RU2577234C1 - Method of performing gastrectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and surgery. After gastrectomy for gastric cancer formed oesophageal-intestinal anastomosis. At switched off at Control loop formed ventracolonic antireflux sleeve-like esophagoenterostomy of Bondar type. At a distance from a side-to-side anastomosis esophagoenterostomy between blind and outlet ends of loop.

EFFECT: method simplifies and reduces injuries corrective surgery, increases antireflux properties of oesophageal-intestinal anastomosis due to reduction of pressure gradient within esophagoenterostomosis.

1 cl, 1 ex, 1 dwg

Description

The invention relates to abdominal surgery and can be used in the treatment of gastric cancer.

Terms used in the description of the invention.

Gastrectomy - complete removal of the stomach with the application of anastomosis.

Anastomosis is a junction between something.

Enteroenteroanastomosis - an anastomosis between the hollow organs or vessels.

Esophago ... is an integral part of complex words, meaning "related to the esophagus."

When performing a gastrectomy, an esophageal-intestinal anastomosis is usually formed between the esophagus and the loop of the jejunum, followed by the formation of an intestinal anastomosis. The disadvantages of such methods are:

- shutting down the duodenum from the digestion process, which can lead to the development of severe biliary dyskinesia;

- loss of reservoir functions of the removed stomach significantly worsens the condition of patients, leading to the development of dumping syndrome.

As an example of the above methods, you can cite the "Method of forming an artificial stomach", known from patent RU 2445018 C2, IPC A61B 17/00, publ. 03/20/2012, in which, after removal of the stomach, an esophageal-intestinal anastomosis is formed between the esophagus and the discharge loop of the jejunum, as well as a reservoir from the small intestine.

For the prototype of the claimed invention, a method of forming an esophageal-enteric anastomosis, known from patent RU 2437623 C2, IPC A61B 17/11, publ. 12/27/2011, In the prototype method, the leading and outgoing bowel sections of the adjacent sleeve are cut equal to its two diameters, the end of the esophagus is sewn with the adjacent edges of the open loops in the upper section with interrupted sutures, after which a valve is created by suturing the edges of the dissected small intestine from above. the size of the diameter of the esophageal opening, then a mucous-serous continuous suture of the small intestine is placed below the formed esophageal-intestinal anastomosis, a reservoir is formed in the form of a ring-shaped loop of the small intestine by dix mezhkishechnogo side to side anastomosis between a leading end of the displaced sutured small intestine and outlet lumen of the small intestine and the resulting loop formed below the valve, and a reservoir formed anastomose the duodenum by superimposing duodenojejunal end to side anastomosis. The result of the operation performed in accordance with the prototype is the formation of two reservoirs - a longitudinal, replacing the distant stomach, and an annular, shunting longitudinal reservoir.

The advantages of the prototype are areflux and an increased degree of compensation of the reservoir function of the removed stomach by the jejunum, thereby significantly improving the quality of life of patients after surgery.

The disadvantages of the prototype are the increased complexity and increased invasiveness of execution. The increased complexity of the execution lies in the formation of a larger number of anastomoses (additional anastomosis between the adductor and outlet loops of the small intestine and duodenojejunal anastomosis). In addition, a long inter-intestinal anastomosis, from which a jejunum reservoir is formed between the esophageal-intestinal and jejunum-duodenal anastomoses, is less reliable due to the increase in the number of sutures.

The objective of the invention is to provide a simple, reliable way to perform gastrectomy, characterized by areflux and an increased degree of compensation of the reservoir function of the removed stomach by the jejunum with reduced morbidity of execution.

The technical results to which the claimed invention is directed are to reduce the morbidity of gastrectomy and increase the degree of compensation of the reservoir function of the removed stomach by the jejunum.

These technical results can be obtained in a method for performing gastrectomy, in which, after removal of the stomach, an esophageal-intestinal anastomosis is formed between the esophagus and the loop of the jejunum.

Technical results are achieved by the fact that on the loop disconnected along the RU, at a distance of about 15 cm from the enteroenteroanastomosis, an anterior-reflux Areflux muft-shaped esophagoenteroanastomosis according to the Cooper type is formed, after which at least 12 centimeters from the esophageal-intestinal anastomosis form the anastomosis between the lateral and lateral anastomoses loop ends.

