RU2018269C1 - Method of connection of tubular digestive tract organs - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: purse-string stitch is put into the mucous membrane of the adducting portion of the tubular organ along its perimeter. The thread ends of the purse-string stitch are drawn outside through a puncture in the organ wall. The organ edge is invaginated into the clearance below the purse-string suture level. The adducting portion of the organ with internal drainage is introduced into the opening of the invagination. The thread ends of the purse-string suture are tied up. EFFECT: high rate of treatment of tubular digestive tract organs. 5 dwg

Description

 The invention relates to medicine, mainly oncology, and can be used to create anastomoses of the esophagus and other parts of the digestive tract.

 The imposition of anastomoses on the tubular organs of the digestive tract, especially on the esophagus, during the surgical treatment of its neoplasms is largely limited by the technical difficulties of surgical intervention, postoperative complications, failure of anastomotic sutures in the early postoperative period, the development of anastomotic structures in the early and late postoperative periods, as well as complexity and invasiveness of the intervention.

 The most formidable complications of the operation: frequent development of anastomotic suture failure, which is one of the main causes of death during operations on the digestive organs, the occurrence of anastomotic strictures, technical difficulties in restoring the digestive tract continuity, continue to stimulate surgical thought along the path of improving the design and technique of applying the anastomosis.

 A search for patent and medical information has revealed various methods of connecting tubular organs.

 Kanshin N.N. et al. (Herald of Surgery 1984, N 1, pp. 52-57) to apply a mechanical compression anastomosis on the rectum and colon, a stapler is used to connect the intestinal walls with special rings, while temporarily unstretched purse string sutures are applied to the ends of the intestines, the working part the apparatus is inserted through the anus or an additional hole into the intestinal wall, after the introduction of the rings, purse string sutures are tightened, the rings and intestinal tissue are stitched with needles, forming an anastomosis. Connecting rings after rejection on the 7th-9th day are secreted out naturally.

 Baltaitis Yu.V. et al. (Clinical Surgery, 1981, N 10, pp. 53-54) developed an end-to-end anastomosis with strengthening the suture line of the serous-muscular cuff, while the serous-muscular layer is separated at the leading end of the organ to be stitched, and the first row of sutures is applied between the outlet end and the base of the cuff, the cuff is screwed onto the outlet end and a second row of sero-muscular sutures is placed between the edge of the cuff and the wall of the outlet organ.

 A known method of forming the esophageal anastomosis of Popov G. (Shalimov A.A. and Polupan V.N. Atlas of operations on the esophagus, stomach and duodenum. M .: Medicine, 1975, p. 81). For this, a cuff is formed: from the mucous membrane of the esophagus the muscle layer is separated, a special device is introduced into the esophagus - a plexiglass prosthesis, the prosthesis is fixed with two ligatures to the esophagus mucosa. Using 4-6 catgut sutures, the esophagus is ligated with the intestine, the latter is pushed onto the prosthesis. This line of sutures is covered with a muscular cuff of the esophagus, which is fixed to the serous membrane of the intestine. After two weeks, the prosthesis is removed using a ligature fixed to the prosthesis.

 Common disadvantages of the above methods are: excessive trauma to the ends of the stitched tubular organs, the presence of special devices made of solid material in the anastomosis lumen, exerting, at a larger size, pressure on the walls of the stitched organs, ischemic tissue in the anastomosis zone, and with a small size, reducing the internal diameter of the anastomosis in the early postoperative period, as well as technical difficulties in implementation, which do not contribute to increasing the reliability of anastomoses and widespread implementation in surgical actics.

 The closest (basic) technical solution to the claimed is a method of forming a terminal anastomosis (US Patent N 4598712, class A 61 17/00, 1986).

The method involves connecting hollow tubular organs by squeezing between their walls with three abutting elements using a special anastomotic gun. To do this, make an additional hole in its wall in the first tubular organ, an anastomotic gun with the device is introduced into the lumen of the first tubular organ through an additional hole in its wall, the first element of the device is placed and fixed with a purse string ligature in the lumen of the first hollow organ, the second element of the device is held and fixed with a purse-string ligature in the lumen of the second hollow organ, an anastomotic gun is actuated, joining together all three elements of the device with squeezing the wall anastomoziruemyh bodies. An anastomatic gun is removed from the lumen of the anastomosed organs, an additional hole is sutured in the first tubular organ,
The described method has significant disadvantages. These include: significant trauma, due to the need for additional dissection of the organ to introduce an anastomotic pistol into its lumen, the presence of a complex device consisting of three elements and a special anastomotic pistol, of a complex design, the device narrows the lumen of the anastomosis while it is in it, due to the bulkiness of the device, its pressure on the walls of anastomosed organs is excluded, which can lead to pressure sores and circulatory necrosis of the anastomosir wall proxy authorities.

 These shortcomings are eliminated in the proposed solution.

 The aim of the invention is to reduce the morbidity, simplification of the method, eliminating the risk of narrowing of the anastomosis in the postoperative period.

 To achieve this goal, a purse string suture is applied to the mucosa of the outlet segment of the tubular organ along its perimeter, the ends of the filament of the purse string suture are brought out through a puncture of the organ wall, the edge of the organ is invaginated into the lumen of the discharge organ below the level of the purse string suture, the leading segment of the organ containing internal drainage is introduced into the lumen of the invaginate and knotted ends of the purse string suture.

