SU1496782A1 - Method of surgical treatment of artial hypertension - Google Patents

Abstract

The invention relates to medicine, namely to surgery and can be used in the surgical treatment of arterial hypertension. The purpose of the invention is to simplify the technique of operation and reduce its trauma. The purpose of the invention is achieved by performing torakofrenolyumbotomicheskogo access right, removing the right adrenal gland, opening the parietal peritoneum along the incision laterally offset the small intestine into the right sinus, further continuing the incision of the peritoneum during the duodenal-jejunal flexure, isolating the left renal and adrenal veins, stitching left adrenal vein in the area of the mouth diameter on both sides to the appearance of venous hypertension proximal to the site of occlusion. The invention makes it possible to improve the results of treatment of patients with severe malignant forms of arterial hypertension, accompanied by hyper aldosteronism.

Description

The invention relates to medicine, namely to surgery and can be used in the surgical treatment of arterial hypertension.

The purpose of the invention is to simplify the technique of operation and reduce its injury rate.

The method is carried out as follows.

The position of the patient on the left side. The right hand is wound up behind the head and fixed. In order to expand the intercostal spaces, a roller is placed under the side. The skin incision begins at the posterior axial line at the level of the right 10 rib and continues along the intercostal space anteriorly along the 10th path, reaching the white line of the abdomen 3-4 cm above the navel. Layers dissect the lower lateral fibers of the trapezius.

muscles, the latissimus dorsi muscle and fibers of the anterior serratus muscle. In the anterior-lateral wall of the abdomen, the external, internal oblique, transverse, and straight abdominal muscles are dissected. The pleural cavity is opened by 10 intercostal spaces, the diaphragm is cut through an oval section, 2-2.5 cm indent from its attachment to the chest wall, during 12-13 cm. The first step to the right of the peritoneal sac with intestinal loops is retracted to the midline, and the kidney tissue with the kidney is retracted below. The right adrenal gland is bluntly extracted with a preliminary displacement of the kidney downwards. After immobilization of the feeding leg of the adrenal gland, ligation of the central adrenal vein and the feeding arteries, the right adrenal gland is removed. The second stage along the access in the transverse

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the direction is cut through the anterolateral parietal part of the peritoneum for 15–20 cm. The loops of the small intestine are retracted to the right and up, the descending colon is left to the left. Finding Treitz's link. Immediately distal to the passage of the duodenum into the thin, along the bend, indent from its edge by 1.5-2 cm,; on the 5-7 cm strip, cut through rk5d1chnu. The left renal vein and the left adrenal vein flowing into it are secreted. The nodular vein is stenosed by flashing along its diameter in the region of its mouth from two sides to the appearance of venous hypertension. Proximal to the site of flashing (pronounced filling and dilatation of the vein by the bloodstream). For flashing use atraumatic thread 5/0. Additionally, a ligature that does not overlap the vein lumen is tightened around the vein in order to enhance the subsequent cicatricial process, resulting in a gradual occlusion of the vein. Then, the abdominal sac is secured with a continuous blanket suture followed by suturing the abdominal and thoracic cavities, leaving active drainage in the retroperitoneal space and the right pleural cavity.

Example. Sick C., 33 years old, complained of persistent headache in the temporal and occipital regions, tinnitus, general weakness, palpitations, dull pains in the region of the heart, reduced vision, nocturia. For the first time, elevated blood pressure numbers were registered 8 years ago after childbirth. The last 2 years, the increase in blood pressure has been constant, the blood pressure figures have reached 300/160 mm Hg. Art. Conservative therapy is ineffective. When examining a patient, there was revealed bilateral adrenal hyperplasia and hyperaldosteronism, confirmed by computer

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Term tomography and functional stress tests, severe and malignant course of arterial hypertension. A decrease in the filtration and secretory functions of the kidneys with an increase in the level of creatinine, a decrease in diuresis, proteinuria was revealed. The patient also had hypertrophy of the left ventricle with impaired blood supply. Ethnologists of arterial hypertension are regarded as nephrogenic, and hyper aldosteronism as secondary.

According to the proposed method, the patient performed the operation. The postoperative period was uneventful, a clear hypotensive effect was obtained with a decrease in blood pressure to 170/100 mm Hg. Art. improved kidney and heart function.

According to the proposed method, 6 patients were operated on. This method is recommended for the surgical treatment of patients with severe malignant forms of arterial hypertension, accompanied by hyper aldosteronism.

Claims (1)

Invention Formula A method of surgical treatment of arterial hypertension, including access to the adrenal glands and the partial stenoznrova- of left adrenal veins, characterized in that, in order to simplify the process and reduce its travmatnchnosti, after removal torakofrenolyumbotomicheskim access right adrenal gland parietal peritoneum is opened, is displaced to the right small intestine sine, The incision of the peritoneum is further continued along the duodenal-musculoskeletal flexure and the left renal vein is infused into the adrenal gland, after which the posterior The second one is pierced in diameter in the region of its mouth on both sides until the appearance of venous gi, pertensia in its proximal part.