SU1755792A1 - Method for treating lymphostasis of lower extremities - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used in the treatment of lymphostasis of the lower extremities. The goal is to reduce the frequency of recurrence of lymphostasis by increasing the throughput of the shunt. Stage 1: A 2–2 cm incision is made along the Ken line below the inguinal fold. The artery and vein are clrcumflexa superficial. Scar tissues are excised. Stage 2: the median laparotomy, the small intestine is brought into the wound, the architectonics of the vascular arcades, the presence of lymph nodes and their interrelation with the blood vessels is determined by the transmitted light. One or two connected lymph nodes are planned, as well as feeding vessels, taking into account the least trauma to the mesentery and sufficient blood supply to the intestine after the lymph node has been removed from the vessels. The blood vessels around the node are stitched and tied up step by step, the latter crossing the vessels feeding the node. The defect in the mesentery is sutured with catgut. 3rd stage: the node is placed in the wound of the inguinal region and anastomose vessels (artery and vein) with vessels allocated in the inguinal region. Afferent lymphatic vessels of the node are placed distally, efferent, starting at the vascular leg of the node, proximally. After the start of the blood flow, the permeability of the anastomoses and blood filling of the lymph node are checked. Hemostasis Stitches on the skin. The method allows to achieve more consistent edema reduction. The method is recommended for practical use. h JV SL 3 GO

Description

The invention relates to medicine, namely, to surgery and can be used in the treatment of lymphostasis of the lower extremities.

The purpose of the invention is to reduce the frequency of recurrence of lymphostasis by increasing the throughput of the shunt.

Example. B-Noah A .. 17 years old, students, entered the clinic with complaints of swelling of the right leg, as well as swelling of the entire left lower extremity. A disease since childhood, when vils swelling of the left leg and foot. Subsequently, the edema spread to the entire limb, also swelling along the vils on the right leg. For the last 3 years, recurrent erysipelas has followed up to 2-3 relapses per year.

Upon admission, the state is satisfactory, complaints of swelling of the entire left lower limb and right lower leg. With

Examination: the edema is dense, no pressure lobes remain. Indurative changes on the skin no. The difference in the circumferences of the lower extremities is + 3-5 cm. In an attempt to direct lymphography, it was not possible to isolate and catheterize the lymphatic vessel, which will indirectly lead to aplasia of the lymphatic vessels. Clinical diagnosis: primary lymphatic edema of both lower extremities, aplasi of lymphatic vessels, complicated by recurrent erysipelas. Taking into account the futility of conservative therapy, the patient was offered an autografting of the mesenteric lymph node of the small intestine, for which the patient agreed. Under endotracheal anesthesia, an autotransplant operation was performed on the lymphatic node of the mesentery of the small intestine on the left lower limb in order to recreate the drainage of the lymph. The mouth of the large saphenous vein with tributaries is exposed by the left incision under the inguinal fold. The inflow going up laterally is highlighted - vena curcumflexa ill spf ,, the name of the arteries is highlighted next to it. Middle laparotomy. Layers open abdominal cavity. No abnormalities were found in the revision of the abdominal organs. A moderate amount of clear effusion. Loops of small intestine are brought into the wound. In the transmitted light, taking into account the architectonics of the vascular arcades, two connected lymph nodes are outlined, feeding vessels are determined. The blood vessels around the lymph node are stitched and tied up step by step, the feeding vessels are taken on microclips and cut off. The lymph node is transferred to the inguinal wound. Careful hemostasis of the mesentery. The abdominal cavity is sutured in layers tightly. Under an operating microscope (magnification 16-25 times), the lymph node is laid in such a way that the efferent lymphatic vessels are located dxally, and the efferent nodes are located in the proximal direction. The blood vessels of the lymph node are anastomosed with a.et.v.clrcumflexa ill spf, prolene 10/00 end to end. Start blood flow. Venous outflow from the site by vils immediately. Checking the patency of the anastomoses. The wound is sutured in layers tightly. Elastic bandage. The postoperative period was uneventful. The patient was examined after 4 months. after surgery, edema was reduced, there was no recurrence of erysipelas.

The proposed method of treatment allows to achieve a more stable reduction of edema.

The method is recommended for use in clinical practice.

Claims (1)

The method of treating lower limb lymphostasis, including using a lymphatic collector as a shunt of a lymphatic reservoir on the vascular pedicle, characterized in that, in order to reduce the frequency of lymphostasis recurrence by increasing the shunt throughput, the mesenteric small intestine flap is used as a lymphoma. vessels of which are anasgomozi-PVIOT in the inguinal region with branches of femoral vessels.