SU1158171A1 - Method of treatment of duodenal hemorrhagic ulcer - Google Patents

Abstract

METHOD FOR TREATING duodenal bleeding ulcers comprising duodenotomiyu, hemostasis, vagotomy, draining the stomach operation, characterized in that in order to prevent recurrence of bleeding, hemostasis is accomplished by suturing to the free portion zve omentum, then gradually invaginate over gland edges duodenotomicheskogo incision until complete overlap the lumen of the lump, and as a drainage operation using gastroenteroanastomosis. (L ate os

Description

The invention relates to medicine, more specifically to surgery, and can be used in the treatment of patients suffering from a bleeding penetrating duodenal ulcer, in particular an unsuccessful obstruction of the posterior wall of this organ with penetration into the pancreas, when known methods of treatment are ineffective.

There is a method of treating profuse ulcerative gastroduodenal bleeding, proposed by I. I. Kalchenko. According to this method, after crossing the prepared one, possibly below the duodenum, not stitching its lumen, dilute it with sides, find sound with bleeding vessels, refresh its bottom and edges, then pierce it with several grooves, do not trap the bile and parcream ducts, tampon an empty epiploon, which is laid on its bottom between the aforementioned sutures, which, when these sutures are tightened, presses against the bleeding vessels and stops the bleeding, then gastric resection with gastroenteroanastomosis is performed 1 m.

However, the known method does not provide the necessary reliability of hemostasis and sealing of the ulcer, since a tampon from the omentum on the affected duodenal segment of the duodenum reduces its lumen, but does not overlap it and does not eliminate the effects of duodenal juice, therefore the packing gland quickly collapses, resulting in with the intestinal wall, the sutures are weakened, and this leads to impaired hemostasis and sealing, ulcers and recurrent bleeding. The method is not applicable to the localization of ulcers below the Vater nipple, since in such cases it is impossible to hem a saannic tampon with the intestinal wall around the ulcer through the lumen of the duodenum, and it is also traumatic, since the stomach is resected.

A known method of treating duodenal bleeding ulcers, in which, after duodenotomy, the arrosed vessels and bottom of the ulcer are sheathed, then vagotomy and pyloroplasty are performed as a draining operation. The method relates to organ-preserving surgical interventions 2.

The disadvantage of this method is that it does not provide the necessary reliability of hemostasis and sealing of the ulcers, since the lumen of the duodenum does not overlap, and during the passage of food masses through the affected area, the sutures are weakened, which leads to a breach of the ulceration and recurrence of bleeding. .

The purpose of the invention is to prevent relapse of bleeding.

This goal is achieved by the method of treating duodenal bleeding ulcers, including duodenomas, hemostasis, vagotomy, stomach draining operation, hemostasis is carried out by stitching to the star of the free epiploon, and then gradually penetrating above the fold of the epidermal fold, the pathway of the epiploon is removed. intestine, and as a drainage operation using gastroenteroanastomosis.

FIG. 1 shows tamponing of an ulcer by a roll from an omentum; in fig. 2 - overlap of the lumen of the organ with a roll tampon and the imposition of the first row of seams invaining the wall of the duodenum; in fig. 3 - invagination of the first row of sutures with the second row of seams of the wall of the duodenum 12; in fig. 4 - performance of selective vagotomy and gastroenteroanastomosis. The proposed method includes the following basic techniques, performed in the following sequence: selecting the duodenal gland, clarify the localization of the ulcers, dissect the intestinal wall above the ultitudinal section, determine the size of ulcers in the lumen of the organ through the defect, perform temporary hemostasis, cut free stuffing box; a tampon is formed from a free gland in the form of a roll, the size of which exceeds the dimensions of the ulcer and the organ lumen; the resulting roll tampons sound and at the same time overlap the lumen of the organ in the affected area, roll the edges of the roll with the back wall of the organ; impose the first row of sero-serous sutures, lead them to invaginira into the intestinal lumen of the edge of the duodenotomic incision; impose a second row of sero-serous sutures, invaginiru them first row of sutures in the intestinal lumen, until the duodenal lumen is completely blocked; perform selective vagotomy and

about gastrojejunostomy.

