SU1264916A1 - Method of forming end intestinal anastomosis - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used for operations on the intestine. The purpose of the invention is to prevent complications by ensuring reliable fixation and viability of invaginate. Mobilize a fragment of the intestine to be removed. Examine the blood circulation in the intraparietal vessels of the intestinal wall in the cavities intended for application of the anastomosis. Blood pressure (BP), both in the proximal and distal segments of the intestine should be above 60 mm Hg. Art. This corresponds to full blood supply, prevention of ischemic sutures. At a distance of 3–5 cm from the outermost preserved direct vessel at the mesenteric and arotivobnezherezhechnogo edges of the intestine, serous-muscular sutures are placed on the leading and outgoing intestinal stumps. Extend the intestine, apply two clamps. Between the clamps cut through the intestinal wall of the electrocautery. The drug is removed, the slice is coagulated. Along the clips themselves, the adducting and withdrawing loops are stitched, forming the second row of sero-muscular sutures of the posterior wall of the anastomosis. During the sutures (L, sutures are located at the mesenteric and anti-mesenteric edges of the intestine, fixing the leading and withdrawing ends to the clamps. Over the clamps, serous-muscular sutures are inserted, the immersing clamps and the walls near the resection line. segment into the outlet. 4 ill.

Description

The invention relates to medicine, namely to surgery, and can be used for operations on the intestine.

The purpose of the invention is to prevent complications by ensuring reliable fixation and viability of invaginate.

FIG. Figure 1 shows the dissection of the intestine by an electrocautery between clamps after the level of intestinal intersection is determined; in fig. 2 - the imposition of the first row of seams posterior wall of the anastomosis; in fig. 3 - the final stage of the formation of invaginate; in fig. 4 - invagination of suture strips to the discharge end.

The method is carried out as follows.

After mobilization of the corresponding fragment of the peep to be removed, a light source is placed behind the intestinal loop under study. Extra organ and intramural vessels are revealed in transmitted light. Under the control of transillumination, the suture strips are freed from defective tissues for suturing — fatty tissue and mesentery to the level of the first stored straight vessel. Here, blood circulation in the intraparietal vessels of the intestinal wall is examined in the bands intended for anastomosis application. According to the level of arterial pressure, an anastomosis site is selected. At the same time, the arterial pressure in the intraparietal vessels, both in the proximal and distal segments of the intestine, must be higher than 60 mm Hg, Art., Which corresponds to a complete blood supply and prevents the inconsistency of seams of ischemic origin. If the level of arterial pressure in the intended suture band is below sufficient to ensure complete hemocirculation, the suture band is moved: proximally in the proximal direction, and distal, in the distal direction to the level of adequate blood supply. In doing so, the level of system pressure at which the measurements were made is taken into account.

At a distance of 3–5 cm from the outermost retained direct vessel at the mesenteric and protivopolochnyh edges of the intestine, serous-muscular interrupted sutures are applied to the drive and the diverting intestinal stump. By traction of these sutures in opposite directions at the intended section, the gut is stretched and two narrow rigid crushing clamps are applied. Between the clamps cut through the intestinal wall of the electrocautery. The drug is removed, the slice is coagulated (Fig. 1).

At the point of entry into the suture line of the first stored straight vessel, a sero-muscular suture is placed on the mesenteric edges of the leading and discharging ends. The same suture is imposed at the anti-skim edges of both segments. The intestinal walls are stretched with the latest ligatures. At this level, the first row of interrupted sutures is imposed without damaging the preserved straight vessel (Fig. 2).

At the clips themselves, the adducting and discharging loops are stitched together, forming the second row of sero-intestinal interrupted sutures of the posterior wall of the anastomosis.

Throughout the seam strip

mesenteric and antipyretic margins

guts have stitches that fix

leading and tapping ends up to

clamps (side seams) (Fig. 3). Over the top

clamps impose nodal serous-muscular sutures, immersing clamps and walls

at the resection line. The clamp is removed and

impose two seams along the edges.

Using a small puffer, the pressure on the dome of the driving loop invaginates the driving loop in such a way that it is stitched from the diverting loop to the diverting loop (Fig. 4).

At the level of the first row of the posterior wall of the anastomosis, a second row of sero-muscular nodular shvov front wall. Patient K. underwent left-sided hemicolectomy. Under the transillumination control, a seam strip was prepared. The blood pressure in the intramural vessels of the putative suture strip of the proximal end was 155/106.30 at the mesenteric margin, 130/85, 30 at the distal end, with a system pressure of 120/80 mm Hg. Art. On the edge of the suture strips, rigid narrow clamps are applied and, in parallel, clamps on the removed preparation. Between them, the intestine is cut by an electrocautery. The drug has been removed. The serous-muscular sutures. At the mesenteric and anti-mesenteric margins, the driving and diverting loops are connected. The intestinal walls are stretched by these sutures and the first row of nodular sero-muscular sutures between the back walls of the intestine is laid at the level of the preserved direct vessel, without damaging it.

The second row of sero-muscular sutures between the posterior walls of the anastomosis is formed at the very clamps. Superimposed on one row of sero-muscular sutures at the mesenteric and anti-mesenteric margins between the leading and distended knees. On top of the clamps, the first row of sero-muscular nodal joints between the anterior walls of the intestine at the resection line is superimposed. With the help of a small tuppher, the suture strips are invaginated into the discharge loop.

A second row of sero-muscular interrupted sutures is superimposed at the level of the first row of posterior walls. The length of invaginate was 4 cm. The postoperative course is smooth. Discharged from the clinic in good condition.

The advantages of the technique are as follows. Immersion of the anastomosis line

provides its extraperitonization, isolation from the abdominal cavity. The first and second rows of stitches are placed at different levels of the same plane, which, in combination with fixation of invaginate with side seams, prevents the anastomosis from narrowing and its obstruction. The technique creates conditions that exclude blood supply disturbance along the suture strip — the main asthma arc between the stored and ligated direct vessels is retained.

In addition, the advantage of the method is also the creation of a wide plane of contact between the serous membranes of the adducting and withdrawing intestinal loops. The use of an aseptic anastomosis formation method prevents infection of the suture plane in the invaginate and the abdominal cavity. An increase in the intestinal pressure with the proposed method not only does not entail the divergence of the sutures, but is accompanied by a closer fit of the serous integument covering and diverting intestinal loops, while

Biologically and mechanically sealed anastomoses are created. In addition, a valve mechanism is created to prevent the intestinal contents from flowing back.

The proposed method of forming anastomosis was performed and tested in 86 patients. Recommended for practical use.

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Claims (1)

Invention Formula The method of forming the terminal inter-intestinal anastomosis, including the invagination of the leading segment into the outlet with screwing the edges of the latter inward, characterized in that, in order to prevent complications by ensuring reliable fixation and viability of invaginate, its size is determined taking into account the arterial pressure of intramural vessels, In this case, invagination is performed after overlapping and fixation of the adductor and outlet segment with longitudinal side seams.