RU2294170C1 - Method for making perforating gastroduodenal ulcer omentoplasty operation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing catheter with loop-shaped ligature into the abdominal cavity through perforation opening along fibrogastroduodenoscope biopsy canal. The perforated opening is closed with tampon manufactured from autoplastic material. The ligature is fixed. The loop-shaped ligature brought out with some indent from the abdominal cavity through additional counter-puncture and passed through draining tube before applying tampon. The tube is introduced into the abdominal cavity to perforation place along ligature into the abdominal cavity. Autoplastic material on feeding pedicle is introduced between two fibers of ligature loop and between the perforation opening and draining tube. The autoplastic material is tightened between the fibers by pulling the catheter and ligature until its contact to organ wall takes place at the perforation opening to fill the opening. The draining tube is pulled towards the autoplastic material uniformly pressing it the perforated opening. Catheter being removed, ligature ends are attached to gastroduodenal probe. Ligature loop is attached to the draining tube outside of the abdominal cavity. Tamponade is carried out with greater omentum strain on feeding pedicle in particular cases. The draining tube is perforated in particular cases for removing exudate from the abdominal cavity.

EFFECT: excluded pyloroduodenal canal stenosis and inflammation around the suture material; high quality of hollow organ defect sealing; reduced risk of traumatic complications.

3 cl, 3 dwg

Description

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

More than 30 methods of treating perforated gastroduodenal ulcers are known, and suturing perforated gastroduodenal ulcers is currently the most common surgical intervention. Of these, suturing of the perforated hole, primary resection of the stomach, vagotomy with suturing of the perforated hole were found (L.A. Shalimov, V.D. Saenko. Digestive tract surgery, Zdorovya, Kiev, 1987, p. 567) - [one].

Known methods for suturing perforated duodenal ulcers. 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 holes are punctured with a ligature needle and tightened, thereby performing several seams. Since the edges of the perforation holes are infiltrated, when such joints are applied, they erupt, which creates the conditions for the formation of inconsistency 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 according to V.A. Krasintsev, suturing with plastic with an isolated omentum according to S.M. Malinovsky, suturing a homogeneous suture with an omentum according to D.M. Dolgat, plastic by a serous-muscular flap of the stomach wall (L.V. Serebryannikov and V.P. Snezhkova. Plastic by an isolated omentum and parietal peritoneum. N.A. Kulichkov and other method ) - [1, str.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 perforations of hollow organs using autoplastic material on the feeding leg, hemming the omentum with extra tampon gauze (V.A. Oppel. Suturing with a mattress seam with plastic omentum. A.B.Savchik) - [1, p.231-232] .

N.P. Polikarpov proposed suturing perforation of hollow organs with tamponade of the omentum on the leg [1, pp. 231-232]. According to this method, a lock of omentum on a leg is brought to the perforated hole using a ligature, two threads of which suture the wall of the stomach or duodenum from only one side of the perforated hole “from inside to 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.

For comparison with the claimed method of omentoplasty perforated gastroduodenal ulcers taken "Method of endoscopic omentoplasty perforated gastroduodenal ulcers" according to the patent of the Russian Federation No. 2192172, IPC 7 A 61 B 17/00, publ. January 23, 2001 - [2]. According to this prototype method, the patient undergo fibrogastroduodenoscopy, find an ulcer with a perforated hole. A catheter with a ligature, made in the form of a loop with the subsequent removal of the endoscope, is inserted through the biopsy channel of the fibrogastroduodenoscope through a perforated hole into the abdominal cavity to a depth of 3-4 cm. Then, under the control of video laparoscopy, a strand of a large omentum is fed into the ligature loop using a manipulator, and the ligature loop is tightened around the omentum. Next, the ligature catheter is pulled to the wall of the hollow organ. Pulling the catheter down the gland on the leg to the edges of the perforated hole, filling it. A catheter with a ligature is fixed in a stretched position to the wing of the nose of the patient, after reaching the required time, the catheter with a ligature is removed.

The disadvantages of the existing method are:

- the effect of the ligature on the lock of the stuffing box is such that it leads to a decrease in nutrition of the stuffing box section, which is above the loop;

- the lack of drainage of the abdominal cavity directly at the site of inflammation can lead to leakage of peritoneal exudate, and subsequently to the abscess of the abdominal cavity.

The technical result to which the invention is directed is to improve the omentoplasty process of perforated gastroduodenal ulcer endoscopically, to exclude narrowing of the pyloroduodenal canal and inflammation around the suture material while simultaneously achieving high mechanical tightness of the closed defect of the wall of the hollow organ, and also to reduce trauma when removing the ligature and the exclusion of possible complications.

