RU2826625C1 - Method for prediction of intestinal anastomosis leakage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to abdominal surgery, gastroenterology. Cerebral/somatic oximeter sensor electrodes are used to measure haemoglobin oxygenation of venous blood of proximal and distal intestinal segments before and 10 minutes after formation of the anastomosis. Averaged results from two electrodes before and after application of anastomosis are calculated, and on the basis of obtained results the index of prediction of intestinal anastomosis leakage (IPAL) is calculated by original formula. If the IPAL value is greater than or equal to 1.0, an insignificant probability of anastomosis leakage is predicted. If the IPAL value is less than 1.0, the probability of anastomosis leakage is high.

EFFECT: method provides higher accuracy and reduced time for intraoperative prediction of intestinal anastomosis leakage due to assessment of intestinal tissue oxygenation before and after anastomosis.

1 cl, 2 tbl, 2 ex

Description

The invention relates to medicine, namely to surgery, and can be used as a method for determining the probability of intestinal anastomosis failure.

The problem of the reliability of intestinal anastomosis is relevant. Suture failure is recorded depending on the location of the anastomosis: rectum - 5-10%; colon - 2%; small intestine - 2%; ilioanal anastomosis - 4-5%; ileostomy - 12%; gastrointestinal anastomosis - 4-7% (Savelyev V.S., Kiriyenko A.I. Clinical surgery. National guidelines. M. 2010).

The healing process of any tissue, including the intestines and stomach, depends on the oxygenation of tissue structures. Therefore, the primary task during abdominal surgery is intraoperative prediction of the course of anastomosis healing based on the degree of oxygenation of the intestinal and stomach walls.

A method for predicting the healing of a surgical wound by measuring tissue microcirculation using a laser microcirculation analyzer is known (Stepankina E.S. et al. Method for predicting the healing of a surgical wound during suturing. RU 2616268. Published 13.04.2017.).

The disadvantages of this method are:

- deterioration of blood flow does not always lead to a critical decrease in oxygenation of tissue structures;

- the error of the method may be due to a vascular reaction (spasm) in response to surgical aggression with a corresponding false result.

The closest in technical essence to the claimed solution is a method for predicting the course of the reparative process of intestinal anastomosis, which consists in the fact that after the formation of the intestinal anastomosis, the redox potential is measured in the tissues along the anastomosis line and, based on the data obtained, the index of predicting healing is calculated using the formula (Vlasov A.P. et al. Method for predicting the course of the reparative process of intestinal anastomosis. RU 2675089, published 12/14/2018).

The disadvantages of this method are:

- the duration of the surgical intervention and anesthetic care, since the time for obtaining a repeat measurement of the redox potential of the intestinal wall is carried out 30 minutes after the formation of the anastomosis.

- unreliability of the final result, changed due to the pathological process of the intestine, which can ultimately distort the final result and affect the prognosis of the course of the reparative process.

The purpose of the invention is to develop a method for predicting the course of the reparative process of intestinal anastomosis based on an assessment of the state of oxygenation of tissue structures along the anastomosis line.

The goal is achieved by measuring the oxygenation of intestinal sections before and after the anastomosis.

Before forming the intestinal anastomosis, INVOZ cerebral/somatic oximeter sensors are applied to the proximal and distal sections of the intestine in the area of the proposed anastomosis line, and the venous blood hemoglobin oxygen saturation is measured. Ten minutes after forming the anastomosis, cerebral/somatic oximeter sensors are again applied to the proximal and distal sections of the intestine from the anastomosis line, and the venous blood hemoglobin oxygen saturation is measured again. Based on the averaged results from the two sensor electrodes, the anastomosis healing prediction index is calculated using the formula:

IPZA=rSO2D/rSO2P,

where IPZA is the anastomotic healing prediction index,

rSO2D - average results of hemoglobin oxygen saturation of venous blood of the intestine before the formation of the anastomosis rSO2P - average results of hemoglobin oxygen saturation of venous blood of the intestine 10 minutes after the formation of the anastomosis.

