RU2515760C1 - Anastomotic instrument - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: ring has a full-width through notch equal to a thickness of mesentery with vessels and nerves, a circular recess along an external side of a border opposite to projections; the ring diameter is equal to a thickness of the sutured intestine; the projections are rounded and has the length no more than 2/3 of the ring width, and their width is equal to a width of the lumens in between and the pitch length of the suture.

EFFECT: device enables reducing a risk of disturbed mesenteric blood flow, reducing a risk of suture cutting.

2 dwg

Description

The invention relates to surgery, namely to surgical instruments, and can be used for intestinal sutures.

A known tool for applying a vascular suture in the form of a stainless steel ring with four sharp teeth along the edge of the ring on one side. The purpose of the tool is to connect vessels without seams. On the ring, the proximal segment of the vessel is disassembled and fixed by pricking the teeth of the ring. Then the distal end is brought in and also pins on the same teeth. No seams and ligatures are not imposed. A good contact is created between the intima of both ends of the vessel. At the end of the operation, the ring is left on the vessel for a firm hold on both ends (M.S. Znamensky. Surgical surgery with topographic anatomy. - Alma-Ata, 1965. - P.70-72).

The disadvantage of the tool is the limited use: sharp teeth injure the walls of the vascular formation, the risk of eruption of the wall is high, which can lead to insufficient fixation of the edges and to the failure of the anastomosis; due to the fact that the ring is closed in a circle, it cannot be removed, and after the creation of the anastomosis it remains in the body as a foreign body. In addition, it is impossible to use this tool to perform an intestinal suture due to the damaging effect on the intestinal wall and the possibility of peritonitis. Performing an invagination suture with its help is also problematic, since the ring will remain inside the walls of the anastomosis, which can narrow the lumen and disrupt the blood supply to the intestinal anastomosis.

The aim of the invention is to expand the possibilities of using the tool to ensure conditions for the normal functioning of the vessels of the mesentery of the intestine, the reliability and low trauma of fixing segments of the intestine during the execution of the intestinal suture by ensuring the closure density and adaptation of the edges of the anastomosis, reducing complications by reducing the likelihood of eruption of the wall in the anastomosis and excluding the presence of a foreign body in the body.

The goal is achieved by the fact that a tool is proposed for applying an anastomosis in the form of a serrated ring with a diameter equal to the thickness of the stitched intestine, with a tooth length of no more than 2/3 of the ring width, while the ring has a through notch across the entire width, equal to the thickness of the mesentery with vascular passing in it -nerve formations, and a circular recess on the outer side of the edge opposite the teeth, the teeth are rounded, and their width is equal to the width of the gaps between them and the length of the stitch of the suture.

Figure 1 presents a General view of the proposed tool. Figure 2 presents the tool in operation.

The tool is made in the form of a gear ring with a thickness of 2 mm and a width of 20 mm, which ensures structural strength, and a diameter of 10 to 20 mm, which corresponds to the thickness of the intestine encountered. The ring has a through notch 1 over the entire width, and the notch width is 6-8 mm, which corresponds to the thickness of the mesentery with neurovascular formations passing there. The length of the teeth 2 of the tool does not exceed 2/3 of the width of the entire ring, because this prevents the displacement of the teeth and the walls of the intestine along the axis when seams are performed. The width of the teeth 2 is equal to the width of the gaps between them and the step size of the performed intestinal suture, i.e. 2 mm (since when applying an intestinal suture to an intestinal tube of small diameter, the seam step is 2 mm, and when applying a suture to an intestinal tube of larger diameter, the step is 4-6 mm). On the outer side of the edge of the tool, opposite the teeth 2, there is a recess 3 under the ligature. The ends of the teeth 2 are rounded to prevent damage to the intestinal wall.

Through cut 1 in the ring will allow you to remove the tool after performing the anastomosis and eliminates damage to the mesentery of the intestine when suturing. The presence of teeth with gaps around the entire circumference of the ring provides a needle with a thread when applying an anastomotic suture. This makes it easy to inject and puncture the needle with the thread, since the intestinal wall is in tension on the teeth.

For the convenience of applying an anastomosis, it is desirable to have a tool of three sizes: with an outer diameter of 10, 15 and 20 mm with a width of teeth and gaps between them of 2 mm. This makes it possible to work with the intestines of various diameters from 10 mm to 20 mm. Rings can be made of metal or plastic, indifferent to biological tissues, which can be sterilized or used as disposable.

The overlay anastomosis "end to end" using the tool is as follows (figure 2). Choose a tool with a diameter corresponding to the diameter of the intestinal tube. Distal 4 and proximal 5 segments of the stitched intestine are isolated. Intestinal segments are laid with intestinal pulp 6, the end of one of the segments is drawn through the inner surface of the ring and pulled (pulled) to the edge of the ring with teeth 2, and the mesentery of the intestine 7 is placed in the slot to create conditions for the normal functioning of its vessels and fix the intestinal wall to the ring by applying ligatures through the recess 3 of the tool. Next, another segment is pulled on top of the fluted segment of the intestine and fixed with a second ligature. Sutures are applied to the flanged sections of the intestine, making injections with a needle and thread through the gaps between the teeth 2. After applying intestinal sutures, the ligatures are removed, the anastomosis is removed from the ring, the intestinal anastomosis is released and the ring is removed.

The technical result achieved is that the use of the tool creates the conditions for the normal functioning of the vessels of the mesentery of the intestine, ensures the reliability and low-trauma of fixing segments of the intestine during the execution of the intestinal suture by ensuring the closure density and adaptation of the edges of the anastomosis, reducing complications by reducing the likelihood of wall eruption in area of anastomosis and excludes the presence of a foreign body in the body.

Using the proposed tool provides the following advantages:

- for the period of the operation, blood flow remains in the mesentery of the intestine, which positively affects its morphofunctional state; during the execution of the anastomosis there is no prolonged squeezing and trauma to the intestinal wall, which creates more favorable conditions for the reparative process in the anastomosis zone;

- significantly reduced terms for the quality of the suture, since the operation is not accompanied by a change in the configuration of the intestine, which is anatomically and physiologically more favorable for the reparative process;

- the intestinal wall is in a straightened state, the edges of its segments are adapted, which makes it possible to perform the operation quickly and more efficiently;

- intestinal suture is the same along the entire circumference of the intestinal anastomosis;

- there is the possibility of performing various types of sutures up to a single-row invagination suture according to Soloviev.

The proposed tool is versatile and easy to use. It can be widely used in surgery, in particular in abdominal surgery, etc. in the restoration and reconstruction of the integrity of the intestine of various diameters.

Claims (1)

A tool for applying an anastomosis in the form of a toothed ring, characterized in that the ring has a through notch along the entire width equal to the thickness of the mesentery with neurovascular formations passing there, and a circular notch along the outer side of the edge opposite the teeth, the diameter of the ring is equal to the thickness of the stitched intestine, the teeth are rounded and have a length of not more than 2/3 of the width of the ring, and their width is equal to the width of the gaps between them and the length of the step of the applied seam.

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