RU2549489C1 - Method for colonic decompression in obturation obstruction - Google Patents

Method for colonic decompression in obturation obstruction Download PDF

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RU2549489C1
RU2549489C1 RU2013155855/14A RU2013155855A RU2549489C1 RU 2549489 C1 RU2549489 C1 RU 2549489C1 RU 2013155855/14 A RU2013155855/14 A RU 2013155855/14A RU 2013155855 A RU2013155855 A RU 2013155855A RU 2549489 C1 RU2549489 C1 RU 2549489C1
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lumen
intestine
probe
obstruction
decompression
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RU2013155855/14A
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Russian (ru)
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Заурбек Валерьевич Тотиков
Валерий Зелимханович Тотиков
Вадим Вальтерович Медоев
Мадина Валентиновна Калицова
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государственное бюджетное образовательное учреждение высшего профессионального образования "Северо-Осетинская государственная медицинская академия" Министерства здравоохранения Российской Федерации
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Abstract

FIELD: medicine.
SUBSTANCE: method requires colonic decompression in obturation obstruction. A minilaparotomy is performed at the level of a projection of blind intestine; an ileal loop is brought into the wound at 15-20 cm from ileocecal valve. A purse-string suture is applied on an antimesenteric edge of the brought ileum. An intestinal wall is incised in the centre of the suture. A metal or plastic sleeve is inserted into the incision. The purse suture is hermetically tightened up. A probe is inserted into a lumen of ascending intestine through a valve in the sleeve, and the content is removed gradually. After the intestine is emptied, the probe is left in the lumen, and an ileostomy is formed.
EFFECT: method provides the intestinal decompression from the short-scar incision in acute obturation colonic obstruction, reduces the number of postoperative complications and fatal outcomes, improves the results of the following surgical intervention by a low number of injuries.
1 ex, 2 dwg

Description

The invention relates to medicine, in particular to surgery, and relates to methods of decompression of the colon with obstructive obstruction.

A known method of open decompression of the colon (Method of open decompression of the colon. // Patent No. 2395237, registered 12/30/2008, application No. 2008152880/14, IPC АВВ 17/00 (2006.01), Timerbulatov V.M., etc.). For colon decompression, a flexible 2-lumen probe 150 cm long is used, with an inner diameter of the outer tube equal to 12 mm, with an inner diameter of the inner tube equal to 4 mm. The working end of the probe with a length of 20 cm has holes on the inner and outer tubes with diameters of 4 and 7 mm, respectively. All components of the probe are made of flexible elastic medical plastic that can be easily washed, dried, disinfected and sterilized in a steam-formalin chamber or in a gamma sterilization apparatus. As an aspiration-irrigation system, for example, an AKV-60-1 “Endoscan” aquapurator consisting of an irrigator and an aspirator is used. Under endotracheal anesthesia under aseptic conditions, a median laparotomy is performed: skin, subcutaneous tissue, aponeurosis of the white line of the abdomen, peritoneum are cut in layers along the midline. Exhaustion from the abdominal cavity is evacuated by suction. Perform an audit of the abdominal organs. After detecting the tumor barrier of the colon using staplers, the leading section of the colon is cut off above the tumor, mobilized, taken out of the surgical field and carefully delimited with napkins and diapers moistened with an antiseptic solution (alcohol solution of chlorhexidine). Next, at the end of the leading section of the colon along the perimeter of the intestine, two purse-string sutures of capron No. 4 are applied at a distance of 1.5-2 cm from each other. The proximal imposed purse string suture is tightened, after which a colotomy is made in the center of the distally applied purse string suture with the formation of a colotomy hole with a diameter of not more than 12 mm. A sterile double-lumen probe is inserted through the colotomy opening into the adducting segment of the colon by 1.5-2 cm, after which the distal superimposed purse string suture is pulled over the probe, while the tension of the proximal superimposed purse string suture is relaxed. This technique eliminates the outflow of intestinal contents under pressure from the lumen of the colon at the time of insertion of the probe into the intestine. By loosening the tension of the proximal purse string suture, the probe is carried out retrograde through the colon, if possible, to the dome of the cecum using manual assistance. The inner tube of the probe is connected to an irrigator filled with 3000 ml of a 0.9% sodium chloride solution at 37 ° C with a Polyvidone sorbent at the rate of 50 g of sorbent per 1000 ml of a 0.9% sodium chloride solution. The outer tube of the probe is connected to an aspirator, which is brought into working position. During the retrograde advancement of the double-lumen probe through the colon using an aspirator connected to the outer tube of the probe, intestinal contents and toxic substances are evacuated from the lumen of the colon. Upon reaching the dome of the cecum, the irrigator is brought into a working position, and the double-lumen probe is gradually advanced in the opposite (antegrade) direction along the colon until complete extraction. During the advancement of the probe, the walls of the colon are washed with the 0.9% sodium chloride solution coming from the intestinal contents of the intestine, toxic substances are absorbed by the sorbent, while the washing water is aspirated with an aspirator through the outer tube of the probe. Manipulations at the time of extraction of the probe from the intestinal lumen are performed in the reverse order than at the time of its introduction into the intestinal lumen. After the end of the probe passes the level of the proximal superficial purse string suture, the latter is tightened, thereby excluding the outflow of the contents of the colon outward at the time of extraction of the probe. The tension of the distally applied purse string suture is weakened, the probe is removed from the lumen of the colon. As a result of decompression, the large intestine is reduced in size, which makes it convenient to resect the area of the colon affected by the tumor, as the next stage of surgery.

