RU2242939C2 - Method for esophagoenteroplasty in case of gastric cancer and tumor-induced duodenal stenosis - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should perform palliative gastrectomy, cross small intestine at not less than 1 m against duodenojejunal curvature, apply adducting and abducting loops through mesenteric opening of cross-sectional colon, apply an esophago-small intestinal "end-to-end" anastomosis onto abducting loop, anastomose an "end-to-side" adducting loop to abducting one being 30 cm against an esophagoenteroanastomosis, suture up the loop being 50 cm against duodenojejunal curvature to peritoneum of anterior abdominal wall by forming an enterostoma, form an "end-to-side" duodenoenteroanastomosis being 30 cm against the enterostoma along the peristaltics, apply a "side-to-side" anastomosis being 5 cm against duodenojejunal curvature between both abducting and adducting intestinal loops. The method enables to drain the segment being above obstruction area.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, mainly to surgery, and may find application in oncology in the treatment of patients with gastric cancer with obstruction of the duodenum caused by a malignant tumor.

A known method of applying esophagoenteroanastomosis, in which the proximal end of the intestinal loop, extending from the esophageal - intestinal anastomosis, is connected with the stump of the duodenum. Food from the esophagus through the discharge loop of the small intestine enters the duodenum, and from there through the intestinal anastomosis into the intestine (Shalimov A.A., Saenko V.F. Digestive tract surgery. - Kiev: Health, 1987, pp. 284, 285, 286 )

The method has significant disadvantages.

It is not applicable for palliative gastrectomy in combination with duodenal stenosis due to a tumor, since it involves the transit of food masses through the duodenum.

As a prototype, we chose the method of Kirkuta - Urbanovich, which is as follows. After removal of the stomach, the small intestine and mesentery are intersected 15 cm below the duodenal - jejunal bend. The upper (leading) end of the intestine is passed through a window in the mesentery of the transverse colon and anastomose with the esophagus of the type "end to end". The lower (diverting) end of the crossed intestine is passed through a window in the mesentery of the transverse colon and anastomosed by the type “end to end” with the duodenum. At the intersection point of the loops, Brown entero-enteroanastomosis is applied.

The above method is also not without significant drawbacks:

1) the method involves anastomosing the stump of the duodenum with the leading loop of the small intestine against peristalsis.

2) the method does not create conditions for early enteral nutrition of patients bypassing the esophageal anastomosis zone.

3) considering the foregoing, the method is not applicable for tumor obstruction of the duodenum.

The aim of the present invention is the ability to drain a segment of the duodenum above the zone of obstruction into the small intestine.

This goal is achieved by the fact that the small intestine is crossed at least one meter from the duodenojejunal bend, the lead and discharge loop are passed through the hole in the mesentery of the transverse colon, an end-to-end esophageal-small bowel anastomosis is applied end-to-end to the outlet loop, leading the loop with anastomosis with an end-to-side outlet that is not less than thirty centimeters from the esophagoenteroanastomosis, about fifty centimeters from the duodenojejunal curve, a loop is sewn to the peritoneum of the anterior abdominal wall e, they form an enterostomy, at least thirty centimeters from the enterostomy along the peristalsis form an end-to-side posterior-sheath duodenojunal anastomosis, approximately five centimeters from the duodenojejunal bend impart a side-by-side anastomosis between the leading and outlet intestinal loops.

The invention "A method of esophagoenteroplasty for gastric cancer with tumor duodenal stenosis" is new, as it is unknown from the level of medicine, namely in surgery of the stomach and duodenum.

The novelty of the invention lies in the fact that the stump of the duodenum is sewn into the outlet loop of the end-to-side type, its segment is adequately drained above the obstruction zone; use a long segment of the leading loop of the intestine, do not deform and do not bend the graft used for esophagoenteroplasty.

In the available sources of information in Russia, the CIS and foreign countries, it was not possible to find a method similar to the proposed method for the formation of esophageojejunoanastomosis.

