SU1360703A1 - Method of resection of stomach for disclosure in case of peptic ulcers of gastroduodenoanastomoses - Google Patents

Abstract

The invention relates to surgery. The purpose of the invention is to ensure reliable sealing of the stump and to prevent its inconsistency. After resection of the stomach, the mucous membrane of the pyloroanthral section is excised. From the sero-muscular layer of the pyloric stomach form two flaps and gastroduodenoanastomosis. Flaps stitch and immersed in the lumen of the duodenum. 2 years after surgery, the patient is maintained and there is no exacerbation of the disease. 5 il. oo o5 o

Description

This invention relates to medicine, in particular to surgery of peptic ulcers in patients who have previously undergone vagotomy with a stomach draining operation.

The purpose of the invention is to provide reliable sealing of the stump and prevent its inconsistency, which is achieved by reseating the mucous membrane of the remaining antrum section after gastrectomy, form two cones (from the side of the large and small curvature) from the sero-muscular flap and immerse them into the lumen of the duodenum, and their stumps are sewn together with separate sutures.

FIG. 1 shows the flap cut from the sero-muscular layer of the antrum; in fig. 2 - the beginning of the formation of two cones from these patches; in fig. 3 - overlay at the base of the formed cones of an eight-shaped pouch string; in fig. 4 - immersion of cones in the lumen

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Example. Patient E. 49 years. He entered the clinic of surgical diseases with a diagnosis of peptic gastvododenoanastoma. Ten years ago, underwent an operation of suturing a perforated ulcer of the duodenum, after three years it was re-operated. Produced by selective proximal tubules with gastroduodenal anastomosis according to Jabley. The year felt satisfactory, then the pains resumed with a distinct seasonal character. He was twice treated in the hospital for gastric bleeding.

X-ray examination: the passage of bari from the stomach goes through the pyloric sphincter and gastroduodeno anastomosis, is accelerated, the relief of the gastric mucosa is rough, the folds are swollen. On the back wall of the gastro-duodenal anastomosis there is a deep niche measuring 1.0-1.5 cm. Fibrogastroscopy: stomach natosh, a, contains bile, 12 gum mucous membrane; in fig. 5 - stitching 20 is edematous, hyperemic at the gastroduoded base of immersed cones with separate seams.

The method is carried out as follows.

After stomach resection, the distal part of it is turned to the right, the proximal is treated according to the known rules and the gastro-neuroanastomosis is formed according to one of the Billroth-2 modifications. The mucous membrane of the pyloroanthral department is excised.

but anastomosis. The latter, on the back wall, is a 1, 5 cm junction crater, covered with fibrin and gray patina. The end of the fibroscope passes freely through the pyloric sphincter into the duodenum. On the side wall of the latter there is a name of 0.5 X 0.5 cm. After the preoperative preparation, it is operated. Stomach resection was performed for deactivation with treatment of the stump by the indicated method. The pyloric diameter of the ear bone was measured. The postoperative period proceeds

smooth. Discharged on the 14th day for outpatient treatment. Examined after a year and two years No complaints, works in the specialty - the driver.

In a similar way operated still

and gastroduodenostomy. From the sero-muscular layer of the pyloric stomach of the greater and lesser curvatures, two triangular isosceles flaps form the base to the pulp and gastroduodenal anastomosis. (The length of the triangular base is 35 4 patients, good results are obtained.

The top of the triangle of small curvature is stitched with a catgut thread and zigzag. One end of the filament serves as a taped and the other is guided through the pulp, brought out through the gastroduodenal anastomosis into the deserosed lumen of the stomach. Similarly, a second flap is sewn, tied, guided through gastroduodenal anastomosis, and a thread is removed from the apex of the second flap through the pyloric pulp. Form using PP. or by the manual manual "cones of triangular, flaps, leaving the catgut filaments in the lumen of the" cones. At the base of the "cones impose a figure of eight pussy. Pot giva for catgut stitches, immersed "cones in

sealing the stump of the antrum during gastrectomy for switching off under conditions Hbix - in the presence of peptic ulcers in the area of gastroduodenal anastomosis. Recommended for practical use.

Claims (1)

Invention Formula The method of gastric resection for shutdown during peptic zvah gastroduodenal anastomosis, including the shelter of the duodenal stump, demucosized gastric flap and the formation of gastroenteroanastomosis, characterized in that the lumen of the duodenum, the purse-string suture 50 of reliable sealing of the stump and the warning “the eight are tightened, tied up. The catgut filaments tie up, which results in a tight tomonization with a screwed cone in the hole of the duodenum 12. The bases of the cones are stitched together by a single day of its inconsistency; they create two cones of sero-muscular flaps on the side of the greater and lesser curvature of the stomach and immerse them in the lumen of the duodenal ulcer with seamed stitches in the transverse direction. 55 separate seams. Example. Patient E. 49 years. He entered the clinic of surgical diseases with a diagnosis of peptic gastvododenoanastoma. Ten years ago, underwent an operation of suturing a perforated ulcer of the duodenum, after three years it was re-operated. Produced by selective proximal tubules with gastroduodenal anastomosis according to Jabley. The year felt satisfactory, then the pains resumed with a distinct seasonal character. He was twice treated in the hospital for gastric bleeding. X-ray examination: the passage of bari from the stomach goes through the pyloric sphincter and gastroduodeno anastomosis, is accelerated, the relief of the gastric mucosa is rough, the folds are swollen. On the back wall of the gastroduodenal anastomosis there is a deep niche measuring 1.0-1.5 cm. Fibrogastroscopy: stomach natosh, ak contains bile, mucous is edematous, hyperemic at the gastroduodenal edema, hyperemic at gastroduodenal anastomosis. The latter, on the back wall, is a 1, 5 cm junction crater, covered with fibrin and gray patina. The end of the fibroscope passes freely through the pyloric sphincter into the duodenum. On the side wall of the latter there is a name of 0.5 X 0.5 cm. After the preoperative preparation, it is operated. The stomach was resected for shutdown with the stump treated in this way. The postoperative period proceeds smooth. Discharged on the 14th day for outpatient treatment. Examined after a year and two years No complaints, works in the specialty - the driver. In a similar way operated still  4 patients, received good results. The method allows to provide reliable sealing the stump of the antrum during gastrectomy for switching off under conditions Hbix - in the presence of peptic ulcers in the area of gastroduodenal anastomosis. Recommended for practical use. Invention Formula The method of gastric resection for shutdown during peptic zvah gastroduodenal anastomosis, including the shelter of the duodenal stump, demucosized gastric flap and the formation of gastroenteroanastomosis, characterized in that the days of its inconsistency create two cones from the sero-muscular flaps on the side of the large and small curvature of the stomach and immerse them into the lumen of the duodenum 12, and the stump of immersed flaps of the stomach. FIG. FIG. fig.Z FIG. 5