RU2385678C2 - Method of prevention of early cicatrisation of vasoepididymoanastomosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely urology, can be used in formation of vasoepididymoanastomosis. A fistula is applied between parovarium and deferent duct. Vasoepididymoanastomosis is formed as "parovarium end to deferent duct side" or "side to side". After vasoepididymoanastomosis is formed, deferent duct at its creation point is catheterised in the antegrade direction with a capillary microirrigator at depth 1.5-2.5 cm. Herewith, the anastomosis point is not reached. In the postoperative period, through the microirrigator anti-inflammatory or antibacterial drug solutions are introduced into a duct lumen. 8-10 days later, the microirrigator is removed. In that specific case, the irrigation volume with a drug solution is 1 ml. The irrigation procedure is performed with using an insulin syringe and a doser "Lineomat" at low speed.

EFFECT: method allows optimising the conditions of healing vasoepididymoanastomosis, preventing development of cicatricial anastomositis and maintaining mechanical patency of deferent duct within anastomosis area in the early postoperative period due to precise drug solution delivery to the fistula point, and also eliminating barometric and mechanical injures of deferent duct.

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Description

The invention relates to medicine, to the field of urology and directly to the technique of forming a vasoepididyimanastomosis.

The effectiveness of vasoepididymostomy depends on the healing conditions of the anastomosis and remains not high enough due to obstructive anastomositis developing after surgery.

Variants of bypass vasoepididymoanastomoses are known, including anastomosis of the wound of the appendage or epididymal duct with a longitudinal opening of the vas deferens according to the “side to side” type using endoprostheses to simulate the epithelization of the anastomosis line and prevent its scarring under anastomositis conditions (Operational Urology: Ed. N.A. Lopatkina, I.P. Shevtsova. - L .: Medicine, 1986. - 480 p.).

During the formation of vasoepididymoanastomoses according to the type “end of the appendage to the side of the vas deferens” or “side to side” anatomical conditions are created for the precision bringing to the site of the anastomosis of medicinal solutions with anti-inflammatory effect through the capillary microirrigator introduced into the vas deferens duct leading to the anastomosis.

The objective of the invention is to increase the effectiveness of vasoepididymostomy.

The problem is solved in that in the method for the formation of vasoepididymoanastomosis, including an anastomosis between the testis epididymis and the vas deferens according to the type “end of the appendage to the deferent duct” or “side to side”, after the anastomosis is performed, the vas deferens at the site of its formation catheterize in the antegrade capillary microirrigator to a depth of 1.5-2.5 cm, not reaching the site of the anastomosis, is fixed in this position with absorbable suture material and removed through the contraperture to the skin of the scrotum, after which the wounds the scrotum is sutured in the traditional way on the drainage. In the postoperative period, a capillary microirrigator is used to introduce medicinal solutions with anti-inflammatory or antibacterial effect into the duct lumen (0.5% dioxidine solution, miramistin solution, hydrocortisone solution, antibiotic solution) to irrigate them with anastomosis. After 8-10 days, the capillary microirrigator is removed. Irrigation is carried out with a medicinal solution in a volume of 1 ml from an insulin syringe using a Lineomat dispenser at a minimum speed.

The proposed method is illustrated in the drawing, where 1 - microirrigator, 2 - bringing to the anastomosis section of the vas deferens, 3 - anastomosis.

Irrigating the anastomosis with medicinal solutions that have an anti-inflammatory effect allows optimizing the healing conditions of the vasoepididyimanastomosis, preventing the development of a gross inflammatory process that threatens scarring of the anastomosis, and supporting the mechanical patency of the vas deferens in the anastomosis. The use of plastic capillary microirrigators comparable with the lumen of the vas deferens and the Lineomat dispenser make it possible to completely exclude the barometric and mechanical traumatization of the vas deferens.

The method is as follows.

Under general anesthesia, after shaving and treatment of the surgical field with antiseptics, scrotal access 4-4.5 cm with hemostasis, a testicle with an appendage and the initial section of the vas deferens are excreted, which are removed to the wound. Form a vasoepididymoanastomosis 3 of the type “end to side of the vas deferens” or “side to side”. After this, the vas deferens 2 at the site of its formation is catheterized in the antegrade direction with a capillary microirrigator 1 to a depth of 1.5-2.5 cm, not reaching the anastomosis, is fixed in this position with absorbable suture material and the scrotum is removed through contraperthesis, after which the wound scrotums are sutured in a traditional way in layers on drainage. In the postoperative period, a capillary microirrigator is used to introduce medicinal solutions with anti-inflammatory or antibacterial effect into the duct lumen (0.5% dioxidine solution, miramistin solution, hydrocortisone solution, antibiotic solution) to irrigate them with anastomosis. After 8-10 days, the microirrigator is removed. Irrigation is carried out with a medicinal solution in a volume of 1 ml from an insulin syringe using a Lineomat dispenser at a minimum speed.

Claims (2)

1. A method for the prevention of early scarring of vasoepididymoanastomosis, including the imposition of an anastomosis between the epididymis and the vas deferens according to the type "end of the appendage to the deferens duct" or "side to side", characterized in that after the anastomosis is performed, the deferent duct is catheterized at the site of its formation direction of the capillary microirrigator to a depth of 1.5-2.5 cm, not reaching the site of the anastomosis, through which in the postoperative period, drug solutions with anti-inflammatory are introduced into the lumen of the duct nym or antibacterial effect, and after 8-10 days mikroirrigator removed. 2. The method according to claim 1, characterized in that the irrigation is carried out with a drug solution in a volume of 1 ml from an insulin syringe using the Lineomat dispenser at a minimum speed.

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