The invention "A method of esophagoenteroplasty for gastric cancer with duodenal stenosis caused by a tumor" is industrially applicable since it can be repeated many times in the surgical treatment of gastric cancer in surgical hospitals: oncology dispensaries, cancer research institutes.

The method is as follows.

The small intestine is crossed at least one meter from the duodenojejunal bend. The lead and lead loops are passed through the hole in the mesentery of the transverse colon.

Impose the end-to-end esophageal-enteric anastomosis (1) (FIG. 1) on the outlet loop (2). The leading loop is anastomosed with an end-to-side outlet at least thirty centimeters from esophagoenteroanastomosis (4). At least fifty centimeters from the duodenojejunal curve, a loop is sutured to the peritoneum of the anterior abdominal wall (6), forming an enterostomy (7). About thirty centimeters from the enterostomy along the peristalsis form an end-to-side duodenoenteroanastomosis (3). At least five centimeters from the duodenojejunal bend, an anastomosis is applied “side to side” between the lead and discharge loops of the intestine (5). Example:

Patient V-ev, 61 years old, medical history No. 15892/0, was admitted to the thoracoabdominal department of the Rostov Scientific Research Cancer Institute on 8.10.02 with a diagnosis of cardiac stomach cancer, art. III, gr. II, dysphagia 2 tbsp. T4N1MO. Histological analysis No. 462311 - cricoid cancer. After preoperative preparation 14.10.02 g under endotracheal anesthesia, a laparotomy was performed, during revision of the abdominal cavity revealed: a tumor of the cardiac section of the stomach, individual metastases to the paracardial lymph nodes. Performed gastrectomy, splenectomy, lymph node dissection according to R2. The small intestine is crossed at least one meter from the duodenojejunal bend, the leading and abduction loops are made through an opening in the mesentery of the transverse colon, the end-to-end esophageal-small intestine anastomosis is superimposed on the outlet loop, the leading loop is anastomosed from the outlet end-to-side at least thirty centimeters from esophagoenteroanastomosis, about fifty centimeters from the duodenojejunal bend, a loop is sewn to the peritoneum of the anterior abdominal wall, an enterostomy is formed, at least thirty imetrah from enterostomy downstream peristalsis formed duodenoenteroanastomoz "end-to-side", approximately five centimeters from duodenojejunal bending superimposed anastomosis "side to side" between the leading and removing loops intestine. Enterostomy removed in the left hypochondrium to the abdominal wall. The abdominal cavity is sutured, the anastomotic zone is drained. From the second day of the postoperative period, enteric nutrition of the patient was started on the enterostomy. On the 11th day, the enterostomy tube was removed. On the 12th day the patient was discharged in satisfactory condition home.

Technique - the economic efficiency of the method lies in the fact that patients with advanced gastric cancer with tumor obstruction of the duodenum, it becomes possible to perform palliative surgery, which consists in removing the tumor of the stomach, with the drainage of the segment of the duodenum above the obstruction, which will allow for early enteral nutrition and increase quality of life for patients.

Claims (1)

The method of esophagoenteroplasty in gastric cancer with duodenal stenosis caused by a tumor, which consists in palliative gastrectomy, formation of enterostomy, application of posterior-free esophageal-enteric and duodenojejunal anastomoses, characterized by the fact that there is less than one small intestine. the abduction loop through the hole in the mesentery of the transverse colon, impose an end-to-end esophageal-enteric anastomosis on the abduction loop , the leading loop is anastomosed with an end-to-side outlet 30 cm from the esophagoenteroanastomosis, 50 cm from the duodenojejunal curve, the loop is sutured to the peritoneum of the anterior abdominal wall, forming an enterostomy, 30 cm from the enterostomy along the peristalsis form the duodenoentero 5 cm from the duodenojejunal bend impose an anastomosis “side to side” between the leading and outlet loops of the intestine.