RU2564964C1 - Intestinal suture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: continuous seromusculosubmucosal suture of an intestinal wall is applied. Herewith the sutures are intersected. The suture extends in parallel with an intestinal wound edge; the needle is pricked out at 3-4 mm from the prick-in. The next stick is found on the opposite side of the intestinal wound by shifting the prick-in point diagonally, at 3-4 mm from the previous prick-out backwards. The stitches are alternated in an inverting and diverting loop by shifting every next prick-in from the previous one. After the continuous suture completes the full circle of the intestinal wall, the knots are tightened up.

EFFECT: method reduces a risk of cutting through, oedema and necrosis of the anastomosis line or the intestinal suture when repairing the gastrointestinal organs by adjusting the wound edges as much as possible with no tension.

2 cl, 2 dwg

Description

The invention relates to medicine, namely to surgery, and can be used in planned and emergency surgery when suturing wounds and applying anastomoses on the organs of the gastrointestinal tract.

As an analogue, a method for applying an intestinal suture is proposed, including piercing the intestinal wall and tying the thread on the serous membrane, characterized in that a through needle is inserted through the needle, departing from the edge of the serous membrane to guide the thread through all layers of the intestinal wall with a puncture on the mucous membrane and subsequent injection into the edge of the mucous membrane from the side of the intestinal lumen, and then the thread is passed from the opposite side through the same layers in the opposite direction with a puncture on the serous membrane, after which the ends of the thread binding (RF patent №2351288).

There are common signs of this method of intestinal suture with the claimed method, which are expressed in the following:

- the method is used in the surgical treatment of injuries and diseases of the gastrointestinal tract;

- the method includes continuous flashing of the intestinal wall;

- the method is performed with the formation of a cross of threads;

- the method involves the formation of a node on the serous membrane.

The disadvantage of this method is the possibility of developing infected closed cavities between the rows of sutures, provoking the development of inconsistency of the sutures, and later, various forms of peritonitis and fistulas of the gastrointestinal tract due to the lack of full adaptation between the edges of the adducting and diverting loops of the intestinal wall, the formation of a moderately expressed tissue shaft with each side, rigidity of the seam line. Ischemia in the anastomotic zone puts pressure on the wound and reduces the diameter of the lumen, which complicates the passage of feces and may be accompanied by a violation of the reparative process.

The technical result of the invention is the elimination of complications in the form of infected closed cavities between the rows of sutures due to the high strength and tightness of the suture, performed taking into account the microsurgical precision technique, which provides the optimal fixing contact area of the intestinal wall membranes.

The essence of the method of applying an intestinal suture, including continuous flashing of the serous, muscle and submucosal layers of the intestinal wall with the formation of a cross of threads, and tying a knot on the serous membrane, consists in the needle passing through the muscle and submucous layers at the border with the mucous membrane, parallel to the edge of the intestinal wounds, puncture is carried out at a distance of 3-4 mm from the injection, the next stitch is sewn similarly to the previous one, on the opposite side of the intestinal wound, shifting the injection site diagonally, 3-4 mm from the previous and stitching it vykoli serous, muscular and submucosal layers in the reverse direction, then stitches on alternate adductor and abductor loop, shifting each subsequent vkoly relative to previous and tie knots after passing a continuous weld over the entire circumference of the intestinal tube.

Another difference is that the suture is applied using microsurgical technique.

Muscular-submucosal flashing of each wall of the intestinal wound in the transverse direction with respect to the edge of the intestinal wound reduces the incidence of suture failure.

The use of microsurgical precision technique and atraumatic microsurgical suture material provides layer-by-layer stitching and careful adaptation of the layers of the intestinal wall.

In FIG. 1, 2 presents a general scheme for the application of adaptive microsurgical intestinal suture.

The method is as follows.