The technical result is achieved by the fact that in the method of endoscopic omentoplasty of perforated gastroduodenal ulcers, including passing through a biopsy channel of a fibrogastroduodenoscope through a perforated hole into the abdominal cavity of the catheter with a ligature in the form of a loop, tamponade of the perforated hole with an autoplastic material on the ligature of the ligament is removed after removal that prior to the tamponade of the perforated hole, the ligature loop is controlled by a laparoscope t through the perforated hole from the abdominal cavity through additional contraperture and passed into the drainage tube indented from its working end, the tube is ligated into the abdominal cavity to the perforation place, after which autoplastic material is introduced between the two threads of the ligature loop and between the perforated hole and the drainage tube on the feeding leg, pulling the catheter with the ligature pull it up to touch the organ wall in place of the perforated hole, filling it, while the drainage tube pulls up they are attached to the autoplastic material, uniformly pressing it to the perforated hole, after removal of the catheter, the ligature ends are fixed to the gastroduodenal probe indented from its working end, and the ligature loop is fixed to the drainage tube outside the abdominal cavity. The tamponade is driven by a strand of a large omentum on a feeding leg. The drainage tube has openings for removing exudate from the abdominal cavity.

The invention is illustrated in figures 1-3, which presents omentoplasty by the present method. Here; 1 - perforated hole; 2 - ligature in the form of a loop; 3 - hollow organ (duodenum, stomach); 4 - autoplastic material on the supply leg; 5 - polyethylene catheter; 6 - biopsy channel of a fibrogastroduodenoscope; 7 - drainage tube with a ligature loop; 8 - gastric (gastroduodenal) tube.

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

A patient undergoes fibrogastroduodenoscopy and an ulcer with a perforated opening 1 is found. A catheter 5 with a ligature 2 in the form of a loop is passed through a biopsy channel 6 of a fibrogastroduodenoscopy through a perforated hole 1 into the abdominal cavity. Then the fibrogastroduodenoscopy is removed, the ligature loop under the control of laparoscopy is removed from the abdominal cavity through an additional contraperture.

Outside (outside the abdominal cavity), a loop is passed inside the drainage tube 7 with an indentation of 3-4 cm from its working end, this drainage tube 7 is introduced into the abdominal cavity through a loop to the perforation site. Between two threads located between the perforated hole 1 and the drainage tube 7, a strand of a large oil seal 4 is inserted on the supply leg. Sipping catheter 5 with ligature 2 tighten the seal between the two threads. Pull the stuffing box 4 and at the same time the drainage tube 7 until it contacts the wall of the organ 3 (duodenum or stomach) in place of the perforated hole 1, filling it. Next, the catheter 5 is removed from the gastrointestinal tract, and the ends of the ligature 2 are fixed to the gastroduodenal probe 8 with a 2-3 cm indent from its working end, which is inserted into the organ 3 along the loop ligature until it touches the wall to evacuate the gastrointestinal contents from the cavity of the diseased organ. Next, the remaining ligature loop emerging from the drainage of the abdominal cavity is fixed to the surface of the drainage tube 7 outside (outside the abdominal cavity). This manipulation is carried out under the control of a laparoscope in order to verify the tightness. The final stage of the operation is the abdominal sanitation, if necessary, and layer-by-layer suturing of wounds after removal of the manipulators.

Thus, the proposed method for endoscopic omentoplasty of the perforated 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 the sealed defect, allows filling when the ulcer is located on the upper wall of the duodenum, an area difficult to access laparoscopic suturing, which gives the right to apply this method along with traditional (laparotomy) and with en ohirurgicheskom embodiment treatment perforated gastroduodenal ulcers.

Claims (3)

1. The method of endoscopic omentoplasty of perforated gastroduodenal ulcers, including passing through a biopsy channel of a fibrogastroduodenoscope through a perforated hole into the abdominal cavity of the catheter with a ligature in the form of a loop, tamponade of the perforated hole with an autoplastic material on the supply leg after removal of the lipogastroduodenoscopy fibrogastroduodenoscope, perforation holes ligature loop under the control of a laparoscope is removed through the perforation hole from the abdominal the cavities through additional contraperture and pass into the drainage tube indented from its working end, the ligature tube is inserted into the abdominal cavity to the perforation site, after which autoplastic material is introduced between the two threads of the ligature loop and between the perforated hole and the drainage tube by pulling the catheter with a ligature pull it up to contact with the organ wall in place of the perforated hole, filling it, while the drainage tube is pulled to the autoplastic material, equal to Pressing it firmly to the perforated hole, after removal of the catheter, the ligature ends are fixed to the gastroduodenal probe indented from its working end, and the ligature loop is fixed to the drainage tube outside the abdominal cavity. 2. The method according to claim 1, characterized in that the tamponade is led by a strand of a large omentum on the supply leg. 3. The method according to claim 1, characterized in that the drainage tube has openings for removing exudate from the abdominal cavity.

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