SU1261633A1 - Method of stomach resection - Google Patents

Abstract

METHOD gastrectomy, vklyuchayushy suturing stump 12 duodenum and forming terminology-lateral cross gastroduodenoanastomoza, characterized in that, with a view to preventing nesosto telnosti seams stump 12 duodenum at nizkosid schnh or penetriruyush their duodenal zvah, stump sutured odnor dnym seam , and during the formation of the anastomosis, the posterior wall of the stomach, the capsule of the pancreas gland and the anterior wall of the duodenum are seized in the first row of sutures, and the stump is additionally sealed.

Description

N5

O5

O5 00 WITH

The invention relates to medicine, namely to surgery, and can be used in the treatment of gastric ulcer and duodenal ulcer.

The aim of the invention is to prevent the inconsistency of the seams of the duodenal stump during low-sitting or penetrating, their duodenal insults.

The method is carried out as follows.

After the skeletonization of the stomach to the level of the intended resection, the stomach is cut from the duodenum below the ulcer. If there is penetration into the head by the pancreas of the gland, an excision is made at the level of the lower border of the ulcer with the release of the posterior wall only to close the stump with one row of sutures.

Next, a stomach resection is performed, the volume of which is established depending on the secretory activity of the stomach, or saving (antral) resection in combination with vagotomy and the formation of a stump with a hole for the anastomosis in its terminal section.

Next, impose a term-lateral anastomosis. In the first row of stitches, sero-muscular, the posterior wall of the gastric stump, pancreatic capsule and the anterior wall of the duodenum are seized, 1.5 cm apart from the suture line on the stump. Thus, the stitched stump is sealed by the posterior wall of the stump stomach and pancreatic capsule. If necessary, the duodenum is mobilized according to Kocher to avoid tension. A transverse or oblique duodenotomy is performed depending on the width of the duodenum to form an opening corresponding to the opening in the stomach stump. Through all the layers impose a knotty or continuous suture on the back wall of the gastroduodenal anastomosis with the transition to its front wall, submerged serous-muscular sutures on the front lip.

Example. Patient B. Diagnosis - duodenal ulcer disease, complicated by penetration of an ulcer into the pancreatic head. After appropriate preparation, the patient was operated on.

Upper median laparotomy. The audit found that the stomach is of normal size, in the area of the duodenal bulb on the back of it there is a chronic gland penetrating into the head of the pancreas. There is an inflammatory infiltrate around the ulcer. Skeletization of the resected part of the stomach along the large and small curvatures, mobilization of the pyloroduodenal area was performed. With some technical difficulties, it was possible to mobilize the duodenum to the level of the lower edge of the ulcer and the stomach was cut off from the duodenum. The cult of the latter is sutured in the open way with single interrupted sutures. A 2/3 of the stomach was resected to form a gastric stump having a hole for the anastomosis 3 cm in diameter.

Next, the stump was mobilized.

5 duodenal ulcer according to Kocher and the first row of sero-muscular sutures of gastroduodenal anastomosis was imposed. At the same time, the posterior wall of the stomach stump, the pancreatic capsule and the anterior wall are seized in the suture. The 12-duodenal stump is 1.5 cm indented from the line of the first row of schvs. Thus, reliable sealing of the first row of stumps of the 12-stump is ensured. duodenal ulcer posterior wall of the gastric stump and pancreatic capsule.

5 Next, a duodenotomy was performed in the oblique direction about 3 cm long, 1.5 cm indented from the suture line. An anastomosis was formed between the stump of the stomach and the duodenum in the “end to side. Patency of the anastomosis is good. Through

0 a gastroduodenal anastomosis was performed with a nasogastric probe for decompression and feeding. The surgical wound is sutured in layers tightly. The postoperative period was uneventful. When the control x-ray examination of the cult of the stomach

5 has a cone-shaped shape, the tone is preserved, the evacuation of it in portions rhythmic. The patient was discharged in a satisfactory condition.

The method allows preserving the natural Q passage of the food through the duodenum during surgical treatment of difficult ulcers, creates reliability of the seams of the duodenal stump, and the imposed anastomosis has an isflux property. This ensures a significant reduction in the number of post-recurrent pathological syndromes and an improvement in the results of surgical treatment of patients with ulcer disease of the stomach and duodenum.

Claims (1)

METHOD OF GASTRIC RESECTION, including suturing of the duodenal stump and forming the lateral lateral transverse gastroduodenoanastomosis, characterized in that, in order to prevent insolvency of the stumps of the duodenal ulcer in case of low-sitting or penetrating duodenal ulcers, the stump is sutured in case of in the first row of sutures capture the posterior wall of the stomach, the capsule of the pancreas and the front wall of the duodenum 12, while additionally sealing its stump. V) th