UA142121U - METHOD OF SURGICAL TREATMENT OF MIDDLE-AMPULAR CANCER CANCER - Google Patents

Abstract

A method of surgical treatment of cancer of the mid-ampullary rectum includes access to the rectum, mobilization and removal of the affected area of the intestine. A purse string suture is applied to the stump of the rectum after its removal through the sphincter. After in vitro tying the purse string suture on the pin of the suturing apparatus, reposition the suturing apparatus into the cavity of the small bowl. The leading and receiving parts of the suturing apparatus are connected and the anastomosis is sutured, restoring the integrity of the rectal cavity.

Description

A useful model belongs to medicine, namely to surgery, and can be used in the treatment of cancer of the mid-ampullary section of the rectum.

There is a known method of surgical treatment of cancer of the mid-ampullary part of the rectum, which includes surgical access to the rectum, mobilization and removal of the affected part of the intestine with an anal ring with the imposition of a terminal flat colostomy on the anterior abdominal wall (Koda

Keii, Zayo Mogio, ZeiKe Kagypigo, Zpiti2gy Kitio ei aI. Oepeguayop oi Te peogesiit az a roiepina! saize oi ayeyesayogu dizogaeg hoPomipud om apietiog gezesiyop og hesia! sapseg beat Soyop Vesiyt 2005; 48: 2: 210-217).

The disadvantage of the analogue is a low quality of life and reduced active social adaptation in the postoperative period.

The task of a useful model is to develop such a method of surgical treatment of cancer of the middle-ampullary part of the rectum, which, due to the preservation of the rectal sphincter, would ensure a better quality of life and social adaptation in the postoperative period.

The problem is solved by the fact that in the method of surgical treatment of cancer of the mid-ampullary part of the rectum, which includes access to the rectum, mobilization and removal of the affected part of the intestine, according to a useful model, the pouch suture is placed on the stump of the rectum after eversion her through the sphincter. After extracorporeal tying of the purse-string suture to the pin of the suturing device, the suturing device is repositioned into the cavity of the pelvis. The driving and receiving parts of the suturing device are connected and the anastomosis is stitched, restoring the integrity of the rectal cavity. This increases the quality of life and adaptation in the postoperative period, as the natural closing function of the rectal sphincter is preserved.

The method is performed as follows. After preparation, a lower-middle laparotomy is performed. After revision of the organs of the abdominal cavity, the lower mesenteric artery and vein are cut high and tied, sympathetic nerves are carefully isolated. The rectum is mobilized with a total mesorectomectomy to the diaphragm of the pelvis with the help of electrosurgical instruments. The left half of the colon and the splenic flexure are mobilized. At the level of 5 cm distal to the tumor and 15-20 cm proximal to the tumor, the intestine is cut, the drug is removed in a single block. A purse-string suture is applied to the duodenum

From Prolen 2.0 with a barbed needle, which, after pre-immersion into the lumen of the intestine, the "mushroom" of the suturing apparatus is tied on the latter. Perineal stage: the patient is placed on his back with his legs raised and spread to the sides. Dilation of the anal sphincter is performed. With the help of 4 Alice clamps, the stump of the rectum is turned out transanally. Presacral drainage is placed in the cavity of the pelvis. On the edge of the everted intestine of the rectum, a wrapping pouch suture is applied with a Prolen 2.0 thread with a barbed needle.

The pocket seam is tightened on the central pin of the receiving part of the sewing machine.

The head of the device is inserted into the cavity of the small bowl. After connecting the leading and receiving parts of the stapling apparatus, the anastomosis is stitched. The used device is removed transanally. Perform peritonization of the pelvic peritoneum above the anastomosis. In the right iliac region, a preventive ileostomy is applied according to the accepted technique.

The laparotomy wound is tightly sutured in layers. The surgical wound is treated with a solution

Betadine 10 95 and apply an aseptic bandage. The drug is sent for histopathological examination.

Example. Patient I1., born in 1965, medical history Me354 was hospitalized from 06/04/2018 to 06/13/2018 with a diagnosis of: Sg of the middle ampullary section of the rectum

TzMIMo cl. c. I. Condition after the preoperative course of TT. 04/18/2018 PGD Mo14670-3 micro: adenocarcinoma Sz. After preparation, a lower-middle laparotomy was performed. After revision of the abdominal organs, the lower mesenteric artery and vein were transected and ligated, and the sympathetic nerves were carefully isolated. The rectum was mobilized with a total mesorectomectomy to the diaphragm of the pelvis with the help of electrosurgical instruments.

The left half of the colon and the splenic flexure were mobilized. At the level of 5 cm distal to the tumor and 15-20 cm proximal to the tumor, the intestine was cut, and the drug was removed as a single block. A pouch suture was applied to the duodenum with a Prolen 2.0 thread with a barbed needle, which, after pre-immersion into the lumen of the intestine, the "mushroom" of the suturing apparatus was tied on the latter. Median stage: the patient was placed on his back with his legs raised and spread to the sides. After preparation, dilation of the anal sphincter was performed. With the help of 4 Alice clamps, the stump of the rectum was turned out transanally. Presacral drainage was inserted into the cavity of the pelvis. A wrapping pouch suture was applied to the edge of the everted rectum with a Prolene 2.0 thread with a barbed needle. The pocket seam was tightened on the central pin of the receiving part of the sewing machine. The head of the apparatus was introduced into the cavity of the small bowl. After connecting the leading and receiving parts of the suturing apparatus, an anastomosis was sewn. The used device was removed transanally. Peritonization of the pelvic peritoneum above the anastomosis was performed. In the right iliac region, a preventive ileostomy was applied according to the accepted method. The laparotomy wound was tightly sutured in layers. The surgical wound was treated with Betadin 10 95 solution and an aseptic bandage was applied. The drug was sent for histopathological examination.

3 patients were treated according to the proposed method, there was no recurrence of the tumor after 1 year.

At the same time, during the treatment of 2 patients by an analogous method, 1 of them had a recurrence of cancer after six months.

Thus, the use of the proposed method provides a better quality of life and high social adaptation in the postoperative period as the natural closing function of the rectal sphincter is preserved.

Claims (1)

USEFUL MODEL FORMULA The method of surgical treatment of cancer of the mid-ampullary section of the rectum, which includes access to the rectum, mobilization and removal of the affected part of the intestine, which is characterized by the fact that the pouch suture is applied to the stump of the rectum after its removal through the sphincter, after extracorporeal tying of the pouch suture on the pin of the stapling machine, the repositioning of the stapling apparatus is carried out in the cavity of the small bowl, the leading and receiving parts of the stapling apparatus are connected and the anastomosis is sutured, restoring the integrity of the rectal cavity.