A method of enhancing intestinal sutures in peritonitis and preservation method dura

 

(57) Abstract:

The method relates to medicine. The purpose of the invention is the prevention of adhesions in the abdominal cavity, the strengthening of intestinal sutures and preservation of the antimicrobial properties of canned Dura mater. The line of stitches cover the Dura mater, taken from the fruit man, the cause of death which was not the inflammation of the meninges. After the removal of the Dura, the membrane was incubated for 1 to 3 days 0.5 - 0.6% solution of neutral formalin, and then in 1% solution of etoniya within 2 to 3 weeks. The method eliminates leakage seams ensure complete sealing. Thanks to its antimicrobial properties affects not only the line of stitches, but also on the surrounding tissue, reducing the risk of inflammation, accelerates the recovery of the sick and the period of his stay in the hospital. 1 C.p. f-crystals.

The invention relates to medicine, and more specifically to the treatment of diseases of the gastrointestinal tract, and can be widely used in the treatment of diseases of the abdominal cavity, especially in acute peritonitis, when the risk of insolvency of intestinal anastomosis.

Given the high risk of the development of resetbit these seams, to protect the suture line from the influence of the microflora of the abdominal cavity.

Characterization of a prototype selected by the applicant.

The known method consisting in the following.

After intestinal anastomosis exposed mesentery-side anastomosis so that it was possible to examine both sides and make sure that there are enough normal serous layer on each side. Each flap is removed from one side only. The base of the stem is chosen as close to the anastomosis. From the base, which is parallel to the edge of the mesentery of the intestine, shaped flap. He first incision, and then removed with excision with scissors from the outer edge to the base of the stem. After separation of the flap turn and cover the line of anastomosis. Fixed flap several silk stitches along each side of the anastomosis.

The prototype has a serious drawback is the floor seam lines infected tissues, which not only protects against the penetration of microorganisms, but are themselves a source of microorganisms. Between these tissues and the intestinal wall occurs a closed, isolated infected cavity, in which are the best us what changes.

The aim of the invention is to provide such a method of enhancing intestinal sutures in peritonitis, which eliminates the possibility of infection, failure of joints and promotes full recovery of the patient.

The proposed method consists in the following.

The line of stitches cover the Dura mater, taken from the fruit man, the cause of death which was not the inflammation of the meninges. Dura after collection shall be kept for 1-3 days in 0.5% solution of neutral formalin, and then in 1% solution of etoniya for one day, where she may well be stored for a long time.

Before applying Dura rasclaat and the inside of the stack on the line of stitches so that it overlaps the joints 1.5-2 cm on each side, and is fixed to the surface of the intestine or stomach sero-muscular sutures of Dacron or nylon.

Dura fruit is remarkable in that it does not cause immunological reactions, does not cause rejection due to underdevelopment in her antigenic structures.

However, it is quite durable, and covering the epithelium is similar in structure to the peritoneum.

patstat biodegradable shell, and immersion in 1% solution etoniya contributes to the preservation of the histological structure of the shell and gives it antibacterial properties.

(Atony has antimicrobial activity. Has a detoxifying effect on staphylococcal toxin. Stimulates the process of regeneration of skin tissues. - Handbook of clinical pharmacology and pharmacotherapy. Ed. "Health", Kyiv - 1986, S. 695).

Preserved by the proposed method Dura fruit retains its antimicrobial properties for many days after the operation (at least 4-5 days).

Histological studies conducted at different times after surgery showed that the Dura mater of the fetus after 6-12 h intimately fixed to the wall of the intestine, providing complete sealing line intestinal sutures, completely eliminates any leakage.

Thanks antimicrobial properties, obtained by impregnation with a solution etoniya, Dura has a favorable effect not only on the line of stitches, but also on the surrounding tissue, reducing inflammation, stimulating wound healing of ulcers.

Examples of specific performance.

P R I m e R 1. White rat Lebanon opened the abdominal cavity, which showed signs of peritonitis: fibrinous-purulent exudate in the abdominal cavity, blood peritoneum, fibrinous layers of the intestinal loops, the parietal peritoneum. The abdominal cavity is washed with a solution of penalizing. The front wall of the stomach is cut in the longitudinal direction length of 1 cm, stitched according to the standard technique 2-line seam. Dura taken from the fetus to 8 months., died of pneumonia, was fixed for 2 days in 0.5% solution of neutral formalin, after which 2 days were kept in 1% solution of etoniya. Before applying solid Dura divided into inner and outer layers. The flap inner layer of the Dura fruit laid on the seam line so that its surface is covered with mesothelium, adjoined to the serosa of the stomach, and the edges of the flap advocated the seam line of 1.5-2.0 cm in both directions. The flap is fixed to the wall of the stomach 4 separate Mylar joints, abdomen band sutured tightly.

