Method for applying suture upon parenchymatous organs

FIELD: medicine, surgery.

SUBSTANCE: one should apply a P-shaped suture, then it is necessary to form a V-shaped suture: one of the free ends of a ligature should be applied under the one that forms the top of letter P, then this ligature should be tightened and thrown over the wound as a Latin letter V. Then free ends of ligature should be tightened into the knot. The method enables to improve hemostasis and increase reliability of sutures.

EFFECT: higher efficiency.

3 dwg, 1 ex

 

The invention relates to medicine, namely to surgery, and can be used during operations on parenchymatous organs.

There are many ways suturing on parenchymatous organs.

Currently, the widely used two basic types of joints: Z-shaped and U-shaped, which is quite simple in execution, and for this reason widespread. However, the seams are not without drawbacks.

So, at the correct overlay widely known Z-shaped weld well enough gravitate towards the outer edges of the wound, at the same time deep the wound edges are not tight, which can lead to the formation of deep hematomas and abscesses.

Also widely known methods of blending the U-shaped seams.

Known, for example, "a Method of suturing deep and piercing wounds of the liver by applying the U-shaped seams" (As the USSR №1068111, publ. 23.01.1984 year).

There is a method of blending hemostatic suture when the wounds of the liver, including U-shaped seams (A.S. USSR №1491476, publ. 07.07.1989 year).

The closest selected as a prototype, is a method of suture on parenchymatous organs, including U-shaped seam, overlapping so that one surface of the liver produce one ucolo and Vicolo needle on each side, and the thread passes through the wound PE the Yeni (A.A. Shalimov. Surgery of the liver and biliary tract. Kiev: Health, 1993, s).

U-shaped seam at its correct application, well seals the deep layers of parenchymatous organ. However, the top edge of the wound turn inside out, thus remains an open wound surface from which the possible leakage of blood or bile. To avoid this, the surgeon is forced to lay on top of a U-shaped seam additional sealing seams, which increases the duration of the operation and leads to additional trauma to the body.

The task to be solved by the invention is to improve hemostasis and improving the reliability of the joint.

The solution is achieved by the known method suture on parenchymatous organs, including U-shaped seam, according to the invention after the application of a U-shaped seam form a V-shaped seam by summing up one of the loose ends of the thread under the thread forming the crossbar of the letter U, lifting her and throwing out through the wound in the form of the Latin letter V, then the two free ends of the thread draw the node.

New in the present invention is the formation of V-shaped seam, which combines the positive characteristics of the known U-shaped and Z-shaped seams, which solved the task.

The way the implementation of the is as follows.

Produce vcol needle thread from one of the edges of the wound, from the peritoneum. Then, having grasped the fabric of the body as deeply as possible under the wound, produce Vicol needle through the opposite edge of the wound in the opposite direction, then after 1.5-2 cm produce vcol needles from the same edge of the wound, through which were Vicol, and, accordingly, put the needle through the edge of the wound, through which previously was vcol.

Thus the U-shaped seam, the next step is the formation of V-shaped seam, which is illustrated by figure 1-3.

The needle together with dressed in her thread down under the thread, which forms a so-called crossbar of the letter "P" (figure 1), tighten it up and thrown through the wound in the form of the Latin letter "V" (figure 2), then the two free ends of the thread draw-node (figure 3).

From the description of this type of seam you can see that it combines the positive characteristics of both U-shaped and Z-shaped seams.

On the one hand, as with the U-shaped seam flattens deep wound edges, which eliminates the possibility of the formation of tissue hematomas and abscesses. On the other hand, you do not need to impose additional seam on the surface of the wound edges, since the V-shaped seam formed by the transmission of thread through the wound (as in Z-shaped seam) brings them tightly between the Oh, therefore not formed an open wound.

Example. Patient K., 19 years old, medical history No. 2917, was admitted to the Department of thoracic surgery №1 design Bureau No. 2, Tyumen 22.02.04, an hour after he inflicted knife wound in the left half of the chest. When applying the General condition of the patient is severe. The breath left moderately attenuated more in the lower sections. Pulse 110 beats per minute, BP - 90/50 mm Hg Abdomen is not swollen, painful in the upper sections. In the sixth intercostal space at the left parasternal line wound 2,5×0.5 cm During inspection of the wound channel is the last top to bottom, left to right, enters the pleural cavity, defined by a hole in the diaphragm. On the chest radiograph of fluid in the pleural cavity no easy straightened, the heart shadow is not extended. Produced drainage of the left pleural cavity silicone tube, stood out not more than 50 ml of blood.

The patient is raised into the operating room, where he made upper median laparotomy. In the abdominal cavity to 600 ml of blood. After draining the abdominal cavity produced its revision. On the left dome of the diaphragm wound 2×0.5 cm sutured interrupted sutures. On the diaphragmatic surface of the left lobe of the liver wound 2,5×1.0 cm, from which the stream of leaking red blood, stitched two V-shaped seams. While bleeding from the wound stopped, the edges of her well what about spectabilis. If further revisions found a perforating wound of the stomach, both wounds sutured double-row suture anchor. Other damage is not detected. Complete drainage silicone tubes obstructive and left subphrenic spaces. Operating the wound is stitched through all the layers.

The postoperative period was uneventful. Drainage tubes from the abdominal cavity were allocated small amount of serosanguineous discharge. Drainage from the abdominal cavity disposed in the second, and from the pleural cavity on the fifth day.

Abdominal ultrasound 01.03.04, the left lobe of the liver without visible pathology, ahogany the structure of its moderately heterogeneous in the wound, intrahepatic ducts are not expanded. Focal formations is not defined. Fluid in the abdominal cavity no.

Sutures were removed on the ninth day. In a satisfactory condition the patient was discharged to outpatient aftercare.

Method suture on parenchymatous organs, including U-shaped seam, characterized in that after applying a U-shaped seam form a V-shaped seam by summing up one of the loose ends of the thread under the thread forming the crossbar of the letter U, lifting her and throwing out through the wound in the form of the Latin letter V, then the two free ends of the thread draw the node.



 

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