RU2254067C1 - Method for developing pancreatogastroanastomosis with antiperistaltic insertion - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with treating patients with the tumor of caput pancreas: one should mobilize a full-layer fragment out of the greater curvature of stomach for the height of pancreatic stump along anterior and posterior walls, form a tubular transplant by suturing anterior and posterior walls of the fragment, rotate the fragment for the angle of 90° counterclockwise, suture in the section of pancreatic stump into its distal end and suture in fragment's proximal end into gastric stump. The method enables to form isolated pancreatogastroanastomosis in case of pancreatoduodenal resections in patients with "lesser" stomach and, also, in case of pancreatoduodenal resections after earlier performed gastric resection.

EFFECT: higher efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, mainly to oncology, and may find application in the treatment of patients with pancreatic cancer and 12 duodenal ulcer.

There is a method of applying pacreatogastroanastomosis in which the pancreatic stump is sutured into the submucosal layer of the incised posterior wall of the stomach, and the stump of the pancreatic duct is immersed in the lumen of the stomach on a plastic drainage through a puncture of the mucous membrane of the gastric wall (Makokha N.S., Nikitchenko S.A. Surgery , No. 1, 1968, p. 55, 56, 57, 58, 59).

The method has significant disadvantages.

With this method, early scarring of the anastomosis occurs between the duct of the pancreas and the gastric mucosa. Perhaps the development in the postoperative period of abscesses between the wall of the stomach and pancreas.

As a prototype, we selected a method for the formation of pancreaticogastroanastomosis, in which the stump of the pancreas is mobilized for 1 cm from the edge of the resection, the anterior semicircle of the pancreatic stump along the resection line is fixed to the serosa of the posterior wall of the stomach with separate interrupted sutures, and a hole in the posterior wall of the stomach corresponding to the diameter of the lumen of the main pancreatic duct, an anastomosis is formed on the catheter between the pancreatic duct and the hole in the wall of the stomach GOVERNMENTAL seams exciting wall duct and sero-muscular layer of the gastric wall fixed rear semicircular stump pancreatic gastric serosa to separate interrupted sutures (VY Kosirev Avtoriferat thesis for a candidate degree of Medical Sciences, Moscow, 2001 YG).

The above method is also not without significant drawbacks:

1) the method does not provide for mechanical protection of the pancreatic stump from gastric contents;

2) with a "small" stomach, tension occurs when pulling the posterior wall of the stomach stump to the pancreatic stump;

3) with pancreatoduodenal resection after previous resections of the stomach, it is also not possible to anastomose the stump of the gland with the posterior wall of the stomach without tension;

4) there is an early scarring of the anastomosis between the pancreatic duct and the wall of the stomach;

5) with a loose type of structure of the duct system of the pancreas, it is not possible to isolate the duct of the gland in isolation for suturing into the stomach.

The aim of the present invention is the possibility of forming an isolated pancreaticogastroanastomosis in pancreatoduodenal resections in patients with a small stomach, as well as in pancreatoduodenal resections after previously performed resections of the stomach.

This goal is achieved by the fact that from the large curvature of the stomach on the left gastrointestinal vessels, a full-layer flap is mobilized, departing from the edge of the greater curvature to the height of the pancreatic stump along the front and rear walls, a tubular graft is formed, stitching the front and back walls of the flap, the flap is deployed onto 90 ° counterclockwise, stitching in the distal end a section of a stump of the pancreas, the proximal end of the flap is sutured into the stump of the stomach.

The invention "A method of forming pancreaticogastroanastomosis with an antiperistaltic insert" is new, since it is not known from the level of medicine, namely in surgery of the stomach and pancreas.

The novelty of the invention lies in the fact that the pancreatic stump is sutured into an isolated antiperistaltic insert formed from the greater curvature of the stomach on the left gastrointestinal vessels that feed it.

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

The invention "The method of forming pancreaticogastroanastomosis with an antiperistaltic insert is industrially applicable, as it can be repeated many times during the surgical treatment of pancreatic cancer in surgical hospitals, especially oncology centers: oncology dispensaries, oncology research institutes.

The method is as follows (see drawing).

They retreat 4 cm proximally from the distal edge of the crossed stomach (1). Cross the right gastrointestinal vessels (2). From the large curvature of the stomach, a 5 cm long full-length flap is mobilized on the left gastrointestinal vessels (3). Retreating from the edge of great curvature to the height of the stump of the pancreas along the anterior and posterior wall. A tubular graft is formed by suturing the front and back walls of the flap with a two-row interrupted suture (4). The flap is turned 90 ° counterclockwise, stitching in the distal end a section of the pancreatic stump, the proximal end of the flap is sutured into the stomach stump with a two-row interrupted suture.

Example.

Patient A-s, 60 years old, medical history No. 15791/0, was admitted to the thoracoabdominal department of the Rostov Cancer Research Institute on 04/18/03 with a diagnosis of pancreatic head cancer St I, column 2. T2N0M0. Earlier, in 1983, a patient had a resection of 2/3 of the stomach according to B-II for ulcers of the output section of the stomach. 04/22/03, under endotracheal anesthesia, a laparotomy was performed, during revision of the abdominal cavity it was revealed: the state after distal resection of the stomach, a tumor of the head of the pancreas 1.5 × 1.0 cm, no distant metastases. Performed pancreatoduodenal resection. Departing 4 cm proximally from the distal edge of the crossed stomach, we crossed the right gastro-omental vessels, from the large curvature of the stomach on the left gastro-omental vessels, a 5-cm full-layer flap was mobilized, retreating from the edge of the large curvature to the height of the pancreatic stump along the anterior and posterior wall formed a tubular graft, stitching the front and back walls of the flap with a two-row interrupted suture, the flap is rotated 90 ° counterclockwise and a section of the pancreas stump is sewn into the distal end, the proximal end of the flap is sewn into the stump of the stomach with a double-row interrupted suture. The abdominal cavity is sutured, the anastomotic zone is drained. Drainage removed on the 14th day. On the 21st day the patient was discharged in a satisfactory condition home.

The technical and economic efficiency of the method lies in the fact that in patients with pancreatic head cancer with a "small" stomach, as well as after previous resections of the stomach, it is possible to form an isolated pancreatogastroanastomosis, which will reduce the frequency of postoperative complications and improve the quality of life of patients.

Claims (1)

A method of forming pancreatogastroanastomosis with an insert during pancreatoduodenal resection after a previous resection of the stomach, characterized in that a full-layer flap is mobilized from the large curvature of the stomach on the left gastrointestinal vessels, the pancreatic stump is retreated from the edge of the large curvature of the stomach, the anterior and posterior walls are formed a tubular graft, stitching the front and back walls of the flap, the flap is turned 90 ° counterclockwise, the stump section is sewn into its distal end along the pancreas, the proximal end of the flap is sutured into the stump of the stomach.