Example. Patient V., 59 years old, engineer, was admitted to the surgical department in urgent order in serious condition with complaints of vomiting of blood, severe general weakness, dizziness, and cold sweat. Suffering from duodenal ulcer disease 18 years. Bleeding started suddenly, 2 hours ago. Anamnesis from bleeding pulmonary tuberculosis, pulmonary heart disease.

Objectively: exhausted, pale skin. Heart sounds are sharply muffled, blood pressure is 60/0 mm Hg. Art., pulse frequent weak filling and voltage with a frequency of up to 130 per minute. Red blood cells 5 2100000, hemoglobin 60%.

Diagnosis: duodenal ulcer disease, complicated by profuse bleeding.

In urgent order. T is to the operating table. During the revision of the abdominal organs, a cranial infiltrate of up to 6 cm in diameter was found, including the posterior wall of the duodenum 12, the pancreas, the lower margin of the liver.

Taking into account the extremely serious condition of the patient (due to the underlying disease) and concomitant ones, it is contraindicated to perform a radical operation. The patient is shown organ preserving surgery with reliable hemostasis of the bleeding vessel in the pool. In this connection, in the projection of the ulcer determined in the center of the infiltrate, the anterior wall of the duodenum is longitudinally dissected with a length of 5 cm.

In the center there are 2 bleeding vessels 1.5 and 2.0 mm in diameter. The tail end was 2 cm above the nipple of Vater. Attempts to complete the operation with excision and stitching of vessels in the starfish were unsuccessful. Stitches were cut, bleeding increased. Then a tampon was formed in the form of a roll of a free omentum, the size of which exceeded the razors of the ulcer and the lumen of the tick, tamponed by stitching the tampon near the ul and tying the ligature on top of the tampon so as not to block the Vater nipple. Then, the lumen of the intestine was blocked above the omental swab, for which the edges of the wall of the tickus invaginated into its lumen, first with one row of sero-serous seams, with the second row of similar seams the first row was invaginated.

Bleeding is completely stopped. Imposed front gastroenteroanastomosis, made selective in Gothi. From the second day after the operation, the hemodynamic parameters of the patient were stable. By day 5, the erythrocyte, hemoglobin, and hematocrit values began to increase. Vomiting was not. Feces normal color without admixture of blood. A fibrogastroscopy was performed, in which the edge, in the form of a strip, of a necrotic omentum is visible. Repeated fibroscopy performed on day 7: gland

absent, lumen kg. ; n; hch yu stenozirovan. Zabrosa.ish in no. When giving barium suspension, lUiccji / K in moderate portions. anacT () 4): i.

Remote ropats with control radiography of the gastrointestinal tract were studied after 1, 3, 6 months. Noe. U operations. The place of suturing is completely stenotic, the contrast through the duodenum does not enter, evacuation through gastroenteroanastomosis. No complaints. After 1.5 months after discharge, he proceeded to his previous job. For 6 months, he gained 7 kg. After 2 years after the operation, fibroscopy was performed - we pass the anastomosis, there is no peptic ulcer of the anastomosis. He feels good, gained 2 kg. Attends group health.

The advantage of the proposed method to the known ones is that it simultaneously not only reliably seals the bleeding sound, but also tightly covers the lumen of the duodenum with an omentum made in the form of a roll, which, in conjunction with gastroenteroanastomosis, excludes the passage of food masses through the affected part of the organ and the destructive impact of gastric and duodenal juice on it, preventing the relapse of ulcer bleeding and increasing the therapeutic effect of surgical of intervention.

Another advantage of the proposed method over the known ones is that it is suitable for any localization of the bleeding penetrating duodenal ulcer, in particular when penetrating into the pancreas with infiltration around the ulcer.

The proposed method represents a real possibility of successful treatment of patients with the indicated pathology, in which the known methods are ineffective.

The method is applied in 10 patients, the results are good, recommended in the practice of surgical institutions.

Claims (1)

METHOD FOR TREATING A DUODENAL BLEEDING BLOOD ULCER, including duodenotomy, hemostasis, vagotomy, gastric drainage, characterized in that, in order to prevent recurrence of bleeding, hemostasis is performed by suturing the free part of the omentum to the ulcer, after which the edges are completely transected. intestinal lumen, and gastroenteroanastomosis is used as a draining operation. Fig.]