RU1816434C - Method of gastrostomy - Google Patents

Abstract

Usage: medicine, surgeons of the stomach and esophagus. The goal is to reduce the trauma of operations by simplifying the technique of creating the valve. The essence of the invention: they form a tube from the wall of the stomach along the large curvature in an isis- or anti-peristaltic manner. 3 purse string sutures are placed on the tube at a distance of 2-3 cm from each other, the first of them is at the end of the tube, then a gastric tube is inserted into the tube lumen, on which the first two sutures are tightened, then the second suture is immersed in the third so that the end of the tube protrudes no less than 0.5 cm above the level of the third seam, after which the latter is tightened and fixed to the tube wall. The tube is brought to the anterior abdominal wall and a lip-shaped fistula is formed. Positive effect: the method reduces the invasiveness of the operation, provides more reliable ostomy tightness in comparison with the prototype, simplifies the technique of creating the valve, and is accessible to all surgeons. 2 ill. ate with

Description

The invention relates to medicine, namely to surgery of the stomach and esophagus.

An object of the invention is to reduce the invasiveness of an operation by simplifying the technique for creating a valve.

 In FIG. 1 and 2 show a diagram of the implementation of the gastrostomy method.

The method is carried out as follows.

At the top of the stem tube, a stoma is formed (Fig. 1), around which a catgut (temporary) purse string suture (1) is applied, a rubber probe 94 is inserted into the lumen, the pouch is tied, after which a 2-3 cm spacing is applied, a second the catgut purse string suture (2), the pouch is tightened around the rubber probe (4), then a third silk suture (3) is applied at a distance of 2-3 cm from the second purse string suture (3), which is not tightened. In FIG. 2 shows the immersion (invagination) of the second cassette (2) with a rubber probe

(4) into the third purse string suture (3), so that the silk purse string suture (3) is 0.5 cm below the level of the first purse string suture (1), then the third silk suture (3) is tightened according to the size of the outer stoma and fix 4-6 gray-serous silk interrupted sutures to the stoma wall. The formed invaginated pedicle stoma is brought to the anterior abdominal wall in the left hypochondrium and fixed to the aponeurosis, after which the first (temporary) purse string suture (1) is removed, the stroma is sutured to the skin, creating a lip-shaped fistula. The rubber probe was removed for 3-4 days and inserted into the lumen of the stoma only during feeding. In the described manner, stomas can be cut out both iso-and antiperistaltically.

Example. Patient B., 57 years old. Diagnosis: cancer of the middle third of the thoracic esophagus with complete stenosis and cachexia (East. And cl.

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column TzNxMo. He imposed a gastrostomy. Operation progress: under general anesthesia by the upper midline incision, the abdominal cavity was opened, and then into the maxi wound. the stomach is brought out a little. In the region of the middle third of the stomach, a large curvature of 8 cm was mobilized. On the wall of the stomach in the region of mobilized large curvature with an interval of 2 cm, 2 silk holders are placed, between which on the front and rear walls of the stomach are the corresponding branches of the NLCA-60 apparatus at a small angle to the large curvature of the stomach with the formation of a cone 3 cm wide at the base, antiperistaltically. The mechanical seam line is covered by gray-serous nodular silk sutures with peritonization of the line at the base of the stem. An invagination stoma was formed in the following way: after opening the apex-stoma, a temporary catgut suture was inserted, a rubber probe with a diameter of 1.4 cm was inserted, the pouch was tightened and tied, a second catgut purse string suture was inserted 3 cm from it, and it was also tightened around a rubber probe, after which, a 3 cm spacing from the second purse string suture, a third silk seam is laid, which is tightened, a second purse string seam with a rubber probe is invaded into the lumen of this third purse string seam, so that the third silk seam is at 0 5 cm below ur ext first seam, then a third suture is tightened in accordance with the size of the probe and is fixed with four gray eeroznymi interrupted sutures to the wall of the stoma. The formed stoma is brought out through an additional 0

a cut in the left hypochondrium to the anterior wall and is fixed to anoneurosis and skin with the formation of a lip-shaped fistula. The shaving cavity is closed tightly. An aseptic dressing was placed on the wound, and around the fistula there was a dressing with glycerin. The rubber probe was removed on day 3 and was introduced only during feeding. Leakage of tightness. There was no maceration of the skin around the rtma.

A positive effect of the proposed method is to reduce the trauma by simplifying the technique of creating a valve. In addition, by proposing the 5th method, the stoma is more reliable than the Prototype method. The method is technically very simple to perform and available to all surgeons. F o-pi.rt u la; -u $ Gobretёn and Gastrostomy method, including the formation of a tube from the stomach wall along a large curvature; creating a valve along the tube; removing the latter to the anterior abdominal wall with the formation of a spongiform fistula , due to the fact that, in order to reduce injuries. operations by simplifying the technique of creating the valve, three purse string sutures are placed on the tube at a distance of 2-3 from each other, and the first one is placed on the end of the tube, then a gastric tube is inserted into the lumen of the tube, on which: the first two sutures are tightened, then the second seam is immersed in the third so that the end of the tube is at least 0.5 cm above the level of the third seam, after which the latter is tightened and fixed to the walls of the tube.

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