P R I m m e R 2. White rat weighing 200 g peritonitis caused by intraperitoneal injection of 10% autoclaves mist. After 18 h under General anesthesia opened the abdominal cavity. The signs of fibrinous-pneumococci, stump which stitched blanket continuous seam and immersed in kisenyi seam, thread after tying knots is not cut off. Dura fruit, fixed according to the described method, divided into inner and outer layers. The flap inner layer is covered with stitched stump the caecum. Threads from superimposed on the intestine cassette suture is drawn through the middle of the flap of Dura mater, tied. When this shell lay tightly to deepen stump ulcer without the formation of "dead" space, serous-muscular Mylar seams edge of the flap is fixed to the wall of the caecum. The operation completed layer suturing of the wound tightly.

The experiments were carried out on 60 white rats, which after calling peritonitis according to the described method was hiding seams stomach colon.

The animals were sacrificed experience after 6, 12, 24, 48, 72 h, 5, 7, 10, 14, 21, 30 day after surgery. Found that already after 6 h of fetal Dura intimately fixed to the suture line and the adjacent serosa. After 12 h Dura hermetically covers the line of stitches, which is confirmed by samples with solutions of dyes and pneumapress, securely OTDELA not been observed immune inflammation, typical rejection reactions. After 5 days on the line of contact between the serosa of the gut (stomach) and Dura marked the development of connective tissue.

Histological preparations of intestine and stomach, covered with fetal Dura mater, in the time from 6 hours to 30 days shows that in none of the cases have not been observed immune inflammation, characteristic reactions of transplants.

Microbiological studies conducted in the period from 6 h to 5 days after the operation showed that the fetal Dura mater saves antimicrobial properties within 72 h: crops from the surface in this period do not provide the growth of microorganisms, while the crops of nearby segments of the intestine and abdominal cavity allow the growth of pathogenic microflora.

In 30 days after surgery, the Dura mater, fixed to the intestine, tightly fused with it, the spikes in this place is not expressed. Histologically showed signs of resorption of the Dura and substitute its own connective tissue without signs of inflammation.

Examples of clinical application.

P R I m e R 1. Patient Century. 22 Le is eologie. Operated urgent repair 15.X.89, Under endotracheal anesthesia produced medium-median laparotomy. When revisions are installed: vermiform process is thickened, hyperemia, has a perforated hole, through which the abdominal cavity is supplied pus and intestinal contents. All cecum, especially its dome, infiltrated and swollen. In the abdominal cavity to 500 ml of pus. Expressed secondary changes serous covers the entire intestine.

Diagnosis: gangrenous-perforating appendicitis, diffuse purulent peritonitis.

The exudate from the abdomen is removed. Produced appendectomy. Technical difficulties, the stump of the vermiform process is immersed in a cassette seam. Given the risk in the development of insolvency seams on the caecum due expressed its changes, but also because of the impact on the joints of the affected exudate abdominal cavity, decided to reinforce the seam at the caecum, and then covered the dome of the caecum fetal Dura mater.

The flap of Dura mater, taken from the fetus 7 months, fixed for 2 days in 0.5% formalin solution and then placed in 1% solution of etoniya within 2 weeks, divided into internal seam and fixed on the edges 4 Mylar ligatures, in the middle stitched the free ends of the threads from a purse-string suture, which are tightly tied. The abdominal cavity rinsed, drained by the standard technique. Operating the wound is stitched through all layers, yarn tied to "bows".

After 48 h produced programmed laparotomy: threads untied, the abdominal cavity is disclosed. During the audit it is found that abdominal purulent exudate, which is removed. The dome of the caecum with fixed thereto a flap fetal Dura mater extracted in the wound: hyperemia of the wall of the caecum decreased, Dura intimately fused with the wall of the intestine, signs of insolvency seams not.

The abdominal cavity is washed, stitched tightly. The postoperative period was uneventful, after 4 days normalized body temperature, appeared peristalic to 10 day mostly returned to normal laboratory values.

The patient spent in the hospital for 18 days and was discharged in satisfactory condition.