Simplicity, reliability and reduced morbidity of the proposed method are provided by reducing the number of anastomoses and the small length of the anastomoses themselves.

The invention is illustrated by the following drawing.

Figure 1 shows the result of a gastrectomy in accordance with the proposed method. The positions in figure 1 are indicated:

1 - esophagus;

2 - esophagoenteroanastomosis;

3 - enteroenteroanastomosis (additional);

4 - transverse colon;

5 - enteroenteroanastomosis;

6 - a stump of the duodenum.

The arrows in Figure 1 show the direction of food movement.

To implement the invention perform the following sequence of actions. The stomach is mobilized by small and large curvature (with both epiploons), and the right and left gastrointestinal arteries and veins are bandaged. The initial section of the duodenum is mobilized, cellulose with lymph nodes is removed from the area of the hepatoduodenal ligament, the common hepatic and splenic arteries. The duodenum is stitched with a mechanical suture, transected, its stump is immersed with two half-mesh sutures. Separately bandage and suppress the left gastric vein and artery. Continue to mobilize the stomach along the greater and lesser curvature to the abdominal esophagus. Perform a vagotomy. The stomach is cut off from the esophagus and removed. At a distance of about thirty centimeters from the ligament of the Traits, the small intestine is crossed. A clutch is formed from the distal loop of the small intestine, which is supplied to the esophagus anteriorly. An esophageal-intestinal anastomosis of the Cooper type is applied. Then enteroenteroanastomosis is applied side by side between the proximal part of the small intestine and the discharge loop of the small intestine at a distance of about 15 centimeters from esophagoenteroranastomosis (according to Ru). At the end of the method, an additional enteroenteroanstomosis is formed side to side between the outlet and adductor loops of the small intestine at a distance of about 12 centimeters from esophagoenteroranastomosis.

An example of clinical performance.

Patient S., 59 years old, was admitted to the hospital on 05/20/2013 with a diagnosis of gastric cancer. When fibrogastroduodenoscopy revealed a tumor of the body of the stomach, an infiltrative-ulcerative form. 05/29/2013, the upper middle laparotomy was performed. During the audit, distant metastases were not detected. In the middle third of the body of the stomach, a tumor of up to 6 centimeters, germinating serosa, is determined by the large curvature with the transition to the front and rear walls. The tumor infiltrates the gastrointestinal ligament up to the spleen. It was decided to perform a gastrectomy, splenectomy. Mobilization of the stomach along the greater and lesser curvatures with both epiploons. The initial section of the duodenum was mobilized. Cellulose with lymph nodes was removed from the common hepatic, splenic, left gastric arteries of the celiac trunk. The duodenum is stitched with a mechanical suture, crossed, its stump is immersed with two half-sutured sutures. The mobilization of the stomach along the greater and lesser curvatures to the esophagus was continued. Mobilized spleen. A G-clamp is applied to the esophagus, the esophagus is nipped. A gastrectomy was performed in a single block with the spleen. A small intestine is crossed at a distance of 30 centimeters from the ligament of Trent. A clutch is formed from the distal loop of the small intestine, which is connected to the esophagus anteriorly. An esophageal-intestinal anastomosis of the Cooper type was applied. Then, enteroenteroanastomosis was applied side to side between the proximal part of the small intestine and the discharge loop of the small intestine at a distance of about 15 centimeters from esophagoenteroanastomosis (according to Ru). Formed additional enteroenteroanastomosis side to side between the outlet and adductor loops of the small intestine at a distance of 12 centimeters from esophagoenteroanastomosis.

Claims (1)

A method of performing a gastrectomy, including the formation of an esophageal-intestinal anastomosis between the esophagus and the loop of the jejunum, characterized in that an anterior-reflux arefuco-shaped esophagoenteroanastomosis is formed anteriorly after a distance of about 12 cm from the loop along a loop disconnected along the Roux at a distance of about 15 cm from the enteroenteroanastomosis esophageal-intestinal anastomosis form an anastomosis "side to side" between the blind and the outlet ends of the loop.

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