RU54757U1 - INTESTINAL ADAPTER - Google Patents

Abstract

The utility model relates to medicine, namely to surgery, and is used for the formation of intestinal anastomoses in patients with pathology of the gastrointestinal tract. The apparatus consists of: a rack mechanism (1), two free branches (2) with river-screw drives (6) made of two plates. The plate has a cylindrical socket (3) with a screw lock (4). Removable devices (5) for fixing the hollow organs of the gastrointestinal tract as a soft intestinal pulp are inserted into cylindrical nests, where they rotate 360 ° around their axis. Using the screw mechanism (7), the jaws of the devices are metered down. The device is used as follows. Removable devices for fixing the hollow organs of the gastrointestinal tract are sequentially applied to the mobilized portion of the intestine or stomach, intended for resection. The sponges of the devices close and fix the wall of the intestine or stomach in a metered manner using a screw mechanism, after which each removable device is inserted into the cylindrical socket of the jaw and is rigidly fixed in the required position. Free branches by river mechanism are bred to extreme positions, after which a section of the intestine or stomach is resected at a distance of about 5 mm from the edge of the superimposed device, and then reduced to the approach of the anastomosed areas. They make a suture, while rotating around their axis the fixation devices of the hollow organs of the gastrointestinal tract achieve constant adaptation of the intestinal wall of both the anterior and posterior lips of the anastomosis. After applying the anastomosis, the sponges of the device are opened, the device is removed.

Description

The utility model relates to medicine, namely to surgery, and is used for the formation of intestinal anastomoses in patients with pathology of the gastrointestinal tract.

Currently, during the formation of anastomoses of the gastrointestinal tract, the stage of suturing the intestinal wall is preceded by the stage of dissection of the intestinal wall with the subsequent reduction and comparison of stitched sections. This method is taken by us as a prototype and is performed as follows [1]. Pre-mobilize a section of the intestine or other organ of the gastrointestinal tract, where an organ resection will be performed, followed by the application of an anastomosis. Two intestinal pulp is placed on the mobilized site distally and proximal to the resection site, after which the organ intersects. The proximal pulp remains on the anastomosed organ and pinches it, preventing the contents from entering the abdominal cavity and its infection. After resection, the stapled areas are matched by the approach of the two pulp, and between the walls of the stitched organs are sutures of the holder or traction sutures. Next, the intestinal pulp is opened and stitching of the corresponding sections of the intestine occurs.

However, this method has the following disadvantages:

1. When applying the pulp there is no dosed pressure on the wall of the stitched organ, which leads to the appearance of a strangulation groove and a violation of microcirculation in the suture zone [2].

2. An exact comparison of the edges of the wound is not achieved, since it is impossible to keep the intestinal pulp by the hands of the assistant surgeon in a strictly stable position [1], which leads to the inversion of the intestinal mucosa, thereby violating the biological integrity of the suture, leakage of intestinal contents into the abdominal

cavity, development of peritonitis, healing of the suture line by secondary intention [2].

3. When an intestinal suture is applied, there is no complete adaptation of the mucous membranes of the stitched areas, therefore, when using this method, there is no biological tightness, the healing of the suture line occurs by secondary tension with a high risk of scar stricture formation [3]

4. It is necessary to perform turns of stitched organs for suturing the posterior lip of the anastomosis, which causes excessive trauma to the walls of the organs and contamination of the surgeon's hands with intestinal contents [4].

5. There is no dosed comparison of stitched sites, which often leads to tension of the anastomosed organs and the development of ischemia of the stitched sites with subsequent failure of the sutures [1].

The purpose of the proposed utility model is to create an apparatus to reduce the number of postoperative local complications by increasing the accuracy of matching (adaptation) of stitched sections of the organs of the gastrointestinal tract.

The goal is achieved in that the intestinal adapter, shown in figure 1, contains a rack mechanism (1), two branches (2) with rack-and-pinion drives (6) made of two plates freely moving along the rack mechanism in a horizontal plane relative to each other friend with a rack-and-pinion drive. In addition, the plates are equipped with cylindrical nests (3) with screw locks (4), where two removable devices (5) are inserted to fix the hollow organs of the gastrointestinal tract (GIT) like soft intestinal pulp. The devices inserted into the cylindrical sockets have the ability to rotate 360 ° freely around their axis. Using the screw mechanism (7) located at the base of the pulp, the jaws of the devices are metered down.

