SU1616615A1 - Method of treating external non-formed intestinal fistula - Google Patents

Abstract

This invention relates to surgery for external intestinal fistula. The goal is to prevent the inconsistency of the sutures during the bypass anastomosis, accelerating wound healing. A side-to-side anastomosis is applied between the leading and discharging knees of the fistula. The latter are placed closer to the fistula with circular ligatures, which are brought out through the hollow tubes and tied to them. In the postoperative period, the abutment of the knee of the fistula is periodically clamped at the beginning, and after the anastomosis is healed both knees. Turns are removed after healing or fistula formation.

Description

The invention relates to medicine, in particular to surgery, and can be used in surgeries for external intestinal fistulas.

The purpose of the invention is to prevent the inconsistency of the anastomotic sutures and accelerate wound healing.

The goal is achieved by producing an adjustable bilateral shutdown of the intestinal loop that carries the fistula by narrowing and blocking the lumen first of the retracting knee, and then both knees of the fistula using extra-peritoneal veins through counter-turnstiles.

The method is carried out as follows.

An incision far from the fistula opens the abdominal cavity, placing the bypass inter-intestinal anastomosis side-by-side between the adductor and the distended knee of the intestine. Then closer to the fistula alternately through

the mesentery around the driving and discharging knees is carried out by ligatures, which lead out through the lumens of thin plastic tubes.

Gradually pushing the tube through the ligatures, the bowel is squeezed and the ends of the thread are tightened; knots are tied at the level of the apex of the wedge-shaped slot or the outer opening of the tube (turnstile). The nodes are then the reference points of the desired turnstile. To tension the ends of the turnstile to limit the narrowing of the intestinal lumen. Turnstiles in working position during the tension period are fixed with a hollow plug or in a wedge-shaped slot of the tube wall. The main abdominal incision is sutured tightly,.

Immediately after the operation, a temporary narrowing (up to 2 hours) is started with the help of a turnstile of the abutment of the intestine, distal to the fistula, the vregpeon argument

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cut up to 6-8 hours up to 2-3 times a day, 8–9 days after the operation, when the dangerous period of possible inconsistency of the inter-intestinal joints is over, they begin the simultaneous clamping of both knees of the intestine carrying the fistula. The clamping force is considered sufficient if there is no discharge from the fistula.

Experimental and clinical observations indicate that the intestinal lumen is 75% narrowed enough to completely stop the passage of intestinal contents.

In some cases even a slight (15-25%) compression of the intestine leads not only to slowing the passage of intestinal masses through the constricted area, but also to complete stasis, which is explained by the adherence of a local organ spasm to the mechanical factor. The ultimate tension of the ends of a keta tournament is the appearance of knots at the outer end of the tube or in the lumen of its wedge-shaped slot.

After the fistula has been formed or fully healed, the turnstiles are removed. In the condition of tensioning the ends of the turnstile, one of them is cut off and, gradually, the end of the turnstile is completely removed for the remaining outside end. The tube is finally removed.

Under observation there were 214 patients with various external intestinal fistulas, of which 108 (51.8%) had non-formed fistulas upon admission. In the group of patients with unformed fistulas, in 5 cases that were extremely severe, clinically, due to the massive loss of intestinal contents and the presence of local peritonitis with progressive water-electrolyte balance and acid-base balance, despite intensive corrective therapy was performed, the operation according to the proposed method (experimental group) - the imposition of a bypass anastomosis with bilateral gut shutdown with a fistula with the help of turnstiles. The operations were performed 2-4 weeks after the operations that entailed the formation of intestinal fistulas. External intracavity occlusive structures in this group were not used.

In patients of the experimental group, intestinal losses stopped for almost 7–9 days, body weight rapidly increased with normalization of water and electrolyte balance, leakages with the formation of fistulas were eliminated. The granulation process in the wound was activated. In 3 cases, the fistula closed spontaneously, in a 2-way, extraperitoneally.

Example. Patient 3., 42 g. He entered the surgical department of the Republican

hospitals with multiple unformed external intestinal fistulas in the right iliac region. On the 5th day after appendectomy of gangrenous appendicitis, intestinal

fistula. In the district hospital, two unsuccessful attempts were made to close the fistula, which led to the formation of multiple fistulas with leakage of intestinal contents. The patient is exhausted. No chair

about the month An intensive infusion therapy was started, but the condition did not improve. An X-ray of the cattle fistula and two fistulas in the ileum of the intestine. 12 days after

the operation according to the proposed method is the imposition of a bypass anastomosis with a two-way shutdown of the fistula using 2 turnstiles installed on the transverse

colon and ileum. There were no complications in the postoperative period. The turnstiles are removed on the 18th day after the formation of tubular fistulas, of which two were closed independently, and one

closed by the method of Sapozhkov.

Under the conditions of the experiment it was proved. but that finding a turnstile on the gut with occasional tightening does not give any local complications. In its own way

exposure to the surrounding tissues and organs of the turnstile is similar to drainage.

Clinical and experimental observations have shown that: the method allows in the postoperative period to overlap

leading and discharging fistula; a change in the overlap of the knees is possible, which is an important condition for preventing the development of inconsistency of anastomotic sutures: there is an acceleration of fistula formation with the elimination of local inflammatory processes, persistent restoration of homeostasis; terms of fistula formation after surgery averaged 27 days versus 57 days in the control

group; more favorable conditions are created for the spontaneous healing of fistulas.

The obtained positive therapeutic effect from the use of the proposed method of treating intestinal fistulas allows recommending it for widespread clinical use.

Claims (1)

The invention The method of treatment of external unformed intestinal fistulas, including: 16166156 the bypass anastomosis and the constriction lead to the skin through the hollow tubes and in fistula in the postoperative period is periodically distinguished by the fact that, in order to pinch, at first, the diverting joint prevention is incompetent, then after healing anastomosis and accelerate wound healing, 5 anastomosis both knee fistula, and ligatures On both knees of the gut bearing the fistula, they are removed after healing or circular ligatures are formed, which are removed by the fistula.