RU2846337C1 - Method for intraoperative evaluation of integrity of intestinal anastomoses using ultrasound - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to surgery, ultrasonic diagnostics and can be used for intraoperative evaluation of intestinal anastomosis leakiness by means of ultrasonography. During the relaparotomy with the inspection of the intestinal anastomosis, a linear sensor is placed on the anastomosis region. A mucosal-muscular layer of the intestine is assessed next to the anastomosis, as well as the anastomosis itself at using wave length 7.5 MHz or 5 MHz. In presence of hypoechoic area without sharp edges in surrounding tissues of anastomosis, corresponding to regeneration of tissues surrounding anastomosis, conclusion is made on consistency of anastomosis. If observing hyperechoic signal interruptions directly above the anastomosis region, a developing anastomosis inconsistency is stated.

EFFECT: method enables assessing the intestinal anastomosis integrity ensured by the presence of a hypoechoic or hyperechoic pattern in the intraoperative ultrasonography.

1 cl, 2 dwg

Description

The invention relates to medicine, namely to surgery. Modern conditions of the theater of military operations dictate new rules for organizing medical care. Providing surgical care is of paramount importance. Treatment of abdominal combat trauma remains relevant. In the structure of the incoming flow, wounded with abdominal wounds account for 7 to 10%. The absence of a change in the number of such wounded is due to the simultaneous improvement and modernization of both the means of protecting a serviceman and the methods of causing damage to manpower. During the provision of qualified care at the 2nd level of evacuation, under certain conditions, it is possible to form intestinal anastomoses according to indications. Then, the wounded is delivered to the next levels by evacuation routes. In order to monitor damage and assess the viability of the anastomosis, such patients often use the tactics of maintaining the abdomen with the formation of a laparostomy. Such patients require repeated relaparotomy at the next stages in order to monitor the viability of the anastomosis or other manipulations performed in the abdominal cavity. There are many different methods that allow for the assessment of small-intestinal and other anastomoses, both intraoperatively and using prognostic methods without relaparotomy. However, they all have their drawbacks: the use of specific equipment that is not available in most medical institutions, the need to perform numerous diagnostic tests, the use of complex and cumbersome scales, the use of which also requires various measurements and analyses. We propose the use of intraoperative ultrasound examination of the anastomosis from the laparotomy wound using a stationary or portable ultrasound device. This method is characterized by its speed and ease of use, availability of tools for assessment, and the objectivity of the data obtained due to the quality of the image obtained. The main purpose of ultrasound assessment of anastomosis is to determine the predictive factors of future failure, which is necessary when choosing the tactics of programmed relaparotomies. When performing an operation, timely determination of possible intestinal anastomosis failure will help the surgeon choose further tactics. The technique is aimed at assessing changes occurring intramurally in intestinal tissues in the area of the surgical connection, where they are not available for visual control.

It has significant advantages over analog methods and techniques, such as:

1. Method for diagnosing failure of biliodigestive, gastroduodenal, and interintestinal anastomoses of the upper sections of the small intestine (RU 2816658 C1).

2. Method for predicting the course of the reparative process of intestinal anastomosis (RU 2675089 C1);

3. Method for predicting intestinal anastomosis failure (RU 2826625 C1);

4. Method for determining the degree of acute anastomosis of gastroduodenal anastomoses (RU 2003132018 A);

5. Method for determining the degree of acute anastomosis of gastroduodenal anastomoses (RU 2277857 C2);

6. Method of dynamic endovideo monitoring of the viability of small intestinal anastomosis in patients with abdominal intestinal pathology (RU 2545449 C2).

Main characteristics compared:

• Time costs;

• The need for laboratory diagnostics;

• Interpretation of the obtained data with recalculation of points/indices;

• Possibility of preventing complications;

The method for predicting the course of the reparative process of intestinal anastomosis (RU 2675089 C1) and the method for predicting the failure of intestinal anastomosis (RU 2826625, A61B 5/145, A61B 17/11) are prognostic methods. However, the use of these developments allows assessing the risks of failure without dynamic control, taking into account changes in the body's homeostasis, the skill of the surgeon in forming the anastomosis, and other external factors that affect the solvency of the suture.

The invention is based on the task of creating a method for intraoperative assessment of the viability of intestinal anastomoses using ultrasound, characterized by lower time costs for implementation and interpretation and not requiring the use of additional materials, reagents and equipment.

The solution to the set problem is ensured by the fact that in the method of intraoperative assessment of the viability of intestinal anastomoses using ultrasound during relaparotomy during revision of the intestinal anastomosis area, a linear sensor is installed on the anastomosis area and an assessment is made of the mucous-muscular layer of the intestine near the area of surgical activity, as well as the place of the anastomosis itself using a wavelength of 7.5 MHz or 5 MHz, while if the surrounding tissues of the anastomosis have signs of an inflammatory process, the formation of an infiltration zone (leukocyte shaft), then this means adequate conditions for regeneration, and in the presence of areas of interruption of the hyperechoic signal directly above the anastomosis area, a conclusion is made about the development of anastomosis failure.

The invention is explained in Fig. 1, which shows an example of placing a linear sensor on a section of a side-to-side interintestinal anastomosis, and Fig. 2, which shows a viable interintestinal anastomosis during an ultrasound examination.

During relaparotomy, during revision of the intestinal anastomosis area using any available ultrasound device (in our case, SonoScape), a linear sensor is placed on the anastomosis area (see Fig. 1) and the mucous-muscular layer of the intestine is assessed near the surgical activity area, as well as the anastomosis area itself in order to examine the suture area using a wavelength of 7.5 MHz or 5 MHz. The use of this frequency range is due to better image detail due to the physical properties of the ultrasound wave. The sensor is placed in different projections in relation to the anastomosis. The surrounding tissues of the anastomosis will have signs of an inflammatory process, the formation of a leukocyte shaft (areas of infiltration), which is an adequate condition for regeneration (Fig. 2). However, the presence of areas of interruption of the hyperechoic signal directly above the anastomosis area (the area of suture formation) tells us about the fact of developing insolvency. At this stage of development, it is possible to perform unloading surgical interventions (removal of unloading double-barreled unnatural anuses) or resection of the anastomosis site in order to prevent the development of leakage of the contents of the hollow organ into the abdominal cavity.

The method of assessing the viability of intestinal anastomoses used in our conditions has proven itself to be a good addition to clinical and intraoperative visual assessment of the interintestinal anastomosis.

In modern armed conflicts, it is extremely important for the medical service in the conditions of staged evacuation to timely identify possible development of complications in order to prevent them. The method we propose is a fast and high-quality assistant in decision-making during programmed laparotomies. Timely determination of possible failure allows preventing primary or repeated contamination of the abdominal cavity with intestinal contents and the onset or progression of peritonitis.

Claims (1)

A method for intraoperative assessment of the viability of intestinal anastomoses using ultrasound, characterized in that during relaparotomy during revision of the intestinal anastomosis area, a linear sensor is installed on the anastomosis area and an assessment is made of the mucous-muscular layer of the intestine near the anastomosis, as well as the anastomosis itself using a wavelength of 7.5 MHz or 5 MHz, in the presence of a hypoechoic area without clear edges in the surrounding tissues of the anastomosis, corresponding to the regeneration of tissues surrounding the anastomosis, a conclusion is made about the viability of the anastomosis, and in the presence of areas of interruption of the hyperechoic signal directly above the anastomosis area, a conclusion is made about the development of anastomosis failure.