THE USING OF STEPPES IN ANTERIOR AND LOW ANTERIOR RESECTIONS OF RECTUM
Azerbaijan Medical University, Baku, AZERBAIJAN
The using of steppes is simplifies the course of the operation in anterior and low anterior resections of rectum with derivatives with tumor origins and prevents the spreading of tumor cells into the abdominal cavity.We consider that using of intraluminar,lineor and contour type of steppes in anterior and low anterior resections of rectum are more expedient.Research were included 37 patients wich were anterior and low anterior resections.Among 20 patients operation were laparoscopic and among 30 were by open way.In patients which were low anterior resection were used contour type steppes and in patients which were laparoscopic anterior resection were used lineor steppes.We were used 55mm length linear steppes among 6 patients,75 mm length among 12 patients (2 patient were laparoscopic) and 100mm length among 2 patients.Also among 7 patients the proximal tip of intestine was sew with lineor steppes.At this time 3 anastomosis were after low anterior resection and 4 anastomosis were after anterior resection.All of this anastomosis were side-tip type.When we used linear steppes there wasnít opening of sewing linea. Itís impossible to close of the distal tip of intestine by hand in the depth of small pelvis during the low anterior resection.There is only one way to prevent this and the spreading of tumor cells to the surrounding tissues.This way is to use the contour steppes. There hasnít been used contour steppes only in 1 patient.Among other 17 patients were used this type of steppes.We were used contour steppes length 45mm.The intraluminar circular steppes are using for the end to end,side-tip and side by side anastomosis.Itís impossible to bring to the end either open or laparoscopic operations without this type of steppes.We were used 31mm length intramural steppes among 2 patients,29mm length among 18 patients (2 patients were laparoscopic),33mm length among 9 patients and 34mm length among 3 patients.In 5 patients the anastomosis were type of end to end by hand. When you are anastomosing with intraluminar steppes youíll need to pay attention that intestinal ring are whole.There were doubts of integrity of rings only among 3 patients.During the pneumopressymetry it was noted that among 3 patients anastomosis were tear off totally or partly.In all causes the operations were bring to the end with putting of iliostomy. So,the using of linear,contour and intraluminar steppes in common in the anterior and low anterior resections of rectum is reduces the time of operation.Also it affects to procedures wich is impossible by hand and protects ablastica wich affects to the results of treatment.
Date: 2014-12-28; view: 173