Перфорація стравоходу у тварин та методи їх лікування (клінічний випадок)

Abstract

У клінічному випадку наведені дані щодо методики оперативного доступу до відкритих пошкоджень стравоходу та застосування еластичної полімерної трубки під час хірургічного лікування тварин, яку вводили у порожнину стравоходу через рановий отвір у краніальному напрямку, що значно покращувало умови візуалізації трубчастої будови пошкодженого органу та сприяло зручності пошарового накладання міцних, герметичних швів. На підставі клінічних досліджень у післяопераційний період доведена ефективність застосованої методики хірургічного лікування тварин за перфорації стравоходу.

The purpose of the work was to research the etiological factors of perforation of esophagus, the clinical condition of animals, and also to perform a technique for surgical intervention to restore the function of the esophagus. The technique of operative access and the imposition of strong, airtight sutures was developed to contribute to the restoration of the esophagus function. The investigation object was three goats with bitten lacerations complicated by perforation of the esophagus in the cranioventral part of the neck, a horse with perforation of the esophagus in the middle part of the neck. The operating field in animals with damage of esophagus was prepared taking into account mechanical and chemical antiseptics, and local infiltration anesthesia was performed. The necrotic edges of the wounds excised, the skin dissected by 12-15 cm, and the neck muscles moved and separated in relation to each other, fixed with wound hooks and provided access to the perforated section of the esophagus. On the detected defects of the esophagus a polymer tube inserted into the cavity of the esophageal tube through the wound openings in the cranial direction until it exited the oral cavity by 10-15 cm, and then along the esophagus, than shifted towards the stomach. Thus, we obtained such a configuration and clear contours of the esophagus, which would facilitate the possibility of controlling the layer-by-layer application of surgical sutures and closing the perforation of the esophageal walls. The first level of Schmiden sutures applied to the mucous and muscle layers. Subsequently, for reliability three intermittent knotted seams imposed on the same layers. The second floor of the sutures – intermittent knotty was placed on the muscles and the adventitious layer of the esophagus (polymer suture material No. 4-6). Thus, a hermetic closure of the perforated defects of the esophagus was achieved. The wound was treated with antibacterial drugs and, first, an interrupted knotted suture was placed on the muscles and then on the muscles and skin. The resin tube removed through the oral cavity. In the postoperative period the neck was restricted in movement by applying wooden corsets for 5-6 days. The wound was treated with antibacterial drugs for 7 days. Feeding was carried out with chopped food, watering in small doses for two weeks. Regeneration of the operating wounds took place without complications due to primary intention. In 6-8 weeks after surgery the clinical condition of the animals was within normal limits, the animals were fed normally.