RU2192172C2 - Method for endoscopic omentoplasty of perforated gastroduodenal ulcers - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: one should conduct fibrogastroscopy. Catheter with loop-like ligature is inserted into abdominal cavity through perforated opening. Under videolaparoscopic control one should direct the strand of major omentum into ligature loop. The latter is tightened up. Omentum should be directed towards the edges of perforated opening. The latter is sealed. Ligature is tightened up and fixed to a nasal wing. The method enables to simplify omentoplasty of perforated gastroduodenal ulcer. EFFECT: higher efficiency. 2 dwg

Description

 The invention relates to medicine, in particular to the treatment of perforated gastroduodenal ulcers.

 Currently, the main treatment for perforated gastroduodenal ulcers is surgery. More than 30 methods of treating perforated gastroduodenal ulcers are known. Of these, perforation hole suturing, primary gastrectomy, vagotomy with ulcer excision and pyloroplasty, selective proximal vagotomy with perforation suturing (A. A. Shalimov, V. D. Saenko, Digestive tract surgery, Health, Kiev, 1987) were used. city, p. 567 [1]).

 Many methods are known for suturing a perforated duodenal ulcer. For the first time in the world, Miculiсz and Heussner perforated ulcers were sutured, and in Russia - R.Kh. Vanah.

 When suturing perforated holes, various sutures are used: purse-string, mattress, single-row, chain-shaped, etc. [1, part II, surgery of the stomach and duodenum, p. 153-374].

 With simple suturing, the edges of the hole are punctured with a needle and thread and pulled together, thus performing several seams. Since the edges of the perforated holes are infiltrated, when such joints are applied, they erupt, which creates the conditions for the formation of insolvency of the joints and the development of peritonitis.

 Known methods for suturing perforations using various additions in the form of an autoplastic material: walls of adjacent organs, omentum, round ligament of the liver, which cover the holes with subsequent suturing of its edges: tamponade with muscles, followed by suturing according to V.A. Krasintsev, suturing with plastic with an insulated gland according to S.M. Malinovsky; suturing with a uniform seam with an omentum according to D.M. Dolgatu; plastic serous-muscle flap of the stomach wall - L.V. Serebryannikov and V.P. Snezhkova; plastic with an isolated omentum and muscles - Yu.X. Petrova, plastic with an isolated omentum and parietal peritoneum - N.A. Kulichkov and other methods - [1, p. 228-232].

 However, an isolated omentum or other biological tissue, lacking nutrition, lengthens the healing time of the suture and can cause inflammatory processes.

 Known methods for suturing perforation of hollow organs using autoplastic material on the feeding leg; hemming of an omentum with additional tamponade with gauze - V.A. Oppel suturing with a mattress seam with plastic omentum - M.A. Kantorovich; plastic reinforced gland - A.B. Savchik [1, p. 231-232]. I.I. Neymark when suturing the edges of the perforated hole fixes the gland on the leg to the seam line. A.A. Shalimov and V.F. Saenko brings the edges of the perforation hole together (without screwing), then 2-3 rows of serous-muscular sutures are applied with 2-3 sutures and hem around the gland on the feeding leg. This method can lead to a narrowing of the pyloroduodenal canal. In addition, it is quite laborious with the laparoscopic method of suturing the perforated hole.

 For comparison with the claimed method of omentoplasty of perforated gastroduodenal ulcers, the method of suturing according to N.P. Polikarpov - suturing with tamponade with an omentum on a leg [1, p. 231-232]. According to this method, a lock of omentum on a leg is led to the perforated hole using a ligature, two strands of which suture the wall of the stomach or duodenum from only one side of the perforated hole from the inside to the outside. Then the ends of the ligature are tied, fixing a lock of the gland in the perforated hole and along the edges of the latter with separate interrupted sutures. However, with this method of suturing, inflammatory granulomas may develop around the ligature in the thickness of the stomach wall. In addition, this procedure is technically difficult to perform with laparoscopic suturing of perforated gastroduodenal ulcers.

 The present invention solves the problem of simplifying the process of omentoplasty of a perforated gastroduodenal ulcer by the endoscopic method, which eliminates the narrowing of the pyloroduodenal canal and inflammation around the suture material while achieving high tightness of the closed defect of the wall of the hollow organ.

 The task is achieved in that, according to the method of omentoplasty of perforated gastroduodenal ulcers with tamponade of perforated holes with autoplastic material on the feeding leg, fibrogastroscopy is performed sequentially through a perforated hole into the abdominal cavity through a biopsy channel of the catheter with a ligature in the form of a loop to a depth of 3-4 cm, removed fibrogastroduodenoscopy and under the control of video laparoscopy, they manipulate the insertion of a large omentum lock into the ligature loop, tighten the loop, let down Alnico on the stem to the edges of perforated holes which closes last plombiruya it tensioned ligature and in this position it is fixed to the wing of the nose of the patient, after the necessary time to remove the catheter ligature.

 The invention is illustrated in the drawings, which shows omentoplasty by the specified method (see Fig. 1, 2).

Here: 1 - perforated hole;
2 - a hollow organ (duodenum, stomach);
3 - autoplastic material on the supply leg (lock of stuffing box on the leg);
4 - catheter with a ligature;
5 - fibrogastroduodenoscope;
6 - ligature in the form of a loop;
7 - the abdominal cavity.

 The method of endoscopic omentoplasty of perforated duodenal ulcers is as follows.

 The patient undergo fibrogastroduodenoscopy, find an ulcer with a perforated hole. A catheter 4 with a ligature 6 made in the form of a loop with the subsequent removal of the endoscope is inserted through the biopsy channel of the fibrogastroduodenoscope 5 through the perforated hole 1 to the abdominal cavity 7 to a depth of 3-4 cm. Then, under the control of video laparoscopy, with the help of a manipulator, a strand of a large gland 3 is fed into the ligature loop 6, the ligature loop 6 is tightened around the gland 3. Next, the catheter 4 with the ligature 6 is pulled to the wall of the hollow organ. Pulling the catheter 4 down the stuffing box on the leg 3 to the edges of the perforated hole 1, filling it. A catheter 4 with a ligature is fixed in a stretched position to the wing of the nose of the patient. As a result, the perforated hole is securely closed (sealed) by a lock of a large gland. After reaching the required time, the ligature catheter is removed.

 Thus, the proposed method for filling a perforation hole is simple in technical design, does not lead to cicatricial changes in the pyloroduodenal canal, eliminates the need for suturing, provides the necessary tightness of a sealed defect, allows sealing if the ulcer is located on the upper wall of the duodenum, an area difficult to access for its laparoscopic suturing, which gives the right to apply the method along with the traditional (laparatomy) and with the endosurgical treatment option perforated gastroduodenal ulcers.

Claims (1)

 The method of endoscopic omentoplasty of perforated gastroduodenal ulcers with tamponade of the perforated hole with an autoplastic material on the feeding leg, characterized in that fibrogastroscopy is performed sequentially through the perforated hole into the abdominal cavity through a biopsy channel of the catheter with a ligature in the form of a loop to a depth of 3-4 cm, the phobododeno is removed under the control of video laparoscopy, they manipulate the insertion of a lock of the greater omentum into the ligature loop, tighten the loop, let the seals down the edges of the perforation holes, which closes the latter, plombiruya it tensioned ligature and in this position it is fixed to the wing of the nose of the patient, after the necessary time to remove the catheter ligature.

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