SU938952A1 - Method of suturing stomach with intenstine - Google Patents

Description

(54) METHOD OF STILING THE STOMACH WITH THE INTESTINE

one

This invention relates to medicine, namely to surgery.

There is a method of stitching the stomach with the intestine by compressing and gripping each half-meter of the organ wall, followed by cutting off the removed part of the organs, diluting the gripped half-meters of the walls of each organ being stitched along the border of compression and moving the organs together, splitting the diluted matching half-meters along the grip line, freeing the wall organs from seizing and squeezing and overlapping immersing sero-muscular sutures 1.

However, when stitching this way, there is no tight contact between the mucous membranes of the intestine and the stomach along the suture line, since when the thicker wall of the stomach is captured by the outer layers, the sero-muscular layers of the stomach wall are diluted and the mucous-submucous layers are placed in the stitching position the seam does not fall. As a result, in 1NV gastrointestinal anastomosis

stitched all layers of the intestinal wall and only the sero-muscular layers of the stomach wall. This is fraught with serious consequences associated with bleeding along the suture line and an unfavorable process of tissue regeneration. In addition, after applying a serous-muscle suture, immersing the first floor of the suture with pressing the walls of the organs through all the layers, a massive anastomosis suture roller is obtained.

The purpose of the invention is to improve the quality of the suture of the gastrointestinal anastomoses by increasing the accuracy of matching the layers of the same name of the stitched walls and hemostasis and reducing the roller imposed

15 stitches.

This goal is achieved in that the method of cross-linking the stomach with the intestine is accomplished by capturing each half-meter 20 of the organ wall, then cutting off the removed part of the organs, diluting the captured half-walls of each cross-linkable organ along the compression boundary and moving the organs together to touch the diluted sections, piercing the diluted half-perimeters along the line of seizure, the release of the organs of the organs from the seizure and contraction and the imposition of immersing sero-muscular sutures, previously stomach and cut off its removed part, then cut the sero-muscular layers at the site of the anastomosis, seize and dissolve the semi-perimeter only the mucous-submucous layers of the stomach walls, sew the intestinal walls through all layers with the walls of the stomach through the mucous-submucous layers, and immerse the sero-muscular sutures are laid so that the section of the sero-muscular layers of the stomach wall lays on the first floor; the suture, for which the sero-muscular layers of the stomach wall are seized, pulled them against the intestinal wall and sutured with sero-muscular E of the bowel wall.

FIG. 1 - stitched stomach images; in fig. 2 is a cross-section of the sutured stomach with dissected sero-muscular layers; in fig. 3 - the stomach compressed with the stapler jaws at the place of application of the anastomosis; in fig. 4 shows a cross section of the stomach after the seizure of the semi-perimeters of the mucous-submucous layers of the wall and cutting off the part to be removed; in fig. 5 - the duodenum, compressed with the stapler jaws at the anastomosis site; in fig. 6 - small intestine, compressed by gu & jaw clamp itself at the site of anastomosis; in fig. 7 is the cross section of the intestine after capturing the semiperimeters of the wall and cutting off the part to be removed; in fig. 8 cross section of the intestine after dilution of the wall half-perimeters; in fig. 9 is a cross-section of the stomach after dilution of half-perimeters of the mucous-submucous layers of the stomach wall; in fig. 10 is a cross section of the stomach and intestine after their approaching and flashing the associated half-perimeters of the walls; in fig. And, the cross section of the anastomotic suture after flashing the stomach wall through mucosal-submucous layers and intestinal walls through all layers in FIG. 12 is a cross-sectional view of the suture of the anastomosis after the insertion of the immersing serous-muscular sutures; in fig. 13 is a schematic depiction of basic Billroth I gastric resection steps; in fig. 14 is a schematic depiction of the basic stages of gastrectomy according to Billroth II modified by Hofmeister-Finsterer; in fig. 15 is a schematic depiction of organs after gastrectomy in a modification of Gaberer-Filet; in fig. 16 is a schematic depiction of organs after stomach resection according to Billroth II; in fig. 17 - a schematic depiction of the main

stages of resection of the stomach with preservation of the pyloric; in fig. 18 is a cross section of the suture of the anastomosis after flashing the mucous-submucous layers of the stomach walls; in fig. 19 is a cross-section of the anastomotic suture after the butt-seaming of the sero-muscular layers of the stomach walls.

