RU2264657C2 - Method for modeling true strain pressure onto large intestinal wall in case of pneumocompression - Google Patents

Abstract

FIELD: experimental medicine, juvenile surgery.

SUBSTANCE: the present innovation deals with intestinal invagination in children. One should force the air by dosages into large intestine of experimental animal. Moreover, it is necessary to perform cross-sectional access into abdominal cavity. Then one should tighten small intestine in area of ileocecal valve, introduce a balloon-catheter into right-hand subhepatic space to place it in abdominal cavity being perpendicular to large intestine, then one should squeeze anal opening manually and increase intraintestinal pressure up to 200 mm mercury column. One should conclude upon strain pressure onto large intestinal wall by the difference of intestinal pressure and that of in balloon-catheter. The method enables to model strain pressure onto intestinal wall being close to natural one in case of pneumocompression at conservative disinvagination.

EFFECT: higher efficiency of modeling.

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Description

The invention relates to experimental medicine, namely to pediatric surgery, and can be used to treat intestinal invagination in children.

An analogue of the proposed method is a modeling method and determining the pressure on the intestinal wall on children's corpses with pneumocompression, depending on the degree of necrosis and the age of the child (V.M. Portnoy // Justification of the conservative method of treatment of intestinal intussusception in children / Clinical and experimental study /. Diss. ...... Candidate of Medical Sciences, t.1-2, Dnepropetrovsk, 1964, 280 p.).

The disadvantage of this method is that the bloating of the intestine was carried out with an open abdominal cavity and normal atmospheric pressure.

The closest prototype to the claimed one is a method for simulating the true pressure of the intestinal rupture during pneumocompression on experimental animals, which consists in injecting air into the intestine, determining the pressure of resistance and the difference in the intestinal pressure and the pressure of resistance determined the true pressure of the rupture of the intestinal wall (M.K. Belyaev, I .B. Yudin. Method for modeling the true pressure of intestinal rupture during pneumocompression // B.I. No. 30, No. 2094856 from 10.27.97, M. class.

The disadvantage of this method is that the determination of the true pressure of the rupture of the intestinal wall was carried out in an experiment that was significantly different from the conditions of conservative disinvasation: air was pumped into the colon and small intestine, while with conservative disinvagination, air stretches only the colon; a balloon catheter was inserted into the right ileal region, and the invaginate is located in the ascending intestine and in the subhepatic space on the right; a balloon catheter compresses both the colon and small intestine, with conservative disinvagination, stretching occurs only in the colon; the anal sphincter was stitched with a ligature, which is not done with conservative expansion; the intra-intestinal pressure during pneumocompression was higher than 200 mm Hg, while with conservative treatment it did not exceed 200 mm Hg.

The objective of the invention is to increase the accuracy of the method by bringing the model closer to the course of natural pathology.

The task is achieved by the fact that through the transverse access along the Sprengel, the abdominal cavity is opened on the right and the small intestine is ligated in the area of the bauginium flap, the balloon catheter is inserted into the subhepatic space on the right and is installed perpendicular to the large intestine, the anal sphincter is squeezed by the hands on the catheter, and the intestinal pressure is pumped into the intestine to a level of 200 mm Hg Determination of the true tension pressure on the wall of the colon allows you to choose a safe level of intestinal pressure with conservative expansion of intestinal invagination in children, depending on the age of the child.

Intestinal invagination is the introduction of the overlying part of the intestine into the underlying, as a result of which intestinal obstruction develops. Under normal conditions, invaginate is located only in the colon. Spreading of invagination in a conservative way is carried out mechanically - retrograde injection of air into the colon. At the same time, the air stretches exclusively the colon, without penetrating into the thin. In this connection, there is a need to determine the true tension of the colon. To do this, through the transverse access along Sprengel, the abdominal cavity is opened on the right and the small intestine is ligated at the level of the bauginium flap, since with conservative treatment the air does not pass into the small intestine.