 The method is illustrated in figures 1-5.

 A purse string suture 2, the ends of the filament in the lumen are imposed on the outlet segment of the tubular organ 1 of the digestive tract from the side of the mucosa (Fig. 1). Through an additional puncture 3 through all layers of the wall of the outlet segment of the tubular organ 1, the ends of the filament of the purse string suture 2 are brought out (Fig. 2). The edge of the outlet segment of the tubular organ 1 is invaginated below the level of the purse string suture (figure 3). Then, the leading segment 5 of the tubular organ of the digestive tract containing the internal drainage 6 (Fig. 4) is introduced into the formed invaginate 4, the ends of the purse string suture are tied (Fig. 5).

 PRI me R 1. B-naya K-a, 67 years old (case history No. 4121 / T) was admitted to the thoraco-abdominal department of the Rostov Cancer Research Institute on 04/04/1988 with a diagnosis of cancer of the cardiac section of the stomach with the transition to esophagus, stage III, group II (histological diagnosis N 294529-31: moderately differentiated adenocarcinoma). 05/05/1988 they performed an operation: torocolaporotomy on the left with diaphragmotomy, proximal resection of the stomach with resection of the lower thoracic esophagus, splenectomy. An isoperistaltic tube was formed from the stomach stump, a purse string suture was placed around its mucosa, the ends of the purse string suture were brought out through a puncture of the wall of the gastric tube, its edge was invaginated into the lumen below the purse string suture, the esophagus containing internal drainage was introduced into the lumen of the formed invaginate, a purse string suture was tied, forming an end-to-end esophageal-gastric anastomosis. They performed pyloroplasty. The abdominal cavity was drained by a tube. The postoperative period was uneventful. Drainage from the abdominal cavity was removed on the 7th day. Sutures were removed on the 10th day. Postoperative wound healing - primary intention. Internal drainage of the anastomosis was evacuated independently on the 9th day naturally. On the 14th day the patient was discharged from the department in satisfactory condition.

 PRI me R 2. B-naya S-a, 63 years old (medical history N 8660T) was admitted to the thoraco-abdominal department of the Rostov Cancer Research Institute on 08/20/1988 with a diagnosis of cecum cancer stage III, group II (histological diagnosis of N 270361-64: adenocarcinoma). On August 28, 1988, an operation was performed: hemicolectomy on the right, when restoring the digestive tract continuity, a purse string suture was placed along the perimeter of the colon, the ends of the filament of the purse string suture were brought out through a puncture of the intestinal wall, the edge of the colon was invaginated into the lumen below the level of the purse string suture, segment of the purse string suture the intestines containing internal drainage were introduced into the lumen of the formed invaginate, a purse string suture was tied, forming an end-to-end anastomosis. The abdominal cavity was drained with a silicone tube. The postoperative period was uneventful, internal drainage stood out on its own naturally in the 8th day. Drainage from the abdominal cavity was removed on the 8th day. The sutures were removed on the 10th day, the healing of the postoperative wound by primary intention. The patient on the 11th day in satisfactory condition was discharged from the department.

 PRI me R 3. Patient D., 58 years old (medical history N 14532 / F), was admitted to the thoracic-abdominal department of the Rostov Cancer Research Institute on 12/20/1989 with a diagnosis of stage gastric cancer III, group II (histological diagnosis N 250620-24: moderately differentiated adenocarcinoma). On 2.0.03.1989, a laporotomy was performed; during the audit, a tumor was found occupying the outlet section of the stomach 4x5 cm, stenosing its lumen, infiltrative-ulcerative type, of dense consistency, growing in the head of the pancreas. They performed subtotal gastrectomy, pancreatoduodenal resection. The anastomosis between the pancreatic stump and the loop of the small intestine was performed by the end-to-loop method, the anastomosis between the stomach stump and the small intestine was performed by Billroth P, the anastomosis between the common bile duct and the small intestine by the end-to-end method. At the same time, a purse string suture was made along the perimeter of the small intestine mucosa, the ends of the thread were brought out through a puncture in the intestinal wall, the edge of the small intestine was invaginated into the lumen below the level of the purse string suture. The common bile duct containing internal silicone drainage was introduced into the lumen of the formed invaginate, a purse string suture was tied, forming an anastomosis. The abdominal cavity was drained with two silicone tubes. In the postoperative period, the patient observed suppuration in the upper third of the postoperative wound, there were no other complications. Drainage from the abdominal cavity was removed on the 10th day. The sutures were removed on the 11th day, the healing of the postoperative wound in the upper third by secondary intention, the patient in satisfactory condition was discharged from the department on the 12th day.

The inventive method has several significant advantages:
reducing the invasiveness of the intervention;
simplicity of technical methods of the method (operations), the method does not require special devices;
the reliability of the anastomosis increases, the possibility of developing its narrowing in the postoperative period is excluded.

Claims (1)

 METHOD FOR CONNECTING TUBULAR BODIES OF THE DIGESTIVE TRACT, including the application of end-to-end anastomosis with compression between the external surfaces of the anastomosed organs, characterized in that a purse string suture is applied to the mucous membrane of the outlet segment of the tubular organ along its perimeter, the ends of the suture end of the organ, the edge of the organ is invaginated into the lumen below the level of the purse string suture, the leading segment of the organ containing internal drainage is introduced into the lumen of the invaginate and the ends of the thread net seam.

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