Moreover, if the IPZA values are greater than or equal to 1.0, this indicates a low probability of anastomotic failure; if the IPZA values are less than 1.0, this indicates a high probability of anastomotic failure.

To determine the value of the prognostic index of the intestinal anastomosis healing process, clinical studies have been performed, which prove

- increasing forecasting accuracy;

- reduction of the time interval for repeated examination to 10 minutes.

In the clinic, the method was tested in 29 patients aged 61+3 years who underwent resection of the colon or small intestine with the imposition of an end-to-end anastomosis. Anastomotic failure was recorded in patients within 3-5 days after the surgical intervention. The results of the testing are presented in Table 1.

As can be seen from the data presented in Table 1, in the group of patients whose anastomotic healing prediction index (AHPI) was less than 1.0, the number of cases of anastomotic failure was 3.2 times higher than in the group of patients whose AHPI was greater than 1.0.

Table 2 shows the time courses of averaged data recorded from the proximal and distal sensor electrodes of the 1NVOZ cerebral/somatic oximeter in 16 patients before and after intestinal anastomosis.

From the data presented in Table 2 it is evident that after 10 minutes and in subsequent periods the cerebral/somatic oximeter readings are equal, i.e. the minimum time interval that allows us to judge the restoration of intestinal oxygenation after the application of an intestinal anastomosis is 10 minutes. Examples of specific implementation.

Example 1.

Patient K., 63 years old. Diagnosis: small intestinal tumor. Median laparotomy was performed under general anesthesia. Intestinal oxygenation in the area of the proposed resection was measured. The cerebral/somatic oximeter reading before the anastomosis was 71%. Partial resection of the small intestine was performed, and an end-to-end anastomosis was performed. After 10 minutes, the oximeter reading was 69%. The anastomosis healing prognosis index was 1.03. In the postoperative period, intestinal peristalsis was restored after 26 hours. The early postoperative period was uneventful. The patient was discharged from the clinic with recovery after 8 days.

Example 2.

Patient X., 60 years old. Diagnosis: small intestinal tumor. The patient underwent midline laparotomy under general anesthesia. The intestinal oxygenation index before resection was 71%. After formation of intestinal anastomosis using the end-to-end method, the cerebral/somatic oximeter index was 82%. The anastomosis prognosis index was 0.87. In the immediate postoperative period, intestinal motility did not recover for 3 days. Peritoneal signs appeared on the 4th day; ultrasound examination revealed fluid in the free abdominal cavity. Relaparotomy was performed, during which areas of suture material cutting through in the anastomosis area with the release of intestinal contents into the free abdominal cavity were detected. Small intestine was re-resected with the formation of an ileostomy.

The novelty of the proposed method lies in the assessment of tissue oxygenation, the main component that determines reparative processes in tissues, and in the intraoperative prediction of anastomosis integrity violation in a shorter time.

Claims (7)

A method for predicting the failure of an intestinal anastomosis, including measuring the degree of oxygenation of the proximal and distal segments of the intestine, characterized in that using sensor electrodes of a cerebral/somatic oximeter, the saturation of hemoglobin with oxygen in the venous blood of the proximal and distal segments of the intestine is measured before and 10 minutes after the formation of the anastomosis, the average results from two electrodes are calculated before and after the anastomosis is imposed, and based on the results obtained, an index for predicting the failure of an intestinal anastomosis is calculated using the formula: IPZA=rSO2D/rSO2P, where IPZA is the intestinal anastomosis failure prediction index, rSO2D - average results of hemoglobin oxygen saturation of venous blood of the intestine from two sensor electrodes before the anastomosis is imposed, rSO2П - average results of hemoglobin oxygen saturation of venous blood of the intestine from two sensor electrodes 10 minutes after the anastomosis was applied; if the IPZA value is greater than or equal to 1.0, a low probability of anastomotic failure is predicted, and if the IPZA value is less than 1.0, there is a high probability of anastomotic failure.