The disadvantage of the existing method is that it cannot be performed through mini-access.

There is a method of treating obstructive colonic obstruction by applying double-barreled loop ileostomy ("Emergency surgery for colon cancer" Alexandrov N.N. et al. 1980, p. 121). Through an incision in the right ileal region, a loop of the ileum is extracted 20–25 cm from the ileocecal angle. The edges of the parietal peritoneum are sutured to the skin with separate silk sutures, and the loop of the intestine is fixed to the edges of the hole in the anterior abdominal wall with the same threads. A glass rod in a rubber tube is brought under the removed intestine. A purse string suture is applied at the top of the removed loop, the intestinal lumen is opened, a rubber tube with a diameter of 1-1.5 cm is drawn in the proximal direction and reinforced with a purse string suture. The outer end of the tube is lowered into the vessel. After 2-3 days, the tube is removed, the hole in the intestine expands in the transverse direction, after which a lip-shaped iliac fistula is gradually formed.

The disadvantage of the existing method is that when the Bauginia flap is viable, the discharge of gases and intestinal contents from the leading parts of the colon involved in obstruction does not occur or is limited due to the valve function of the Bauginia flap, so it is impossible to empty the leading parts of the colon.

The invention is aimed at solving the problem, which consists in creating a method of decompression of the colon with obstructive obstruction.

The solution to this problem will allow decompression of the colon in acute obstructive obstruction, reduce the number of postoperative complications and deaths and improve treatment outcomes in this category of patients.

The technical solution of the claimed object is that a minilaparotomy is performed at the projection level of the cecum, a loop of the ileum is removed at a distance of 15-20 cm from the bauginium flap, a purse string suture is placed on the mesenteric edge of the excreted ileum, an incision is made in the center and an incision is made a metal or plastic sleeve, after which the purse string suture around it is tightly tightened, a two- or one-lumen probe is inserted into the lumen of the ascending intestine through the valve on the sleeve and the contents are gradually removed mine, after emptying the intestine, the probe is left in the lumen and an ileostomy is formed.

