SU906531A1

SU906531A1 - Method of applicating side anastomosis of tubular organs

Info

Publication number: SU906531A1
Application number: SU802940835A
Authority: SU
Inventors: Иван Ильич Митюк; Владимир Трофимович Бурый
Original assignee: Винницкий Медицинский Институт Им. Н.И.Пирогова
Priority date: 1980-06-13
Filing date: 1980-06-13
Publication date: 1982-02-23

Description

Изобретение относится к медицине, а именно к хирургии, и может быть использовано при наложении боковых анастомозов сосудов желчных протоков и других трубчатых органов, где необходима герметичность, повышенная прочность, ламинарное течение жидкости.The invention relates to medicine, namely to surgery, and can be used when applying lateral anastomoses of the vessels of the bile ducts and other tubular organs, where tightness, increased strength, laminar fluid flow is required.

Известен способ наложения бокового анастомоза трубчатых органов, который включает выполнение бокового отверстия в трубчатом органе с последующим подсоединением к нему под углом трубчатого трансплантата fl] .A known method of applying a lateral anastomosis of tubular organs, which includes performing a lateral hole in the tubular organ, followed by connecting to it at an angle of the tubular graft fl].

Недостатками известного способа являются длительность времени наложения, возможность спадения соустья транслан— тэта при низком давлении, недостаточная герметичность и прочность анастомоза, что ограничивает область его использования.The disadvantages of this method are the length of the application time, the possibility of subsidence of the anastomosis of the translan-theta at low pressure, insufficient tightness and strength of the anastomosis, which limits the scope of its use.

Цель изобретения — повышение на — нежности и герметичности анастомоза и предупреждение спадения анастомоза.The purpose of the invention is to increase the tenderness and tightness of the anastomosis and to prevent the collapse of the anastomosis.

Поставленная цель достигается тем, что согласно способу наложения бокового анастомоза трубчатых органов, включающему выполнение бокового отверстия в трубчатом органе с последующим подсоединением к нему под углом трубчатого трансплантата, конец трансплантата рассе· кают на 2/3 окружности под углом с образованием лоскута, далее на органе выполняют Т-образный разрез и разво— дят образовавшиеся лоскуты, затем сшивают трансплантат и орган на линии изгибов и краях разреза, а лоскуты фиксируют к трансплантату и органу, после чего на стенки трубчатого органа с противоположной стороны бокового анастомоза накладывают сводящие швы в поперечном направлении.This goal is achieved by the fact that according to the method of applying a lateral anastomosis of tubular organs, including making a lateral hole in a tubular organ and then connecting it at an angle of a tubular graft, the end of the graft is dissected into 2/3 of a circle at an angle to form a flap, then on the organ perform a T-shaped incision and flaps are formed, then the graft and organ are sutured on the bend line and the edges of the incision, and the flaps are fixed to the graft and organ, and then onto the walls bchatogo body from the opposite lateral sides of the anastomosis is applied which reduce the seams in the transverse direction.

На фиг. 1-8 изображена схема осуществления способа наложения анастомоза трубчатых органов.In FIG. 1-8 shows a diagram of a method for applying an anastomosis of tubular organs.

Способ осуществляется следующим образом.The method is as follows.

