Method for a single-row interrupted intestinal suture

FIELD: medicine, abdominal surgery.

SUBSTANCE: one should perform marginal serous-muscular-submucous suturing for every wall of intestinal wound in oblique direction against cross-sectional intestinal axis being parallel to lateral branches of intraparietal intestinal vessels at an angle being opened towards mesenteric edge. Puncturing in and puncturing out of stitches at the serous membrane of every further suture should be performed being on the same line with puncturing in and puncturing out of stitches at the border of submucous and mucous layers of previous suture. Sutures should be tightened at forming the knots at serous membrane. The innovation suggested enables to decrease the frequency in developing failed sutures.

EFFECT: higher efficiency.

1 dwg

 

The invention relates to medicine, namely to surgery, and can be used for suturing wounds of the gastrointestinal tract and the formation of anastomoses between its parts.

As similar features of Keratoscope I.D. way double row boundary nodal intestinal suture (Semenov G.M., Petryshyn V.L., Kovshova was M.V. Surgical suture. - SPb: Peter, 2002. - S.162-163).

The disadvantages of this method are: stitches without taking into account the architectonics of lateral branches intramural intestinal vessels, circulatory disorders of the bowel wall along the line of sutures, education moderately expressed “fabric shaft, the rigidity of the lines of stitches, infection of closed cavities between the rows of stitches. These deficiencies contribute to the development of insolvency of the seams, which is a common cause of peritonitis, abscesses of the abdominal cavity and fistulas of the gastrointestinal tract.

As similar features A. Bira (A. Bier) way single-row anchor serous-muscular intestinal suture (Semenov G.M., Petryshyn V.L., Kovshova was M.V. Surgical suture. - SPb: Peter, 2002. - S-160).

The disadvantages of this method are: no hemostatic properties and the need to perform additional hemostasis, suturing without taking into account the architectonics of lateral branches intramural intestinal vessels, violation of kr is vosyliene the gut wall along the line of stitches, the lack of complete adaptation of the submucosal and mucosal membranes, insufficient mechanical strength, poor physical and biological Hermeticism. These drawbacks provoke the development of insolvency seams and, as a consequence, different forms of peritonitis and fistulas of the gastrointestinal tract.

The closest in technical essence to the proposed method is Pirogov N.I. way single-row anchor intestinal suture, including the regional flashing serous, muscular and submucosal layers of both walls of the intestinal wounds with the formation of the node to the serosa (Semenov G.M., Petryshyn V.L., Kovshova was M.V. Surgical suture. - SPb: Peter, 2002. - P.160-162).

There are General characteristics of this method intestinal suture with the stated method, which are expressed in the following:

the method used in the surgical treatment of injuries and diseases of the organs of the gastrointestinal tract;

the method includes flashing serous, muscular and submucosal layers of the intestinal wall;

the method involves forming a node on the serosa;

the method provides layer-by-layer adaptation of the walls of the stitching organs with the preservation of the casing structure;

the method involves providing sufficient physical integrity;

the method provides the healing of wounds and ANAS is Amosov primary intention.

However, the known method has some disadvantages, such as: insufficient biological integrity of the weld and circulatory disorders of the tissues of the colon on the line of sutures, as the stitches are made without regard to the architectonics of lateral branches intramural intestinal vessels.

These deficiencies are the basis for the development of insolvency of the seams and the resulting peritonitis and intestinal fistulas.

The task of the invention is the development of the method of single intestinal suture anchor having a high biological and mechanical strength.

The solution of this problem allows to reduce the incidence of insolvency of the seams, which is achieved serous-muscular-submucosal flashing each of the walls of the intestinal wounds in oblique with respect to the transverse axis of the intestine direction parallel to the lateral branches intramural intestinal vessels at an angle open towards the mesenteric edge of the ulcer. Thus vCal and Vicol stitches on the serosa of each subsequent weld produced on the same line with Vicolo and Colom stitches on the border of the submucosal and mucosal layers of the previous seam.

The drawing shows the General scheme of a single overlay node intestinal suture.

The method is as follows.

Produce vcol needle in a serous membrane (1 intestinal wall at a distance of 5-6 mm from the wound edges. The needle passes through the muscle (2) and submucosal layers (3) oblique with respect to the transverse axis of the intestine direction parallel to the lateral branches intramural intestinal vessels at an angle open towards the mesenteric edge of the ulcer. Vicol carried out in the edge of the wound on the border of the submucosal layer of the mucous membrane (4). Then perform vcol on the border of the mucosal and submucosal layer opposite edge of the wound and the needle is carried out in reverse order through the submucosal and muscle layers also at an angle open towards the mesenteric edge of the ulcer. Vicol needle carried out on the serous membrane at a distance of 5-6 mm from the wound edges. The next seam impose similar to the previous, with WCOL and Vicol stitches on the serosa produce in line with Vicolo and Colom stitches on the border of the submucosal and mucosal layers of the previous seam. The first suture is tied with the formation of the node to the serosa. Then put the third seam and tied the second. And so on until complete wound closure.

In the end, a line of single-row anchor intestinal sutures with the best preserved intramural intestinal blood flow and two cross levels of contact intestine submucosa and serosa, with serous level of each subsequent seam overlaps submucosal previous level. Above the PTO is you attach the suture line of high biological and mechanical strength.

The method studied in the experiment, and then used in the clinic in 16 patients. Complications associated with the technique of blending intestinal suture, is not marked.

Thus, the proposed method single intestinal suture anchor has a high biological and mechanical strength and can be recommended in a wide surgical practice.

The way single-row anchor intestinal suture, including the regional serous-muscular-submucosal flashing intestinal wounds and the formation of the node to the serosa, wherein each of the walls of the intestinal wounds stitch in oblique with respect to the transverse axis of the intestine direction parallel to the lateral branches intramural intestinal vessels at an angle open towards the mesenteric edge of the ulcer; vcol and Vicol stitches on the serosa of each subsequent weld produced on the same line with Vicolo and Colom stitches on the border of the submucosal and mucosal layers of the previous seam.



 

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