SU1286170A1 - Method of resection of large intestine - Google Patents

Abstract

The invention relates to surgery. In order to prevent violations of the evacuation of intestinal contents and inflammatory complications, they mobilize the large intestine, cut through the sero-muscular layer, the rectum. Along the posterior semicircle of the rectum, the mucous membrane from the muscle layer to the level of the internal sphincter of the rectum is separated, forming a tunnel through which the mobilized colon is retracted, resect it and form a colorectal anastomosis. The mobilized mucosa is looped together with the colon into the rectal lumen. Crush clips are applied with the grip of the anterior wall of the descending intestine and the mucous membrane of the anterior wall of the rectum from the side of the abdominal cavity. A sheet of parietal peritoneum is hemmed over the seams. sh with

Description

Yu

X) oi

The invention relates to medicine, in particular to surgery, and can be used in the surgical treatment of malformations and diseases of the colon. The purpose of the invention is to prevent violations of the evacuation of intestinal contents and inflammatory inflammatory complications, which is achieved by performing the operation without opening the rectum and eliminating the blind pocket in the anastomosis area.

Figure 1 shows the rectal mucosa with a turnstile attached to it and a hole in the separated mucosa along the posterior rectum semicircle; Fig. 2 shows a rectal lining of the rectum and a mobilized thick gut retracted to the perineum in a loop through a tunnel and a hole in a separated mucosa; FIG. 3 shows crosslinked mucous membranes of the posterior gum circumference of the mobilized large intestine and the lower edge of the orifice of the posterior semicircle of the rectum, forming the posterior semicircle of the colorectal anastomosis, and the distal end of the rectal mucosa; Figure 4 shows a crush clamp (for example, fenestrated) superimposed on the anterior wall of the retracted mobilized colon and the separated mucosa of the anterior semicircle of the rectum, in contact with it, with an excess of the distal end of the rectal mucous membrane located between the branches.

The method is performed as follows. The abdominal cavity is opened with one of the accesses for operations on the colon and rectum. Taking into account the level of resection and the necessary length for lowering the perineum, they mobilize the large intestine 1. Circularly dissect the sero-muscular layer of the rectum 2 in the ampulla- ble of the TLT, and it is deformed and produces a proximal rectal section 3 that forms mucous the rectal intestine tube 4. In the posterior semicircle of the rectum 3, the mucous membrane 5 is separated from the muscle layer 6 to the level of the internal sphincter of the rectum 7, forming a tunnel 8. From the perineal side, the anal enlargement of the anal canal 9 is performed. The rectal mucosa 5 is higher than the level of the internal sphincter of the rectum 7, forming an opening in the separated rectal mucosa 10 along the posterior rectum semicircle 3. The mucous rectum of the intestine 4 imposes a turnstile 11, the ends of which are t to the crotch through the tunnel 8 and the anal canal 9. By sweeping over the turnstile 11, a loop is looped through the tunnel 8 and the hole in the separated rectal mucosa 10 the mucous case of the rectum 4 and lowering

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mobilized colon 1 perineum. The mobilized large intestine 1, which is relegated to drowseness, and the partially mucous rectal sheath 4, is resected. The mucous membrane of the retracted mobilized colon 12 is sutured along its posterior semicircle with the lower edge of the mucosal opening of the posterior semicircle of the rectum 13, forming the posterior semicircle of the colorectal anastomosis. the front semicircle of the straight collet 15 to the contact

g of its ampulla with the posterior wall of the retracted mobilized thick dusk 1, and apply a crushing clamp 16 (e.g., hollowed) onto them in such a way that the mucous membrane of the posterior semicircle of the rectum 5 is separated

0 and the excess of the distal end of the rectal mucosa 4 lies between the jaws of the crushing clamp 16. From the abdominal cavity, press the upper edge of the sero-muscular layer of the straight pussy 2 along the circumference to the mobilized large intestine 1. A sheet of parietal peritoneum is hemmed over the seams 17

Example. Child K. 5 years 2 months. From the anamnesis it is known that a boy with a birth does not suffer from persistent constipation, abdominal distention, and occasionally vomiting. Pischer emptying was achieved only with the help of enemas. Upon receipt of a complaint about the absence of an independent chair, an increase in the volume of the abdomen, poor appetite, and an increase in size.

An objective study found a lag in physical development, body mass deficiency of 3.2 kg, pale, adynamic. The abdomen is enlarged due to distention of the intestine, enlarged loops of the large intestine have been palpated, in the sigmoid colon

0, tight fecal masses were determined. During rectal examination, the rectal sphincter tone is elevated, the ampoule is empty, having collapsed from, mucus when removing the finger on the glove. On a radiograph of the abdominal organs, a high standing of the diaphragm domes, dilated colon loops, fluid levels in the descending and sigmoid colon were determined. On the irrigogram, a narrowed zone was determined in the rectosigmoid Department of the thick peel with a funnel-like transition to the suprastenotic expansion; colon dilated, haustratsi missing until the right half of the colon.

General clinical and biochemical studies have shown moderate hypoprotein 5, my anemia, and toxic changes in the myocardium. Diagnosis: Hirshsprung disease, recto-sigmoid form, I degree of subcompensated stage.

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For 10 days, preoperative preparation was carried out, aimed at the rehabilitation of the intestine, correction of metabolic disorders, detoxification.

