RU1782557C - Method for surgical treatment of complicated duodenal ulcers - Google Patents

Abstract

The invention relates to medicine, namely to abdominal surgery, can be used in the surgical treatment of complicated duodenal ulcers. The essence of the invention: dissection of the anterior wall of the duodenum above the ulcer, removal of the ulcer catheter from the lumen, excision along the perimeter of the mucous and muscle membranes, indent 3-4 m from the edge of the ulcer, isolation and fixation of the olysomuscular layers of the proximal and distal intestines above the ulcer , suturing the incision of the anterior wall of the intestine.

Description

The invention relates to medicine, namely to methods of surgical treatment of complicated chronic pyloric ulcer and duodenal ulcer.

A method is known for the surgical treatment of bleeding duodenal ulcers, including proximal selective vagotomy and isolation of the ulcer defect from the action of digestive enzymes in order to reduce postoperative complications due to reliable hemostasis by plugging the ulcer with a portion of the anterior duodenal wall. Then a two-row gastroduodenoanastomosis is created.

The disadvantages of this method are that the duodenal ulcer itself is not excised, the larger the ulcer diameter, the larger the area of the anterior duodenal wall that needs to be cut, and this in its

the turn will complicate the further imposition of gastroduodenoanastomosis.

A known method of surgical treatment of bleeding ulcers of the duodenum is that after duodenotomy in the area of the ulcer, circular stripes of the mucous membrane are cut out along the perimeter of the intestine, the width corresponding to the diameter of the ulcer, then the edges of the ulcer are sutured with U-shaped sutures with the capture of a bleeding vessel and using the same sutures, the ulcers cover the wall of the intestine devoid of the mucosa, then two rows of gray-serous sutures and a gastroenteroanastomosis are applied.

The disadvantages of this method are, firstly, that, as in the previous method, the duodenal ulcer itself is not excised, and secondly, the method involves stopping the passage of food through the duodenum, which method XI

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It impairs digestive function, and thirdly, due to the imposition of gastroenteroanastomosis, the risk of dumping syndrome, afferent loop syndrome and alkaline reflux gastritis is increased.

A method is known for the surgical treatment of bleeding duodenal ulcers, including stitching the stomach along a large curvature with the duodenum, followed by dissection of the large curvature of the stomach, pylorus and descending part of the duodenum. After that, a flap is cut out from the stomach or duodenum, which is then applied to the bleeding sound and fixed.

The disadvantages of this method are, firstly, that, as in the previous two methods, the very sound of the duodenal ulcer is not excised, and secondly, the dissection of the pylorus contributes to the occurrence of dumping syndrome, alkaline reflux gastritis, and thirdly Fixation of a flap of the stomach or duodenum to a bleeding ulcer can lead to a relapse of bleeding.

A known method for the surgical treatment of bleeding duodenal ulcers is that after performing a laparotomy and revision of the abdominal organs, in order to prevent recurrence of bleeding and shorten the healing time, the necrotic tissue of the ulcer is first removed, then the defect is filled with a layer of hemostatic a collagen sponge containing biological regeneration stimulants and on top cover a second layer of reinforced collagen.

The disadvantages of the method are that it can be used with relatively small ulcers, its use in case of bleeding from large callous ulcers can lead to a relapse of bleeding, in addition, the healing of the ulcer defect will be longer, the scar will be rougher. In connection with this, significant deformation of the duodenum is possible, up to the narrowing of its lumen.

There is also a known method for the treatment of acute gastroduodenal bleeding, selected by us as a prototype. According to the prototype method, the treatment is carried out as follows.

Selective proximal vagotomy, limited mobilization of the bulb from the side of lesser curvature with the first right gastric artery, and transverse dissection of the anterior, upper, and posterior walls of the duodenum are performed. Next, the intestine is excised and sutured in the transverse direction with a two-row suture, starting from its posterior wall.

The disadvantages of this method are, firstly, that in a number of cases it is necessary to band the right gastric artery, which cannot but affect the deterioration of blood circulation in the ulcer zone and duodenoplasty itself, and secondly, this method cannot be used for ulcers large sizes, since it is not possible to stitch the edges of the resulting defect after excision of the edges of the ulcer,

The aim of the invention is to reduce the number of relapses of bleeding, postoperative mortality and relapse of ulcer disease by removing the ulcer defect from the lumen of the duodenum.

The goal is achieved in that after opening the lumen of the duodenum along the perimeter, a section of the mucosa and muscle of the indentation is excised not less than 3-4 mm from the ulcer, the mucous and muscular layer of the proximal part of the duodenum is isolated, it is displaced until the defect is completely closed and fixed with the mucous-muscular layers of the distal part of the intestine.

