SU1454407A1 - Method of surgical treatment of duodenal peptic ulcer - Google Patents

Abstract

The invention relates to medicine, intended for the treatment of pyloroduodenal ulcer. The purpose of the invention is to ensure complete suppression of the acid-producing function of the stomach by eliminating vagal stimulation of gastrin-producing cells and reducing the likelihood of disturbing the evacuation function of the stomach due to the fact that the vagotomy along the lesser curvature of the stomach is performed while preserving the innervation of the cardia and the piloroduodenal Latraje branch in combination with vagotomy along the greater curvature. 1 il.

Description

one

The invention relates to medicine and can be applied in the treatment of piloroduodenal localization.

The purpose of the invention is to ensure complete suppression of gastric acid-producing function by eliminating vagal stimulation of gastrin-producing cells, as well as reducing the possibility of impaired gastric evacuation function, which is achieved by performing vagotomy along the lesser curvature of the stomach while maintaining the innervation of the cardia and the pilaroduodenal Latarge branch in combination vagotomy along the greater curvature.

The method is illustrated with a schematic drawing of the operation shown in the drawing.

The method is carried out as follows.

Upper median laparotomy is performed. Conduct an audit. In the presence of gastric stenosis, the degree of its severity is specified. Cross the gastrocolic ligament. Vagotomy is performed along the lesser curvature of the stomach by gradually capturing, intersecting and ligating in small portions of the neurovascular bundles of the anterior 1, and then the posterior 2 leaves of the omentum from the pylorus to the cardia. Under

The cardia intersects the serous membrane 3 with the nerves passing through it. The small curvature of the stomach is released within these limits from the small omentum and is re-peritonized by serous-muscular sutures.

Q At the same time, the pyloroduodenal branch of the 4th nerve of Latarge is preserved. Along the greater curvature, the denervation of the antrum and the body of the stomach is supplemented by the intersection of the nerve plexuses accompanying the gastro-epiploic arteries by means of skeletization during 1-2 cm of the right artery 5 at the level of the pylorus, and of the left 6 - at the greater curvature of the stomach. Additionally, several short arteries 7 are intersected along with veins and nerve branches.

20 proximal to the left gastro-epiploic artery. The diaphragmatic gastric cord is distal distal to the cardia. Vo4

cl

four

restore the integrity of the gastrocollioma. When stenosis of the stomach is performed, a drainage operation is performed by one of the known methods.

The healing of ulcers after this operation is provided by a decrease in gastric secretion, which occurs after denervation of the body of the stomach producing hydrochloric acid and pepsin, and a decrease in the production of the secretion stimulator, gastrin, by denervated antral section. The motor-evacuation function of the stomach ensures the preservation of the innervation of the motor centers located in the cardiofundal zone, the connection of which with the body of the stomach and the antral region is carried out by intramural nerve plexus. Spasm of the gatekeeper does not occur.

The method was studied experimentally on 9 dogs with gastric fistulas and the initial part of the duodenum. It was found that the operation of the proposed method inhibits insulin secretion by 80-85% compared with the norm. Over 9 months, the level of insulin secretion remained unchanged and did not show an upward trend. During the first month after the operation, the speed of emptying the bread from the stomach was slowed down compared with the norm by 20–25%, however, by the end of the second month it had completely returned to normal.

Example. Patient F., was admitted to the hospital on 01.04.84, with a diagnosis of duodenal ulcer, athyperteum ulcer. With fluoroscopy of the stomach and duodenum, a niche was found in the area of the duodenal bulb, which confirmed the diagnosis of duodenal ulcer. Evacuation of the stomach is not broken. In fibrogastoduodenoscopy, the neck of the posterior wall of the duodenal bulb is 1.0x0.8 cm in size, the bottom of the ulcer is covered with fibrin, and the bulb is deformed. Analysis of gastric secretion: Basal production of hydrochloric acid was 12, 3 mmol / l, and stimulated with insulin - 27.6 mmol / l. The concentration of gastrin in the blood, determined using radio-immunological method, is 160 pH / ml. 04/08/1984, an operation was performed on the proposed method - subcardial-vagotomy. Produced by the vagotomy along the lesser curvature of the stomach by gradually capturing, intersecting and ligating in small portions of the neurovascular bundles of the anterior and then the posterior leaflets of the small

five

0

five

0

five

0

the gland from the gatekeeper to the cardia. Under cardia, the serous membrane with the nerves passing through it is circularly crossed. Mala curvature of the stomach is reperitized with sero-muscular sutures. At the same time, the pyloroduodenal branch of the nerve of LaTaré is preserved. Along the greater curvature, denervation of the antrum and the body of the stomach is supplemented by the intersection of the nerve plexuses accompanying the gastro-epiploic arteries by skeletonization for 1–2 cm of the right artery at the level of the pylorus, and of the left one at the greater curvature of the stomach. In addition, several (3-4) short arteries are intersected along with the veins and nerve branches proximal to the left utero-epiploic artery. The integrity of the gastrocolic colony is restored. The postoperative period was uneventful. Examined after 6 months. and 1 year after surgery. After 6 months after one-, the walkie-talkie of evacuation from the stomach is not disturbed, the basal gastric secretion decreased by 60%, and stimulated by insulin - by 73%. With fibrogastroduodenoskopii - zva healed. The concentration of gastrin in the blood was 80 pg / ml, i.e. a decrease of 50% compared with the preoperative level was detected. After 12 months after surgery, the evacuation function of the stomach is not impaired, fibrogastroduodenoscopy revealed a scar at the site of a large ulcer, the basal gastric secretion was 3.5 mmol / lt. e. decreased in comparison with the pre-operative one by 80%, and insulin-stimulated decreased by 72%.

The method ensures the complete suppression of the acid-producing function of the stomach in the absence of evacuation disorders.

Recommended for clinical use.

Claims (1)

Invention Formula A method of surgical treatment of duodenal ulcer disease, including denervation of the stomach along the lesser and greater curvature, with preservation of the pyloroduodenal branch of La Rarge, characterized in that, in order to ensure complete suppression of the acid-producing function of the stomach while maintaining its motor function, denervation along the lesser curvature is performed with the intersection of the latex branch of the nergar leading to the antrum, and the denervation of the fundus of the stomach is performed by circular serotomy under cardia.