SU1264943A1 - Method of forming esophagogastroanastomosis - Google Patents

Abstract

The invention relates to surgery and can be applied during operations on the stomach and esophagus. The purpose of the invention is to prevent reflux esophagitis by invaginating the distal esophagus into the stomach with the shelter of the invaginated area with an excess of the gastric mucosa. The upper median laparotomy is performed, the proximal end of the stomach and the abdominal esophagus are mobilized. The muscular membrane of the esophagus in the abdominal section is dissected to the submucosal layer. Mucous membranes stitch, take on two handles and cut off the stomach at this level. On the front and back walls of the stomach, serosal r-minus membranes are dissected, and mucous membranes are pierced with a UO-60 apparatus. Cut off the removed part of the stomach. The hardware suture on the side of the lesser curvature is covered with knots with sero-muscular sutures. The stump of the stomach is formed in the form of a cone-shaped tube 6–7 cm long. The proximal end of the tube is mobilized, at its apex it is separated and the serous-muscular layer 1.5 cm wide is removed. A sero-myechoid membrane 5–7 mm wide is separated from this section. Form the esophageal-gastric anastomosis. The mucous membranes of the esophagus and stomach sew. On the esophagus, a muscular layer is taken into the suture above the seam line of the mucous membranes 2.5 cm, and the menstrual membrane is stitched on the stomach at the base of the separated sero-muscular membrane. The valve is formed by the stitching of the sutures and an additional immersion of the esophagus by the dissector. Separated serous-muscular membrane wrapped on the esophagus and stitched to the longitudinal mycene to the neck layer of the esophagus. The bruise wall wound is layered tightly in layers. 2 pcs.

Description

one

The invention relates to medicine, namely to surgery, and can be used in operations on the stomach and esophagus.

The purpose of the invention is the prevention of refpux esophagitis, which is achieved by invagination of the distal esophagus into the stomach with the shelter of the invaginated area with an excess of the gastric mucosa.

Fig, 1 shows schematically one of the stages of the operation; FIG. 2 shows a schematic representation of a gastrointestinal anastomosis, a longitudinal

cut

In the drawings, the esophagus I is indicated, a tubular cult 2 of the stomach, a mucous membrane of the stomach 3, a serous muscle cuff L of the stomach,

The method is carried out:; in the following way.

The upper median laparotomy is performed, mobilization of the proximal stomach and the abdominal end of the esophagus. The esophageal gland in the abdominal section is dissected circularly to the submucosal layer. Contracted, it exposes the submucosal layer over 1 cm. Mucous membranes are pierced with a UO-40 apparatus, taken on two handles, and at this level they cut off the stomach. On the planned line of resection along the anterior and posterior walls of the stomach, the serous-small membranes are dissected, the mucous membranes are pierced with a UO-60 apparatus. Cut off the removed part of the stomach. The hardware seam from the side of small curvature is covered with nodal serozhnr-meppechnymi seams. In this case, the cult of the stomach is formed in the form of a cone-shaped tube from the greater curvature of 6-7 cm in length, 3-3.5 cm wide at the top. The proximal end of the tube is mobilized by ligating two branches of the second order of the right gastro-epiploic artery. At the top of the tube, around the entire circumference, the serous-muscular sheath 1.5 cm wide is removed and the serous-muscular sheath J5-7 mm wide is separated below this section. Begin to form an esophageal-gastric anastomosis. The rear semicircles of the esophagus and the stump of the stomach sew 3-4 interrupted sutures. For this on the esophagus into the seam is the muscular membrane above

64943a

2.5 cm of mucous cut, muscle membrane is stitched in the stomach at the base of the severed serous membrane, with the capture of the mucus layer. When the threads are tightened, the stump of the stomach moves to the esophagus and stitches are tied.

The mucous membranes of the esophagus and the stomach are sutured by a submucosal-mucous suture with two opposing catgutoseum strands. The catgut filament on the intestinal needle is pierced with a submucosal layer on the esophagus and the cult of the stomach, indented, 2-3 mm from the tan of the left suture. Thread is pulled in half and tied. Similar . sew the opposite angle of the anastomosis. The submucosal 20 layers of the posterior wall are sutured to the middle of one of the strands of the right anastomosis. The submucosal layers of the other half of the posterior wall are sutured (a 2 mm submucosal layer, 25 p, 2 mm in pitch) is sewn into the seam of the left corner. The threads straighten slightly and tie. The mucous membranes of the esophagus and the stomach with the previously applied tantalum gus are cut above this suture by 1-2 mm. The remaining 30 shimis with catgut threads sew the submucosal layers of the right and then the left half of the anterior wall of the junction. The anterior semicircle of the esophagus and the stump of the stomach sew 3-4 interrupted sutures. On the esophagus, the sheath of the mucous membranes of the seam mucous membranes is taken 2.5 cm to the suture, and the minuscule sheath at the base of the separated XQ of the serous-minus sheath is stitched on the stomach. Valve formation. Produced by tying seams and further immersing the esophagus with a dissector. The otoeparovannuyu serous minuscule sheath, wrapped in the esophagus and hemmed to the longitudinal muscle layer of the esophagus. The wound of the abdominal wall is thickened by layers tightly.

The development of a valve formation method 50 in proximal gastrectomy was carried out in an experiment on dogs. All. Animals well re. Carried the operation. Complications of the esophageal-gastric anastoma 55 mosaic after surgery is not common.

Observations of animals in dynamics and radiographic studies of them showed a functional field.

Claims (1)

Claim A method for the formation of esophagogastroanastomoea, including proximal resection of the stomach, separation of the serous & peccular cuff at the top of the stomach stump, the formation of an anastomosis with the end of the esophagus and gastric mucosa seized in the sutures, the anastomosis is covered with a serous-muscular cuff, which is designed to prevent reflux disease , before separation from the distal end of the stump, a circular strip of the serous-muscular membrane is additionally removed, and after the formation of the anastomosis, the end of the esophagus is invaginated into the stomach, at the same time, its invaginated area is covered with an excess of the gastric mucosa and is fixed. the value of the valve being formed. Animals throughout the observation period (up to 2 years) maintained good appetite, there was no vomiting. 5 did not differ in their behavior from non-operated animals. At various times after surgery, the animals were withdrawn from the experiment by intracardiac injection of ether against the background of hexeyal anesthesia. In 10 studies of macropreparations, a valve with a height of up to 2 cm is well introduced, its inner hole is closed. On the section, the esophagus mucosa is folded, smooth, shiny, 15 ¹ Histological studies of preparations from animals with a follow-up period of 3 months to 2 years after surgery showed that the valve tissues do not undergo trophic and rub-20 new changes, retain their shape and tissue structure. The method of valve formation during proximal resection of the stomach was used in the clinic in 20 patients aged ²⁵ from 42 to 67 years. All operations were performed from peritoneal access. There was no failure of the sutures after the operation. Patients were allowed to drink for 2-3 days, take food - 30 for 3-4 days. No regurgitation of food, dysphagia, pain in the sternum was observed either in the early or in the distant postoperative period. During an X-ray examination, from 3 months to 3 years after the operation, the esophagus is not expanded, the esophageal-gastric anastomosis opens at the time of passage of the contrast medium to 2 cm, and barium suspension from the esophagus to the stomach stump is noted before. IN ΓΊ-- '