Проводят подготовку трансплантата’ (сосуна, протока, трубчатого аллотрансплантата и др.). На край трансплантата по его окружности на разном расстоянии наклацывают три держалки 1, одну 5 из которых накладывают П-образным швом снаружи внутрь (фиг. 1). По обе стороны этой держалки под углом около 45° проводят разрез 2 стенок, продолжающийся до проекции двух других дер- 10 жалок. По линиям 3 проекции может быть проведен разрез с иссечением двух треугольников и образованием лоскута 4 (фиг. 2). У основания лоскута накладывают две держалки 5 в вице П-образ- 15 н.ых швов прошиванием снаружи внутрь. Затем подготавливают боковое отверстие трубчатого органа. В месте наложения бокового анастомоза(фиг. 3) на стенке трубчатого органа проводят Т-образный 20 разрез 6. Наклацывают цержалки 7 на уголки образовавшихся лоскутков 8 (фиг. 4) и отводят их в стороны. Образуется треугольное отверстие 9, к вершинам которого фиксируют трансплан- ’5 таг прошиванием П—обраэными держалками 1 и 7 изнутри наружу, (фиг. 5). Сопоставленные края трубчатого органа у образованного отверстия и трансплантата укрепляют П—образными, обвивными или 30 другого вица швами (фиг. 6) при от— веденных лоскутах по линии разреза и изгиба таким образом, чтобы на всем протяжении они соприкасались внутренними сторонами. При этом швы могут наклацызаться через все слои трубчатого органа или только через внутренние. Возможно также применение комбинированного метода - наложение фиксирующих швов и использование клеевых композиций. Лоскут 4 трансплантата фиксируют к трубчатому органу, а лоскут 8 трубчатого органа (фиг. 7) - к трансплантату. Лоскуты фиксируют клеем или швами. · После этого создают искривление трубчатого органа в проекции анастомоза в противоположную сторону последнему (фиг. 8) посредством наложения сво цяших швов 10 на наружные слои трубчатого органа или фиксацией его к прецложащим тканям и образованием угла отхождения трансплантата около 15° к продольной оси трубчатого органа.Transplant ’is being prepared (sucker, duct, tubular allograft, etc.). On the edge of the graft around its circumference, three holders 1 are placed at different distances, one of which 5 is laid with a U-shaped seam from the outside inward (Fig. 1). An incision of 2 walls is carried out on both sides of this holder at an angle of about 45 °, which continues until the projection of the other two supports 10. Along the lines of projection 3, a cut can be made with the excision of two triangles and the formation of a flap 4 (Fig. 2). At the base of the flap, two holders 5 are placed in the vice P-shape - 15 n.stitches by stitching from the outside to the inside. Then prepare the lateral hole of the tubular organ. In the place of application of the lateral anastomosis (Fig. 3), a T-shaped incision 6 is made on the wall of the tubular organ 6. The Zerkers 7 are put on the corners of the formed patches 8 (Fig. 4) and taken to the sides. A triangular hole 9 is formed, to the tops of which a transplant’s tag 5 is fixed by stitching the P-shaped holders 1 and 7 from the inside out (Fig. 5). The juxtaposed edges of the tubular organ at the formed opening and the graft are strengthened with U-shaped, twisted or 30 other vis sutures (Fig. 6) with the flaps allotted along the cut and bend lines so that they are in contact along the entire length along the inner sides. In this case, the seams can be clipped through all the layers of the tubular organ or only through the inner ones. It is also possible to use the combined method - the application of fixing sutures and the use of adhesive compositions. The graft flap 4 is fixed to the tubular organ, and the graft flap 8 is fixed to the graft. The flaps are fixed with glue or seams. · After this, a tubular organ is bent in the anastomosis projection in the opposite direction to the latter (Fig. 8) by applying the suturing sutures 10 to the outer layers of the tubular organ or by fixing it to the precocious tissues and forming a graft exit angle of about 15 ° to the longitudinal axis of the tubular organ.

Предлагаемый способ наложения бокового анастомоза повышает его прочность в месте соединения, предупреждает проникновение содержимого трубчатого органа между соединенными тканями, создает ламинарный поток жидкости в области анастомоза по трансплантату, что особо важно при наложении анастомоза с наличием значительного динамического давления, например, в кровеносных сосудах, и предупреждает в них тромбооб— разование, а также спадение стенки трубчатого органа и закрытие анастомоза при низком давлении в нем: при использовании клея ускоряет наложение бокового анастомоза.The proposed method for applying a lateral anastomosis increases its strength at the junction, prevents the penetration of the contents of the tubular organ between the connected tissues, creates a laminar fluid flow in the region of the anastomosis along the graft, which is especially important when applying an anastomosis with significant dynamic pressure, for example, in blood vessels, and prevents thrombosis in them, as well as collapse of the tubular organ wall and closure of the anastomosis at low pressure in it: when using glue yaet imposing side anastomosis.