In this case, the use of flap fetal Dura mater to hide seams on the inflamed appendicitis in terms of diffuse purulent peritonitis helped to avoid the development nezostalo able to reliably verify, what fetal Dura mater, being fixed to the wall of the intestine in the presence of peritonitis, intimately fixed to it, ensuring the tightness of the seams, and antibacterial properties of the membrane have a positive effect on nearby areas of the intestine, reducing the severity of inflammatory processes.

P R I m m e R 2. Patient K., 72 years, history N 1874, was admitted to the surgical Department with the diagnosis: ruptured stomach ulcer. From history revealed that sickened more than 18 hours ago, when there was a "dagger" pain in the epigastric region. When clinical, laboratory, x-ray confirms the diagnosis.

Operated urgent repair. Under endotracheally anesthesia produced upper median laparotomy. From the abdomen is removed approximately 1.5 liters of fibrinous-purulent exudate. On the front wall of the antrum detected perforating a hole diameter of 1.5 cm, aperture edges thickened, infiltrated. Diagnosis: kallena ulcer antrum of the stomach, complicated with perforation, spilled fibrinous-purulent peritonitis.

When suturing perforated holes was observed erupting filaments due to the expressed and the major seam. However, given the changes the edges of the ulcer, the presence of fibrinous-purulent peritonitis, there were concerns about the possible development of insolvency seams. Decided to cover the line of stitches fetal Dura mater, canned according to the described method. Cut the flap fetal Dura mater, layered, inner layer is covered by the line of stitches on the stomach so that the edges of the flap was performed in both directions from the line of stitches 2 see the Flap is fixed at the edges 4 Mylar sero-muscular sutures to the wall of the stomach. The peritoneal cavity is drained 3 drains, surgical wounds sutured in layers.

The postoperative period was uneventful. No signs of insolvency of the seams was not observed. The patient was discharged from the hospital 8 days after surgery in satisfactory condition.

In this particular case, the use of fetal Dura mater able to effectively protect the seams on the stomach from the effects of the infected contents of the abdomen, as well as to preserve the integrity of the suture line by reducing the surrounding tissue inflammation, stimulation of regeneration.

P R I m e R 3. Patient C. 68 years, history N 1324, she entered in Hirundo order. Made of medium-median laparotomy. In the abdominal cavity revealed fibrinous-purulent exudate, which is removed. The area of the small intestine at a distance of 80 cm from ileo-ceilinga angle disadvantaged in the inner ring of the left inguinal canal. After dissection of the restraining ring and retrieve the wound disadvantaged section of the intestine is determined that it is unsustainable. Resection of part of intestine, the continuity of the digestive tract restored by imposing anastomosis, end-to-end between the leading and lateral segments of the colon according to the standard technique. Given the presence of diffuse fibrinous-purulent perforata, there were concerns in danger of insolvency seams anastomosis. In this regard, decided to cover the line of stitches fetal Dura mater canned according to the described method.

Cut the flap of Dura required length, 2.5 cm in width, line joints covered by the flap all the way through. 6 Mylar sero-muscular sutures flap is fixed to the walls of the intestine. The abdominal cavity sanitized, drained, surgical wounds sutured in layers.

In the postoperative period, despite signs of paresis of the intestine, swelling, is erali healthy.

In this case, the strengthening of joints small bowel anastomosis Dura mater of the fetus is possible to preserve the integrity of the suture line even when postoperative paresis of the intestine.

It is safe to say that if this sick strengthening the line of anastomosis Dura mater was not conducted, intestinal wounds probably erupted least because of bloating, which could lead to very serious complications.

Implementation of the proposed method generates a number of positive effects - completely eliminates the infiltration of the joints. Fetal Dura mater after 6-12 h after surgery intimately fixed to the wall of the intestine or stomach, provides complete sealing seam lines. Thanks to its antimicrobial properties, a positive effect not only on the line of stitches, but also on the surrounding tissues, reduce the risk of inflammation, accelerates the recovery of the patient, decreases the duration of his hospital stay, sharply reduced the number of fatal cases.

A METHOD OF ENHANCING INTESTINAL SUTURES IN PERITONITIS AND PRESERVATION METHOD OF THE DURA.

1. A way to strengthen the intestinal sutures for peritonitis, vklyuchayuscikh the abdominal cavity, intestinal seam cover inner layer of the Dura fruit.

2. Method of preserving Dura fruit, characterized in that, with the aim of strengthening the intestinal sutures and save antimicrobial properties for a long time, the treatment is carried out with a 0.5% formalin solution for 1 to 3 days, then 1% solution etoniya from 1 to 14 days.

 

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