The invention consists in dissecting the anterior wall of the duodenum above the ulcer, removing the ulcer crater beyond the digestive tract, for which a section of the mucous and muscular membranes of the indentation is cut along the perimeter not less than 3-4 mm from the ulcer, the mucous-muscular layer is secreted - the maximality of the part of the duodenum, they are displaced until the ulcer crater is completely closed and fixed with the mucous-muscular layers of the distal part of the intestine.

A method for the surgical treatment of bleeding duodenal ulcers is as follows. After laparotomy, revisions of the abdominal cavity organs, the anterior wall of the duodenum is dissected in the projection of the ulcer. A section of the mucous and muscle membranes is excised along the perimeter, an indentation of at least 3-4 mm from the edge of the ulcer. Bleeding from small vessels is stopped by diathermoelectrocoagulation. Bleeding vessels of the bottom of the ulcer are stitched with one or two eight-shaped lavsan or kapron sutures. The mucus-muscular layer of the proximal part of the duodenum is then isolated and fixed to the mucus-muscular layers of the distal part of the intestine with single lavsan (kapron) sutures with nodules outward. So

in this way, the bottom of the ulcer is outside the lumen of the duodenum. The wound of the anterior wall of the duodenum is sutured in layers. The operation is supplemented depending on the condition of the patient with selective proximal vagotomy. The abdominal cavity is sutured in layers.

PRI me R 1. Patient D., 48 years old, medical history No. 8643, was admitted for peptic ulcer of the duodenum complicated by bleeding. Operated at the height of bleeding. After laparotomy and revision of the abdominal cavity organs, a kallous ulcer of the posterior wall of the duodenum 2x2x1 cm in size was found, penetrating into the pancreas. Performed transversely by duodenotes above the ring. A section of the mucous and muscle membranes is indented 3 mm from the edge of the ulcer along the perimeter. The alveolar-muscular layer of the proximal part of the duodenum was isolated and fixed with the mucous-muscular layers of the distal part of the intestine by separate nodal lavsan sutures. The wound of the anterior wall of the duodenum is sutured with a two-row suture. The operation is complemented by selective proximal vagotomy. The abdominal cavity is drained, sutured in layers, tightly.

After 12 days, the patient was discharged in satisfactory condition from the ward. During the patient's stay in the hospital and for one month after the operation, no recurrence of bleeding was observed.

PRI me R 2. Patient K., 52 years old, history of disease No. 3693, was admitted for duodenal ulcer complicated by bleeding. Operated at the height of bleeding. After a laparotomy and revision of the abdominal cavity organs, a chronic, callous ulcer was found, located on the posterior wall of the duodenum, penetrating into the pancreas 3x2x1.5 cm in size. Transverse duodenotomy above the ulcer was performed. A section of the mucous and muscular membranes is excised along the perimeter by a 4 mm indent from the edge of the ulcer. The mucous-muscular layer of the proximal part of the duodenum was isolated and fixed with the mucous-muscular layers of the distal part of the intestine by separate nodular nylon sutures. The wound of the anterior wall of the duodenum is sutured with a two-row suture. The operation is complemented by selective proximal vagotomy. The abdominal cavity is drained, sutured in layers tightly.

After 14 days, the patient was discharged in satisfactory condition from the ward. During the patient's stay in the hospital and for 12 months after surgery, recurrence of bleeding was not observed.

The advantages of the claimed method for the surgical treatment of bleeding chronic duodenal ulcers is that this method can be used for large, callous, penetrating ulcers, when known surgical interventions cannot be applied. Removing the ulcer crater from the lumen of the gastrointestinal tract allows for more reliable hemostasis and to prevent recurrence of bleeding. The movement of the mucous-muscular layers provides greater strength compared to the movement of one mucosa and practically does not disrupt the blood supply to the tissues, and the comparison of the edges of the proximal part of the defect of the mucous and muscle layer with the mucous and muscular membrane of the distal part of the defect promotes faster healing of the edges of the defect, provides a natural passage food, the integrity of the pylorus, prevents the formation of a rough scar and does not deform the organ’s light, which is especially important for surgical Sheep bleeding from the duodenal ulcer, and can also be used for bleeding stomach ulcers.

All this helps to reduce mortality, the number of postoperative complications in patients operated on at the height of bleeding due to chronic duodenal ulcers.

The foregoing is confirmed by the preclinical test report attached to the application materials.

Claims (1)

The claims A method for the surgical treatment of complicated duodenal ulcers, including dissecting the anterior duodenal wall above the ulcer, removing the ulcer crater from the lumen by stratification of the intestinal wall, isolating and stitching the layers of the proximal and distal parts of the duodenum above the ulcer, suturing the incision of the anterior intestinal wall, characterized in that , in order to reduce the number of recurrent peptic ulcer, a section of the mucous and muscle membranes is excised along the perimeter, an indent of 3-4 mm from the ulcer, and then phy they mucus-muscular layers of the intestine with each other.