The proposed method of cross-linking the stomach with the intestine is shown in a specific example, for which it is advisable to use conventional rigid clamps, any

from known organ stubs, for example

UG-70, and stapler type SK-60. This, however, does not exclude other options.

individual steps, such as suturing the stomach with a crayfish suture.

The method is carried out as follows. After suturing the stomach 1 (Fig. 1) with suture 2 and cutting off its removed part with a hard

the clamp 3 compresses and seizes the stomach portion 4 at the site of application of the anastomosis. The sero-muscular layers 5 (Fig. 2) of the wall of the stomach 1 on the side of the remaining part of the stomach are incised along the jaws, as a result of which sections 6 and 7 of the serous-muscular layers 5 are slightly consumed. Using the properties of sero-muscular and mucous-submucosal shells, the walls of the stomach are relatively easy to exfoliate, freeing the area of mucous-submucosal layers 8 between sections 6 and 7 8-12 mm wide.

Clamp 3 (Fig. 1) is removed and edges 9, 10 of half-perimeter of the stomach wall are taken by mucous-submucosal layers 8 (Fig. 2), closer to the distal section 6 to suture-holders 11 (Fig. 3).

With the help of seams-holders 11, the stitched stomach 1 is installed between the jaws of the corresponding clip 12 of the stapler type SK-60 and the wall of the stomach 1 is atraumatic

squeeze. Along the border 13 (Fig. 4) of compression (2-3 mm) from it from the side of the removed section 4 (Fig. 3) of stomach 1, the upper and lower half-perimeter of the stomach wall are gripped by mucous-submucous layers (Fig. 4) with the help of fixing elements 14 of the binder, the sponges of which also contain stores 15, charged with U-shaped brackets 16, pushers 17 and dies 18 with holes for bending the brackets.

After fixation of the walls by mucous-submucous layers 8, the removed section 4 of the stomach stump 1 is cut off.

Claims (1)