The device is used as follows. Removable devices for fixing the hollow organs of the gastrointestinal tract are sequentially applied to the mobilized portion of the intestine or stomach, intended for resection. The sponges of the devices close and fix the wall of the intestine or stomach in a metered manner using a screw mechanism, after which each removable device is inserted into the cylindrical socket of the jaw and is rigidly fixed in the required position. Free branches by the river mechanism are bred to extreme positions, after which a section of the intestine or stomach is resected at a distance of about 5 mm from the edge of the superimposed device.

Next, free jaws with rack-and-screw drives reduce the anastomosed areas to come closer, after which, by rotating removable fixation devices of hollow organs, an exact comparison is achieved - adaptation of the layers of the wall of the stitched organs. They make a suture, while rotating around their axis the fixation devices of the hollow organs of the gastrointestinal tract achieve constant adaptation of the intestinal wall of both the front and rear lips of the anastomosis. After applying the anastomosis, the device sponges are opened, the device is removed.

The device for adapting anastomosed sections of the hollow organs of the gastrointestinal tract - an intestinal adapter, called AK-1, was manufactured at JSC Medical Instrumental Plant named after V.I. Lenin "of Worsma.

The developed device allows you to:

- Accurately compare stitched sections of the digestive tract due to the stability of the rack drive.

- Dose squeeze a section of the wall of the stitched organ due to the presence of a screw, not a cremallera mechanism of the pulp.

- Convenient rotation of devices 360 ° around its axis with a stationary location in the rack and pinion mechanism allows to negate

trauma to the walls of organs and contamination of the surgeon's hands with intestinal contents.

- When a suture involving AK-1 is applied, the adaptation of the mucous membranes of the stitched sections is achieved completely, which prevents the absence of biological tightness, the healing of the suture line occurs by first intention without the risk of scar formation.

The experiments were performed on 10 outbred dogs of both sexes weighing from 20 to 30 kg. The healing and morphofunctional state of the tissues of the anastomotic region, sutured with a two-row suture (Lambert-Albert type), as well as the healing and morphofunctional state of the tissues of the region of the intestinal anastomoses end to end, formed using the intestinal adapter, were studied. Reliable data appear on the 5th day of the postoperative period and indicate an increase in the physical strength of the studied tissues sutured using an intestinal adapter, compared with anastomoses performed by a two-row Lambert-Albert type suture without the use of an intestinal adapter.

Clinical examples.

1. Patient Kosepatov NP, 73 years old. History No. 3042. He was hospitalized in the surgical department of MDLP GKB No. 12 from 11/15/2004 to 11/26/2004. Diagnosis: pancreatic cyst. Internal drainage was performed by forming a cystoyunoanastomosis with an adaptive-precision suture using AK-1. The postoperative period was uneventful. Discharged in satisfactory condition.

2. Patient Yesaulov N.A., 53 years old. History No. 1042. He was hospitalized in the surgical department of MLPU GKB No. 12 from 04/18/2005 to 05/03/2005. Diagnosis: ulcer of the lower third of the body of the stomach. A resection of 2/3 of the stomach was performed according to Billroth-1. Gastroduodenoanastomosis is performed by an adaptive-precision suture using AK-1.

The postoperative period was uneventful. Discharged in satisfactory condition.

Information sources.

1. Buyanov V.M., Egiev V.N., Udotov O.A. Surgical stitch. Moscow., 1993.

2. Zaporozhtsev A.A. The mechanism of occurrence and prevention of peritonitis after operations on the organs of the gastrointestinal tract. Abstract. Dis., Doct. honey. sciences. Minsk, 1984.

3. Kutukov V.V. Operational methods for the prevention of suture failure on the organs of the gastrointestinal tract. Abstract. Dis., Doct. honey. Sciences, M. 2001.

4. Istomin N.P. Ratov V.G. Collection of scientific papers "Problems of emergency surgery." M. 1988; s43-45.

Claims (1)

Intestinal adapter, containing two jaws with rack-and-pinion drives, freely moving along the rack and pinion mechanism in a horizontal plane relative to each other and made of two plates, characterized in that on each plate of the jaw there is a cylindrical socket with a screw lock, which is inserted for rotation around its axis 360 ° removable device for fixing the hollow organs of the gastrointestinal tract as a soft intestinal pulp, and at the base of the removable device there is a screw mechanism, with the help of which the jaws of the device are metered down.