RU2376944C1 - Method of pelvic bottom formation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to oncology, and can be used in treatment of patients with malignant tumors of organs of small pelvis. After tumor removal right greater psoas muscle is mobilised by its cutting off from region of proximal fixation, vascular pedicle being preserved. Right greater psoas muscle is relocated into formed cavity of small pelvis. Right greater psoas muscle is fixed with separate interrupted sutures to stumps of resected muscles of pelvic bottom. Drainage is led out in perineum. Stoma is applied.

EFFECT: method allows to prevent displacement of small and large intestine loops into small pelvis due to reliable filling of wound cavity, plugging of wound surface and thus ensure prevention of post-operation X-ray therapy complications and development of commissure-formation process in small pelvis; reduces frequency of dysuric disorders in early post-operation period, allows to carry out pelvic bottom reconstruction and eliminate complications induced by infection of relocated transplant.

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Description

The invention relates to medicine, mainly to oncology, and may find application in the treatment of patients with malignant tumors of the pelvic organs.

A known method of forming the pelvic floor, in which the wound from the perineum was sutured in layers tightly, drained by tubular drainage. A mobilized omentum was moved from the abdominal cavity to the pelvic cavity, plugging the wound surface and filling the pelvic cavity (Ratner Yu.A. Surgery, 1965, No. 11, p.66).

The method is not without drawback. It does not provide a differentiated approach to patients in whom the omentum is small or absent in connection with a previous operation, or omentectomy is mandatory for oncological indications.

As a prototype, we have chosen the "Method for the treatment of pelvic floor defect", patent No. 2106813, C1, published 1998.03.20, which consists in the formation of a skin-fascial-muscle transplant based on the gluteus maximus muscle.

This method is also not without drawbacks, because is more traumatic, and after reconstruction, the wound cavity of the pelvis remains unfilled, which creates the condition for lowering loops of the small or large intestine that fall into the postoperative irradiation zone, and the displaced musculoskeletal graft suffers from a lack of blood supply, is often infected, which increases the healing time.

The aim of the present invention is the reconstruction of the pelvic floor.

The goal is achieved by mobilizing the right large lumbar muscle, which is cut off at the proximal fixation point, while maintaining the vascular pedicle. Then the muscle is moved into the resulting pelvic cavity and fixed with separate interrupted sutures to the stumps of the resected muscles of the pelvic floor.

The invention "Method for the formation of the pelvic floor" is new, since it is unknown from the level of medicine, namely in surgery of the pelvic organs.

The novelty of the invention lies in the fact that after the main stages of the operation, the retroperitoneal space is opened, the right major lumbar muscle is mobilized, cut off from the proximal fixation point, on the vascular pedicle containing the lumbar-iliac artery and veins, and moved to the wound cavity of the small pelvis, filling its volume and tamponing the wound surface. The muscle is sutured with the stumps of the resected muscles of the pelvic floor.

In the available sources of information in Russia, the CIS and foreign countries, it was not possible to find a method of forming the pelvic floor similar to the proposed one.

The invention "Method for the formation of the pelvic floor" is industrially applicable, as it can be repeated many times during the surgical treatment of malignant tumors of the pelvic organs in surgical hospitals, especially oncological clinics: oncology dispensaries, cancer research institutes.

The method is as follows.

An extended operation is performed to remove malignant tumors of the pelvic organs, after removing the tumor, the perineal wound is sutured in layers, tightly. The right major lumbar muscle is mobilized, cutting it off from the proximal fixation point, and, retaining the vascular pedicle, it is moved to the formed pelvic cavity, the wound cavity is filled, the wound surface is tamped, the mobilized muscle is fixed with separate interrupted sutures to the stumps of the resected pelvic floor muscles. The colon is removed to the side, a stoma is placed. Drainage through contrapertures to the perineum is removed.

Example: Patient M, 63 years old, medical history No. 11387 / H, was admitted to the thoraco-abdominal department of the Rostov Research Institute on 10/03/07 with a diagnosis of cancer of the lower ampulla of the rectum St II, column 2. T3N0M0. Under endotracheal anesthesia, on 05.10.07, a laparotomy was performed, during revision of the abdominal cavity revealed: a tumor of the lower ampullar rectum 7 × 6 cm in size, circularly narrowing intestinal lumen, dense, tuberous, no distant metastases were detected. It was decided to perform abdominal-perineal extirpation of the rectum. The rectum with pararectal fiber, lymphatic dissection of the paraaortic and iliac lymph nodes, and pelvic muscle resection were mobilized and removed in a single block. After removal of the drug, the perineal wound is sutured in layers. The retroperitoneal space is open, the right large lumbar muscle is mobilized, cut off from the proximal fixation point, moved to the wound cavity of the small pelvis on the lumbar-iliac vessels, and is fixed to the stumps of the pelvic floor muscles. A large omentum was mobilized and moved along the left lateral canal into the pelvis, covering the formed pelvic floor, the sigmostoma was removed in the left hypogastrium, the abdominal cavity was drained, the drainage was installed in the pelvis, and removed in the right hypogastrium. The abdominal cavity is sutured in layers. Iodine. Aseptic dressing. The patient was discharged 12.10.07 (on the 9th day) in satisfactory condition. Sutures were removed on the 15th day, sutures of the perineal wound were removed on the 35th day. 3 weeks after surgery, the patient was sent to radiation therapy.

The technical and economic effectiveness of the method lies in the fact that patients after removal of malignant tumors of the pelvic organs manage to form a pelvic floor, plug the wound surface and fill the wound cavity. To prevent the movement of loops of the small and large intestines and the development of adhesions in the pelvis. Reduce the patient’s hospital stay. Reduce the incidence of dysuric disorders in the early postoperative period and the incidence of postoperative complications to prevent complications of postoperative radiation therapy.

Claims (1)

A method for forming the pelvic floor during removal of a pelvic tumor, including removal of drainage in the perineum, stoma application, characterized in that, after removal of the tumor, the right major lumbar muscle is mobilized, cutting it off from the proximal fixation area, preserving the vascular pedicle, and moving the right large lumbar muscle into the resulting the pelvic cavity and fix with separate interrupted sutures to the stumps of the resected muscles of the pelvic floor.