SU1324647A1 - Method of treatment of cardial gastric ulcers - Google Patents

Abstract

The invention relates to medicine, more specifically to surgery, intended for the treatment of patients with a cardiac zhuyo link, in which the upper edge of the ulcer reaches the esophago-gastric junction. The purpose of the invention is the preservation of the patency of the esophageal-gastric junction, the reservoir function of the stomach stump and the prevention of the inconsistency of its sutures. To do this, resection of the stomach is made, its small curvature is excised, it is mobilized from the 12th duodenal intestine to the esophagus, gastroanastomosis is formed with partial excision of the greater curvature, and the mucous membrane is cut from the distal part of the anterior and posterior lateral walls of the greater curvature. The shape of the remaining mucosa corresponds to the shape of the esophagus defect. The demucosated edge is brought to the right wall of the esophagus, the back lip and the stump wall are formed by a series of catgut and silk scvs, the edge of the mucous membrane is combined with the edge of the defect at the esophagus, the front wall of the stump is formed, leaving a lumen for the anastomosis, the edge of the seam at the edge of the esophagus. The lumen of the duodenal stump is measured with the lumen on the anterior wall of the stomach stump, the excess lumen on the side of the esophagus is sutured with catgut and silk sutures. The anastomosis between the stump of the 12 duodenal ulcer and the lumen of the stomach stump form an end-to-end type. The patency of the anastomosis is checked by palpation, but also by introducing fluid into the stump of the stomach through a probe. The method will be performed at any localization of the ulcer of the cardinal section, allows you to save a part of the organ, to avoid gastrectomy. 4 il. c (L SAE tsD Nj about: 4

Description

The invention relates to medicine, namely to surgery, and can be used in patients suffering from ulcer disease of the stomach, when the calve is in the cardiac area and its upper edge reaches the level of the esophageal-gastric junction.

The purpose of the invention is to preserve the permeability of the gastro-ventricular junction, the reservoir function of the gastric stump and the prevention of the inconsistency of its sutures, which is achieved by lateral suturing of the gastric stump and strengthening the first row of stitches at the esophagus with a demucosal stump edge.

FIG. 1 shows a view of the stomach stump after resection and excision of the mucous membrane at its lower margin; in fig. 2 - formation of the posterior wall of the stomach stump; in fig. 3 - suturing in the area of the esophageal-gastric junction; in fig. 4 - a general view of the operation.

Example, Patient K., 61 years old. Diagnosis: Zv of cardial department of a stomach. A laparotomy was performed, a revision of the abdominal cavity was performed, the gard of the cardial part of the stomach was detected 6x4 cm, the upper edge of the ulcer was located 0.5 cm from the esophageal-gastric junction. Mobilized small and large curvature of the stomach, small from the duodenum to the esophagus, pain

sha - to the distal branch of gastric 35th gastric disease applied in six

omental artery, below the gatekeeper imposed two clips. The duodenum is cut off, the cult of 1 stomach is formed by excision of the entire small.

the sick. A positive effect in the immediate and late period was confirmed by clinical, radiological, fibrogastroscopic examinations — curvatures with an ulcer and partially (to levels of 0. Large-curvature recommended for mobilization), nor into surgical practice, from the distal anterior part.

and the posterior wall of the greater curvature is excised by the mucous in the form of a sickle, the shape of the remaining mucosa must correspond to the shape of the defect in the esophagus 2,

The demucosated edge 3 is led to the right wall of the esophagus, the posterior lip 4 and the wall of the stump p - 50 are formed, thereby maintaining the patency of the esophageal catgut sutures and silk No. 4, but the gastric junction, the reservoir combines the edge of the mucous membrane of the esophagus crab and the p q cat45

Claims (1)

Invention Formula A method of treating cardiac gastric ulcers by resecting it with excision of the lesser curvature and forming a gastroduodenal anastomosis, characterized in that, at the cost of the function of the gastric stump and the prevention of the inconsistency of its sutures, after resection around the perimeter of the lower 55 edge, the stump is excised with a crescent gut nodal stitches No. 3, seized mucous-submucosal-minor layers, a second row of silk stitches No. 3 are applied with the capture of the serous-minor layer 5 from the esophagus and the submucosal The shoulder layer 6 is a demucosated edge of the gastric stump with additional cover for the suture line. The lumen of the duodenal ulcer is comparable with the lumen on the anterior wall of the stomach stump, the lumen from the esophagus is sutured by a number of nodular catgut sutures and a number of silk sutures No. 4, Kocher's 12 gut is mobilized, an anastomosis 7 is formed between the stumps 12 - duodenal ulcer and lumen of the stomach stump next to catgut. yours and next to silk sutures No. 4, end to end. The patency of the anastomosis was palpable and by the introduction of fluid into the stump of the stomach through a probe. Drain the abdominal cavity. Layers sutured anterior peritoneal wall. The advantage of the proposed method in the treatment of gastric ulcer disease before a known method is that it will be performed at any localization of cardiac ulcer, prevents the occurrence of post-gastro-resection complications, i.e. violation of the patency of the esophageal-gastric junction, the reservoir-evacuation function of the gastric stump, the inconsistency of the seams of the gastric stump. The method allows to preserve part of the organ, to avoid gastrectomy. 1 The proposed method of treatment by the link of preserving the patency of the esophageal-gastric junction, the reservoir Invention Formula A method for treating cardiac gastric ulcers by resection with excision of the lesser curvature and the formation of a gastroduodenal anastomosis, characterized in that, in order to preserve the patency of the esophageal-gastric junction, the reservoir function of the stump of the stomach and the prevention of the inconsistency of its sutures, after resection around the perimeter of the lower edge of the stump, excise the sickle-shaped the section of the mucous membrane, the supply of the demucosated edge to the right wall of the esophagus and form the posterior, and 3 13246474 then the front wall of the stump, with a thinning edge, trim the lil. the lumen for the anastomosis, in this case the joints of the esophagus. 9g one 9G ig. Compiled by T. Shakhmatova Editor P. Gereshi Tehred I.Popovich Proofreader L, Pilipenko Order 2987 / 3f Circulation 595 Subscription VNIIPI USSR State Committee for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5 Production and printing company, Uzhgorod, st. Project, 4