RU2196513C2 - Ultrasonic control method for building intestinal anastomosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves building anastomosis on intestine expanded on rubber balloon. Correctness of anastomosis structure is controlled in intra-operation ultrasonic examination. EFFECT: enhanced effectiveness of anastomosis control. 1 dwg

Description

 The invention relates to medicine, namely to surgical methods for applying intestinal anastomoses.

Known methods of controlling the imposition of intestinal anastomoses, based on testing their tightness by introducing fluid into the lumen of the anastomosed organ (Kostyuk G.Ya., Zhuchenko SP, Ceiling P.L. Clinical surgery. - 1990. - 2. - p. 10- 11), however, having a number of disadvantages:
1) the lack of objective criteria for assessing the condition of the anastomosis;
2) the inability to control directly at the time of application of the anastomosis;
3) when conducting hydraulic tests, it is possible that the infected fluid enters the abdominal cavity.

The closest in technical essence is the method of transabdominal ultrasound diagnosis of diseases of the colon (Orlova L.P. "Visualization in the clinic", 5, 1994, pp. 53-61; Kushnerov A.I. "Method of ultrasound examination of the colon". Method. recommendations of the Minsk Medical Institute, 1994, 13 pp.), however, having a number of drawbacks:
1) the possibility of research only through the anterior abdominal wall;
2) the introduction of intracavitary fluids can lead to failure of the anastomosis;
3) the use of this method does not allow to objectively judge the state of the imposed anastomosis in dynamics;
4) quantitative assessment of the structures of the superimposed anastomosis is difficult.

 The aim of the invention is the objective control of the intestinal anastomosis.

 This goal is achieved due to the fact that the application of the anastomosis is carried out on the intestine straightened with a rubber balloon, and the correctness of the application is controlled by intraoperative ultrasound examination.

The method is as follows:
In an experimental animal, median laparotomy is performed under endotracheal calypsol anesthesia. When revising the abdominal cavity, the colon is determined, its transverse section is mobilized. The large intestine is dissected in the transverse direction. A catheter with a rubber balloon at the end is inserted into the organ cavity through the anus. A solution of 0.9% sodium chloride is injected into the rubber balloon until the organ walls expand. Anastomosis is applied on the expanded gut. At the same time, intraoperative ultrasound monitoring of already placed sutures on the intestine is carried out with a 9.0 MHz sensor on a Logiq-700 apparatus (see drawing). The operation is completed by suturing the abdominal cavity tightly, the animal is removed from the experiment.

Case Study
Experimental animal (outbred dog) 6. Under endotracheal calypsol anesthesia, the abdominal cavity is opened in layers. During the audit, the transverse section of the colon is isolated, it is mobilized and dissected to end-to-end anastomosis. A catheter is inserted through the anus with a rubber balloon at the end, through which a solution of 0.9% sodium chloride is introduced into the lumen of the balloon until the anastomosis zone is straightened, after which sutures are made and an intestinal anastomosis is formed. In parallel with the 9.0 MHz sensor on the Logiq-700 apparatus, the dynamics of the superimposed anastomosis was studied. After applying the anastomosis and monitoring it with ultrasound, the abdominal cavity is sutured in layers tightly. The animal is removed from the experiment.

 The application of this method was carried out with the imposition of intestinal anastomoses in an experiment on 10 animals. There were no complications in the early and late postoperative period.

Significant differences of the proposed method for ultrasonic monitoring of the intestinal anastomosis:
1) non-invasive visual-informative research method;
2) makes it possible to clearly differentiate the layers of the wall of the colon that fall into the anastomosis zone;
3) an objective and quantitative research method;
4) the introduction of a rubber balloon into the lumen eliminates leakage of intestinal contents into the area of application of the anastomosis from the overlying parts of the organ and does not infect it;
5) makes it possible to conduct dynamic tests of the anastomosis and under ultrasound control.

Claims (1)

 The method of ultrasonic control of the imposition of intestinal anastomosis, including ultrasound examination of the colon, characterized in that the imposition of the anastomosis is carried out on the rectified rubber balloon of the intestine, and the correctness of the imposition is controlled by intraoperative ultrasound examination.