Using the second clamp 19 (Fig. 5), the binder compresses the end 20 of the duodenum 21 or side 22 (Fig. 6) of the duodenal or small intestine 23 depending on the modification of the resection of the stomach. At the same time, the stitched sections of the intestines are installed between the jaws of the clamp 19, so that after connecting the clamps 12, the matching half-meters of the stomach and intestine walls do not have a mutual displacement along the jaws jaws. Then, at a distance of 2-3 mm from the border 13 (Fig. 7), the bowel grip is gripped with the help of locking elements 14, the upper and lower half-perimeters of the gut wall 24, and then the removed end 20 (Fig. 5) or the side 22 (Fig. 6) guts. The fixed upper and lower half-perimeters of wall 24 (Fig. 8) of the intestine and mucous-submucosal layers 8 (Fig. 9 of the stomach wall) are diluted. The organs are brought together before the contact of the diluted cross-sectional areas and the semiperimeters are exactly matched, junction clamps 12 and 19 (Fig. 10) a binder. As a result, mucous-submucous layers 8 of the stomach wall and all layers of the intestinal wall 24 are placed between the associated magazines 15 and the matrices 18, fixed in pairs on the upper and lower jaws of the clamps 12 and 19. Sew along the grip line The upper and lower semi-perimeters of the intestinal wall through all the layers with mucous-submucous layers of the stomach wall.To do this, pushing the brackets 16 (Fig. 8, 9) from the magazines 15 is moved by moving the pushers 17 from the magazines 15. Legs of the brackets 16 pierce the mapped upper and lower semi-perimeters of the walls organs, and take care with the aid of the dies of the dies 18 (Fig. 1 and B-shaped or other, suitable for stitching, shape, forming a brace 25). The walls of the organs are freed from fixation and the stitcher is removed from the surgical wound. The stapled suture 25 (Fig. 11) sews only mucous-submucous layers 8 of the stomach wall and all layers of the intestinal wall 24, while ensuring reliable and tight contact of the mucous membranes 26 and 27 of the stomach and intestine. The first implant of the anastomosis suture thus superimposed in this way ensures uniform matching and compression of the mucous membranes 26 and 27 of the stomach and intestine, their reliable and tight contact. In addition, flushing of the mucous-submucous layers of organs is guaranteed, which ensures good hemostasis of the suture, controlled by the surgeon, since the first floor of the seam 28 is slightly twisted relative to the cavity of 29 organs. Capturing only the mucous-submucous layers 8 of the stomach wall into the suture makes it possible to obtain small dimensions of the roller of the first floor of the suture 28. In the process of applying the first floor 28 of the seam of the gastrointestinal anastomosis, the lumen of the organs being stitched does not open, which ensures a high degree of aseoticism of the operators. After the stomach was stitched together with the intestine with the staple stitches 25, the immersing sero-muscular suture 30 (Fig. 12) was imposed, thus, a cut of 7 serous-muscular layers 5 of the stomach wall 1 lay down on the first floor 28 of the suture. To do this, the sero-muscular layers 5 (in Figs. 11 and 12) of the stomach wall 1 at a distance of 2-5 mm from section 7 are sutured, suture them against the wall 24 of the intestines 21 and 23 and sew with the seromatical layers. 31 of the intestinal wall at a distance of 2-5 mm from the first suture 25. The immersing sero-muscular suture 39 (Fig. 12) is slightly shifted relative to the suture 25 and is located on the gut 21, 23. Very mobile sero-muscular layers 5 of the stomach wall 1 allows They are easy to do, as if overlapping the seam 28 on the first floor. The imposing serous-muscular suture 30 thus applied ensures the tightness of the suture and a good comparison of the sero-muscular layers 5 and 31 of the walls of the stomach and intestines 21 and 23 and the mucous membranes 26 and 27. In combination with the first floor of the seam, it provides small dimensions of the seam roller. All this contributes to good regeneration of cross-linked fabrics and healing by primary tension. The small dimensions of the plunger seam roller allow a gentle, elastic seam of the gastrointestinal anastomosis to be obtained without deeply screwing the suture into the lumen of the anastomosis and without narrowing the lumen. The proposed method of silshany stomach with the intestine ensures uniform matching and compression in the seam of the mucous membranes of the stomach and intestine, their reliable and tight contact, ensures flashing of the mucous-submucosal layers of organs, which allows to obtain a good hemostasis of the suture controlled by the surgeon. The proposed method of superimposing the first floor of the suture and the immersing second floor allows for a good comparison of sections of the mucosal submucosal and serous-muscular layers of the stomach and intestinal walls, as well as the small dimensions of the seam roller. The invention of the method of cross-linking the stomach with the intestine by trapping each half-meter of the organ wall followed by cutting off the removed part of the organs, diluting the gripped half-meters of the walls of each stitching organ along the compression line and bringing the organs apart, touching the diluted half-meters along the capture line, freeing the organs wall from gripping and squeezing and applying immersing sero-muscular sutures, characterized in that, in order to improve the quality of the suture gastrointestinal anastomoses by improving the accuracy of matching of like layers crosslinkable walls and hemostasis and reduce roller nakladshaemyh joints previously sutured stomach and cut its removable part further dissect sero-muscular layers in place anastomosis, gripped and diluted semiperimeter only muco-submucosal layers of the walls of the stomach, sew the walls of the intestine in Figure 1 FIG. all layers with the walls of the stomach through the mucous-submucous layers, and the immersing sero-muscular sutures are applied so that the sero-muscular layers of the stomach wall are laid down: lay down on the first seam assembly, for which the sero-muscular layers of the stomach wall are captured, intestinal wall and sew with the sero-muscular layers of the intestinal wall. Sources of information taken into account in the examination 1. Shkrob O. S. New apparatus for cross-linking the intestines SK-60. - Surgeons, 1977, N 3, p. 120-122. FIG. g / 3 16 Id G7; /// // Л ///// Л / j J ГП vte i / Ч Ил; ASЛй: АА а д / fi Itllii ... i | t j. CTP:. . .. /five hell / 7 / g / Z (V / / 7 / / 5 / J Fig. 7 /// 3/19 24 S g / 74s / w 7 FIG. / 3