In the area of the subhepatic space to the right (where the intussusception should be located), a catheter balloon connected to a pressure gauge to determine the "resistance" pressure, which is perpendicular to the colon, is inserted through the trocar. With pneumocompression, the colon stretches and squeezes the balloon catheter (while the small intestine is in a collapsed state), pressure "resistance" from the organs and tissues of the abdominal cavity, which varies depending on age, is recorded on the manometer. Pressure "resistance" depends on the age of the child, on body weight and muscle layer of the anterior abdominal wall. The smaller the child’s age, the lower the “resistance” pressure (thin anterior abdominal wall) and the older the child, the greater the “resistance” pressure (massive anterior abdominal wall). During pneumocompression, the anal sphincter is compressed by hands, while the intestinal pressure does not exceed 200 mmHg.

The method is as follows. Through transverse access along the Sprengel, the small intestine is ligated in the area of the bauginium flap to the right. A catheter balloon connected to a pressure gauge to determine the pressure of "resistance" is inserted into the right abdominal cavity through the trocar into the experimental animal’s abdominal cavity. A balloon catheter in the abdominal cavity is installed perpendicular to the colon. The anterior abdominal wall is sutured in layers. A tube connected to the manometer and Richardson balloon is inserted into the rectum. The anal sphincter is squeezed by hands on a tube. When air is injected into the intestine, the colon, swelling, squeezes the balloon catheter and the pressure "resistance" of the surrounding tissues is determined on the manometer. The injected intra-intestinal pressure does not exceed 200 mmHg. The difference between the intestinal pressure and the pressure of "resistance" will be the true tensile pressure on the wall of the colon. Excess air is discharged through the anus into the environment.

Example 1

Dog Bug, 6 months old, weight 7 kg, female. Under mask anesthesia, a transverse incision along the Sprengel makes access to the abdominal cavity and bandages the small intestine in the area of the bauginium damper. In the right subhepatic space, a catheter balloon connected to a manometer is inserted through the trocar. A balloon catheter is installed in the abdominal cavity perpendicular to the colon. The anterior abdominal wall is sutured in layers. A tube connected to the manometer and Richardson balloon is inserted into the rectum. The anus is squeezed by hands on a tube. Air is pumped into the colon to the level of intra-intestinal pressure of 200 mm Hg, while another pressure gauge fixes the pressure "resistance" from the organs and tissues of the abdominal cavity, which amounted to 65 mm Hg. The true tension pressure on the wall of the intestine will be the difference between the intestinal pressure (200 mm Hg) and the pressure of "resistance" (65 mm Hg) - 135 mm Hg. If the intra-intestinal pressure is exceeded 200 mm Hg. air returns through the anal sphincter to the environment. Bowel rupture was not observed.

Example 2

Dog Friend, 1 year 3 months, weight 16 kg, male. Under mask anesthesia, a transverse incision along the Sprengel made access to the abdominal cavity and the small intestine was ligated at the level of the ileocecal angle in the area of the bauginium damper. A catheter balloon connected to a manometer was inserted into the right subhepatic space through a trocar. A balloon catheter is installed in the abdominal cavity perpendicular to the colon. The anterior abdominal wall is sutured in layers. A tube connected to the manometer and Richardson balloon was inserted into the rectum. The anal sphincter is squeezed by the hand on the tube. Air is pumped into the colon, the pressure is fixed on the manometer - 200 mmHg. At the same time, the pressure is recorded on another pressure gauge - 110 mm Hg, indicating the pressure "resistance". True tension pressure on the wall of the colon will be equal to 90 mm Hg If the intra-intestinal pressure is exceeded 200 mm Hg. air returns through the anal sphincter to the environment. Gut rupture was not observed.

Thus, in conditions of a closed abdominal cavity, an intestinal pressure of 200 mm Hg, with a hand hole in the anus, the true pressure stretching on the wall of the colon depends on the age of the patient and is unable to cause its rupture. This method of modeling the true tension pressure on the wall of the colon allows you to choose the optimal safe pressure during conservative disinvagination depending on age.

Claims (1)

A method for simulating the tension pressure on the intestinal wall during pneumocompression during conservative disinvagination, including dosed injection of air into the colon of an experimental animal, characterized in that they provide transverse access to the abdominal cavity, the small intestine is ligated in the area of the bougain damper, the balloon catheter is inserted into the right subhepatic space and set in the abdominal cavity perpendicular to the colon, the anus is squeezed by hands, the intestinal pressure is raised to 200 mm Hg and by the pressure difference in the intestine and the catheter balloon, the tensile pressure on the colon wall is judged.