature sources describing these two methods (L.N. Bisenkov, S. V. Grishakov, S. A. Shalaev, A. D. Kucherenko. “Surgery of advanced and complicated forms of lung cancer”, St. Petersburg, 2006) , it is indicated that either a single row of nodal sutures is applied to the atrium using atraumatic material, or when a hardware suture is used, one charge of a mechanical stitch of the ear of the heart. Thus, two rows of tantalum clips are formed in the atrium. It is indicated that additional reinforcement of the hardware seam is not required. We have taken this method as a prototype. Our experience shows that a double stitching seam to ensure reliable stitching of the left atrial tissue is not enough. Cardiac muscle tissue near the mouth of the pulmonary veins is quite thin compared to the myocardium of other departments, and can be injured by the branches of the stapler, in addition, the stapler does not always provide adequate fixation of staples.

Thus, the basis of the invention is the task of ensuring reliable fixation of the edges of the defect of the left atrium, while not lengthening the time of the operation.

This problem is solved by the fact that in the method of suturing the stump of the left atrium, a conventional technique and tools are used, but the hardware suture is not applied directly to the myocardium, but with the help of 2 spacers cut from a fragment of the pericardium of the patient himself or from a synthetic mesh consisting of vicryl and spilled.

The inventive method allows you to reliably compare, connect and strengthen the edges of the myocardial defect of the left atrium, without complicating the technique of the operation and without lengthening the timing of the operation.

In the proposed method of hardware suturing of the stump of the left atrium using auto- or allografts, the reinforcement of the hardware suture on the left atrium with the help of a pad from a Vicryl-Prolen mesh or from pericardial fragments is used for the first time.

To solve the above problem, the results of treatment of patients undergoing resection of the left atrium for locally advanced lung cancer were investigated.

The method is illustrated by photographs: photo 1: a set of tools and materials necessary for the implementation of the method. Photo 2: hardware suture of the left atrium, reinforced with autografts (pericardial fragments).

The method of suturing the stump of the left atrium is as follows. Patient position during the procedure: on a healthy side. A standard lateral thoracotomy is performed in the IV intercostal space, the pericardium is opened, the pulmonary artery and veins are secreted. Intrapericardial treatment and ligation of a tumor-free vein are performed, then a vein affected by the tumor is isolated. Atrial resection size is estimated. The size of the resected area of the atrium depends not only on the degree of its lesion by the tumor, but also on the anatomical features of the pulmonary vein infiltration - as a single trunk or separately. Edge resection, which is essentially gradual, we performed using a stapler (photo 1). Preliminarily, 2 fragments are cut from a Vicryl-Prolen mesh or from pericardial fragments in size suitable for the apparatus branches (photo 1), and are fixed to the apparatus branches using the physical adhesion effect. The apparatus with formed gaskets is brought to the atrium, the limiter is lowered, the screw tightening the jaws is tightened, and the pusher compressing the paper clips is lowered. There is a hardware formation of two rows of staple seam. The proximal section of the vein is ligated, the atrium intersects. Control over the result is carried out immediately after manipulation (photo 2). Control includes typical measures taken to control hemostasis.

Mechanism of action: direct mechanical effect.

The proposed method differs from the existing ones in that there is a reinforcement of the double hardware suture on the left atrium with the help of gaskets made of synthetic material or from a fragment of the pericardium. This is due to the plastic properties of the grafts.

An example of a specific implementation.

Example 1

Patient T., 52 years old, was admitted to the department with a diagnosis of central cancer of the lower lobe of the right lung T4N2MO IIIb stage. The histological conclusion No. 5252-57: low-grade bronchial cancer. The operation was performed: combined pneumonectomy on the right with resection of the pericardium, left atrium, diaphragm. The left atrium is treated with a stapler using pads cut from the pericardium. Upon further observation, the patient showed no signs of atrial suture failure in the early and late postoperative periods.

Example 2

Patient C, 52 years old, was in the ward with a diagnosis of primary multiple metachronous cancer: central cancer of the upper lobe of the left lung T3N2M0 IIIa stage. Laryngeal cancer T1N0M0 stage I after radiation treatment. Remission. A combined pneumonectomy was performed on the left with resection of the pericardium and left atrium. Resection of the left atrium was performed using a stapler using gaskets made of synthetic Vicrya-Prolene material.

Upon further observation, the patient showed no signs of atrial suture failure in the early and late postoperative periods.

Histological conclusion No. 58845-60: the fragment, represented by the striated cardiac muscle tissue of a typical histological structure, is adjacent to the macrodrug.

Example 3

Patient I., 69 years old, ambulatory card number 456761. He was admitted to the Department of Thoracic Surgery CHOKOD June 22, 2005 with a diagnosis of central cancer of the upper lobe of the left lung T4N2M0 IIIb stage.

Histological conclusion No. 14748: glandular squamous cell carcinoma. Operation performed: combined left pneumonectomy with resection of the left atrium. Only hardware suturing of the left atrium was performed without reinforcing the suture with an auto- or allograft. In the early postoperative period, a clinic of profuse bleeding arose, emergency retoracotomy was performed, and the source of bleeding, the atrial resection line, was identified. Despite the measures taken, biological death has been ascertained.

Thus, our proposed method can be implemented in any multidisciplinary medical institution performing surgical treatment of lung cancer. When performing the proposed method does not require special surgical instruments, enough instruments from a large surgical kit, which are in any hospital hospital that provides surgical medical care. As a reinforcing material, it is possible to use gaskets cut out of an auto material (a fragment of the pericardium) or of synthetic material: a vikrilov-prolenovy grid. The method provides a good fixation of the edges of the atrial defect, no bleeding from the stump of the atrium and insolvency of the atrial suture are observed. If you do not apply the proposed method, complications in the form of insolvency of the atrial suture, leading to death, are possible.

The invention is used in medicine, in particular in surgery and oncology, and can be used in the surgical treatment of locally advanced lung cancer.

Claims (1)

The method of hardware suturing of the left atrial stump using auto- or allografts, including bringing the stapler directly to the atrium and applying here 2 rows of tantalum staples, characterized in that 2 rows of tantalum staples are reinforced with pads cut from fragments of the pericardium or from synthetic vikrilov-prolenovy grid.

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