An injection of 1 needle with a thread 6/0 is made into the serous membrane of 2 intestinal walls at a distance of 2-3 mm from the edge of the wound. The needle is passed through the muscle 3 and submucosal layers 4 at the border with the mucous membrane 5 parallel to the edge of the intestinal wound 6, prick 7 - at a distance of 3-4 mm from the injection. Then, on the opposite side of the intestinal wound, shifting the injection site diagonally, 3-4 mm from the previous injection (stitch), the serous, muscular and submucosal layers are similarly punctured, in the opposite direction. Next, the injections alternate on the lead and outlet loop, displacing each subsequent inject relative to the previous one by 3-4 mm, and after passing a continuous suture along the entire circumference of the intestinal tube, a knot is formed from the side of the serous membrane.

As a result, a line of a single-row continuous suture is formed with maximum adaptation of the edges of the intestinal wound and ligature crossings from the side of the serous membrane.

Experimental testing of the method was carried out on an unfixed gastrointestinal complex of a pig and 30 rats of the Vistar line. The speed of execution and the reliability of the suture were noted. Daily assessed the general condition of the animals by their activity, body weight, physiological settings and appetite. All animals showed a positive dynamics of changes in body weight in the postoperative period. The use of this suture showed the absence of complications such as inconsistency of the joints of the anastomosis and anastomositis, which was confirmed by morphological examination of the zones of anastomoses on the 10th and 14th day. When relaparotomy revealed that the diameter of the intestinal tract ranged from 4000 to 7000 microns. The discharge sections of the intestine with a diameter of 3500 to 10,000 microns. The diameter of intestinal anastomoses varied from 5000 to 10000 microns. The tissue roller was not detected along the suture line; maturing granulation tissue with numerous capillary type blood vessels and focal clusters of fibroblasts forming collagen tissue was found, especially around the suture material. The proposed suture creates optimal conditions for wound healing by maintaining the property of the intestine to change the diameter in the anastomotic zone, as close as possible to the physiological function of the intestinal peristaltic wave, ensuring sterility and tightness of the intestinal suture.

To preserve the mechanical strength of the intestinal wall under conditions of dynamically changing intraluminal pressure, its ability to deform is especially important. The increase in pressure in the intestinal lumen is accompanied by an increase in its diameter, i.e. stretching the wall. Which, in turn, is due to intestinal paresis and perifocal edema of the anastomosis zone. The diameter of the intestine in the early stages after surgery can increase one and a half times or more. This leads to a proportional increase in the distance between the seams and the stitched fabrics. Under these conditions, the use of adaptive microsurgical intestinal suture can prevent overstretching of the tissues and significantly impede the failure of the sutures. Distribution of multi-vector tensile forces prevents teething. The large area of contact of the serous membranes of the intestinal segments provides tightness with subsequent rapid healing of the anastomosis. The indicated moments give the seam lines high biological and mechanical strength.

Using the proposed method for applying intestinal suture provides the following advantages:

- intestinal suture is performed in conditions of maximum functional adaptation of the edges of the intestinal wall, which reduces the thickness of the anastomosis;

- the stitches on the leading and outlet loops of the intestine are displaced relative to each other and do not overlap, thereby not compressing the wall of the intestine in the area of the anastomosis;

- under conditions of dynamically changing intraluminal pressure, the anastomotic zone is capable of deformation;

- the distribution of multi-vector tensile forces prevents the eruption of joints;

- create more favorable conditions for the reparative process in the intestinal anastomosis.

The proposed intestinal suture is easy to use and can be widely used in surgery, in particular in abdominal surgery, etc., while restoring the integrity and reconstruction of the organs of the gastrointestinal tract.

Claims (2)

1. Intestinal suture, including continuous flashing of the serous, muscle and submucous layers of the intestinal wall with the formation of a cross of threads and tying a knot on the serous membrane, characterized in that the needle is passed through the muscle and submucosal layers at the border with the mucous membrane parallel to the edge of the intestinal wound, the puncture is carried out at a distance of 3-4 mm from the injection, the next stitch is sewn similarly to the previous one, on the opposite side of the intestinal wound, shifting the injection site diagonally, 3-4 mm from the previous injection and stitching the ozy, muscular and submucosal layers in the opposite direction, then alternate the stitches on the adduction and abduction loops, displacing each subsequent injection relative to the previous one, and knot after passing a continuous suture along the entire circumference of the intestinal tube. 2. The method according to p. 1, characterized in that the suture is applied using microsurgical equipment and instruments.

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