The method is as follows, under general or epidural anesthesia, minilaparotomy is performed at the level of the projection of the cecum, a loop of the ileum is discharged into the wound at a distance of 15-20 cm from the bauginium flap. A purse string suture is placed on the mesenteric edge of the excreted ileum, in the center of which an incision is made and a metal or plastic sleeve is inserted. At the end of the sleeve introduced into the intestinal lumen there is a common lumen, the opposite end is presented in the form of two tubes (Fig. 1). On one of them a polyethylene sleeve is attached, on the other there is a valve. After insertion of the sleeve into the intestinal lumen, the purse string suture around it is tightened. A two- or one-lumen probe is inserted into the lumen of the ascending intestine through the valve on the sleeve and the contents are gradually removed by introducing into the lumen under slight pressure of the liquid (Fig. 2). After emptying the intestinal lumen to clear water, the probe remains in the lumen and an ileostomy is formed.

Thus, colon decompression is performed in obstructive obstruction.

The essence of the method is confirmed graphically in the figures, where

figure 1 - derived through the mini-access loop of the ileum with a special sleeve installed in its lumen;

figure 2 - removal of the contents of the colon using a probe inserted through a valve on the sleeve.

According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known, which allows us to conclude that the invention meets the criterion of "novelty."

According to the authors, the essence of the claimed invention should not be obvious for specialists from a known level of medicine, since it does not reveal the above possibility of creating a similar method of colon decompression in obstructive obstruction, which will reduce the number of postoperative complications and deaths and allows us to conclude compliance with the criterion of "inventive step".

The set of essential features characterizing the essence of the invention, in principle, can be repeatedly used in medicine to obtain the result of creating a method for decompression of the colon with obstructive obstruction, which allows us to conclude that the invention meets the criterion of "industrial applicability".

The method is implemented in the clinic and is used in patients with obstructive colonic obstruction.

Clinical example

Patient M., 63 years old, was hospitalized in a surgical hospital on 12/19/2012 with a clinic of acute intestinal obstruction. In the course of studying the medical history of the disease, it was revealed that already in the last 2 months the patient has noted general weakness, alternating diarrhea and constipation with an unstable appearance in the stool of an admixture of dark blood and mucus. About 3 days before admission, bloating, violation of stool and gas, pain, nausea, general weakness began to be noted.

Survey

Complete blood count (12/19/2012): Hb 108 g / l .; erythritol. 2.8 "10 12 / l; col. pokl 0.8; retic .; thrombus. 286.3; lake. 6.6′10 9 / L; n 7%; with 52%: e 1%; l 36%; m 4%; ESR 25 mm per hour. Survey radiography of the abdominal cavity (12.19.2012). Conclusion: signs of acute colonic obstruction.

Ultrasound of the abdominal cavity (12/19/2012). Conclusion: the phenomena of colonic obstruction.

Colonoscopy (12.19.2012). In the descending colon, a circular tumor is determined that stenoses the lumen of the intestine up to 0.5 cm. A biopsy is performed. Conclusion: moderately differentiated adenocarcinoma.

Decompression and infusion therapy was prescribed, against which, after 6 hours, acute obstructive colonic obstruction was not resolved, which is clinically and radiologically confirmed. After a short preoperative preparation, the patient was operated on. Under epidural anesthesia, the patient underwent minilaparotomy at the level of the projection of the cecum, a loop of the ileum was removed at the wound at a distance of about 15 cm from the bauginium flap. A purse string suture was placed on the anti-mesenteric edge of the excreted ileum, in the center of which an incision was made, and a special plastic sleeve was introduced into the lumen of the intestine, having a common lumen at one end (inserted into the intestine), presented on the other in the form of two tubes. On one of them is attached a polyethylene sleeve connected to an electric suction, on the other there is a valve. After insertion of a sleeve into the intestinal lumen, the purse string suture around it is tightly tightened. A double-lumen probe was inserted into the lumen of the ascending intestine through the valve on the sleeve, and the colonic contents proximal to the tumor were removed in stages by introducing into the lumen under slight pressure of the liquid. After emptying the lumen of the intestine to clear water, the probe is left in the lumen and an ileostomy is formed.

In the postoperative period, washing of the intestinal lumen through a probe was performed for 7 days. 10 days after the elimination of obstruction and decompression of the colon, the patient completed the second radical stage of treatment in the amount of left-sided hemicolectomy with the formation of anastomosis and preservation of ileostomy. There were no postoperative complications.