Middle laparotomy. During revision, abdominal organs were found: the aganglionic zone up to 15 cm long captures the nadampular section of the rectum and partially the sigmoid colon with a diameter of up to 3 cm; the proximal end of the sigmoid colon, expanding funnel-shaped, gradually passes into the descending and transverse colon expanded to 10–12 cm of agaustarized with the hypertrophied and sclerosed wall; the right half of the colon with a diameter of 4-6 cm, its wall is gustrirovana without pronounced visible pathological changes.

The boundaries of the resection are outlined and the colon is mobilized to the hepatic angle. With an indentation of 3 cm from the level of the transitional fold of the peritoneum, the sero-muscular layer of the rectum is circularly dissected and the removal of the supravular and partially ampulla of the rectum is performed around its circumference and a rectal mucous membrane is formed. By the posterior semicircle of the rectum, the mucous membrane is separated from the muscle layer to the level of the internal sphincter of the rectum and a tunnel is formed.

Perineal focal extension of the external sphincter of the rectum and widening of the anal canal. The rectum mucous membrane of the rectum along the posterior semicircle above the internal sphincter was cut in the transverse direction into half the diameter of the rectum. Through the tunnel and the formed hole in the separated mucosa, the ends of the turnstile placed on the rectal mucosa are placed in the crotch. By sweeping over the turnstile on the crotch, stretch the loop of the rectal mucosa and mobilized the colon to the level of the intended resection. The mobilized colon and the partially mucous rectal mucosa are resected from the perineum. The edge of the mucous membrane of the posterior semicircle of the descending colon is hemmed in separate catgut sutures to the lower edge of the mucosa of the posterior semicircle of the rectum above the level of the internal sphincter, and thus the posterior semicircle of the colorectal anastomosis is formed. By squeezing the distal end of the rectal mucosa, the mobilized mucosa of the anterior semicircle of the rectum is maximally retracted until the ampul- lar section touches the anterior semicircle of the reduced colon, and a crushing terminal clamp is applied to them in such a way that there is a clamp between the branches of the colon. the mucous membrane of the posterior semicircle of the rectum and the excess of the distal end of the mucous membrane of the rectum were separated, the latter were cut off. A vent tube is inserted into the lumen of the colon.

From the side of the abdominal cavity upper

0 the edge of the sero-muscular layer of the rectum is hemmed along the circumference to the mobilized colon by individual sero-muscular sutures. A sheet of parietal peritoneum is additionally hemmed to the serous membrane of the large intestine over the suture line. The window in the mesentery of the colon sutured. Toilet abdominal. The wound of the anterior abdominal wall sutured in layers tightly.

The postoperative course is smooth. On the 2nd day, a separate chair,

0 began to depart gases. On the 5th day, the fenestrated crush clamp was dropped along with the necrotized front wall of the colon and the rectal mucosa. The wound of the anterior abdominal wall was healed by primary tension.

 At the time of discharge, the child’s condition is satisfactory. No complaints. It drowns the urge to the bottom. The chair is independent 3-4 times a day, the stool is mushy. Recommended: the sphincter is tonic, in the ampulla remains feces, the anastomosis is wide, located obliquely, its upper lip is 3-4 cm higher than the lower one, and there is moderate infiltration in the form of a roller along the upper semicircle of the anastomosis. Discharged with recovery. Re-examined after 1 year 9 months. J The condition is good, there are no complaints, he gained 7 kg in weight, he is good at drying up the urge to the bottom, the stool is independent 1-2 times a day, the stool is decorated. The stomach of the correct form, symmetrical, soft, painless, is palpable to the left in the ileal region in the form of 0 m soft coerce of up to 3 cm wide, the mobile intestine. Rectal: the sphincter is tonic, its volitional stress is felt. When sigmoidoscopy anastomosis wide without cicatricial and inflammatory changes. Almost healthy. Continues to watch.

Since all manipulations on the rectum are performed outside the sphincter apparatus, the possibility of damage to the rectum sphincters is excluded, and, therefore, impaired stool function is prevented and the physiological defecation act is preserved. Due to the formation of intestinal fistula end to end, the anatomical shape of the intestine is preserved,

5, postoperative complications such as the formation of a "blind bag and" spurs are eliminated and, thus, create favorable conditions for the natural passage of intestinal contents and the act of defecation. As a result of the oblique position of the intestinal fistula (the anterior semicircle of the anastomosis is 3-4 cm higher than the posterior one), such postoperative complications as cicatricial stenosis and anastomotic deformity are excluded, and it is possible to anastomose intestines of different diameters. Since colon resection and opening of the lumen of the intestine are performed outside the abdominal cavity, infection of the abdominal cavity is prevented and the possibility of peritonitis is prevented, and consequently, postoperative complications are reduced. Stitching the sero-muscular layer of the rectum to the wall of the mobilized colon above the level of the anastomosis with its subsequent periotonization of the suture line with a sheet of parietal peritoneum increases the reliability of the anastomosis and prevents the possibility of peritonitis, which also reduces the number of postoperative complications.

Claims (1)

Invention Formula Method of colon resection, including mobilization of the colon, dissection of the sero-muscular layer of the rectum, formation of a tunnel between the mucous membrane and the muscle layer on the posterior semicircle of the intestine with the formation of a hole in the mucous membrane and the release of the mobilized colon through it and resection with the formation of a colorectal anastomosis using crushing clamps, characterized in that, in order to improve the evacuation of the colon contents and prevent development of pyoinflammatory complications, a mobilized mucous membrane in the form of a loop is reduced together with the large intestine to the rectum, and the crushing clips impose, with the capture of the anterior C1, of the reduced intestine and the mucous membrane of the anterior wall of the rectum. 77 ; / FIG. eri 2