RU2179410C2 - Method for preventing reflux esophagitis in performing surgical treatment of cardia ulcers - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out subtotal pylorus-retaining stomach resection with wedge-like ulcer excision. Valve is built on the excised ulcer place from mucous duplicature. EFFECT: enhanced effectiveness of treatment. 4 dwg

Description

 The invention relates to medicine, in particular to surgical gastroenterology, and can be used to prevent reflux esophagitis in case of gastrectomy with regard to cardia ulcers.

 In the surgical treatment of cardia ulcers, a high mobilization of the stomach is performed, accompanied by the destruction of all three components of the cardiac closure function: muscle, diaphragmatic, and valve (Gorbashko A.I., 1994; Zemlyanoy A.G., 1997), which results in 54% of the postoperative period patients to severe phenomena of reflux esophagitis, often requiring repeated surgical interventions (Gorbashko A.I., 1994).

 There is a method of surgical treatment of cardiac ulcers and prevention of reflux esophagitis by sagittal excision of an ulcer, tubular pyloric preservation of the stomach resection and correction of the cardiac closure function by Nissen fundoplication (Gorbashko A.I., 1994). However, the disadvantage of this method is the difficulty of performing an operation to prevent reflux esophagitis with localization of an ulcer near the esophagus, in addition, fundoplication by the Nissen method often gives pronounced strictures of the esophagus.

 The aim of the invention is to simplify and increase the effect of the method of prophylaxis of reflux esophagitis with resection of the stomach for cardia ulcers.

 This goal is achieved by the fact that according to the method of treating cardia ulcers and prophylaxis of reflux esophagitis by means of a tube-shaped saw-cutting resection with wedge-shaped excision of an ulcer, a valve is created from the mucous membrane.

 The method is as follows. The stomach is mobilized by subsidizing second-order vessels, preserving the main trunks of blood vessels, nerves and extraorgan anastomoses (Fig. 1). Then produce subtotal resection with preservation of the pyloric pulp (figure 2). After that, the ulcer of the cardia is wedge-shaped, the gastric mucosa is separated to the edges up to 1.5 cm on both sides (Fig. 3), the remaining serous-muscular wall is additionally excised by 0.5 cm and serous-muscular sutures are applied to the wound, without seizure being separated mucous membrane. In this case, a fold is formed from the duplicate of the mucosa, which closes the entrance to the esophagus in the form of a valve (Fig. 4). Then, the lesser curvature is sutured and a gastropylooroanastomosis is formed. We give a clinical observation.

 Patient T., 58 years old (source. Bol. 4096), was admitted to the hospital on 09/10/94 with complaints of aching pain in the left hypochondrium, belching with air, pain in the right iliac region, constipation up to 3-5 days. During the examination, a clinical diagnosis was made: Peptic ulcer. Chronic callous ulcer of the posterior wall of the cardiac section of the stomach, reflux esophagitis, delichosigma, diverticulum of the sieve colon. 1.10.94 g, the operation was performed: subtotal tubular resection of the stomach with preservation of the pyloric pulp. Resection of the sigmoid colon. During an operation on the posterior wall of the stomach, at the level of inflow into the stomach of the esophagus, ulcerative infiltration with penetration into the pancreas. The sigmoid colon forms an additional loop about 50 cm long. In the mesentery its multiple whitish deforming scars (mesosigmoiditis). An anterior gastrotomy was made in the body of the stomach. On the back of the stomach 5 ohms to the left of the esophagus there is an ulcer measuring 2.5 x 2.0 cm, depth up to 0.5 cm. Its bottom is gray, covered with fibrin. A wedge-shaped excision of the ulcer segment was performed for urgent histological examination, atypical cells were not detected. The stomach is mobilized along the greater curvature to the lower pole of the spleen. The stump of the right gastrointestinal artery is bandaged 1.5 cm proximal to the ciloric pulp. According to the lesser curvature, the stomach is mobilized along its wall from a level of 1.5 cm from the pyloric pulp to the esophagus and is crossed 2.0 cm above the pyloric pulp. In the zone of ulcer penetration, the posterior wall of the stomach is cut off from the pancreas, subtotal resection of the stomach is performed. The ulcer is excised in the form of a triangle. In a triangular wound, the mucous membrane is separated by 1.5 cm, the walls are excised to 0.5 cm, and sero-muscular sutures are applied to the defect according to Pirogov-Mateshuk. Then a gastro-pyloric anastomosis is formed. An additional loop of the sigmoid colon was mobilized and removed. Colonic continuity is restored by the application of an end-to-end anastomosis. In satisfactory condition, was discharged on October 31, 84 for outpatient treatment.

 During the follow-up examination one year after the operation (source bol. 5713), the condition is satisfactory, there are no complaints, it works. Endoscopically signs of reflux esophagitis detected. X-ray: barium suspension freely enters the stomach, evacuation from the stomach portioned, not broken, data for a sliding hernia of the esophageal opening of the diaphragm has not been identified.

 Thus, the proposed method for the prevention of reflux esophagitis with subtotal pyloric preserving gastric resection for cardia ulcers can not only reliably cure peptic ulcer and provide a physiological passage of food into the duodenum, but also exclude the development of persistent reflux esophagitis that occurs in the postoperative period during surgery treatment of this localization of ulcers, a fairly simple but reliable method.

Claims (1)

 A method for the prevention of reflux esophagitis in the surgical treatment of cardia ulcers by subtotal pylorus-saving gastrectomy with wedge-shaped excision of an ulcer, characterized in that a valve is formed from a duplicate of the mucosa at the site of the excised ulcer.

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