The patient was discharged on the 14th day after the operation in satisfactory condition.

Thus, the simplicity and effectiveness of the proposed method can reduce the number of postoperative complications and deaths and improve the treatment results of this category of patients.

Claims (1)

  1. A method of decompression of the colon with obstructive obstruction, characterized in that minilaparotomy is performed at the level of the projection of the cecum, a loop of the ileum is placed at the wound at a distance of 15-20 cm from the bougain damper, a purse string suture is placed on the mesenteric edge of the ileum, in the center of which a purse string is made cut and insert a metal or plastic sleeve having a common clearance at the end introduced into the intestine, at the other end in the form of two tubes, with a plastic sleeve attached to one of them, connected to the electric suction, the valve is located on the other, after which the purse string suture around it is tightly tightened, a two- or one-lumen probe is inserted into the lumen of the ascending intestine through the valve on the sleeve and the contents are gradually removed by introducing liquids into the lumen under low pressure, after emptying the intestine probe is left in the lumen and form an ileostomy.
RU2013155855/14A 2013-12-16 2013-12-16 Method for colonic decompression in obturation obstruction RU2549489C1 (en)

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Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU1012920A1 (en) * 1981-04-16 1983-04-23 Zuev Vasilij Drain
SU1553082A1 (en) * 1988-06-20 1990-03-30 Ростовский научно-исследовательский онкологический институт Device for forming intestine stoma
RU2121376C1 (en) * 1995-12-13 1998-11-10 Богомолов Николай Иванович Enteric probe
WO2003065946A1 (en) * 2001-11-26 2003-08-14 Zassi Medical Evolutions Inc. Pad for use with continent ostomy port
GB2409978A (en) * 2004-01-19 2005-07-20 Peter Andrew Priest Fistula Connector
RU2360705C1 (en) * 2008-03-04 2009-07-10 Тенгиз Григорьевич Мосидзе Application mode of isolated small intestine loop as artificial biological kidney
RU2395237C1 (en) * 2008-12-30 2010-07-27 Государственное образовательное учреждение высшего профессионального образования "БАШКИРСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ Федерального Агентства по здравоохранению и социальному развитию" (ГОУ ВПО БГМУ РОСЗДРАВА) Method of open decompression of large intestine
RU2472459C2 (en) * 2007-08-31 2013-01-20 Кимберли-Кларк Ворлдвайд, Инк. Stoma extender

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU1012920A1 (en) * 1981-04-16 1983-04-23 Zuev Vasilij Drain
SU1553082A1 (en) * 1988-06-20 1990-03-30 Ростовский научно-исследовательский онкологический институт Device for forming intestine stoma
RU2121376C1 (en) * 1995-12-13 1998-11-10 Богомолов Николай Иванович Enteric probe
WO2003065946A1 (en) * 2001-11-26 2003-08-14 Zassi Medical Evolutions Inc. Pad for use with continent ostomy port
GB2409978A (en) * 2004-01-19 2005-07-20 Peter Andrew Priest Fistula Connector
RU2472459C2 (en) * 2007-08-31 2013-01-20 Кимберли-Кларк Ворлдвайд, Инк. Stoma extender
RU2360705C1 (en) * 2008-03-04 2009-07-10 Тенгиз Григорьевич Мосидзе Application mode of isolated small intestine loop as artificial biological kidney
RU2395237C1 (en) * 2008-12-30 2010-07-27 Государственное образовательное учреждение высшего профессионального образования "БАШКИРСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ Федерального Агентства по здравоохранению и социальному развитию" (ГОУ ВПО БГМУ РОСЗДРАВА) Method of open decompression of large intestine

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
АЛЕКСАНДРОВ Н.Н. и др. Неотложная хирургия при раке толстой кишки. 1980 Минск. с.121 . ВОРОБЬЕВ Г.Н. Хирургическая тактика при обтурационном нарушении проходимости ободочной кишки. Хирургия 1993. N5. c.47-51 *

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Effective date: 20151217