Claims

The invention relates to medicine, in particular to surgery, and can be used when applying the lateral anastomosis of the bile duct and other tubular organs, hernia requires tightness, increased strength, linear flow of fluid. There is a known method of applying lateral anastomosis of tubular organs, which involves making a lateral opening in the tubular organ followed by compaction of the angle of the tubular graft 1 to it. The disadvantages of this method are the length of time of application, the possibility of collapse of the adjoining transplant at low pressure, insufficient tightness and strength anastomosis, which limits its use. The circuit of the invention is the enhancement of the safety and tightness of the anastomosis and the prevention of onastomosis recession. The goal is achieved in that according to the method of applying a lateral anastomosis of tubular organs, including making a lateral opening in the tubular organ, followed by subconnecting to it at an angle of the tubular graft, the end of the graft is dissected into 2/3 of the circle at an angle with the formation of a flap, then on the organ is performed The T-shaped incision and dilution of the formed flaps, then sew the graft and organ in the line of bends and edges of the incision, and the flaps are fixed to the graft and organ, after which on the opposite side of the lateral anastomosis, reducing joints are applied in the transverse direction. FIG. 1-8 depict a flow chart for the method of applying anastomosis to tubular organs. The method is carried out as follows. The graft is cemented (vessel, duct, tubular alplant and arr.) "Three handles 1 are placed on the edge of the graft around its circumference at different distances, one of which is put in a U-shaped seam from outside to inside (Fig. 1). On both sides of this holder at an angle of about 45, 2 walls are cut, continuing until the projection of the other two cores. Along the line m 3 of the projection, an incision can be made with the excision of two triangles and the formation of a flap 4 (Fig. 2). At the base of the flap, they lay the color of the hanger 5 in the vice U-shaped stitches by flashing from outside to inside. Then prepare the side holes of the tubular body. At the place of application of the lateral entry 03a (Fig. 3), a T-shaped incision 6 is made on the wall of the tubular organ 6. The handles 7 are placed on the corners of the formed flaps 8 (Fig. 4) and diverted to the sides. A triangular hole 9 is formed, to the vertices of which the graft is fixed by flashing the pinlet 1 and 7 with a piercing from the inside of the arm. (Fig. 5). The mated edges of the tubular organ at the formed aperture and the graft are reinforced with U-shaped, obvivny or circumferential seams (Fig. 6) with retracted flaps along the incision and bend line so that they are in contact with the inner sides throughout. In this case, the seams can be applied through all layers of the tubular organ or only through the inner ones. In addition, it is also possible to use the combined method — the imposition of fixing stitches and the use of adhesive compositions. The graft flap 4 is fixed to the tubular organ, and the flap 8 of the tubular organ (Fig. 7) is fixed to the graft. The flaps are fixed with glue or seams. After this, a curvature of the tubular organ is created in the anastomosis projection in the opposite direction to the latter (Fig. 8) by imposing reducing seams 10 on the outer layers of the tubular organ or fixing it to the presenting tissue about 15 ° to the graft. the longitudinal axis of the tubular organ. The proposed method of imposing a lateral anastomosis increases its strength at the junction, prevents the penetration of the tubular organ contents between the connected tissues, creates a laminar fluid flow in the anastomosis area along the graft, which is especially important when applying an anastomosis with significant dynamic pressure, for example, blood vessels, and prevents them from thrombosis, as well as falling of the wall of the tubular organ pipe and closing the anastomosis at low pressure in it; when using glue, it accelerates the imposition of lateral anastomosis. The method of applying a lateral anastomosis of ribbed organs, including making a side opening in a tubular organ followed by connecting it to an angle of a tubular graft, characterized in that, in order to increase the reliability and tightness of the anastomosis and prevent the anastomosis from falling, the end of the graft is cut in 2/3 of angularly with the formation of a flap, then a T-shaped incision is made on the organ and the flaps formed are diluted, then the graft and the organ are sutured in a line of bends and ra x sections and flaps are fixed to the graft and organ posle.chego on the tubular body wall at the opposite lateral sides of the anastomosis, impose a set Suitable seams in the transverse direction. Sources of information taken into account in the examination 1. Ostroverhov G. I. and others. Operative surgeons and topographic anatomy. M., 1972, p. 153.