UA12371U - Technique for applying end-to-end esophago-esophageal anastomosis - Google Patents

Abstract

The technique for applying end-to-end esophago-esophageal anastomosis comprises the surgical access, the generation of the anastomosis, and the sewing of the wound. First, the needle pierces the tissues on the side of the internal fascia of the neck involving the muscular layer. The second piercing is made at some distance of the site where the needle goes out of the tissues. The lower division of the esophagus is sewed. The first row of the mucosal-submucosal uninterrupted sutures is made around the anastomosis followed by applying muscular-fascial suture to the anterior labium of the anastomosis.

Description

Description of the invention

A useful model belongs to medicine and can be used in the treatment of a completely complete rupture of the esophagus in its various departments.

The operation in the case of a complete rupture of the esophagus, as a rule, is reduced to the formation of an end-end esophago-esophageal anastomosis.

There is a known method of forming an end-to-end esophageal-small-intestinal anastomosis |1)|), which includes operative access, formation of an end-to-end esophageal-small-intestinal anastomosis, and suturing the wound. At 70, the back wall of the esophagus is dissected 38 mm below the level of the intended anastomosis.

With an atraumatic needle, a section of the wall with a width of mm, which includes the muscle and mucous layers, is captured. From the side of the intestine, the same tissues of a similar thickness are captured. The dart is tied using a needle holder from the side of the lumen. After applying two ordinary knots, the ends of the dart are cut as short as possible. Single seams are applied, moving from the middle, alternately from the right and left. The knots of the last single sutures are tied by 72 sutures, and they are covered with separate serous sutures. After that, the wound is sutured layer by layer.

The main disadvantages of this method are: - high trauma; - high probability of puncture of seams.

The method of forming end-end esophago-esophageal anastomosis (IL), which includes operative access, formation of end-end esophago-esophageal anastomosis, and suturing of the wound, is closest in technical essence to the claimed method. At the same time, a continuous suture is applied through all layers of the esophagus, then knotted thin sutures are applied to the muscular membrane of the esophagus. After the wound, the layers are sewn tightly.

The main disadvantages of this method are: - violation of blood circulation in the place of anastomosis formation; c - a high percentage of penetration of overlapping seams.

The basis of a useful model is the task of creating a method of forming an end-to-end esophago-esophageal anastomosis, which would contribute to the reduction of trauma, reduce the disruption of blood supply to the anastomosis, and would prevent sutures from tearing. --

The task is solved due to the fact that in the method of forming an end-end - esophago-esophageal anastomosis, which includes operative access, the formation of an end-end esophago-esophageal anastomosis with subsequent suturing of the wound, according to a useful model, the formation of the anastomosis begins with a puncture from the side of the internal fascia of the neck and by grasping the muscle layer 1 cm from the edge of the wound with a step of Zmm at a distance of bmm from the puncture site, an injection similar to the first one is performed with the same 3o ligature, the lower part of the esophagus is sutured in the same way and a knot is tied, after applying another two - sutures, similar to the first, form the first floor of the continuous mucosal-submucosal suture according to Multanovsky along the entire perimeter of the anastomosis and complete the creation of the anastomosis by imposing a muscle-fascial suture on the front lip of the anastomosis according to the above-described principle. "

The method is carried out as follows. From 70 An incision is made along the outer edge of the nodular muscle, starting from the corner of the lower jaw to the lower edge of the thyroid cartilage. Along the entire length of each incision, the superficial fascia of the neck, platysma,

From" superficial and deep leaves of the personal fascia of the neck. The oscillating muscle is removed laterally, after which the back wall of its vagina is dissected, then the muscle together with the vascular-nerve bundle of the neck is pulled outward.

The thyroid gland, which lies on the way to the esophagus, together with the sternohyoid and sternohyoid muscles are pushed inwards, the scapulohyoid muscle is crossed. In the depth of the wound - they bandage and dissect before the organ tissue and impose an anastomosis. At the same time, the formation of the anastomosis begins with an injection from the side of the internal fascia of the neck, grasping the layer 1 cm from the edge of the wound with a step

Zmm at a distance of bmm from the puncture site, perform a puncture similar to the first one. With the same ligature, in the same way, the lower part of the esophagus is stitched and a knot is tied. After applying two more sutures, similar to the first, -I 20 perform the formation of the first floor of the mucosa-submucosa continuous suture according to Multanovsky along the entire perimeter of the anastomosis.

C They complete the creation of the anastomosis by placing a muscle-fascial suture on the front lip of the anastomosis according to the principle described above. After that, the wound is tightly sutured layer by layer.

The formation of the anastomosis is started 1 cm from the edge of the wound, so that the support for the thread passes at a distance from the wound and does not interfere with tissue consolidation. With a step of 3 mm, so that the seams are applied without disturbing the blood supply to the tissues. At a distance of mm to ensure a sufficient support area of the ligature on the internal cervical fascia.

Example

A newborn has a tracheoesophageal fistula at the level of the fifth cervical spine. After lavage of 60 bronchi, anesthesia and treatment of the operative field, access to the trachea and esophagus is performed along the front edge of the nodular muscle on the right. Hemostasis. A fistula form of esophageal atresia was detected. After applying soft elastic pastes to the adduct and abductor sections of the esophagus, the back wall of the trachea was plasticized with local tissues. After the removal of the fistula, an esophageal defect was formed with a diastasis of up to 1.5 cm between the adductor and abductor sections. The continuity of the esophagus was restored by forming an anastomosis. Because the anastomosis is started with a puncture from the side of the internal fascia of the neck, grasping the muscle layer 1 cm from the edge of the wound with a step of Zmm, at a distance of bmm from the puncture site, an injection similar to the first one was performed. With the same ligature, the lower part of the esophagus is stitched in the same way and a knot is tied. After applying two more sutures, similar to the first, the formation of the first floor of the mucosa-submucosa continuous suture according to Multanovsky is carried out along the entire perimeter of the anastomosis. The creation of the anastomosis is completed by placing a muscle-fascial suture on the front lip of the anastomosis according to the principle described above. Next, the wound is tightly sutured in layers. The postoperative period was characterized by a smooth course. The child's nutritional function has been restored.

Advantages of the proposed method: 70 - ensuring reliable tightness, strength and asepticity; - prevents seams from stretching; - excludes narrowing of the lumen of the esophagus; - does not disturb the peristalsis of the organ.

Sources of information used in the preparation of the application: 1. ILittmann. Operative surgery. - 2nd edition. in Russian speech - Budapest.: Publishing House of the Academy of Sciences

Hungary, 1982. -194p. 2. Emergency surgery / Ed. N.I. Blynova and B.M. Khromova. - L.: Medicine, 1970. - P.96-98 (prototype).

Claims (1)

The formula of the invention is the method of forming an end-to-end esophago-esophageal anastomosis, which includes operative access, the formation of an end-to-end esophago-esophageal anastomosis with subsequent suturing of the wound, which differs in that the formation of the anastomosis is started by a puncture from the side of the internal fascia of the neck and the capture of the muscle layer 1 cm from the edge of the wound with a step of 3 mm, at a distance of b mm from the puncture site, a puncture is performed, similar to the first, with the same ligature, the lower part - the esophagus is stitched in the same way and a knot is tied, after applying two more stitches, similar to the first , perform the formation of the first floor of the continuous muco-submucosa suture according to Multanovsky along the entire perimeter of the anastomosis and complete the creation of the anastomosis by imposing a muscle-fascial suture on the front lip of the anastomosis "- according to the above-described principle. in (ze) with yo - and? - ime) (95) -i - 60 b5