RU2246908C2 - Method for closing perforation gastric openings - Google Patents

Abstract

FIELD: medicine, surgery, oncology.

SUBSTANCE: one should mobilize a tumor-free gastric section being the nearest to perforation opening. Both perforation opening and tumor should be covered with a section of unaffected gastric wall. This section should be fixed in tension from three sides with interrupted sutures to healthy gastric tissues around the tumor. The method increases reliability of closing large perforations in case of irremovable tumor and improves life quality in oncological patients.

EFFECT: higher efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery.

There is a method of closing the perforation of the stomach according to the method, which consists in the fact that the perforated opening of the stomach is sutured with knotted sutures imposed in the direction transverse to the axis of the stomach. On top of these sutures, a second row of gray-serous interrupted sutures is also imposed, also in the transverse direction. (Abdominal surgery Imre Litman, Budapest, 1970, p. 189).

The disadvantage of this method is the impossibility of its use with severe infiltration of the stomach wall, as well as with perforation of the tumor.

Closest to the proposed is a method of closing the perforation of the stomach with an omentum. The adjacent part of the greater omentum is placed in the perforation hole and sewn with overwhelming, not tightly pulled seams around the hole to the wall of the stomach. (Operational surgery edited by I. Litman, Budapest, 1982, p. 426).

The disadvantage of this method is the impossibility of its use with huge, more than 3 cm perforations on top of an unremovable tumor with infiltrated edges, as well as in the absence or small size of the gland.

The technical result of the invention is the emergence of opportunities, as well as improving the reliability of closing large, more than 3 cm in diameter perforations of the wall of the stomach at the apex of his tumultuous tumor and improving the quality of life of cancer patients.

The technical result is achieved by mobilizing the stomach-free portion of the stomach adjacent to the perforation hole that is sufficient to cover the tumor, the perforation hole and the tumor are covered with a portion of the unaffected stomach wall, which is fixed in small tension from three sides with interrupted sutures to healthy stomach tissues around the tumor.

The method is as follows (drawing): the stomach-free portion of the stomach 1, sufficient to cover the tumor, is mobilized adjacent to the perforation hole, the perforation hole 2 and the tumor 3 are covered with a portion of the unaffected stomach wall 4, which is fixed in small tension from three sides with interrupted sutures 5 to healthy tissues of the stomach around the tumor.

Example.

Patient K., 47 years old, medical history No. 11900 \ 2, was admitted on November 25, 02 for the purpose of examination and planned surgical treatment. The condition of the patient 27.11.02 sharply worsened, the clinical picture of perforation of the stomach appeared. The diagnosis was made: cancer of the cardiac section of the stomach with a transition to the esophagus, liver, diaphragm, celiac trunk, metastases to the liver and abdominal lymph nodes, perforation of the stomach, peritonitis. An operation was performed on an emergency basis: plastic surgery of the perforated opening of the stomach with its bottom, sanitation and drainage of the abdominal cavity, Kader gastrostomy. 11/27/02.

A laparotomy was performed, a tumor of the cardial section of the stomach 10 × 12 cm was detected, passing to the esophagus, growing into the diaphragm and aorta, metastases to the liver. At the top of a motionless tumor, a perforated hole 3 × 4 cm in size, the edges of the hole are a decaying tumor. The greater omentum is not pronounced, inflamed, has multiple metastases. In the abdominal cavity a large amount of gastric contents. It is not possible to perform a radical operation, palliative removal of the tumor is also not possible due to its germination in the aorta, all known methods of suturing a perforated hole cannot be applied. The fundus of the stomach was mobilized in the area not affected by the tumor, the perforated hole and the tumor were covered by it and the site edges with nodal sutures with atraumatic thread on three sides, hemmed around the tumor to healthy tissues of the stomach, peritonization by the edge of the left lobe of the liver was made from above. In the antrum of the stomach, a gastrostomy according to Kader is superimposed, the abdominal cavity is sanitized, drained. The wound of the abdominal wall is sutured in layers tightly. Drainages removed on the fourth day. The postoperative course was complicated by leakage of gastric contents around the gastrostomy tube, after healing of the wound around the tube to stop leakage of fluid around it, the patient was discharged in satisfactory condition for treatment at the Oncology Center 11.1.03.

Using the proposed method allows the closure of perforated openings of the stomach, of a tumorous nature, as well as increasing the reliability of closing large - more than 3 cm in diameter perforations of the wall of the stomach at the top of its undecided tumor and improving the quality of life of cancer patients.

Claims (1)

The method of closing the perforated openings of the stomach in the presence of an underexposed tumor, characterized in that they mobilize the stomach-free portion of the stomach adjacent to the perforation hole, the perforation hole and the tumor are covered with a portion of the unaffected stomach wall, which is fixed in tension from three sides with interrupted sutures to healthy stomach tissues around the tumor .